Inside crisis-hit special care: ‘They are not monsters. They are ordinary kids that have gone through difficult things'

Irish Times

2 days ago

It was an 'affront to the rule of law', said Mr Justice John Jordan in the High Court recently, that beds were not available for three vulnerable children in need of immediate placements in the special care system.
One of the three without a place in the most secure form of care was a teenager who was 'free falling' and whose father believed would die without a place.
Another was a self-harming child who attempted suicide after being 'drawn into a life of criminality' and had been 'subjected to sexual exploitation'.
Children and young people deemed to be at such a risk to themselves, or others, as to need therapeutic residential care may be detained in this system by order of the court.
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Mr Justice Jordan, who hears the weekly special care list, was told only 14 of
Tusla
's 26 special care beds were open – down from 15 weeks earlier. Today, 15 are operating.
He described the system as being 'in crisis', adding: 'This dysfunctional system is getting worse. It is an indictment of the State that those special care beds are not available.'
Mr Justice John Jordan oversees the special care list in the High Court. Photograph: Áras an Uachtaráin
As recently as June 19th,
Mr Justice Jordan said it was like 'winning the All-Ireland'
to hear, for the first time in more than six months, every child with a special care order had a placement.
Last Thursday, however, the 'no beds' list section was back. The
parents of a vulnerable teenager said they were 'at their wits end'
due to no placement being available for their child despite an order being granted the previous week.
There were 'significant concerns' for the child who was described as being suicidal and had 'overdose tendencies', said Sarah McKechnie, barrister for Tusla. 'It is my understanding a bed won't be available until in or around August 25th.'
In an online post, the child's mother said the teenager was in hospital following a suicide attempt – the latest of many. She said she would refuse to allow the discharging of her child from hospital in an attempt to keep them safe.
Special care remains in the spotlight as a system in crisis. There are 26 beds across three centres, but they have never all been in operation. One of the centres, Coovagh House, is in Limerick. The other two are in Dublin – Ballydowd in Lucan and Crannóg Nua in Portrane.
The Crannóg Nua special care unit for minors in Portrane, Co Dublin. Photograph: Bryan O'Brien
The numbers involved are small; just 0.2 per cent of the 5,761 children in care need special care. However, the service attracts trenchant criticism for its limitations given the risks faced by those who need it.
Tusla, arguing in 2023 for higher pay rates to recruit more special care workers, told the Department of Children 'the current crisis in ... capacity has the potential to lead to a fatal outcome for a child who cannot access special care'.
In recent weeks, The Irish Times was granted unprecedented media access to the largest special care unit, Crannóg Nua. Adjacent to the St Ita's Hospital campus, and behind 20-foot high fences, the facility is bright and modern, located on a landscaped campus. However, just five of the 12 beds are open.
During the visit, social care workers, kitchen staff, the on-campus school principal and management talk about how the facility works. There were glimpses of three children, all of whom were calm, during and between activities with their support workers.
A notice board in the dining area of Crannóg Nua special care unit for minors in Portrane, Co Dublin. Photograph: Bryan O'Brien
Once an order is made, gardaí get involved to 'ensure [the child is] brought safely to the service', says Tusla.
Each child has an en suite single-bedroom – which they may personalise with posters or photos – though there is little to no privacy. They are locked into bedrooms at 10.30pm and can be checked on through a hatch, explains Aisling Byrne, social care leader.
She shows the common area, laundry room and kitchenette. Dotted around are safety pods – industrial-strength beanbags on to which children are brought when being restrained.
An innovation of Crannóg Nua, the pods have reduced injuries to children and staff given restraint used to mean two staff bringing a child by force to the ground.
The school at the heart of the campus is led by Jacqui McCarron. She shows small classrooms where the Junior Certificate curriculum is followed, including art, woodwork, home economics, PE and core academic subjects.
Jacqui McCarron, principal of the school at Crannóg Nua special care unit, stands next to a 'cubbie' unit, a multi-sensory calming booth. Photograph: Bryan O'Brien
'We have the opportunity to work intensively with them, see what's working,' she says. 'They make progress and that is powerful for their self-esteem. You wouldn't believe how much completing the Junior Cert means to them. It is probably the only academic success they will ever have.'
The profile of the children is undeniably difficult, says William O'Rourke, assistant national director of alternative care. Typical histories include 'self harm and suicidality, substance misuse, sexual exploitation, violence or aggression towards and from others, property damage, mental health presentation and antisocial or criminal behaviour'.
'We are seeing more and more sexual exploitation, emerging mental health issues, emerging personality disorders,' he says.
Special care offers intensive therapeutic interventions during a total break from the child's environment.
William O'Rourke, Tusla's assistant national director for alternative care. Photograph: Bryan O'Brien
'Their lives may be so chaotic in the community and they don't actually see this until they come in and stabilise,' says O'Rourke. 'We can see what's happening to them truly when they come to a service like this.
'Take the risks away and you are then dealing with the person. It may be the first time they are being seen for who they are, and not just as them in their circumstances.'
He adds that 'the kids generally settle within days' and engage with staff and education and develop positive relationships.
'It is a really positive intervention when you remove the risk and hopefully identify what they need.'
From 2013 to the end of last year there were 269 admissions to special care, some of which were repeat. The annual high was 33 children in 2014. Last year there were 14 – seven boys and seven girls.
There has been no longitudinal study on long-term outcomes of the system, O'Rourke says, though one is 'being commissioned' by the Department of Children.
Crannóg Nua staff have an optimistic yet realistic approach.
'There is no quick fix,' says Oisin Mulchrone, deputy social care manager. 'They are coming from very challenging circumstances, some with family dynamics that are probably quite entrenched in challenges. It is hard to move away from that.'
Mulchrone says he 'couldn't imagine working anywhere else'.
Oisin Mulchrone, deputy social care manager, at the sticker-festooned door of a service user's bedroom at Crannóg Nua. Photograph: Bryan O'Brien
'You see young people moving on and you want to see them doing well. People do this because they want to make a difference for the young people. It's not for the faint-hearted sometimes, but the good greatly outweighs the bad.'
For James (18) special care was 'probably the calmest time' in his life, says his mother Martha (not their real names).
By the time an order was made, James, who was 15 at the time, had more than 35 care placements in the preceding four months.
Explaining his background, Martha says James was a 'clingy' and anxious toddler. He was diagnosed with ADHD at six.
'He had no friends . . . He had an SNA (special needs assistant) from junior infants to fifth class.'
While in fifth class, James was expelled. His parents tried home schooling but his behaviour deteriorated. He was violent towards his siblings and parents. An incident at home resulted in gardaí being called and his parents reluctantly agreed to voluntary care.
'We thought he would finally get the help he needed,' says Martha.
Unable to find a foster placement due to his behaviour, Tusla contracted private providers to accommodate James in what are known as unregulated special emergency arrangements (SEAs).
'He was shipped around B&Bs, hotels, holiday homes. He spent nights in Garda stations, hospitals, care-staff's cars,' says Martha. 'He could be in Drogheda one night and the next night in Cork. He could be three nights there and then to Monaghan.'
She added: 'There was no stability, no care plan. He was being transported in taxis, his belongings in black plastic bags, living on takeaways.'
In his final weeks in SEAs, James was 'out of control', she says. 'He ransacked his placements; broke into staff cars; there were altercations with the guards. He accumulated criminal charges at this time too, something he never had before going into care.'
Before entering special care, James was assessed by a social worker with the Child and Adolescent Mental Health Service (CAHMS). She noted: 'Difficulty in engaging [him] at a time of extreme distress . . . significant recent trauma in number of recent placement moves and removal from family home likely to explain significant dysregulation at this time'.
The gymnasium at Crannóg Nua special care unit for minors in Portrane. Photograph: Bryan O'Brien
Special care was the last option for James, says Martha, and agreeing to it was 'very distressing'.
'It took [James] about 12 to 16 weeks to settle. He was full of frustration, stripped of all liberties, feeling punished. He was there more than two years. Staff didn't just see a case file or a troubled teen, they saw him – his fears, his humour, intelligence and his pain.
'They set boundaries but also built trust day by day. They listened when he spoke, even when his words came out in anger. He slowly began to trust them back.'
Leaving special care was tumultuous, with aftercare planning ad hoc. James was initially offered only homeless services, but the morning he was to leave his family was told a city centre apartment with security-guards was available.
He remains without access to HSE adult psychiatric care. His health has deteriorated, he lost the apartment and has slept rough. Martha is hoping he will be provided with an after-care placement.
Tusla said it could not comment on an individual case but that SEAs were used when 'a regulated emergency placement is unavailable, and an immediate place of safety is required for a young person'.
Their use has declined – from 170 children last December to 57 at present. Where a child spends 'an extended period' in a SEA, 'there is increased oversight of the arrangement with additional supports'.
James's case epitomises problems in the wider care system that lead to 'additional pressure' on special care, says Terry Dignam, co-founder of Children's Residential and Aftercare Voluntary Association.
He points to an 'ongoing crisis in CAMHS', the decreasing availability of foster carers, a lack of residential placements, an 'over-reliance' on private providers and that almost 100 high-support beds were 'stripped out of the system' in 2014.
'We need far more early supports for families. If we had a properly functioning care system, with high-support beds to take in some of the kids falling into crisis, we wouldn't have such a reliance on special care,' he says. 'We would have fewer children escalating to that level because we would have the interventions earlier.'
The key obstacle to opening all 26 beds, says Mark Smith, Tusla's director of special care services, is recruiting and retaining staff in what is seen as the toughest job in social care.
To have 20 beds open, five more than the current 15, would require 35 additional staff, he says. Opening all 26 would require an additional 77. There are currently 110 whole-time equivalent (WTE) social care staff in the three units.
A classroom in the Crannóg Nua school. Photograph: Bryan O'Brien
The sanctioning of a new grade of special care worker last year was 'a significant victory for Tusla', Smith says. The top pay rate on this grade is €68,169, on a 23-point scale closer aligned with that at the Oberstown child detention campus.
Two new staff are employed on this grade, with five at 'varying stages of recruitment', underlining continuing difficulties. Staff retention is improving, however. In the year to May, it stood at 84 per cent, up from 76 per cent a year earlier.
Solving the special care crisis, says Dignam, is not only up to Tusla, which 'gets a lot of flack'. It will require 'substantial investment' by the several agencies, including the HSE, across the system, the reopening of high-support beds, and 'vastly' improving CAMHS and adult mental health services.
Special care work is 'a great job if you commit to it', says O'Rourke.
'It's a job that's very, very rewarding. You see the young people here. They are not demons. They are not monsters. They are ordinary kids that have gone through some really difficult things.'