Unit 3 Health And Social Care Level 3 Research Paper
Task 3
Module Title: Safe Guarding in Health and Social Care
Assignment Title: Understanding working practices and strategies that are used to minimise abuse within health and social care contexts.
Content
(LO 3)
Introduction:
Topics Discussed:
How existing work practices and strategies are designed to minimise abuse in health and social care contexts (3.1)
Evaluation of the effectiveness of working practices and strategies used to minimise abuse in health and social care contexts (3.2)
How possible improvements to working practices and strategies can minimise abuse in health and social care contexts (3.3)
Conclusion:
References:
Introduction
For the following assignment I will discuss in detail current strategies …show more content…
and practices used within our service that are designed to minimise abuse to the client. This will happen through synthesis of examining practices such as record keeping, creating care plans, attending care reviews, case conferences and serious case reviews, provision and updating of risk assessments, knowledge of safeguarding policies & procedures, abiding by confidentiality policies and procedures, showing awareness of the company complaints policy and anti-discriminatory practices, maintaining effective communication at all times, following national standard recruitment procedures, providing continuous on-going training and finally whistle blowing legislation.
I will also evaluate the effectiveness of these practices and strategies by looking at past and present case studies and identifying good practice, what might of went wrong in these and cases and why. And finally I will recommend possible improvements that if made can improve current practices and strategies it may help us learn from past mistakes. “What experience and history teach is this-that nations and governments have never learned anything from history, or acted on any lessons that might be drawn from it” (Hegal 1830, cited in Reder & Duncan 2004:95).
Ireland is currently on the brink of introducing a new Child and Family Support Agency, which as this essay will outline, stemmed from policy decisions rooted in the child protection failures of the State. The recommendations of the Report of the Task Force on the Child and Family Support Agency 2012 recommend the shape the agency should take. This agency sets out to replace the current HSE system in governing the area of child protection. In line with this new agency’s recommendations, my current setting are engaging in a unit to unit internal audit of all of our child protection practices and strategies. This new agency has set up new improved guidelines that have previously failed children and vulnerable adults in the disability sector of care. The new draft of standards for people in residential care with disabilities is designed to help those who had previously slipped through the net. This draft is divided into two sections, one for vulnerable adults and the other for young children. Previous standards were more inclined to favour adult services rather than children. This will mean our unit will be subject to unannounced visits from monitoring body HIQA (Health Information Quality Authority) where previously it was only main stream registered houses that were prone to visits. When these visits occur we are monitored and reported about under the following headings:
• care practices and operational policies;
• staffing;
• Accommodation;
• Education;
• Access arrangements;
• Health care;
• Religion;
• Provision of food and cooking facilities;
• Fire precautions;
• Safety precautions;
• Insurance;
• Notification of significant events;
• Records.
Our company are very consistent in their approach to child protection issues. We have within the company, our own child social worker and child protection officer. Her job is to investigate any complaints, allegations or serious incidents involving any service user. Each unit will send their relevant reports to the CPO regarding child protection issues for monitoring purposes.
In the case of each young person who comes into our care we follow the necessary protocol to ensure there is no risk to them. In our high support units where there are young people who have a history of violence and aggression, we never leave anyone working alone or open to allegations. These young people have a history of making allegations towards staff so it is vital that we follow company practices and strategies. A very important practice is to record everything that happens. We keep daily records of how each young person’s day went by completing a timeline dairy. Each young person has the right to read this log and it contains information about them.
All relevant information about each young person is kept in files in a secure strong room which only staff have access to. These files contain very important information about each young person including previous assessments, diagnosis, family history etc. No young person is allowed access to these as they contain information that could prove harmful to their wellbeing. Each young person has their own person centred designed care plan that contains their current interventions and goals going forward. The rights of young people are reflected in all centre policies and care practices. Young people and their parents are informed of their rights by supervising social workers and centre staff.
Young people’s views are sought when decisions are being made that affect their daily life and their future. Child Care (Placement of Children in Residential Care) Regulations 1995, Part III, Article 4. Supervising social workers, managers and staff members consult with young people and their families about decisions that affect their lives and future. The opinions and views of young people are sought and valued. They help inform policies and practice and the daily running of the centre. All young people in residential care are able to express concerns or complain about their care. Our company has a complaints procedure agreed by the Health Board and written information about it is given to children, their parents, staff members, social workers and others with a legitimate interest in the centre. Our complaints procedure clearly outlines the following:
• What constitutes a complaint?
• How a young person can be helped to make a complaint;
• Who they can complain to, in and outside the centre; The procedure to be followed (steps to be taken, time scale, who investigates the complaint, where and how it is recorded, feedback to the complainant); how a person making a complaint can appeal a decision if they are
Unhappy with the outcome.
Staff are to understand the purpose of a complaints procedure and treat complaints professionally. They routinely record how an individual’s concerns are resolved.
Young people and parents are able to make a complaint and understand how it will be dealt with. All serious complaints are promptly notified to the appropriate person in the HSE (Health Service Executive). Complaints made by young people and parents are recorded and taken seriously, and clear conclusions are reached. There are systems in place to monitor the incidence and outcomes of all complaints.
Attention is paid to keeping young people in the centre safe, through conscious steps designed to ensure a regime and ethos that promotes a culture of openness and accountability.
Our units have a written policy on safeguarding young people within the centres. Our policies complement good care practices, effective management, children’s rights, social work supervision and visiting, monitoring and child protection. Our policies include:
• Recruitment procedures (including Garda vetting);
• Induction and on-going training, supervision and appraisal of staff;
• monitoring standards of care;
• staff understanding that part of their role in safeguarding children is to monitor colleagues’ practice and raise concerns as appropriate;
• Complaints procedures;
• Advocacy support for young people;
• Children’s rights and participation;
• Interdisciplinary working and informed therapeutic interventions;
• Contact (including access) with family and community members;
• Private access and communication by young people to social workers, advocates, solicitors and other people with a legitimate interest in their welfare. Staff understand the policy and it is carried out in practice.
Our units also have written guidelines on the nature of appropriate professional relationships between staff members and young people, including one-to-one contact and visits to the homes of staff. Young people have access to facilities for making and receiving telephone calls in private (unless in the interest of vulnerable children or adults and is requested to be supervised by parents, social worker or the courts). Young people know about groups and organisations set up to promote their rights such as EPIC (Empowering young people in Care) and may participate in their activities if they choose.
Our units also have written policies and procedures, agreed with by the regional child care manager and consistent with the national guidelines for the protection of children as set out in Children First, in relation to:
• Measures to be taken in the event of an allegation of current abuse or neglect in the children’s residential centre;
• Measures to be taken in the event of an allegation of past abuse or neglect in the children’s residential centre (or previous care placements);
• Measures to be taken in the event of an allegation concerning the abuse or neglect of a resident of the centre outside that centre. The centre has agreed arrangements in place with the supervising social worker for bringing allegations of abuse to the attention of parents or guardians. Staff members are trained in the principles and practices of child protection.
Staff members are given guidance in relation to safe care practices. Staff members are under a clear obligation to report any child protection concerns to the centre manager or, in the event that the concerns relate to the centre manager, to the relevant line manager and Health Board child care manager. (National Disability Standards 2013)
Certainly, there are no shortages of reports and inquiries to draw upon when reflecting on Ireland’s child protection history, each accompanied with a set of recommendations, in many respects mirroring that of the previous. Reder & Duncan (2002) cited in Reder and Duncan, (2004:96) state that ‘one way to ascertain whether practice has improved is to note whether similar problems have recurred over the years’. Unfortunately when Ireland reflects on our practice improvements, despite the many recommendations and government’s acknowledgement of our many failings in this area, we have not yet managed to reform our system. Based on these findings we could argue as to whether the government remains reactive to public pressure and lacking in proactive ability to truly reform. A relevant example of this concept was the introduction of the ‘Children First Guidelines, 1999’, as a response to the many cases in the Ninety’s which highlighted the then current failings of the system, for example; Kilkenny Incest Case, 1993; The West of Ireland Farmer Inquiry, 1995. They aimed to systematically standardise the recognition and reporting of child abuse. Despite good intentions, the DCYA, (2008) found Ireland lacking in consistency with the implementation of Children First and we have continued to be faced with further inquiries and scandals following their implementation such as the Roscommon Child Care Case, (2010). To examine this further, it is important to assess what is significantly different about how this new agency is proposing to bring about fundamental reform.
Our so called new Child and Family Support agency is unique in the sense that certain services for children will be ‘realigned from across a number of agencies into a single comprehensive, integrated and accountable agency for children and families, the Child and Family Support Agency’ (DCYA, 2012A) with its intention hence to encapsulate family support as well as child protection. However, will this new structure and approach reduce risk for young people and create a safer environment for them or is the ‘result often more ‘noise’ but little constructive change’ (Kemshall, 2010:1258). Minister for Children and Youth affairs Francis Fitzgerald recently announced the plans to implement the new agency in January 2013, and also outlined what services would hence fall under the new agency (DCYA, 2012c). This integration of services in theory presents as a plausible initiative, however one must consider this in terms of risk and ask the question of what determines the choice of certain services included relevance or lack of, towards reforming child protection in Ireland. The inclusion of The National Education Welfare Board for instance proves a favourable step forward, given the early contact and considerable length of service the educational system provides to young people. However, lack of inclusion of relevant medical professionals and the implications of this decision in terms of risk requires investigation. Surprisingly, despite recommendations made by the Report of the Task Force on the Child and Family Support Agency 2012, Public Health Nurses (PHN’s) have not been included (DCYA, 2012c). Given the agency’s strong emphasis on early intervention services and previous evidence of how PHN’s can prove beneficial in gathering data for research (Dolan & Holt: 2002:240), creates doubt or confusion as to the reasons behind this decision. This appears to mirror the confusion as to why other relevant medical professionals such as General Practitioners are not proposed to be included. The relevance of this in terms of risk has been highlighted through past failings of general practitioners in safe guarding our young people (The West of Ireland Farmer Inquiry, 1995) and subsequent practice highlights that their involvement in such procedures remains the exception rather than the rule. This is evident in research completed by Polnay, (2000:118) where it was confirmed ‘many GPs (nearly 50%) simply will not go to case conferences’ and made recommendations to include ‘child protection in GP training’. The Children Acts Advisory Board (CAAB) was established under the Child Care (Amendment) Act 2007, with one of their roles including conducting research relating to its functions. CAAB (2009) discusses the ‘privileged position afforded to higher professionals such as doctors and psychiatrists’. It may hence be a case of the Irish Medical Council holding too much power or hierarchy in the eyes of the government. Based on this hypothesis, it could imply that we have not learned as a society and government from our past mistakes, if the hierarchy is to be compared to that held previously by the Catholic Church (Ryan Report, 2009) with adult power again appearing to take precedence over the best interests of the child. It is important that we learn from our past failings and particular reports that stemmed from them (The West of Ireland Farmer Inquiry, 1995) and attempt to include relevant medical professionals in our efforts to reduce risk and reform child protection. The new agency intends to implement a new model called the differential Response Model (DRM) in addressing child protection concerns/referrals. Due to the increase in referrals expected from the mandatory reporting aspect of the Children First Bill 2012(DCYA, 2012d) and this relatively new to Ireland DRM Model, it is important to look internationally for learning, comparison and preparation. The idea of a whole of government approach appears to be developing internationally with Buckley, (2012:70) describing how ‘the most commonly shared theme between aspiring reformers in Australia, the US and the UK has not adapted this approach and have chosen to establish a core agency to govern child protection (Ross et al, 2011). Positive outcomes have been identified in the utilisation of this approach in the area of ‘family violence reform’ in Australia, with the importance of inter-agency working and collaboration remaining a vital element in the success (Ross et al, 2011). Ireland has not adapted this approach and have chosen to establish a core agency to govern child protection. However as Buckley, (2012:71) outlines ‘separating child protection services from partners in health, mental health and disability, will create challenges to communication and integration’. As identified the relevance of inter-agency working is very much relevant in our own system due to our new DRM Model and our expected increase in referrals in the near future.
This DRM model operates on a two tiered response approach and is hoped that it will assist in addressing all child protection/welfare referrals at a quicker rate, with the response made ‘in proportion to the severity of the concern…..an important element is that response may be made by a community-based voluntary agency’ (Buckley, 2007:3). This model is also based on the belief that all areas will have a body willing to work collaboratively with the new agency, which may not transpire. Buckley, (2007:5) highlights, in countries such as Australia ‘partnerships are put on a very clear and formal footing’, however ‘relationships between the voluntary services in Ireland are less formal and sometimes problematic’. How then, can the new agency ensure that their agenda remains clear not only within their own newly integrated services, but also now within partnering services? What appears to be emerging is a focus on standardisation of assessment, reporting and accountability as a means of ensuring a clear approach. This is particularly evident with the imminent arrival of mandatory reporting, due to the enacting of the Children First Bill, 2012 into law expected in early 2013. New South Wales led the way with mandatory reporting in Australia (Harries & Clare, 2002). Since its introduction it has led to a surge in reporting, with the state requiring many reforms aimed at reducing the weight of the demand and has proved a very costly measure (Ainsworth & Hanson 2006:33-41). In 2002 a major report for the Western Australian Child Protection Council concluded that there was ‘no national or international evidence that mandatory reporting was an effective way to reduce the incidence of child abuse and neglect’ (Harries & Clare 2002, cited in Ainsworth & Henson 2006:33). Despite these international findings, the Irish government will be implementing mandatory reporting, which raises the question again of government intentions and reactions. Is this a genuine measure to bring about reform or as Ainsworth (2002:63) states is ’mandatory reporting more about politics than about protection’. This leads on to discuss what truly brings about change in practice if standardisation, regulation and accountability have proven to fail. One initiative that has been promoted time again in various reports and is a fundamental aspect of the ethos of the new Child and Family Support Agency is that of interagency working. There appears to be a presumption that interagency working is and in itself a good thing, conversely is there evidence to support this?
‘The importance of inter-agency coordination and collaboration in both safeguarding children and promoting their welfare has been previously identified in research studies exploring aspects of the child protection system’ (Sinclair & Bullock, 2002 cited in Devaney, 2008:251).
This example highlights the importance but not the impact, which is also evident in the Laming report which ‘proposed that improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded’ (Richardson & Asthana, (2006:660). As a result of this finding, it is important for the new Child and Family Support Agency to look beyond the almost mirrored recommendations witnessed over the past few decades and look at some of what Buckley, (2009:5) refers to as ‘Depth Issues’ in reducing risk to children.
There is always room for improvement in work practices and strategies in relation to minimising abuse. We as a professional service must continue to collaborate better with external multi-agency parties such as social workers etc. There is a short fall in social workers in this country and this leads to increased workloads, back logs in referrals which can lead to safeguarding issues. Supervising social workers have clear professional and statutory obligations and responsibilities for young people in residential care. All young people need to know that they have access on a regular basis to an advocate external to the centre to whom they can confide any difficulties or concerns they have in relation to any aspects of their care. Social workers need to provide services like ours with the relevant sufficient background information about the young person who they which to place in our service. Sometimes young people are placed in our care without a prepared a care plan. Staff need to be more aware of the emotional and psychological needs of young people, and through the key worker role and the general ethos of the centre, facilitate the assessment and meeting of those needs. The author feels that young people are not prepared enough for leaving the units in ways that are appropriate to their age, understanding and maturity. The preparation reflects whether they are going to live with their family or in a foster family, another children’s residential centre, shared care, supported lodgings, an aftercare arrangement, or other agreed plan. Staff need to relate more to young people in an open, positive and respectful manner. Best practice states we need to take into account of young people’s individual needs and respect their social, cultural, religious and ethnic identity. Young people have similar opportunities and leisure experiences to their peers and have opportunities to develop talents and pursue interests. So staff interventions must appear to show an awareness of the impact on young people who have experienced separation and loss and, where applicable, neglect and abuse.
Our units use a method of physical restraint that has been researched and is based on reputable practice. There is a written policy that is understood by all staff and young people in the centre. Where physical restraint is used, it is applied in a way that is consistent with the requirements of the policy. However there are times that staff need to show that they have used other methods to try and deescalate the situation before using physical restraint. Physical restraint is never used as a sanction or punishment, but only to protect children from immediate risk of injury to self or others, or serious damage to property. We are trained to use physical restraint using the minimum amount of force necessary and for the shortest period of time. The actions of staff are proportionate to the circumstances that led to a child needing to be physically restrained. Physical restraint is not a regular feature of the care a young person experiences, however in our high support units; it appears to feature on a daily basis. If a young person is frequently physically restrained a review of the care plan should be arranged as a priority. Staff are appropriately and sufficiently trained in the use of physical restraint. Only those so trained should ever be involved in it. Their competence is checked regularly and refresher training is provided.
All young people have a right to education. Supervising social workers and centre management need to ensure each young person in the centre has access to appropriate education facilities. Education is valued and the educational needs of each young person are addressed. However it is each young person’s right to refuse to go to school at the appropriate age but each young person must be encouraged and assisted to reach his or her educational potential. Where possible, the supervising social worker tries to maintain the young person in his or her own school on coming to live in the centre. Our service must take more interest in our service user’s education programs, continue to attend all relevant school functions and meetings, and supports the young person in the centre by having the physical facilities and household routine for homework and study. The supervising social worker and centre manager in consultation with the school, must ensure an educational assessment is carried out for any young person where there are any questions relating to ability, specific learning difficulties, under achievement or special talents. Young people with deficits in educational attainment or temporarily not attending school should be supported with extra tuition yet this is not the case. Young people who are approaching school leaving age should be strongly encouraged to participate in third level education or vocational training programmes as appropriate to their abilities, interests and aspirations, and this is reflected in their care plan.
Conclusion
The author hypothesises by writing this assignment, the difficult job we face as professionals working within the health and social care sector in the maintaining of safe and secure practices and strategies regarding minimising abuse.
The author is mindful and fully aware of the benefits of best practice when issues of child protection and protection of fellow professionals are at risk. Our particular model is aimed at providing a “personal centred approach. This provides the client with a sense of social inclusion, empowerment and independence in making their own choices and decisions. This essay illustrates my own personal framework to practice through the use of a case example. It stresses the importance of young people receiving a full assessment to allow understanding of a young person’s behaviours and the importance of evidence based practice in addressing their needs. It identifies how other dynamics such as the power of organisational culture can impact on the care a young person receives. It stresses the difficulty of ensuring a balance between adhering to evidence based practice and statutory regulations against ensuring a homely normal environment and being open to adaptation. Although it promotes evidence based practices it identified the importance of being able to adapt to suit the needs of the young person. The concepts of inclusion, consultation, communication and the key-working relationship all proved vital in every young person’s progress. The importance of being aware that rehabilitation is a long process that involves taking things at the young person’s pace is promoted in this essay. I remain firm in my belief that every child is a unique individual and the importance of adapting a varied, inclusive approach to interventions to ensure paramountcy of child welfare in our work is
vital.
References
1. Department of Children and Youth Affairs. (2012A). Report of the Task Force on the Child and Family Support Agency. Dublin: Government Publications
2. Department of Children and Youth Affairs (2012 C). Press release: Minister Francis Fitzgerald TD announces arrival of the Child and Family Support Agency.
3. North Western Health Board. (1998) The McColgan Report – West of Ireland Farmer Case. Government Publications
4. Commission to Inquire into Child Abuse. (2009). Report of the Commission to inquire into child abuse, volumes I-V (Ryan Report). Dublin: Government Publications
5. Department of Health. (1993). Report of the Kilkenny incest investigation. Dublin Government Publications
6. Health Service Executive. (2010). Roscommon Child Care Case: Report of the Inquiry Team to the Health Service Executive. Dublin. Health Service Executive. Retrieved from: www.hse.ie/eng/services/publications/services/children/roscommonchildcarecase.pdf 10.05.13
7. Reder, P. & Duncan, S. (2004). Making the Most of the Victoria Climbie´ Inquiry Report. Child Abuse Review Vol. 13: 95-114
8. Western Health Board (1996) Kelly- a child is dead. Government Publications.
9. Devaney, J. (2008). Inter-professional Working in Child Protection with Families with Long-Term and Complex Needs. Child Abuse Review Vol.17: 242-261
10. Buckley, H. (2012). Using Intelligence to Shape Reforms in Child Protection. Irish Journal of Applied Social Studies Vol.12. No.1:63-74.
11. Buckley, H. (2009). Reforming the child protection system: why we need to be careful what we wish for. Irish Journal of Family Law Vol.12 (2)
12. Buckley, H. (2007). Differential Responses to Child Protection Reports. Irish Journal of Family Law Vol.10 No.3
13. Richardson, S. Asthana, S. (2006). Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture. British Journal of Social Work Vol.36: 657-669
14. Child Care (Placement of Children in Residential Care) Regulations 1995, Part III, Article 4
15. Kemshall, H. (2010). Risk Rationalities in Contemporary Social Work Policy and Practice. British Journal of Social Work Vol.40: 1247–1262
Module Title: Safe Guarding in Health and Social Care
Assignment Title: Understanding working practices and strategies that are used to minimise abuse within health and social care contexts.
Content
(LO 3)
Introduction:
Topics Discussed:
How existing work practices and strategies are designed to minimise abuse in health and social care contexts (3.1)
Evaluation of the effectiveness of working practices and strategies used to minimise abuse in health and social care contexts (3.2)
How possible improvements to working practices and strategies can minimise abuse in health and social care contexts (3.3)
Conclusion:
References:
Introduction
For the following assignment I will discuss in detail current strategies …show more content…
and practices used within our service that are designed to minimise abuse to the client. This will happen through synthesis of examining practices such as record keeping, creating care plans, attending care reviews, case conferences and serious case reviews, provision and updating of risk assessments, knowledge of safeguarding policies & procedures, abiding by confidentiality policies and procedures, showing awareness of the company complaints policy and anti-discriminatory practices, maintaining effective communication at all times, following national standard recruitment procedures, providing continuous on-going training and finally whistle blowing legislation.
I will also evaluate the effectiveness of these practices and strategies by looking at past and present case studies and identifying good practice, what might of went wrong in these and cases and why. And finally I will recommend possible improvements that if made can improve current practices and strategies it may help us learn from past mistakes. “What experience and history teach is this-that nations and governments have never learned anything from history, or acted on any lessons that might be drawn from it” (Hegal 1830, cited in Reder & Duncan 2004:95).
Ireland is currently on the brink of introducing a new Child and Family Support Agency, which as this essay will outline, stemmed from policy decisions rooted in the child protection failures of the State. The recommendations of the Report of the Task Force on the Child and Family Support Agency 2012 recommend the shape the agency should take. This agency sets out to replace the current HSE system in governing the area of child protection. In line with this new agency’s recommendations, my current setting are engaging in a unit to unit internal audit of all of our child protection practices and strategies. This new agency has set up new improved guidelines that have previously failed children and vulnerable adults in the disability sector of care. The new draft of standards for people in residential care with disabilities is designed to help those who had previously slipped through the net. This draft is divided into two sections, one for vulnerable adults and the other for young children. Previous standards were more inclined to favour adult services rather than children. This will mean our unit will be subject to unannounced visits from monitoring body HIQA (Health Information Quality Authority) where previously it was only main stream registered houses that were prone to visits. When these visits occur we are monitored and reported about under the following headings:
• care practices and operational policies;
• staffing;
• Accommodation;
• Education;
• Access arrangements;
• Health care;
• Religion;
• Provision of food and cooking facilities;
• Fire precautions;
• Safety precautions;
• Insurance;
• Notification of significant events;
• Records.
Our company are very consistent in their approach to child protection issues. We have within the company, our own child social worker and child protection officer. Her job is to investigate any complaints, allegations or serious incidents involving any service user. Each unit will send their relevant reports to the CPO regarding child protection issues for monitoring purposes.
In the case of each young person who comes into our care we follow the necessary protocol to ensure there is no risk to them. In our high support units where there are young people who have a history of violence and aggression, we never leave anyone working alone or open to allegations. These young people have a history of making allegations towards staff so it is vital that we follow company practices and strategies. A very important practice is to record everything that happens. We keep daily records of how each young person’s day went by completing a timeline dairy. Each young person has the right to read this log and it contains information about them.
All relevant information about each young person is kept in files in a secure strong room which only staff have access to. These files contain very important information about each young person including previous assessments, diagnosis, family history etc. No young person is allowed access to these as they contain information that could prove harmful to their wellbeing. Each young person has their own person centred designed care plan that contains their current interventions and goals going forward. The rights of young people are reflected in all centre policies and care practices. Young people and their parents are informed of their rights by supervising social workers and centre staff.
Young people’s views are sought when decisions are being made that affect their daily life and their future. Child Care (Placement of Children in Residential Care) Regulations 1995, Part III, Article 4. Supervising social workers, managers and staff members consult with young people and their families about decisions that affect their lives and future. The opinions and views of young people are sought and valued. They help inform policies and practice and the daily running of the centre. All young people in residential care are able to express concerns or complain about their care. Our company has a complaints procedure agreed by the Health Board and written information about it is given to children, their parents, staff members, social workers and others with a legitimate interest in the centre. Our complaints procedure clearly outlines the following:
• What constitutes a complaint?
• How a young person can be helped to make a complaint;
• Who they can complain to, in and outside the centre; The procedure to be followed (steps to be taken, time scale, who investigates the complaint, where and how it is recorded, feedback to the complainant); how a person making a complaint can appeal a decision if they are
Unhappy with the outcome.
Staff are to understand the purpose of a complaints procedure and treat complaints professionally. They routinely record how an individual’s concerns are resolved.
Young people and parents are able to make a complaint and understand how it will be dealt with. All serious complaints are promptly notified to the appropriate person in the HSE (Health Service Executive). Complaints made by young people and parents are recorded and taken seriously, and clear conclusions are reached. There are systems in place to monitor the incidence and outcomes of all complaints.
Attention is paid to keeping young people in the centre safe, through conscious steps designed to ensure a regime and ethos that promotes a culture of openness and accountability.
Our units have a written policy on safeguarding young people within the centres. Our policies complement good care practices, effective management, children’s rights, social work supervision and visiting, monitoring and child protection. Our policies include:
• Recruitment procedures (including Garda vetting);
• Induction and on-going training, supervision and appraisal of staff;
• monitoring standards of care;
• staff understanding that part of their role in safeguarding children is to monitor colleagues’ practice and raise concerns as appropriate;
• Complaints procedures;
• Advocacy support for young people;
• Children’s rights and participation;
• Interdisciplinary working and informed therapeutic interventions;
• Contact (including access) with family and community members;
• Private access and communication by young people to social workers, advocates, solicitors and other people with a legitimate interest in their welfare. Staff understand the policy and it is carried out in practice.
Our units also have written guidelines on the nature of appropriate professional relationships between staff members and young people, including one-to-one contact and visits to the homes of staff. Young people have access to facilities for making and receiving telephone calls in private (unless in the interest of vulnerable children or adults and is requested to be supervised by parents, social worker or the courts). Young people know about groups and organisations set up to promote their rights such as EPIC (Empowering young people in Care) and may participate in their activities if they choose.
Our units also have written policies and procedures, agreed with by the regional child care manager and consistent with the national guidelines for the protection of children as set out in Children First, in relation to:
• Measures to be taken in the event of an allegation of current abuse or neglect in the children’s residential centre;
• Measures to be taken in the event of an allegation of past abuse or neglect in the children’s residential centre (or previous care placements);
• Measures to be taken in the event of an allegation concerning the abuse or neglect of a resident of the centre outside that centre. The centre has agreed arrangements in place with the supervising social worker for bringing allegations of abuse to the attention of parents or guardians. Staff members are trained in the principles and practices of child protection.
Staff members are given guidance in relation to safe care practices. Staff members are under a clear obligation to report any child protection concerns to the centre manager or, in the event that the concerns relate to the centre manager, to the relevant line manager and Health Board child care manager. (National Disability Standards 2013)
Certainly, there are no shortages of reports and inquiries to draw upon when reflecting on Ireland’s child protection history, each accompanied with a set of recommendations, in many respects mirroring that of the previous. Reder & Duncan (2002) cited in Reder and Duncan, (2004:96) state that ‘one way to ascertain whether practice has improved is to note whether similar problems have recurred over the years’. Unfortunately when Ireland reflects on our practice improvements, despite the many recommendations and government’s acknowledgement of our many failings in this area, we have not yet managed to reform our system. Based on these findings we could argue as to whether the government remains reactive to public pressure and lacking in proactive ability to truly reform. A relevant example of this concept was the introduction of the ‘Children First Guidelines, 1999’, as a response to the many cases in the Ninety’s which highlighted the then current failings of the system, for example; Kilkenny Incest Case, 1993; The West of Ireland Farmer Inquiry, 1995. They aimed to systematically standardise the recognition and reporting of child abuse. Despite good intentions, the DCYA, (2008) found Ireland lacking in consistency with the implementation of Children First and we have continued to be faced with further inquiries and scandals following their implementation such as the Roscommon Child Care Case, (2010). To examine this further, it is important to assess what is significantly different about how this new agency is proposing to bring about fundamental reform.
Our so called new Child and Family Support agency is unique in the sense that certain services for children will be ‘realigned from across a number of agencies into a single comprehensive, integrated and accountable agency for children and families, the Child and Family Support Agency’ (DCYA, 2012A) with its intention hence to encapsulate family support as well as child protection. However, will this new structure and approach reduce risk for young people and create a safer environment for them or is the ‘result often more ‘noise’ but little constructive change’ (Kemshall, 2010:1258). Minister for Children and Youth affairs Francis Fitzgerald recently announced the plans to implement the new agency in January 2013, and also outlined what services would hence fall under the new agency (DCYA, 2012c). This integration of services in theory presents as a plausible initiative, however one must consider this in terms of risk and ask the question of what determines the choice of certain services included relevance or lack of, towards reforming child protection in Ireland. The inclusion of The National Education Welfare Board for instance proves a favourable step forward, given the early contact and considerable length of service the educational system provides to young people. However, lack of inclusion of relevant medical professionals and the implications of this decision in terms of risk requires investigation. Surprisingly, despite recommendations made by the Report of the Task Force on the Child and Family Support Agency 2012, Public Health Nurses (PHN’s) have not been included (DCYA, 2012c). Given the agency’s strong emphasis on early intervention services and previous evidence of how PHN’s can prove beneficial in gathering data for research (Dolan & Holt: 2002:240), creates doubt or confusion as to the reasons behind this decision. This appears to mirror the confusion as to why other relevant medical professionals such as General Practitioners are not proposed to be included. The relevance of this in terms of risk has been highlighted through past failings of general practitioners in safe guarding our young people (The West of Ireland Farmer Inquiry, 1995) and subsequent practice highlights that their involvement in such procedures remains the exception rather than the rule. This is evident in research completed by Polnay, (2000:118) where it was confirmed ‘many GPs (nearly 50%) simply will not go to case conferences’ and made recommendations to include ‘child protection in GP training’. The Children Acts Advisory Board (CAAB) was established under the Child Care (Amendment) Act 2007, with one of their roles including conducting research relating to its functions. CAAB (2009) discusses the ‘privileged position afforded to higher professionals such as doctors and psychiatrists’. It may hence be a case of the Irish Medical Council holding too much power or hierarchy in the eyes of the government. Based on this hypothesis, it could imply that we have not learned as a society and government from our past mistakes, if the hierarchy is to be compared to that held previously by the Catholic Church (Ryan Report, 2009) with adult power again appearing to take precedence over the best interests of the child. It is important that we learn from our past failings and particular reports that stemmed from them (The West of Ireland Farmer Inquiry, 1995) and attempt to include relevant medical professionals in our efforts to reduce risk and reform child protection. The new agency intends to implement a new model called the differential Response Model (DRM) in addressing child protection concerns/referrals. Due to the increase in referrals expected from the mandatory reporting aspect of the Children First Bill 2012(DCYA, 2012d) and this relatively new to Ireland DRM Model, it is important to look internationally for learning, comparison and preparation. The idea of a whole of government approach appears to be developing internationally with Buckley, (2012:70) describing how ‘the most commonly shared theme between aspiring reformers in Australia, the US and the UK has not adapted this approach and have chosen to establish a core agency to govern child protection (Ross et al, 2011). Positive outcomes have been identified in the utilisation of this approach in the area of ‘family violence reform’ in Australia, with the importance of inter-agency working and collaboration remaining a vital element in the success (Ross et al, 2011). Ireland has not adapted this approach and have chosen to establish a core agency to govern child protection. However as Buckley, (2012:71) outlines ‘separating child protection services from partners in health, mental health and disability, will create challenges to communication and integration’. As identified the relevance of inter-agency working is very much relevant in our own system due to our new DRM Model and our expected increase in referrals in the near future.
This DRM model operates on a two tiered response approach and is hoped that it will assist in addressing all child protection/welfare referrals at a quicker rate, with the response made ‘in proportion to the severity of the concern…..an important element is that response may be made by a community-based voluntary agency’ (Buckley, 2007:3). This model is also based on the belief that all areas will have a body willing to work collaboratively with the new agency, which may not transpire. Buckley, (2007:5) highlights, in countries such as Australia ‘partnerships are put on a very clear and formal footing’, however ‘relationships between the voluntary services in Ireland are less formal and sometimes problematic’. How then, can the new agency ensure that their agenda remains clear not only within their own newly integrated services, but also now within partnering services? What appears to be emerging is a focus on standardisation of assessment, reporting and accountability as a means of ensuring a clear approach. This is particularly evident with the imminent arrival of mandatory reporting, due to the enacting of the Children First Bill, 2012 into law expected in early 2013. New South Wales led the way with mandatory reporting in Australia (Harries & Clare, 2002). Since its introduction it has led to a surge in reporting, with the state requiring many reforms aimed at reducing the weight of the demand and has proved a very costly measure (Ainsworth & Hanson 2006:33-41). In 2002 a major report for the Western Australian Child Protection Council concluded that there was ‘no national or international evidence that mandatory reporting was an effective way to reduce the incidence of child abuse and neglect’ (Harries & Clare 2002, cited in Ainsworth & Henson 2006:33). Despite these international findings, the Irish government will be implementing mandatory reporting, which raises the question again of government intentions and reactions. Is this a genuine measure to bring about reform or as Ainsworth (2002:63) states is ’mandatory reporting more about politics than about protection’. This leads on to discuss what truly brings about change in practice if standardisation, regulation and accountability have proven to fail. One initiative that has been promoted time again in various reports and is a fundamental aspect of the ethos of the new Child and Family Support Agency is that of interagency working. There appears to be a presumption that interagency working is and in itself a good thing, conversely is there evidence to support this?
‘The importance of inter-agency coordination and collaboration in both safeguarding children and promoting their welfare has been previously identified in research studies exploring aspects of the child protection system’ (Sinclair & Bullock, 2002 cited in Devaney, 2008:251).
This example highlights the importance but not the impact, which is also evident in the Laming report which ‘proposed that improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded’ (Richardson & Asthana, (2006:660). As a result of this finding, it is important for the new Child and Family Support Agency to look beyond the almost mirrored recommendations witnessed over the past few decades and look at some of what Buckley, (2009:5) refers to as ‘Depth Issues’ in reducing risk to children.
There is always room for improvement in work practices and strategies in relation to minimising abuse. We as a professional service must continue to collaborate better with external multi-agency parties such as social workers etc. There is a short fall in social workers in this country and this leads to increased workloads, back logs in referrals which can lead to safeguarding issues. Supervising social workers have clear professional and statutory obligations and responsibilities for young people in residential care. All young people need to know that they have access on a regular basis to an advocate external to the centre to whom they can confide any difficulties or concerns they have in relation to any aspects of their care. Social workers need to provide services like ours with the relevant sufficient background information about the young person who they which to place in our service. Sometimes young people are placed in our care without a prepared a care plan. Staff need to be more aware of the emotional and psychological needs of young people, and through the key worker role and the general ethos of the centre, facilitate the assessment and meeting of those needs. The author feels that young people are not prepared enough for leaving the units in ways that are appropriate to their age, understanding and maturity. The preparation reflects whether they are going to live with their family or in a foster family, another children’s residential centre, shared care, supported lodgings, an aftercare arrangement, or other agreed plan. Staff need to relate more to young people in an open, positive and respectful manner. Best practice states we need to take into account of young people’s individual needs and respect their social, cultural, religious and ethnic identity. Young people have similar opportunities and leisure experiences to their peers and have opportunities to develop talents and pursue interests. So staff interventions must appear to show an awareness of the impact on young people who have experienced separation and loss and, where applicable, neglect and abuse.
Our units use a method of physical restraint that has been researched and is based on reputable practice. There is a written policy that is understood by all staff and young people in the centre. Where physical restraint is used, it is applied in a way that is consistent with the requirements of the policy. However there are times that staff need to show that they have used other methods to try and deescalate the situation before using physical restraint. Physical restraint is never used as a sanction or punishment, but only to protect children from immediate risk of injury to self or others, or serious damage to property. We are trained to use physical restraint using the minimum amount of force necessary and for the shortest period of time. The actions of staff are proportionate to the circumstances that led to a child needing to be physically restrained. Physical restraint is not a regular feature of the care a young person experiences, however in our high support units; it appears to feature on a daily basis. If a young person is frequently physically restrained a review of the care plan should be arranged as a priority. Staff are appropriately and sufficiently trained in the use of physical restraint. Only those so trained should ever be involved in it. Their competence is checked regularly and refresher training is provided.
All young people have a right to education. Supervising social workers and centre management need to ensure each young person in the centre has access to appropriate education facilities. Education is valued and the educational needs of each young person are addressed. However it is each young person’s right to refuse to go to school at the appropriate age but each young person must be encouraged and assisted to reach his or her educational potential. Where possible, the supervising social worker tries to maintain the young person in his or her own school on coming to live in the centre. Our service must take more interest in our service user’s education programs, continue to attend all relevant school functions and meetings, and supports the young person in the centre by having the physical facilities and household routine for homework and study. The supervising social worker and centre manager in consultation with the school, must ensure an educational assessment is carried out for any young person where there are any questions relating to ability, specific learning difficulties, under achievement or special talents. Young people with deficits in educational attainment or temporarily not attending school should be supported with extra tuition yet this is not the case. Young people who are approaching school leaving age should be strongly encouraged to participate in third level education or vocational training programmes as appropriate to their abilities, interests and aspirations, and this is reflected in their care plan.
Conclusion
The author hypothesises by writing this assignment, the difficult job we face as professionals working within the health and social care sector in the maintaining of safe and secure practices and strategies regarding minimising abuse.
The author is mindful and fully aware of the benefits of best practice when issues of child protection and protection of fellow professionals are at risk. Our particular model is aimed at providing a “personal centred approach. This provides the client with a sense of social inclusion, empowerment and independence in making their own choices and decisions. This essay illustrates my own personal framework to practice through the use of a case example. It stresses the importance of young people receiving a full assessment to allow understanding of a young person’s behaviours and the importance of evidence based practice in addressing their needs. It identifies how other dynamics such as the power of organisational culture can impact on the care a young person receives. It stresses the difficulty of ensuring a balance between adhering to evidence based practice and statutory regulations against ensuring a homely normal environment and being open to adaptation. Although it promotes evidence based practices it identified the importance of being able to adapt to suit the needs of the young person. The concepts of inclusion, consultation, communication and the key-working relationship all proved vital in every young person’s progress. The importance of being aware that rehabilitation is a long process that involves taking things at the young person’s pace is promoted in this essay. I remain firm in my belief that every child is a unique individual and the importance of adapting a varied, inclusive approach to interventions to ensure paramountcy of child welfare in our work is
vital.
References
1. Department of Children and Youth Affairs. (2012A). Report of the Task Force on the Child and Family Support Agency. Dublin: Government Publications
2. Department of Children and Youth Affairs (2012 C). Press release: Minister Francis Fitzgerald TD announces arrival of the Child and Family Support Agency.
3. North Western Health Board. (1998) The McColgan Report – West of Ireland Farmer Case. Government Publications
4. Commission to Inquire into Child Abuse. (2009). Report of the Commission to inquire into child abuse, volumes I-V (Ryan Report). Dublin: Government Publications
5. Department of Health. (1993). Report of the Kilkenny incest investigation. Dublin Government Publications
6. Health Service Executive. (2010). Roscommon Child Care Case: Report of the Inquiry Team to the Health Service Executive. Dublin. Health Service Executive. Retrieved from: www.hse.ie/eng/services/publications/services/children/roscommonchildcarecase.pdf 10.05.13
7. Reder, P. & Duncan, S. (2004). Making the Most of the Victoria Climbie´ Inquiry Report. Child Abuse Review Vol. 13: 95-114
8. Western Health Board (1996) Kelly- a child is dead. Government Publications.
9. Devaney, J. (2008). Inter-professional Working in Child Protection with Families with Long-Term and Complex Needs. Child Abuse Review Vol.17: 242-261
10. Buckley, H. (2012). Using Intelligence to Shape Reforms in Child Protection. Irish Journal of Applied Social Studies Vol.12. No.1:63-74.
11. Buckley, H. (2009). Reforming the child protection system: why we need to be careful what we wish for. Irish Journal of Family Law Vol.12 (2)
12. Buckley, H. (2007). Differential Responses to Child Protection Reports. Irish Journal of Family Law Vol.10 No.3
13. Richardson, S. Asthana, S. (2006). Inter-agency Information Sharing in Health and Social Care Services: The Role of Professional Culture. British Journal of Social Work Vol.36: 657-669
14. Child Care (Placement of Children in Residential Care) Regulations 1995, Part III, Article 4
15. Kemshall, H. (2010). Risk Rationalities in Contemporary Social Work Policy and Practice. British Journal of Social Work Vol.40: 1247–1262