Home > Deaths among children and young people in state care, after care or known to the HSE.

Pike, Brigid (2012) Deaths among children and young people in state care, after care or known to the HSE. Drugnet Ireland, Issue 43, Autumn 2012, pp. 12-13.

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In June 2012 the report of the Independent Child Death Review Group (ICDRG) was published.1 The review group investigated the deaths (between 1 January 2000 and 30 April 2010) of 196 children and young people who were in care, in receipt of aftercare or known to the child protection services in Ireland at the time of their death. Of the 196 deaths, 112 were due to non-natural causes. The breakdown of deaths over the ten-year period was as follows: 

Children (aged 4–17 years) in care: 36 deaths
°          19 deaths from natural causes
°          17 deaths from non-natural causes
Young people (aged 18–23 years) in aftercare: 32 deaths
°          5 deaths from natural causes
°          27 deaths from non-natural causes
Children (aged <1–17 years) known to the HSE: 128 deaths
°          60 deaths from natural causes
°          68 deaths from non-natural causes
The ICDRG examined the files and reports of the HSE in respect of all 112 children and young people who died of non-natural causes and provided a comprehensive case summary for each individual, together with summaries of aspects of good practice and causes for concern in each case.
The ICDRG found that 17 of the 112 children and young people had a history of problem alcohol use and 29 a history of problem drug use. Thirty (27%) of the 112 non-natural deaths were directly drug-related, and of these, the greatest proportion occurred among young people in aftercare:
°          children (aged 4–17 years) in care: 5 (29% of 17 deaths in this category)
°          young people (aged 18–23 years) in aftercare: 14 (52% of 27 deaths)
°          children known to the HSE (aged <1–17 years): 11 (16% of 68 deaths)
The review group did not give details as to which drugs caused the deaths.
The other causes of non-natural death were:
°          28 (25%) owing to suicide;
°          17 (15%) owing to road traffic collisions;
°          16 (14%) were unlawfully killed; and
°          21 (19%) owing to other accidental or unknown causes.
Many of the 196 children had also lived with problem alcohol use (n=37) or problem drug use (n=19) in the home. The ICDRG noted the HSE was aware of drug and alcohol misuse problems among the families:
… the HSE was aware of drug and alcohol abuse within a number of families, in particular by parents, which must as a natural consequence have given rise to concerns as to the welfare of the children, yet the HSE closed their files in a number of these cases despite the drug and alcohol abuse continuing. Children are vulnerable by their very nature and not to continue to attend to these issues and the implications for their welfare is to expose them to too great a risk of harm. Risk indicators such as this were not followed up adequately, or at all, by the HSE in a number of the files. In some cases no social worker was assigned to these families. (p. xxiii)
The ICDRG made the following recommendations with regard to how social workers should involve drug and alcohol services, and conversely how drug and alcohol services should work with the child welfare and protection services:
In a significant number of cases, it was evident that drug and/or alcohol abuse by parents was having a very damaging effect on their ability to consistently parent their child. Indeed, in some cases, drug and/or alcohol abuse was the key factor in the child/young person being referred to the HSE or being taken into care. This is a problem which has to be tackled. When a Social Worker comes into contact with a family where drug/alcohol abuse is significantly disrupting familial life, it is essential that such abuse is addressed in a robust manner. The effect on the children has to be recognised and the parents must be made aware of the support and treatment options that are available. Parents must be encouraged and enabled to take up those supports.
Furthermore, drug and alcohol services must be actively integrated into the child protection system. These services have the capacity to alert Social Workers to potentially devastating events happening between parents with drug and/or alcohol problems and their children often before the children are ever referred to the HSE. There must be open channels of communication between drug and alcohol services and the child protection system so that where these services become aware of child protection concerns, this information is quickly conveyed to the child protection system. The planning around these children and families must actively engage each part of the system. (p. 409)
The ICDRG report is not the first to highlight the vulnerability of children and young people, particularly those leaving state care. The plan to implement the recommendations contained in the Ryan Report (the report of the Commission to Inquire into Child Abuse) acknowledged the association between state care and future poor outcomes for children: 2
Those with a care history continue to be over-represented among those who are, for example, accessing addiction services, coming into contact with the criminal justice system and experiencing homelessness in adulthood. (p. xii)
The implementation plan included an appraisal of the gaps in service provision around pre-release planning and called on the HSE to ensure that care plans included aftercare planning for all young people of 16 years and older (Action 67). The implementation plan also highlighted the gaps in aftercare services for young people. While acknowledging that some attempts to provide aftercare had been effective in the past, it stated:
Aftercare services are not provided consistently to all children across the State. Some HSE areas have dedicated aftercare workers, but most do not. …The provision of aftercare by the HSE should form an integral part of care delivery for children who have been in the care of the State. It should not be seen as a discretionary service or as a once-off event that occurs on a young person’s 18th birthday, but rather a service that he or she may avail of up to the age of 21. (p. 48)
The implementation plan included two actions to provide for, and monitor the provision of, an enhanced system of aftercare, which, if implemented consistently and effectively, would contribute to a reduction in youth homelessness and a concomitant reduction in exposure to substance use.
Action 64: The HSE will ensure the provision of aftercare services for children leaving care in all instances where the professional judgment of the allocated social worker determines it is required.
Action 65: The HSE will, with their consent, conduct a longitudinal study to follow young people who leave care for 10 years, to map their transition to adulthood.
1.Shannon G and Gibbons N (2012) Report of the independent child death review group 2000–2010. Dublin: Government Publications. Available at www.drugsandalcohol.ie/17774
2. Office of the Minister for Children and Youth Affairs (2009) Report of the Commission to Inquire into Child Abuse, 2009: implementation plan. Dublin: Stationery Office.

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