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Inspection Report

Ballydowd

Ballydowd
South Western Area Health Board

Executive Summary

Ballydowd Special Care Unit (SCU) is a purpose built secure residential child care facility which opened in the autumn of 2000 to cater for the needs of young people with serious emotional and behavioural problems. The young people are detained in Ballydowd by order of the High Court for their own care and protection not because they have committed offences. There are 24 beds for both boys and girls in three residential units. In addition there is an education block, an administration block and a recreation block. It is run by the South Western Area Health Board (SWAHB) and was originally envisaged as a regional resource, that is that young people from each of the 3 health boards in the Eastern Regional Health Authority (ERHA) would be accommodated there. However, it is now a national resource, accepting referrals from all over the country.

SWAHB has experienced considerable difficulty staffing Ballydowd and, as a consequence, the unit is not fully operational. At the time of inspection just one of the residential units was in operation. There were 5 young people in this unit with another 2 about to be admitted. In addition, one young person who had been in this unit had been moved to a second unit to be cared for alone under special arrangements that involved the use of agency staff.

There are excellent facilities in Ballydowd, including a school, a gym and a fitness suite. While the complex looks somewhat forbidding from the outside, once inside it is bright and pleasantly decorated. There is an open area around which the various blocks are arranged. This has some hard playing surfaces but is mainly in grass and some shrubs and flowers have been planted. Inspectors found that the young people in the one unit that is fully operational were being looked after very well. Staff members related to the young people in an open, positive and respectful manner. Food was plentiful, nutritious and appetising. A balance had been struck between the need for security and the need to allow the young people exercise some choice and control in relation to their living environment. For instance, the young people were only locked in their rooms in exceptional circumstances rather than as part of the routine. There were good child protection systems in place. Attention was being paid to the rights of the young people in terms of access to information, consultation and complaints procedures. The education offered to the young people was of a very high standard, both in terms of the range of subjects taught and the quality of the learning experience. The young people spoke very positively of their experiences at school. The system of placement planning and review was excellent. There were frequent review meetings involving the young people and the families.

Things had not worked out well for the young person being cared for alone. The actions of staff were informed by a genuine desire to respond appropriately to the young person's difficulties. Despite this, inspectors believe that certain actions taken, such as locking the young person up for long periods, exacerbated a difficult situation. The situation might not have reached crisis point if certain basic issues had been attended to in the initial stages of the young person's placement. There was no care plan and communication between the social work and care team was poor.

Inspectors commend the fact that Ballydowd staff have been working on improving co-operation and communication with the referring social work departments.

Despite the fact that the Ballydowd policy document states that young people must have care plans prior to admission there were no care plans for 3 of the young people. This is unacceptable.

Inspectors learned of difficulties accessing specialist services for some of the young people. This issue has been addressed by health board and Ballydowd management. Greater clarity has been achieved in relation to the issue of input from the psychiatric services. Where no specialist service is available within the public sector it will be bought in from the private sector. However, the process of accessing specialist services can be cumbersome and time consuming. This reflects fragmented and unco-ordinated services rather than any lack of effort on the part of those caring for the young people in Ballydowd.

There is an urgent need for a national regulatory framework for the practice of locking young people alone in their bedrooms. The Department of Health and Children must address this issue. In the meantime, the management advisory group of Ballydowd ought to develop guidelines for staff in relation to this practice. While not a regular feature of life in Ballydowd, this was done excessively with one young person.

Inspectors had some other concerns. The current lack of suitable step down facilities means there is a grave danger that young people will be detained longer than necessary because of lack of alternative facilities. There is also an unhelpful inflexibility in the current arrangements whereby decisions, such as whether a young person can have an outing away from the unit, are being made by the High Court. This has led to frustration for the young people and delay in implementing plans for their reintegration to the community. Some of these matters could be best left to the discretion of the professionals looking after the young people.

In making orders to detain young people in Ballydowd the court reserves for itself discretion in relation to the duration of orders. This is unsatisfactory. The use of special care should be strictly time limited. However, this problem will be resolved when the Children's Act comes into operation.

The families of the young people are involved in their care. All of those interviewed praised the staff for their care of the young people. Parents expressed confidence in the competence of members of staff. They spoke of being made feel welcome in Ballydowd and of good communication with the care staff. Parents attend the reviews of the young people and are given assistance with transport for attendance at reviews and for visits to their children.

There is a good staff team in Ballydowd. Inspectors were particularly impressed with the approach to induction and in service training of staff, staff supervision and the use of a staff consultant. Good management practices were apparent. Managers were available to both staff and young people. Young people spoke positively of staff, teachers and managers. Professionals with contact with Ballydowd spoke approvingly of an openness to the views and perspectives of others on the part of Ballydowd staff. This quality of openness will help the management and staff of Ballydowd to learn from the experience of a challenging first year.