Today, the Health Information and Quality Authority (HIQA) has published five reports on four special care units operated by the Child and Family Agency (Tusla).

Special care units are secure, residential centres for children aged 11 to 17 years. Children are placed in a special care unit by a court when their behaviour poses a risk of harm to their life, health, safety, development or welfare, and the placement is needed for the child’s care and protection. Special care is a building where the external doors are locked. In special care, children receive the additional help and supports that they require and attend school on the grounds of the unit. 

On 1 January 2018, special care units became designated centres under the Health Act 2007 (as amended). In line with the transitional arrangements set out in Section 48(6) of the Child Care (Amendment) Act 2011, HIQA must make a decision of the registration of these units by 31 December 2018 in order for the centre to operate.

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. HIQA’s decisions to register centres are informed by the provider’s capacity and capability to deliver a safe and effective service that complies with the Health Act 2007 and the regulations and national standards that apply to special care units.

Two of the reports published today relate to Coovagh Special Care Unit, while one report relates to each of the following centres — Ballydowd Special Care Unit, Crannog Nua Special Care Unit and Gleann Alainn Special Care Unit.

Overall, inspectors found that the purpose, aims and objectives of each of the units were clear and there was good collaboration between staff and the children’s families and social workers and other professionals involved in the children’s care. Furthermore, all four centres that children had good relationships with staff and were supported to maintain contact with their families. However, children were not happy about a number of the rules in the units. Inspectors also found that the needs of each child had not been taken into account with regard to the policy of locking doors throughout the units, locking all bedroom doors at night and setting bedtimes for children. In addition, children in two of the units were not given opportunities to participate in meaningful activities appropriate to their needs and wishes.        

Each child had a documented programme of care. Children had access to a therapeutic team and the programmes of special care were found to be having an impact on the stabilisation of some behaviours and giving children the skills to work through their difficulties without resorting to shouting, aggression, violence or further behavioural difficulties. However, inspectors found in three of the four centres inspected that delays in securing an onward placement for the children had the potential to undermine the progress that had been made with them. 

Tusla’s governance and management arrangements required improvement to ensure sustainable positive outcomes for the children. Three of the four centres had clear organisational structures but the management structure in the other unit was transitioning at the time of the inspection. All of the units were well resourced in terms of staffing for the number of children currently living in the centres. However, a number of beds in the units were closed due to staffing shortages. 

Management systems in each of the four units were not always effective in ensuring that the service provided was safe, appropriate to the child’s needs, consistent and effectively monitored.

Since these inspections, Gleann Alainn Special Care Unit has informed HIQA of its intention to close as a special care unit by the end of the year. The three remaining special care units have been registered.