Full Care Order Granted – 2013vol1#14

The HSE was granted a full care order for a six-year old child, without the consent of the mother, in the Dublin District Court.

The respondent is a single mother, she was not married to the father of the child and they separated on the child’s first birthday due to the father’s ongoing violence. She lives in supported accommodation and has a learning disability. She had been in care herself.

The social worker for the mother and child explained that after the child had been placed in voluntary care by his mother in 2010, a shared care arrangement was put in place in 2011 due to the child’s attachment to his carer. He said the son’s behaviour towards the mother was oppositional and defiant and that the psychologist had noted concerns regarding the attachment between them, and diagnosed possible ADHD.

However, the Child and Adolescent Mental Health Service (CAMHS) came to the decision that the child did not have ADHD and did not require medication. The social worker felt that the mother was adamant her son receive a diagnosis for ADHD and medication.

The mother had repeatedly sought the hospitalisation of her son as well as medication for ADHD.

The social worker recounted how the foster placement eventually broke down due to an allegation in August 2011 by the child that his foster brother had touched him inappropriately. The mother told her son to punch [the foster mother], hit her and call her a “gee bag”. She said she “would have [the foster mother] shot”. The social worker said that the mother is known to have given her son Coke and Mars Bars on the way back to his foster mother in order that he would display the type of behaviour she felt he displayed with her.

Responding to a question concerning safety awareness, he said that he had observed the child running towards the main road and that the mother did not stop him. He said the mother continuously discussed inappropriate things such as respite and needing a break from her son in front of the child, which he classified as emotional abuse.

He said that in November 2011 the mother brought the son to hospital by ambulance with suspected pneumonia and tried to force a hospital to admit him. When she failed she brought him to another hospital and demanded they do the same, but he was not admitted there either.

From this time the child’s behaviour deteriorated greatly, he started to demonstrate sexualised behaviour at his foster home, he touched himself inappropriately and told the foster carer that his foster brother “did that”. The guards were notified by the mother. The school reported possible emotional and physical abuse (threatening him with a leather belt and wooden spoon).

By January 2012, his behaviour had destabilised so much that his welfare was at risk in his mother’s care, therefore the social worker recommended an interim care order to protect the child’s welfare.

The social worker told the mother’s barrister that for the first four years and four months of the child’s life the mother minded him herself. He was a sick baby because he was born with a genetic disorder. After the mother’s sister died in Nov 2010, the mother began to have difficulty with her son’s behaviour. The sister had been a strong source of support before her death and the mother suffered a lot of guilt placing her son in shared care partly due to her own history in care.

Asked if the allegations against the foster brother were inconclusive, the social worker replied “yes”. He told the judge shared care was not a solution at this point, “not at a school going age”.

The principal for the boy’s school said he had settled in well, that his behaviour is within the realm of normal. Earlier on, while he was in his mother’s care, the principal said that his behaviour was disruptive but while in care his behaviour calmed.

She told the barrister for the mother that he was well presented and interacted well with his peers and teachers, and academically was fine.

In September 2011 a psychologist with the HSE carried out a parenting capacity assessment of the mother. There was a cognitive assessment of intellectual ability, her diagnosis was that the mother is at the top end of a mild disability, meaning that she had difficulty in assimilating information and “problems with abstract thinking, in everyday terms she would be slower to take in information.” “Basically it is a question of giving clear information, not over-complicating it. It’s just a question of being clear”, she said.

She said the mother also presented with significant attentional difficulties, she tends to flit from subject to subject. She tends to have a forceful and confrontational style. She had an expectation, learned from home, to be in confrontation with services. She becomes more disorganised under stress. She presented as having a strong attachment to her son but difficulty in coping with his care and is easily overwhelmed by day to day stresses. The psychologist felt that shared care is no longer an option, it didn’t work to begin with. She recommended a full care order.

Asked if a parenting course would help she told the judge that the mother becomes “dramatic and extreme under pressure” and “there is not a particular intervention that will break that cycle”.

The psychiatrist who specialises in child maltreatment and fabricated illness explained that with illness fabrication, the mother wants the child to be recognised as ill but does not actually want the child to be ill. She is using the child for the gratification of her own needs because of her anxiety, he said. The wish for the attention she received from having a sick child when he was an infant (she got very little attention herself as a child) could be a reason for the fabricated illness.

The solicitor for the HSE asked the psychiatrist if the child was harmed by the repeated attempts at hospitalisation. She replied that with fabricated illness one presumes the child is harmed, as they undergo frequent and unnecessary medical treatments. The child has been prescribed anti-convulsants, he had been given x-rays, he had a restricted diet and was in danger of receiving special education. However, he was only harmed to a minor way in his daily life.

The psychiatrist felt that as the mother had “enormous unmet personal needs for very understandable reasons, [she used her son] as a vehicle to fulfil these needs” and it is unlikely that “therapy would help in the short term, in terms of capacity to meet [the child’s] needs. I do not believe the capacity is there. She is not able to realistically differentiate between [the child] as an individual and her as an individual. She cannot believe that [the child’s] experience in the care system can be different to hers.”

There was an element of emotional neglect because the mother “does not have the capacity to empathise”. Emotional abuse here is underpinned by the mother’s low self esteem, to change this would be a long term project that would take more than therapy. She recommended reducing access to once a month “because he has to be allowed to process the loss of his mother, he can be helped to begin to grieve, even the most maltreated children, the last thing they want is to be relieved of their parents”.

She said “love is necessary but not sufficient – you can be affectionate and hold love but that is not the same as being aware and responsive of the child’s own emotional state.”

The Judge asked if “on balance is it better that he move to another carer or to his mother” to which the psychiatrist replied “without doubt to another carer”.

The psychologist for the HSE said the child presented with average intelligence and mild needs in other areas. His behaviour was manageable within the crèche. But the mother was finding him hard to manage at home, regularly questioning if there was a particular diagnosis for his behaviours. His skills of independence were less than a child of average intelligence.

The team leader said that the boy is a very healthy child. Since he has been received into the care of the HSE he has not needed medical care in hospital. He has thrived in his current placement, and he has developed a positive relationship with the team leader. The Team Leader notes that during access his behaviour deteriorates. He believed that shared care is not in the child’s best interests and that his health, development and welfare would be impaired if he was to live with his mother. He recommended a full care order with access reduced to once a month.

The mother told her barrister as a child she was in care from the age of two to 16. She lived with one foster family for five years, a second foster family for a short period and otherwise she lived in a children’s home. The mother felt that being moved around so much as a child affected her a lot and she said that she does not want her child to go into full time care because it would have a bad effect on him too. The mother wishes to have shared care of her son with her cousin.

The mother explained that she was significantly affected by her sister’s death in 2010 and so was her son. She said that her son’s behaviour deteriorated after this time and she placed him into voluntary care because she was so upset about her sister, she subsequently took him for two days over Christmas. She asked to have him back after Christmas and was told he needed to go into respite care first. She was not offered any help with her own problems.

The mother’s cousin gave evidence that she was reunited with her at a family funeral in 2011, where she found out that her nephew was in respite care under the HSE. Since then she has attended eight or nine of the mother’s fortnightly access visits with the son, where she has interacted with him. The cousin wishes to have shared care.

The GAL said she had met him about 10 times and visited him in his foster placements. The GAL gets on very well with the mother.

She gave her opinion on shared care that “the effect would be disastrous, we’d be looking at an extremely disturbed little boy who would be very quickly out of control”. She recommended a full care order with a reduction in access. She did not think reunification could be promoted if a full care order was granted.

The judge granted the order.