The Health Information and Quality Authority (HIQA) has today published reports on Ballydowd, Crannóg Nua and Coovagh House Special Care Units. Special care units are secure residential units for children whose behaviour places them at risk. They are placed in special care by the High Court for their own safety and protection.  

HIQA inspects against the Health Act 2007 (Care and Welfare of Children in Special Care units) Regulations 2017 and the National Standards for Special Care Units, which apply to special care units in Ireland. 

Overall, there were positive findings in relation to the quality of care provided to children placed in these units. Children’s right to a voice and to express their views was promoted, and they had influence, where possible, over decisions made about their lives. Each of the units had committees and groups in place which included children, and through these mechanisms, children were able to contribute to changes, for example, to the décor of the units and the facilities provided. A new outcome-based model of care was introduced in all three special care units since their last inspections in 2018. This model emphasised the individuality of each child and the requirement of interventions that best suited their particular needs.

There was a concerted effort made across the three special care units to reduce the need for restrictive practices. This was particularly noticeable in Ballydowd, where a considerable cultural shift had taken place which resulted in a significant reduction in institutional practices. The inspection of Ballydowd found that these changes improved the quality of care experienced by the children placed there at that time. 

There were similar findings across all three special care units in relation to absconds. Despite risk management strategies and measures taken to bring about a reduction, the there was no sustained pattern of reduction. Some children were at potential risk when on abscond, and measures were being taken to address these risks. However, more needed to be done to improve the effectiveness of responses to children who repeatedly absconded and were at potentially high risk when on abscond. 

There are times when children make allegations against staff in special care units, and the Chief Inspector is notified when this happens. A review of these allegations showed that the majority of them related to the use of physical restraint during an incident. All allegations were reported appropriately to relevant social work departments to ensure children were protected from abuse. Although inspectors were satisfied that no child remained at risk during these inspections, there was variance in how these allegations were handled by managers in special care units. This was primarily attributed to a lack of up–to-date national policy for the management of allegations of this nature. 

While each of the special care units fulfilled their function, there were improvements to be made in the governance and management arrangements in place by the Child and Family Agency (Tusla), who is the provider of special care units. National policies and procedures had yet to be finalised and put in place and the arrangements to monitor and report on the quality of special care were not in compliance with the regulations. Two of the three special care units were not resourced to provide the number of beds they were registered for, and staff shortages were evident.

Action plan responses were provided to address the non-compliances identified in this inspection, along with timelines for implementing these actions.