Ms Clare Murphy:

I thank the Chair and members of the committee for the invitation to appear here today. I am joined by Ms Kate Duggan, chief executive officer and Mr. Pat Smyth, national director for finance and corporate services.

Tusla, the Child and Family Agency, is responsible for the provision of the statutory service for child protection and welfare services across the country. In our approach to service planning and delivery, we continually seek to promote the rights of children, to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children.

In 2022, we received 82,855 referrals to our service, an increase of 13% on 2021, which we expect to increase up to 20% by year end. As well as an increase in the number of referrals, we have also noted an increase in the number of children and young people presenting with more complex needs, who also require access to other external specialist health and social care services, such as disability, mental health and addiction services to better meet their needs.

In responding to these children and young people we liaise with other State agencies, particularly the HSE, recognising that it is our duty as State agencies to work together to provide the integrated services that a child or young person needs rather than an individual, their family or a carer having to navigate different agencies or services, particularly at a vulnerable time in their lives.

Being in loco parentisto 5,565 children and young people in the care of the State, we know that delays and access to these specialist health and social care services, to diagnosis, particularly dual diagnosis and to intervention, continues and we see the impact that this can have on the individual's development, well-being and life outcomes.

We recognise that in many instances this is the result of an inadequate supply of suitably qualified professionals, recruitment and retention challenges, financial resources, inconsistency in service delivery models and siloed approaches to service design and delivery.

We also know that for children and young people who have experienced significant trauma in their live, particularly because of harm, abuse and significant neglect, who present with complex needs, a joint approach of clinical diagnosis-intervention from the HSE, in conjunction with child protection and welfare expertise from Tusla, is required to better understand the needs of the individual and the most appropriate intervention or response pathway.

To support this more integrated working between Tusla and the HSE, the first joint protocol for interagency collaboration between the HSE and Tusla to promote the best interests of families was agreed in 2017, underpinned by a memorandum of understanding, MOU, signed by both the Department of Health and the Department of Children and Youth Affairs. This protocol established clear expectations of joint working by both agencies at all levels to promote best outcomes for children known to either or both agencies. In 2020, this protocol was reviewed and strengthened, which has resulted in improved collaboration and integration of services for children and young people who require the intervention and support of both Tusla and the HSE. However, challenges remain within and across both agencies and further progress is required, including: improved internal service integration; clarity on the most appropriate response pathway for children and young people with dual or more presentations, such as an intellectual disability and mental health concerns, or mental health and addiction concerns; clarity on the most appropriate response pathway for children and young people presenting with suicidal ideation and self-harming but who do not meet the threshold for CAMHS; the inclusion of joint working in context of children and young people requiring access to primary care services; the need for a more sustainable, longer-term integrated model of funding for both community services and care arrangements not dependent on resources; prioritisation of children in State care - the Statein loco parentis- to all services provided by the State; and an approach to supporting young people as they transition to adult services, whose needs are such that they cannot be met by a single agency or service.

Tusla is currently outlaying €38.6 million on accommodation costs for children and young people with disabilities. The clinical management of these cases is shared with the HSE through the joint protocol with an agreement to share costs. However, due to funding difficulties in the HSE, these costs fall mainly to be met by Tusla.

In instances where a specialist assessment or therapeutic service has not been available in the public service for a child or young person in the care of the State or where there has been a significant delay in accessing a service, Tusla has commissioned same from the private sector. Our spend to date in 2023 is approximately €5.057 million on psychological and therapeutic services.

In addition, our family support services continue to co-ordinate a Tusla-led early intervention practice model called meitheal, which is designed to ensure that the strengths and needs of children and their families are effectively identified, understood and responded to in a timely way. It is an early intervention, multiagency approach tailored to the needs of the individual child or young person that identifies the various service and agency responses required in a local area to meet the needs of children, young people and families.

Over the past 18 months, the agency has also commenced the development of internal therapeutic services in all six regions to enable a general preliminary assessment of children and young people coming into State care to better inform care planning and to assess at an early stage if referral to a specialist external service, specifically disability or mental health services, is required.

As an agency, we are also concerned about a small but increasing number of families who, because of their inability to access appropriate services, such as respite, residential disability, addiction or mental health services, are volunteering their children into the care of Tusla in an effort to access such State services because they feel they have no other option available to them. We believe that the appropriate services or support should be available to these children to ensure they can remain with their families.

In 2022, we requested the Office of the Ombudsman for Children to bring together key stakeholders to discuss how interagency collaboration can be improved at a strategic level, at both departmental and agency level, to better respond to and plan for these children and young people, which resulted in a positive interagency and interdepartmental engagement. We look forward to being part of the next phase of this initiative.

I assure committee members that we are taking and will continue to take any action we can to improve services for the children and families we serve. We are deeply committed to upholding the rights of all children, but sometimes we are dependent on external agencies to uphold some of these rights. Our reform programme from 2023 to 2025 is focused on ensuring that we can continue to provide better, more integrated and timely service for the children and families we serve. We will continue to build on the integrated approach to date and on improving systems for the future.