HSE Child Protection and Welfare Service in Carlow/Kilkenny - hiqa.ie

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Inspection of the HSE Child Protection and Welfare Service in Carlow/Kilkenny Local Health Area in theHSE South RegionHealth Information and Quality Authoritythe suite of documents that supported the gathering of information about childrenand families. Inspectors observed the process whereby the duty team leader andthe social workers on duty sought specific information relating to the child, the familycomposition and the referrer. The category of concern and the action to be takenwere recorded by social workers in a template document. The social worker alsorecorded further actions such as the need to undertake an initial assessment and orthe closing of the file. The option for emergency action, notification to the GardaSíochána, referral to another agency was also recorded in the intake recordtemplate. The duty team leader agreed and approved the outcome of the screeningand the actions proposed by the social worker. This system was being utilised by thesocial workers but there were significant delays at times in both duty teamscommencing information gathering. Inspectors were told that it was usual practicefor social workers to be rostered to work duty for two or three days over a four- tosix-week period. This meant that a number of social workers could be involved incarrying out preliminary enquiries into a single referral, resulting in a fragmentedapproach. This undermined the robustness of the system.As part of the preliminary enquiry, social workers gathered information aboutchildren and families and exercised their professional judgment to inform decisions.However, decision making was not guided by a clear understanding of thresholds ofharm. Inspectors observed checks being undertaken by social workers with Gardaí,public health nursing departments, referring teachers and other professionals andthere was also evidence of contact with parents and visits to children in their homesand in school. This information was used to inform decision making, but there wasno evidence that consideration had been given to defined thresholds of harm. Thismeant that potential risks to children were not being consistently managed.In the majority of cases, limited written feedback was provided to members of thepublic as appropriate or professionals who made referrals to the social workdepartment. Standardised letters were issued to referrers by the social work teamleaders, acknowledging receipt of the referrals. Professionals, community andvoluntary group representatives confirmed that the standard process was to receivea written acknowledgement of the referral. Inspectors were told by the social workteam leaders and social workers that in many instances the social worker wouldindicate that the referral was placed on the duty list awaiting assessment.Representatives from local schools, hospital, community and voluntary groups toldinspectors that this response was not satisfactory. In some acknowledgement letterswhich inspectors viewed, it was stated that ‘if in your opinion, this family requires aservice as a matter of urgency please contact the duty social worker by return’.Hospital staff told inspectors that the referral would not have been made in the firstinstance unless there were concerns and the letter placed a further onus on thereferrer to manage and monitor the risk which was in many cases outside of theircontrol as children and pregnant women may have subsequently been dischargedhome.18
Inspection of the HSE Child Protection and Welfare Service in Carlow/Kilkenny Local Health Area in theHSE South RegionHealth Information and Quality AuthorityStandard 2:3 – Timely and effective action is taken to protect childrenThis standard was met in partThe duty team leaders prioritised cases using their own experience rather thanagreed criteria. There was a national prioritisation framework, the HSE’s Frameworkfor Measuring the Pressure document, and this included a prioritisation scale,guidance for the analysis of risk and risk assessment questions. Staff were either notaware of or were not implementing this framework. The area manager and theacting principal social worker told inspectors that the purpose of the framework wasto report on intake activity and waiting lists. They did not see it as a guide tooperational activity. Within this framework there were tools to guide the socialworker, social work team leader and acting principal social worker to manage intake,assessment and allocation activity but these were not in use. Rather, decision makingwas based on the experience and skills of the individual social worker under thedirection of the social work team leader. Whilst staff members were experienced, thisapproach was not safe or sustainable in the medium to long term.There was the possibility that an inconsistent approach could be taken in identifyingand managing risk to children. The HSE Framework for Measuring the Pressureprovided key principles to guide social workers in the consistent application of riskassessment processes, but as stated, this document was not in use. Inspectors weretold by social workers that they were guided by the practice notes in the ChildProtection and Welfare Practice Handbook, although it did not contain a riskassessment framework, by their professional knowledge and by the advice anddirection of the social work team leader. Team leaders said that they were informedby their experience and Children First (2011) when prioritising referrals. Inspectorsfound there was the potential for a number of approaches to be used within thesocial work department and this did not lend itself to a consistent and agreedapproach to decision making and prioritisation.Decision making was not always timely. Within the HSE Child Protection and WelfarePractice Handbook, timelines are set out for the screening of referrals. These shouldtake place, where possible, within 24 hours of being made. Initial assessmentsshould take place where possible within 20 days following the receipt of the referral.Inspectors were told by social workers, and found from review of files, that thesetimelines were not always met. Some of the delays were as a result of the way inwhich the duty system was structured. Inspectors were concerned that the outcomefor some children could be poor as critical decisions might be delayed.Inspectors found that there was good quality information gathered to informdecisions regarding children. The content of the initial assessment process in the LHAwas in line with Children First (2011) and this process was integrated into theelectronic information system. Inspectors reviewed files where assessments werecompleted and they included direct contact with family members, external agencies,and a range of professionals. There was some evidence that the views of the child,parents and carers were sought as part of the assessment. Inspectors also found19
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