Distressed children who may have been sexually abused must wait up to three months to be assessed, writes Padraig O'Morain

'I am aghast. I just don't believe that a child in distress should be left waiting, but it appears this is the norm." Dr Kieran Harkin, a Dublin GP, is talking about his reaction to the discovery that distressed children who may have been sexually abused have to wait for as long as three months to be seen at the assessment unit at Our Lady's Hospital for Sick Children in Crumlin, Dublin. And that three-month waiting time applies to children who have been prioritised. Children who have not can wait seven months.

Dr Harkin, a member of the Eastern Regional Health Authority (ERHA), obtained this information in reply to a question he put down to the then acting chief executive officer, Liam Woods.

In a reply admirable in its candour, Woods said special consideration is given to "children aged five and under, or when the alleged assault has taken place in the last 72 hours or when children who present are extremely distressed. These cases are placed on a priority waiting list which, due to the number of referrals to the unit that meet these criteria, is approximately three to four months". After assessment, children can wait as long as five months for therapy, he said.

These waiting times are unacceptable, he added, and he announced a review of the situation at St Louise's unit at the hospital.

Social workers say that if a child needs to be taken into care, perhaps because the alleged abuser is living in the house and cannot be persuaded to move out, it can be difficult to get a care order from a court without an assessment from the child-abuse unit. Conversely, if the alleged abuser moves out or is forced out by a barring order obtained by a spouse, then that person, if innocent, experiences the injustice of spending many months outside the home and under suspicion until the assessment is done.

Dr Harkin's question had been prompted by a fellow GP who had come to him because he knew he was on the board of the ERHA. "A patient had presented with a nine-year-old daughter who had allegedly been raped some months previously. The child was not sleeping and was unwell in many ways. They were still waiting for her to be seen at St Louise's."

He was surprised. Three years earlier he had made representations on behalf of another colleague whose patient was a child who had allegedly been sexually assaulted by another child. At that time it was taking two to three months to be seen. He assumed it was a temporary hitch in the service that had long since been rectified.

At first he could not believe the situation was worse now than it was then. "I phoned Temple Street [Children's University Hospital in Dublin\] and they had just as big a waiting list." The health board said it would pay for a private assessment, but he could not find anyone to do it.

Dr Harkin believes the long waiting list for sexually abused children is disgraceful. "I am ashamed to be part of this situation," he says.

"The sad thing is it's not unbelievable," says Eileen Prendiville, national clinical director of Children at Risk in Ireland (CARI). If the number of children who need assessment is causing delay, then it follows that the assessment service is being under-resourced, she says. CARI provides a support service for the families of abused children. It also provides therapy for children after they have been assessed. It trains health-board and other professionals in aspects of dealing with child abuse.

The situation, she says, varies around the country, and in some health-board areas children can be seen quickly or immediately if necessary.

In Dublin, however, parents of children believed to have been abused face a huge dilemma: how to comfort the child without endangering the assessment. "While they are waiting for assessment, any conversations they might have with the child could lead to evidence being disputed [by the alleged abuser\]," she says.

"A lot of parents end up sort of ignoring it. They are in crisis, trying to negotiate with the professionals, trying not to appear upset."

But, she says, the child's hurt cannot be ignored while waiting for assessment. "If you had a child who fell down the stairs and broke his leg, you wouldn't walk into the room next time and ignore it."

CARI, which has seven centres around the country, can advise parents on how to comfort the child without asking leading questions or otherwise endangering the assessment.

Prendiville was not surprised that Dr Harkin could find nobody to do a private assessment on behalf of his colleague. Since Dr Moira Woods was found guilty of professional misconduct in January last year, following a complaint to the Medical Council in relation to her management at the Rotunda Hospital of alleged cases of child sexual abuse in five families in the 1980s, doctors have become very cautious about making definite diagnoses, she says.

"The preschoolers are the ones where the professionals are more wary. If it's intra-familial abuse of a preschooler, you know your assessment has to stand up in court. You know your professional reputation and your licence to practice is on the line. It's a lot easier if the child goes away and disappears into the woodwork."

Dr Woods, now retired, agrees that doctors are cautious about becoming involved in the work. "There is no 'proof' other than forensic examination - either the presence of semen (in an acute rape situation, which is a rare presentation in child abuse) or pregnancy," she told The Irish Times. "This has meant that many doctors are afraid of expressing opinions and has inhibited investigation in some cases."

She contrasts the situation in Dublin with that in Toronto, where a case conference is convened within 24 hours of a reported case of child abuse and the lead professionals are not doctors but psychologists, social workers and counsellors.

The service in Dublin is a long way removed from the Canadian service described by Dr Woods. But the ERHA promises matters will improve. It has, it says, "initiated a detailed review of the current resources at St Louise's and other relevant services in order to determine what action is required to provide a more responsive service to the needs of these young children and their families."

CARI's helpline is at 1890-924567. More information available from the organisation's website, www.cari.ie

Grinding to a halt: why protection services are struggling

• Dealing with sexual abuse is just one aspect of the work of the child- protection services - but the entire system is struggling with lack of resources, social workers say. It would not be unusual for 100 or more cases in which concerns have been expressed about children, usually to do with neglect, to be awaiting attention in any social-work office in the east, according to social workers in the trade union IMPACT.

Many posts are vacant. Many others are filled by foreign social workers who cannot be expected to become familiar with the Irish system straight away. Vacancies may be exacerbated by inefficiency.

One woman answered an advertisement for family support workers in August 2000, was offered a full-time post a year later and was trying to surmount a series of bureaucratic obstacles a further year on to take up the job. She was then offered a half-time job instead of the full-time job she had been appointed to. By then she had found work elsewhere. Eastern Health Shared Services, which handles health board recruitment in Dublin, Kildare and Wicklow, says the delay was due to industrial action. The woman says she was never told this.

About 4,500 children are in care, of whom 4,100 are in foster care. Pat Whelan of the Irish Foster Care Association says social-work shortages mean many foster parents do not get the support they need. She says hard-pressed social workers place young children with families that have not been assessed for fostering and were originally recruited to provide lodgings fortroubled teenagers. The Northern Area Health Board in Dublin says it uses the supported-lodgings scheme to pay allowances to relatives who care for young children.

One social worker in the eastern region supports Whelan's comments, confirming that young children have been placed in emergency situations with families not assessed as foster parents.

Children can be taken into care if a court is satisfied that they have been mistreated or that their health, development or welfare has been, or is likely to be, impaired or neglected and that without a care order they are unlikely to get the protection they need. Alternatively, a supervision order, giving social workers the right to see the child periodically, can be granted.

Social workers say they are slow to take children into care except where the family situation is so bad that they have to be removed at once. They prefer to place the child with relatives. Whelan says social workers are not getting around to assessing relatives' suitability for fostering - though the recruitment of relatives as foster carers is an "excellent" development.

When children are in care, their situations should be regularly reviewed by social workers, with a view to enabling a return home. But staff shortages mean many children have no allocated social worker.