Services for Children & Families Primary National - PowerPoint PPT Presentation

Primary & Social Care Network “Services for Children & Families – Primary National Implementation of Policy” Care Team Child & Family Network Event Wednesday 21 st November, NUIG Children & Families Jim Breslin Health Service Executive Community Integrated Services 1

HSE Role & Function • The Health Service Executive (HSE) was established in January 2005 as the single body responsible for meeting Ireland's health and social care needs. • HSE is the largest employer in the State with more than 65,000 staff in direct employment and a further 35,000 staff employed by major voluntary agencies funded by the HSE. • The budget of €12 billion is the largest of any public sector organisation. • The HSE’s performance of its functions, and particularly so its childcare functions, is the subject of independent monitoring and inspection by the Health Information & Quality Authority 2

HSE Role & Function in Children’s Services • HSE, as successor to health boards, has onerous responsibilities in the childcare arena: - Childcare Act, 1991 - Section 3(1) “ It shall be a function of every health board to promote the welfare of children in its area who are not receiving adequate care and protection .” • Other relevant legislation includes Children Act, 2001; Adoption Act, 1988, 1998 & 1991 Child Trafficking and Pornography Act 1998; Child Care (Placement of Children in Foster Care) Regulations, 1995; Refugee Act, 1996; Ombudsman for Children Act, 2002; Children (Family Welfare Conference) Regulations, 2004; Child Care (Special Care) Regulations, 2004; Child Care (Amendment) Act 2007 Health Act, 2007 Child Care (Placement of Children with Relatives) Regulations, 1995; Child Care (Placement of Children in Residential Centres) Regulations, 1995; Child Care (Standards in Children’s Residential Centres) Regulations, 1996; • The legislative touchstones of the HSE’s approach are to act in the “best interests” of a child and, in doing so, give due consideration to the wishes of the child. 3

HSE Role & Function in Children’s Services • In order to fulfil statutory and other responsibilities the HSE provides a range of services directly, or indirectly by commissioning other providers on its behalf, including - Child health e.g. maternity & infant care, developmental screening - Family support services - Early years services - preschools/nurseries/crèches - Family welfare conference services - Assessment of child abuse referrals - Adoption services - Emergency/medium/long term care placement in residential and foster care - Special/secure care - After-care services - Youth homeless services - Assessment and care for separated children seeking asylum and children moving to and from other jurisdictions - Support services for individuals and families experiencing domestic violence 4

International Comparison of Children in Care • Percentage of Children Under 19 in care - Ireland 4% - England 4% - Scotland 11% - Wales 7% - USA 6% - Australia 2% • Placed with Foster Families (Relative or Non-Relative) - Ireland 84% - England 65% - Scotland 43% - Wales 86% - USA 70% - Australia 79% 5

Overall HSE Organisational Structure • Health and Personal Social Services are divided into three service delivery units: - Primary, Community and Continuing Care (PCCC) delivers health and personal social services in the community and other settings. - Population Health promotes and protects the health of the entire population. - National Hospitals Office (NHO) provides acute hospital and ambulance services throughout the country, including paediatric acute care. 6

Primary, Community & Continuing Care • Primary Community and Continuing Care (PCCC) provides health and personal social services in health facilities and communities all over Ireland. • This includes primary care, mental health, disability, child, youth and family, community hospital, continuing care services and social inclusion services. • Services, including regional and national services, are delivered through 32 Local Health Offices (LHOs). 7

Key Personnel in Children & Families Service Delivery • • Office of the CEO PCCC - Leadership & Coordination of Delivery system - Support to Expert Advisory Group on Children & Families (Chaired by Prof. Gerry Loftus) • Assistant National Director – Jim Breslin - Policy Guidance • Lead Local Health Manager • Assistant National Director – Seamus Mannion - Gerry O’Neill: National Manager Special Care & High Support • Specialists - Bernard Gloster: West - Caroline Cullen - Hugh Kane: Dublin Mid Leinster - Seamus Moore: South - Aisling Gillen - Pat Dunne: Dublin North East - Paul Harrison • Specialists - John Smyth - Ita O’Brien: West - Marie Kennedy: Dublin Mid Leinster - Peter Kieran: South - Vacant: Dublin North East - Claire O’Kelly: National - Aidan Waterstone: National • The above personnel comprise the PCCC National Steering Group for Children and Family services. Groups are established from time to time to address specific pieces of work and report into the Steering Group. 8

Organisational Change in the Health Services • Establishment of Heath Boards • Prospectus (progenitor of HSE) said: McKinsey described the purpose of the 'Care "An important structural problem is evident in of Children Sub-programme' as being the way in which agencies have been established as a 'part-solution' rather than a "to care for children in the community more radical 'full-solution' which would roughly between the ages of 6 weeks and 16 address the interrelated nature of the years. It will include the school health system. This often leads to a dilution of the service, immunisations, general medical effectiveness of system critical functions, services, including identification of emotional hidden and poorly used pockets of expertise disturbance, dental, ophthalmic and oral and an inappropriate location of functions. services, care of 'problem' children and care Our findings reflect the need for of handicapped children in the community". comprehensive structural reform." Audit of Towards Better Health Care: Management in the Health Boards Structures and Functions in the Health System - Prospectus (2003). (1971) In today’s parlance McKinsey envisaged the health boards developing a broad range of children’s services to be delivered within local communities and in an integrated fashion. 9

What happened between McKinsey (1971) and Prospectus (2003) – The Case of Children’s Services? (In just 1 Slide!!) • During the 1970s social workers began to be recruited and they developed a broad based generic social work service, which included child welfare and protection. Scope and scale of child welfare and protection services was quite limited at this stage. • Subsequent awakening to reality of child abuse. - 1984 88 child protection referrals; - 1989 1,242 referrals; - 2005 9,503 referrals. • Social work departments took key responsibility for the investigation of cases of child abuse and the provision of appropriate interventions. • This response was constrained by a number of issues including poorly developed statutory and policy framework, absence of national or regional plans, insufficient resources and no overall agreed model of provision. • Issues such as these were highlighted in the reports of a series of investigations of high profile cases, starting with the Kilkenny Incest Investigation (McGuinness, 1993). • Concerted response saw the development of child care policy, legislation & regulations, provision of additional social work, social care & management posts and a significant increase in resources. 10

Increasing Specialisation a By-Product of Emerging Recognition of Child Protection Issues • During this period within community services, without very clear planning or articulation, a process of specialisation and compartmentalisation was also underway. - "A specialised infrastructure was put in place from the early 1990s where the dominant focus was on child protection and on fulfilling statutory responsibility to identify children at risk. While these services were both necessary and important, awareness has grown in recent years of the need to target preventive approaches and in particular to develop and expand family support services." National Health Strategy - Quality and Fairness (2001) . • Arguably, this process served to incrementally undermine the original ‘joined up’ concept of Community Care services envisaged by McKinsey. • Physically social workers - having originally been located in health centres with public health nurses, community welfare officers, area medical officers and other staff - were, as departments grew, increasingly independently located. • In the process other professionals retreated from issues of “child protection” (broadly defined) leaving these to Social Work Departments to manage alone • More recent attempts to emphasise family support and early intervention (in line with evidence base), while being partially successful, would have benefited from key childcare professionals being more embedded in local communities and integrated with a greater range and number of other community based service providers • Attempts to address early intervention also suffered from the ongoing demands on limited resources for crisis responses to serious child protection cases 11