Today, the Health Information and Quality Authority (HIQA) has published two inspection reports on thematic inspections of restrictive practices in Crannóg Nua and Ballydowd Special Care Units. 

In September 2025, HIQA launch a thematic inspection programme on restrictive practices in special care units. This thematic programme aims to drive quality improvement across special care units, so that the provider only uses restrictive practices (within the context of an already restricted placement), when absolutely necessary for the safety of the child or others. These inspections were based on the National Standards for Special Care Units 2014.  

Overall, a high level of compliance was found in both designated centres for special care. Crannóg Nua Special Care Unit was found to be compliant with the standards assessed, which means children enjoyed a good quality of life, where the culture, ethos and delivery of care were focused on reducing or eliminating the use of restrictive practice. Ballydowd Special Care Unit was found to be substantially compliant, which means that the provider had generally met the requirements of the standards, but some action was required to be fully compliant. 

Both services were found to be committed to ensuring the children lived in the least restrictive environment, as far as possible in the context of a secure service. There were clear lines of accountability for the safe delivery of restrictive practices at individual, team and organisational levels. Staff and managers provided care which was rights based, trauma informed and the least restrictive possible. The provider recognised that children’s rights should only be restricted in exceptional circumstances and restrictive practices were implemented in a way which did not unduly compromise the children’s dignity and quality of life. This was achieved through the implementation of provider policies and effective oversight systems.

Improvements were required in Ballydowd Special Care Unit with regard to the mechanisms to ensure learnings were effectively communicated to staff. In addition, some improvements were required in assessing children’s risks on admission and involving children in decision-making regarding the use of restrictive practices. 

Notes to the Editor:

• HIQA regulates special care units 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.
• A restrictive practice is a practice that limits an individual’s movement, activity of function, interferes with the individual’s ability to acquire positive reinforcement; results in the loss of objects or activities that an individual values, or requires an individual to engage in a behaviour that the individual would not engage in given freedom of choice. Restrictive procedures include single separation and physical, environmental and chemical restraint.
• Thematic inspections carried out by the Chief Inspector of Social Services aim to promote quality improvement in a specific aspect of care, in this instance, restrictive practices. This programme was developed following a comprehensive analysis of literature published on restrictive practices used in secure care placements (special care units and detention centres) and engaging with an expert advisory group and young adults with care experience in special care units. A summary of this review of literature can be found here.