Children in special care unit forced to urinate on floor

Some troubled children at a special care unit were forced to urinate on the floor while being isolated in a “safe room” for long periods of time time, according to social services inspectors.

It is one of a series of highly critical findings in an inspection by the Health Information and Quality Authority (Hiqa) into Ballydowd Special Care Unit, Lucan, Co Dublin, which provides secure accommodation for boys and girls aged between 11 and 17 years of age with emotional and behavioural difficulties.

Most concern focuses on the use of “single separation”, which involves the isolation of disruptive young people in safe rooms or designated locations away from other young people.

In the six months prior to the inspection, there were almost 150 episodes of single separation involving nine children. This compared to fewer than 50 incidents in the last 12-month period examined by Hiqa.

Of these incidents, one in five involved separation of more than eight hours. Some children were isolated for much longer, with one young person in continuous single separation for five days.

The report states that, on occasion, some children had no access to toilet facilities or showers.

Two children had urinated on the floor of a safe room, as they were not allowed access to a toilet on the basis of risk. Three children were locked in a room for periods of over 24 hours and did not leave the room in that period.

The report also states that some children in single separation were forced to sleep without a mattress or blankets on numerous occasions. This was because mattresses and bedding had been torn by young people and used for self-harming.

One young person complained about having to sleep only in tracksuit bottoms without a top or blanket and told staff members that they were freezing throughout the night.

Records of prolonged separation showed missed opportunities to end the intervention, according to Hiqa.

The rationale for continuing separation was not always based on risk. There was also a lack of consistent recording and informed decision making about these practices.

Staff members had not received training on the practice of single separation and inadequate information was often provided to managers - who were off-site - to inform their decision making about authorising the continuation of a child in single separation.

In response to the findings, Fred McBride, the chief operating officer of Tusla, the Child and Family Agency, said the organisation accepted that use of single separation was not adequate on occasions when faced with “intense and sustained pressure from challenging and violent behaviour.”

“Tusla regrets this and is currently taking steps to strengthen its decision making procedures and facilities,” he said.

When considering the use of single separation, the key challenge for care staff was to balance the dignity and rights of young people with Tusla's legislative duty of care to all children and staff in a facility.

"All young people in single separation have access to toilet and washing facilities. However, the reports references instances where this was not possible. Access was restricted when a risk assessment determined they were unsafe due to indications of self-harm," he said.

The Children's Rights Alliance said some of the practices amounted to "inhuman and degrading treatment" of vulnerable young people, many of whom have had traumatic experiences in their lives.

"​The European Committee for the Prevention of Torture is very clear that in the area of juvenile detention, a rigorous selection and training programme must be put in place for staff. Clear avenues of complaint are also essential to protect children in detention from harm," said Tanya Ward, the alliance's chief executive.

She called on Tusla to act urgently to ensure no child had to endure similar treatment in the future.

Mr McBride said Tusla was developing a specially designed single occupancy facility at Ballydowd which will be better equipped to deal with "extreme challenging behaviour" and which is likely to reduce the need for single separation.