WHAT IS SPECIAL CARE?
Special care refers to a type of care that is given to children and young people who are in need of special care and protection and would usually be placed in what is known as a Special Care Unit.
WHAT ARE SPECIAL CARE UNITS?
There are currently three Special Care Units in the Republic of Ireland under the management of the Health Services Executive (HSE). Regulations outlining the operation of these units were signed by Minister for Children in 2004.
Special Care Units are purpose built secure locked facilities, managed by the Health Services Executive. This means that the children and young people are contained therein and cannot leave the facility of their own accord. The units also have a higher staff to child ratio compared to other residential units in Ireland.
The Social Services Inspectorate within the Health, Information and Quality Authority has a statutory function to inspect the statutory children’s residential centres including Special Care Units. These inspections are conducted in conjunction with the National Standards for Special Care Units developed by the Department of Health and Children. Inspection reports are available to download on the link below.
http://www.hiqa.ie/functions_ssi_inspect_rep.asp#SpecialCareUnit
WHERE ARE THE SPECIAL CARE UNITS LOCATED?
Ballydowd Special Care Unit
Situated in Co. Dublin, Ballydowd is a 15-bed unit, catering for both males and females.
Coovagh House Special Care Unit
Located in Co. Limerick Coovagh House is a 5-bed unit catering for both males and females.
Gleann Alainn Special Care Unit
Based in Co Cork, Gleann Alainn is a 5-bed unit, catering for females only.
WHO IS PLACED IN SPECIAL CARE?
A child requiring Special Care will display behaviour that puts him/her “at a real and substantive risk to his or her health, safety, development or welfare” and is unlikely to receive special care or protection “unless the court makes such an order.” Only children and young people between the ages of 11 and 17 are eligible for special care due to the nature and seriousness of such interventional steps and the restriction of that individual’s liberty.
An example of this may be a child who is self harming/suicidal, abusing drugs and/or alcohol, and where all other attempts by the Health Services Executive have not stabilised the current, serious situation. Only children and young people with serious emotional and behavioural difficulties who meet the Criteria for the Appropriate Use for Special Care Units can access these facilities.
WHAT IS THE PROCESS TO PLACE A CHILD OR YOUNG PERSON IN SPECIAL CARE?
How is an application made?
The decision to proceed with an application for special care is one that is not taken lightly and involves various levels of professionals working within the Health Services Executive. Following agreement between the relevant professionals, a referral to the Family Welfare Service is made. Regulations outlining the operation of Family Welfare Conferences were signed by Minister for Children in 2004.
The purpose of the Family Welfare Conference is to establish if there are any alternatives to special care that can be utilised. A Family Welfare Conference is facilitated by a Family Welfare Conference Coordinator and is attended by the child or young person and their social worker. Other important people in the child or young person’s life such as their parents, extended family members, significant family friends or their foster carers will also be invited to attend the conference. Should the Family Welfare Conference recommend special care then the Health Services Executive will proceed with the application for special care.
Where no family members are willing to participate in the Family Welfare Conference or it is inappropriate for their participation the decision to proceed with the application for special care remains with the Health Services Executive.
What happens next?
The application for special care is completed by a social worker using a standardised application form with supporting documentation. The application will contain up-to-date information and the circumstances surrounding the real and substantive risk to the child or young person. There will also be full details of the discharge plan with the onward placement of the child. This information is sent to the National Special Care Admission and Discharge Committee, National Specialist – Alternative Care, Oak House, Millennium Park, Naas, Co. Kildare.
What is the Role of the CAAB with special care applications?
It is the responsibility of the CAAB to ensure that the Criteria for the Appropriate Use of Special Care Units have been followed correctly and to provide views based on the case information received regarding the appropriateness of a placement in a special care unit. This Criteria was established by the CAAB in collaboration with the HSE in order to protect the most vulnerable children and young people, while ensuring that their liberty was restricted as a measure of last resort and for the shortest possible time.
CAAB has a statutory function of “in consultation with the Health Service Executive, prepare and publish criteria for the admission to and discharge from special care units of children subject to special care and interim special care orders”. CAAB will be reviewing the current criteria regarding the admission to special care units in 2008 and will be also establishing criteria for the discharge from such units, in consultation with the HSE.
The CAAB will advise both the applying social worker and the National Special Care Admission and Discharge Committee of its view on the application for special care. This view is also one of the statutory functions of CAAB. The main purpose of the CAAB in relation to application to special care is one of checks and balances, in the best interests of the child or young person.
What is the Role of the National Special Care Admission and Discharge Committee with special care applications?
The National Special Care Admission and Discharge Committee, part of the HSE, will also examine the documentation and apply the criteria. The Committee consists of the centre managers of the special care units, a representative of the Irish Association of Young People in Care, a child care manager, a mental health professional with an independent chair.
If they decide that the child or young person should be placed in special care they will inform the social worker of the date when the child or young person can be placed there. The social worker will then instruct the HSE legal team who will make the required application for a Detention Order for that child or young person to the High Court.
Should the National Special Care Admission and Discharge Committee decide that the child or young person does not meet the Criteria they will refer the case back to the local HSE team who will plan/arrange for alternative supports for that child or young person.
What is the Role of the Court?
Although the HSE has the sole authority to apply for special care for a child or young person, the High Court is the only court that has the inherent jurisdiction or decision making power to make an order to place the child or young person in a Special Care Unit. The court may also appoint a Guardian Ad Litem.
WHAT HAPPENS IN SPECIAL CARE UNITS?
The Special Care Units provides the child or young person with a model of care and appropriate interventions which are based on relationships, containment and positive reinforcements in order to stabile the persistent and extreme situation. Each Special Care Unit has an onsite school so that the child or young person can continue their education as part of the model of care provided by the unit.
HOW LONG CAN A CHILD OR YOUNG PERSON IN A SPECIAL CARE UNIT?
The length of time can vary however in most cases the minimum would be three months and the average length of stay would be approximately 6 months. Where appropriate significant others such as the child or young person’s family can visit them in the Special Care Unit. The child will also be visited by their Guardian Ad Litem should they be appointed one by the court.
WHAT HAPPENS WHEN A CHILD OR YOUNG PERSON LEAVES SPECIAL CARE?
A child or young person would move to an onward placement that the social worker would have already considered prior to the child or young person being placed in special care. This would form part of the discharge plan and would usually be to an open residential unit, foster carers or the family. Prior to the child or young person actually leaving the special care unit, there would be a period of transition whereby the child or young person would visit their new placement and have overnight stays before moving into to that placement on a full time basis.
WOULD A CHILD OR YOUNG PERSON EVER RETURN TO A SPECIAL CARE UNIT?
Yes this can happen on occasion where the child requires secure care and protection and the criteria must be fulfilled.
Children Act 2001, sec 23B (1) (a) & (b).
Sec 227 (1) (c) of the Children Act 2001 as amended by the CCA 2007