District Court grants Care Order under Child Care Act 1991 s.18 for 9-month-old child due to parental unfitness.

[2013] IEDC 2

AN CHUIRT DUICHE THE DISTRICT COURT

HEALTH SERVICE EXECUTIVE

APPLICANT

-AND-

B

RESPONDENT

CHILD CARE ACT, 1991— SECTION 18

IN THE MATTER OF A CHILD

22 January 2013

1. This is an application for a Care Order under section 18 of the Child Care Act, 1991 in respect of a Child aged 9 months.

2. The Child’s mother is the respondent and she is present in Court and legally represented by her solicitor and counsel.

3. The Child’s father is not present in Court and has not participated in the proceedings. He is not a legal Guardian to the Child. I am

satisfied by reason of the Statutory Declarations filed in Court that he has been properly served and is fully aware of the nature of

the proceedings listed for hearing.

4. The Child was appointed a Guardian Ad Litem (“GAL”) to represent the Child’s separate interest in the proceedings. The GAL is

present and is legally represented.

5. An Interim Care Order was made in respect of the Child in March 2012, shortly after his birth.

6. The Respondent mother has been known to the HSE for a considerable period having had extensive involvement with Social

Services in Country 1 and subsequently with the HSE. The Respondent mother has suffered considerable levels of stress and distress

in her life since in or around 1989. Her personal relationships have been tumultuous and she has experienced violence within these

relationships. She has given birth to seven children. HSE interventions were insufficient to prevent her four youngest children coming

into HSE care in May 2006. One of the children spent a period in Special Care. Tragically, her first born son died in 2010. The following

year, the Applicant mother lost her own mother. Over the years, extensive support services have been offered to the Respondent

mother and her children but were insufficient to address HSE concerns around substance abuse, mental health difficulties, and poor

school attendance by the children, and inadequate poor boundaries set for the children.

7. The HSE entered into a ‘Contract’ with the Applicant mother and the Child’s father after the making of the Interim Care Order. This

involved agreements regarding access and participation in a parental capacity assessment. The parents were unable to take up

agreed access with the Child since October 2012, resulting in the arrangements for access being suspended. The Interim Care Order

has been extended on 19 occasions to the date of this hearing. There is a poor relationship between the Respondent mother and the

HSE although each has a different perception of the cause for this poor relationship.

8. The HSE now bring this application for a full Care Order on the basis that the Child’s health, development, and welfare has been

avoidably impaired or neglected and is likely to be avoidably impaired or neglected if the Child is returned at this time to the care of

his mother.

9. The threshold facts for the making of a Care Order have been set out by the HSE and focus on the child’s neo-natal experience of

harm, his poor birth weight, his inability to tolerate food or feeding, his ongoing developmental difficulties, the inability of the

Respondent mother to provide him with consistent care by virtue of instability in her life, mental health difficulties and

alcohol/substance misuse, inadequate engagement with access and inadequate engagement with the parental capacity assessment.

Counsel representing the mother has conceded many of proposed findings of fact set out formally by the HSE. The Court has been

advised that she does not oppose the granting of the Care Order.

10. The Court heard evidence from the following:

• the GP;

• the Medical Social Worker;

• Social Worker 1;

• the Garda;

• Social Worker 2;

• the Paediatrician;

• the GAL; and

• the mother.

Evidence of the GP

11. The GP gave oral evidence regarding the Reports received by her from the child’s Consultant Paediatrician, and her Registrar as

set out at Appendix 16 of the Booklet of Reports furnished to Court. These Reports address the concerns for this child at birth when it

was noted that he was 3 standard deviations below the norm for weight. Urine toxicology carried out on the baby revealed opiates

and benzodiazepine positivity. Symptomatology abstinence was noted to include irritability, high-pitched cry, hypertonicity, tremors,

loose stools, hiccups, and sneezing. These symptoms were on-going following his birth and contributed to poor post-natal weight

gain. Due to hypothermia and persistent low glucose levels, a septic screen was performed including a lumbar puncture. Infection was

out-ruled as a cause for these signs and symptoms. In addition, any antenatal transmission of toxoplasmosis and CMV were out ruled.

A cranial and renal ultrasound was also carried out which revealed no abnormality. However, he was at risk of developmental and

behavioural challenges due to this antenatal exposure. He requires consistent follow up.

Evidence of the Medical Social Worker

12. The Medical Social Worker’s evidence was in support of the facts outlined in the Medical Social Work Report to Court which

included, inter alia, the mother’s difficulties regarding homelessness; her self reported diagnosis of paranoid schizophrenia, her history

of substance abuse, and bereavement issues which have assailed her.

Evidence of Social Worker 1

13. Social Worker 1’s evidence to Court was that the Respondent mother had issues with substance abuse and mental health

difficulties and found it difficult to ensure that her children attended school regularly. Interventions produced improvements; however,

they were short lived. In her opinion, alcohol misuse was a significant aspect of the problem. However, when the four younger

children came into HSE care she noted that the Respondent mother had regular and consistent access with her children in care and it

was very positive thing for the children who looked forward to it. Unfortunately, tragedy then befell the Respondent mother with the

death of her eldest son, followed by the death of her mother and personal upheavals in her life.

Evidence of the Garda

14. The Garda gave evidence that the Respondent mother had convictions for road traffic offences and there was an instance of an

outstanding bench warrant which was enforced.

Evidence of the Allocated Social Worker

15. The Allocated Social Worker, gave evidence of the veracity of his report dated 15 January 2013. It was his professional opinion

that the child, the subject matter of the proceedings, remains a high risk of future neglect if he is returned to his mother’s care at

this time. He reviewed the history of the case, feedback received by him from a range of professionals who had contact with the

Respondent mother, including the medical social worker, the Respondent’s GP and the psychiatric services. He has concluded that the

Respondent mother and the Child’s father each show inadequate parenting capacity to parent this child. He noted that the

Respondent mother has disengaged herself from the Social Work Department and was difficult to contact as she frequently changes

her telephone number and fails to update the HSE. It was his experience that the Respondent mother was inconsistent in her

engagement in the Parental Capacity Assessment to be conducted by the Psychologist. Although she initially engaged with the

Psychologist, she did not persevere with follow up sessions. His evidence was that the Respondent mother’s mental health difficulties

were unclear and schizophrenia was not formally diagnosed, but she had suffered one psychotic episode as well as suffering from

depression. She was eclectic in her engagement with professionals. His attempts to communicate with the Respondent father also

consistently failed. He was conscious that the Respondent mother’s relationship with the child’s father has manifested in incidents of

domestic violence and he was unclear whether the relationship between the parents was truly over.

Evidence of the GAL

16. The child, who is the subject matter of the proceedings, is too young to express any wishes and feelings regarding his care to the

GAL. The GAL also gave evidence that the child is responding well with his foster carers. The GAL’s opinion was that the child should

remain in the care of the HSE as the mother has made no meaningful efforts to engage with or attend access to the child and that

reunification cannot be considered.

17. The GAL attested to the veracity and accuracy of her reports submitted to the court in this case and of her Report dated 16

January 2013. She summarised the overarching difficulties of the Child’s mother, which included substance abuse, bereavement and

mental health difficulties, and her recent experience of homelessness. The GAL noted the self-reported diagnosis of paranoid

schizophrenia by the mother. She also noted the opinion of the Respondent mother’s GP who believed that the Respondent was ‘a

paranoid schizophrenic with an unstable personality disorder, an alcohol dependant syndrome, an addictive personality, and a long

history of defaulting on all medical interventions.’ The GAL also noted the results from the Child’s urine tests which demonstrate that

the Respondent mother was using substances while pregnant.

18. The GAL referred to a further report to the Court detailing the mother’s recent admission to hospital on 16 January 2013 and her

subsequent admission into a Psychiatric Unit. The GAL expressed serious concerns for the Respondent mother’s mental health. She

was fully satisfied that she presented in good health today, however she was very unwell quite recently. The GAL visited the

Respondent mother in her personal capacity when she heard that she had been hospitalised. She also visited her in her professional

capacity to outline the importance of the Care Order hearing. During the latter visit, she noted that the mother expressed a desire to

put ‘all the historic stuff’ behind her and ‘make a new beginning’. She expressed the hope that the Respondent mother seeks help for

her mental health difficulties. She noted that the Child very much resembled his mother and was a very sweet child notwithstanding

his difficulties.

Section 18 Threshold Criteria

19. The mother has been present in Court and has, notwithstanding the difficulties that life has put in her path, attempted to secure

the best outcome for her child.

20. Following some dialogue between the parties, I note that there is a concession by the mother that many of the findings of fact

(sought by the HSE) are conceded.

21. It is conceded that the Respondent mother has been subjected to domestic violence. It is conceded that the Respondent mother

has Road Traffic Act Convictions and I am satisfied, based on the Garda’s evidence, that there are other obstacles facing the mother.

It is conceded that the Respondent mother suffers from mental health difficulties but it is emphasised by the mother’s counsel that

there is no specific professional diagnosis of the extent of those difficulties. It is conceded that the Respondent mother has suffered

depressive episodes and one paranoid episode.

22. It is not conceded, however, that the mother engaged in threatening and abusive behaviour towards professionals.

23. It is conceded however that the Child requires stability, security, and consistency in his care and the mother conceded that she

is not currently in a position to provide these requirements. Accordingly in those circumstances, the Respondent mother consents

that the threshold criteria exists for the Court to make a Care Order in respect of her son. She consents to a Care Order in respect of

the Child until he reaches the age of 18 — subject to safeguards to be put in place by the Court.

Findings

24. Having read the reports and booklets furnished, the GAL report, and having listened to all submissions and evidence adduced by

the parties, I am satisfied that the threshold criteria of section 18(1)(c) are met in this case and that at this time the Child’s health,

development, and welfare is likely to be avoidably impaired or neglected if he is returned to the care of his mother at this time and I

am satisfied that a full Care Order is a proportionate response to circumstances triggering the threshold criteria in this case. The Child

requires care or protection which he is unlikely to receive unless the Court makes an order under this section. The period should be

until he reaches 18 years in order to ensure continuity of care.

Section 37 Access

25. Access under section 37 in favour of the mother should be at the discretion of the HSE but it must be noted that access is vital

for both the Child and the mother and the father, subject to engagement in that regard. In the event that the parties are dissatisfied

with the arrangements that are put in place by the HSE, the parties have liberty to apply to the Court for an order under section 37

of the 1991 Act. The frequency and supports that may be necessary to ensure that the access is meaningful shall be determined

through dialogue and review on an ongoing basis by the HSE with the parents. It should be noted that the access, within the context

of section 37, includes sibling access.

Section 47 Directions

26. Under section 47, it is conceded that the directions proposed by the GAL’s report are adopted by the HSE and are as follows:

• That there is a care review in one year, 23 January 2014. This will act as both an opportunity and a target for the

mother, who very much wants to put her life in order, to start on a clean slate and engage meaningfully with both

the HSE and with mental health professionals. The GAL should be re-appointed for the purposes of the care review,

such reappointment to be two months in advance of the hearing date.

• In the event of the foster placement not being matched within a period of six months from today’s date, the

matter should come back before the Court and the GAL reappointed.

• The matter should also come back before the Court in the event of any change, either contemplated or through

an unforeseen event, in the current foster placement and the GAL is to be reappointed.

• In the event that the case becomes unallocated to a social worker or a fostering link worker for a period of four

weeks, the matter should come back to Court and the GAL reappointed.

• In the event that the current GAL is no longer practising, the HSE should bring an application for an alternative

GAL.

• The HSE should update the Court in one year’s time with regard to the Child’s care plan and the HSE’s solicitor

shall, before the end of the week, furnish the existing care plan to the Court. The Plan should include ongoing

status of the Child in the Paediatrician’s care.

• The GAL is discharged with the usual order from this date.

• In light of the mother’s homelessness, I direct the HSE to provide assistance and referrals for her so as to enable

her to secure any therapeutic interventions that she may need to affect the stability in her life.

• After Care Review (in the event that the Child remains in care until his 18th birthday) to take place on his 17th

birthday [date given].