Interim care order extended for girl in single occupancy residential placement- 2022vol2#7

An interim care order was extended for two months for a girl in residential care where she was the only resident. She had previously been in secure care and had significant behavioural difficulties.

The mother and father were in court, and each had their own legal representation. There were legal representatives from the Child and Family Agency (CFA) and the guardian ad litem (GAL). Evidence was heard by the Dublin District Court from the social work team leader and the GAL. The judge informed the court that he had met with the girl on the previous occasion the matter was in court. Dates had been set for a section 18 full care order hearing.

Evidence of the social work team leader

The social work team leader said the young girl had complained previously to the judge and again to her social worker and the GAL that she was not being listened to. However, the social work team leader said her allocated social worker would speak to the girl a minimum of two times per day and it was mostly three times per day. She would visit the girl at least three times per week in her placement.

The girl wanted a community residential placement with others her own age. She said because this had not happened the girl felt ignored. She said the girl was actively involved in her care plan. Although there were some difficulties at the placement she was doing well in this placement. This placement was single occupancy, and she had a staff ratio of two members of staff to just her.

The girl’s mother had concerns about the isolation from peers that this placement created.

The multidisciplinary team met weekly to discuss this placement and it was felt at this time the young girl would not manage in a communal residential setting. It was recognised that the girl ultimately wanted to return home, but all the professionals involved in her care as well as her parents agreed she was not yet ready for this.

Part of the difficulty for the girl involved the change of staff. The girl had developed good relationships with some staff but lacked trust in other staff. The social work team leader said this was difficult because of the national shortage of appropriately trained and available staff. The social worker discussed each staff roster with the placement provider to try to ensure difficulties were avoided. She [the social worker] hoped to create a core team who worked well with the girl, one of whom would be on duty each day. The difficulties of behaviour were often associated with staff change-over times. It was hoped creating a core team would help towards alleviating some of the behavioural difficulties.

The social work team leader said that the multidisciplinary team were in the process of an assessment in order to create a structured behaviour management plan that met the girl’s needs. This would include a step-by-step plan as to how all staff should respond to unwanted behaviours. These behaviours included the girl self-ingesting or inserting toxic substances into her body.

She said access had happened between the girl and her parents for one 30-minute period and one 60-minute period at home. This had gone well, more access visits were planned but it was very early days.

There had been confusion regarding the girl’s last day at school. As a result, the girl had missed a social date she had been looking forward to. The social work team leader acknowledged the distress this had caused to the girl and to her parents. She said it was an accidental miscommunication, but she had put in place procedures to ensure that would not happen again. Activities had been planned for the school holidays. The staff at the placement would try to facilitate as much access with her peers as possible. The girl wanted to climb a mountain and the staff within the placement had developed a fitness plan with hikes and this had been adhered to.

The judge said when he had met with the girl, the burdens she had discussed with him were her isolation and that her peers in school did not know of her circumstances. He asked the social team leader if the girl had a phone and what had been done to address the school issue.

The social work team leader said the girl did not have a phone at present, but she did have supervised access to a tablet and access to a landline to make telephone calls. Free access to a phone and social media contributed greatly to self-destructive behaviours. It was envisioned that much more work had to be done with the girl before that could be re-introduced. With regard to the school the social worker said this had not been discussed with the girl but that she would ensure that it was addressed, and a plan could be made with the girl and the school for the new term.

She said it had been recommended that a psychiatric assessment be completed but that the Child and Adolescent Mental Health Service (CAMHS) had stated they would not do this as they felt the girl’s difficulties came under the category of behaviour rather than mental health. However, the placement provider had been given funds from the CFA to source this assessment privately.

Evidence of the GAL

The GAL said that the behaviour issues remained and said: “Even if you ask her [the girl] she has difficulty explaining why she does it, she cannot explain it.” The behaviours had serious consequences and until this was better understood the staffing ratio of two carers 24 hours per day were necessary.

He said some of the more junior staff struggled and the placement had struggled to find sufficiently qualified staff. The multidisciplinary team had suggested a core group of 9-12 staff but at present there were only six. The girl had been sensitive to junior staff. She relied on them to keep her safe, if she did not have confidence in the staff, it increased her anxiety and stress, and the behaviours were more prevalent.

He said the behaviours had to be manageable before any treatment could begin. It was essential to have staff with the girl who could manage her behaviours and notwithstanding the national difficulties of staffing, recruitment and retention of staff had to be a priority. There had been measured progress, but it was still a fragile situation. He said he had recommended activities in the summer to ensure that the girl was kept occupied. Any contact with peers was to be encouraged. He had also suggested an advocate for the girl as she was in a single occupancy placement. She was surrounded by professionals and she might benefit from contact from someone in an advocacy role.

The judge granted an extension of an interim care order for two months on the consent of all parties and hoped the psychiatric assessment would have been completed by then.