Suffer the children at State's hands
How can the HSE's procedures and policies for dealing with abuse be so damaging, asks Shane Dunphy
IN THE past week we have been bombarded with stories that seemed to plumb the depths of human depravity. News headlines resounded with accounts of abduction and child pornography.
There are no words to express how damaging child sexual abuse can be. This, one of society's last taboos, warps the survivor's relationships with both parents and siblings, tainting even the most simple of interactions. Molestation skews a child's capacity to trust anybody, not least themselves.
Sadly it is just not possible for even the most loving family to guide their wounded progeny through the dark places to which abuse can lead them. It is simply too hazardous a journey, requiring highly skilled, specially trained help.
The accepted wisdom is that such assistance can be found through the the Health Service Executive (HSE) and its teams of social workers, therapists and care staff.
Regretably, last week our social services were under attack too.
Emily Logan, the Ombudsman for Children, criticised Ireland's child welfare systems in the strongest possible terms for failing to provide the appropriate therapeutic intervention to an 11-year-old girl who had been violently raped. The parents of the girl in question had followed the recommended course of action, going to the gardai and reporting the crime before approaching the HSE for advice. Yet despite their efforts, things went badly awry.
This two-pronged approach, going to police and social workers alike, is important for survivors of abuse, as it demonstrates two crucial points: firstly, that what has happened is a crime and is both morally and socially unacceptable – sexual predators will often tell their victims that their abusive actions are normal, healthy and right, even that the child has done something to instigate them.
The daunting step of going to the police station – a symbolically powerful location in most children's minds – and reporting the assault to a sympathetic, attentive garda can be massively cathartic. A well-trained police officer will know how to assure the frightened child that they are believed and that the crime was a serious one that will be thoroughly investigated and the correct remedy pursued.
Such a message is essential for the healing process to begin – children are often so affected by their ordeal that the fact that what they experienced should never have happened needs to be underscored many times.
Going to the HSE, the second vital step, is more practical then ethical. Help in the form of private therapists can, of course, be sought, but the HSE has access to a wider pool of specialists.
The first point of contact with the HSE usually occurs through a phone call to the duty desk – a phone staffed during office hours by a social worker whose job it is to take all referrals. This call will involve a series of simple questions designed to get the necessary information as quickly and efficiently as possible.
Follow-up, usually within the next day or two, can happen in one of two ways: either a visit to the child's home by a social worker, or the family, if they are willing, may be asked to come to the Community Care offices for a more in-depth chat.
It is important to remember that, at this stage, the child is still not on the books of the HSE proper. The decision will not yet have been made as to whether or not the case warrants long-term involvement.
That step will not be taken in cases of alleged sexual abuse without the child going through a CSA (Child Sexual Abuse) Assessment. And it is this process that caused Emily Logan to make her criticisms.
CSA Assessment is a tricky, delicate business. Its purpose is, on the one hand, to establish the extent of psychological and emotional damage inflicted by gauging the child's understanding of what has happened to them and measuring their responses to various stimuli; on the other hand,
the assessors often hope to harvest evidence to aid in criminal prosecution. The latter is achieved by soliciting as much information as possible without being leading or suggestive, and through forensic medical examination.
As attested to by the girl to whom Emily Logan referred, the CSA Assessment can be as devastating and traumatising an experience as the abuse itself if not handled with the deftest and most gentle of touches.
The 11-year-old in question baulked from participating in the process at what was almost the first step: she was asked to give an interview about the rape without her mother being present – the very strict guidelines for such interviews insist the subject be alone and free from the influence of parents or other significant adults.
The report from the HSE on their running of the case stated that the girl's mother was "difficult", pointing out that she insisted on a female doctor carrying out the horrifically invasive medical examination the assessment process requires. It took two months to locate a suitably qualified female physician.
One can only conclude that, once the exam was carried out, mother and daughter alike probably felt the wait had been worthwhile.
Child protection is supposed to be about keeping children from harm – the name itself surely spells this out. How then can the procedures and policies be so damaging? How can we have strayed so far from what we set out to do?
This week two little girls from Athlone are beginning their own path through the assessment process. We can only hope that their experience of it is as gentle as possible and that the necessary support is made available with all due haste.
Shane Dunphy is a child protection expert and lecturer. He is the author of a series of books on his experiences as a child protection worker, including 'Wednesday's Child' and 'The Girl Who Couldn't Smile'