Mr. Pat Bergin:

The Senator raised a number of points about self-harm and restrictive practices, and I would like to talk through those issues because it is important to offer a better insight into them. It may help the committee if I describe particular scenarios and what happens with young people in Oberstown.

If we have a young person - for example, a 16 year old - who is in crisis, not managing well or demonstrating behaviour that is a concern, that behaviour will be evident in a number of different ways. The young person may refuse to go to the kitchen, refuse to return from school, turn furniture upside down or be threatening to staff. That might be the scenario. The default position of all staff in Oberstown is to engage verbally with that young person. What normally happens is that other young people are moved away from the environment in which the incident occurs, after which staff can start to engage. One considers the staff team and who has the best relationship with this young person. The staff member and the young person start talking at length. More often than not, the scenarios last 40 minutes on the corridor and two or three staff members try to get an understanding with this young person of what is going on, what his or her way out is and how he or she will manage. They will relate this back to scenarios that occurred the previous day or the day before that.

Young people on the campus have what we call individual crisis management plans. We develop these with young people. If they face crises, we try to establish what things work and do not work for them. Everyone is different. Some young people will say they want to ring home. We will tell them they can do so when they have calmed down, and that will help them. Other young people will say they want to be away from Mary or Tommy or Billy. Each individual crisis management plan is known to the staff and they will draw on that plan. However, if a young person in this situation continues to become more volatile, staff will make an assessment. They will evaluate the risk. The risks can vary. The risk could be that an incident has been ongoing for an hour, by which time it is half nine at night, the young person is creating a challenge on a corridor and no other young people can go to bed because that person is there. The decision is then made that we need to move that young person on. The young person is made aware of the possibilities, which may involve what we call a physical intervention. The physical intervention can be to walk him or her out of the corridor or to go into a full restraint.

All the staff are trained in what we call management of actual or potential aggression, MAPA, as part of our behaviour management programme. This looks at how to physically hold someone in as safe a way as possible, for both the young person and any other young people there. Staff are trained in this and the physical restraint involves two or three staff members. It is neither an option that staff like nor an option in which people want to participate for many different reasons. Staff are very mindful that once they get into a physical intervention with a young person, there is a possibility they will damage the relationship with that young person and that someone will get hurt, either the young person or the staff member.

A restraint may involve two or three staff members, or perhaps more, holding a young person on the corridor or the floor until he or she calms down. There are very clear approaches going back years in this regard. If one physically restrains someone, one keeps a hold of him or her there until he or she calms down, and in calming down one then regains control. One then agrees a plan with that young person. The plan may be to go to the young person's bedroom or the sitting room. The young person may be asked what he or she wants or what is the issue. A key focus of the physical intervention is to ensure that while that young person cannot manage, he or she is being helped to manage. All the training we have done over the years is around not only maintaining the relationship, but also ensuring that people are safe. This is another key focus of the approach. We do not want people hurt or in pain.

The top part of the body is held on the floor, the legs are maintained in one position and one person talks. It is a very scientific approach. Only one person speaks at a time in case the young person gets confused. There is one voice and one direction and that is about moving on. If the young person is allowed to calm down then the situation can be moved along. The number of physical restraints has substantially decreased in Oberstown because people are spending far more time talking. That took a shift in culture. Rather than going in and physically moving the child and putting him into a room, we are now spending time in the corridor or in the yard engaging with them. That has become part of the norm.

There was a reference earlier to self-harm. The same approach is applied on that issue. One spends time - as long as it takes - with the young person who is self-harming. However, if it gets to a point where there is a serious risk that the young person is going to damage himself or herself, there must be physical intervention because one has a responsibility to keep that young person safe. We have many options for that eventuality. There are psychiatric services on site. We have spent a long time working with the HSE and the assessment consultation therapy service, ACTS, team to ensure we have mental health services on site. There is access to a GP. We have a medical team. We have nurses on site from 8 a.m. to 10 p.m. We have a medical suite. All of these services are available and are accessed as required. If something occurs after 10 p.m., we call CareDoc or the medical emergency services. We do whatever is required.

The other restrictive practice relates to handcuffs, and it was referenced earlier. Handcuffs are not routinely used on the campus. There are exceptional circumstances where a staff member would use handcuffs to manage behaviour. However, all young people - 99% of them - arrive on the campus in handcuffs. They leave with gardaí every day in handcuffs. That is the nature of young people being in detention. We have been attempting to introduce a policy where young people are not handcuffed when they are leaving the campus with a member of staff. That is based on a risk assessment. If we were to take a young person off campus today and were he to run away, the first question that would be asked is why was he not secured. The young person would have become a risk and might offend out in the community.

The three points to which reference was made earlier are covered by the term "restrictive practice". I will speak about single separation in a moment. We want to highlight that it is something that is very significant. To restrict the movement of a young person and to take away his or her control is not routine. We are attempting to highlight with all of our staff that this is outside of the norm and it is working. There needs to be accountability when these restrictive practices are used.

There was a reference to records earlier. Staff know how to restrain. The focus then is to record it. While what they have done is important and appropriate and has resulted in the safety of the young person, unless it is recorded, we do not know what has happened. That has been a shift in culture and it is improving significantly. Linked with that is the concept of single separation. Single separation is used across the campus in many different forms. There was reference to young people coming in on admissions. If that happens they may be separated for a length of time, depending on the concerns around their behaviour. This morning, like every morning, we check how many lads are on single separation. There are 42 children on the campus this morning, two of whom are on what we call structured programmes. Due to behaviour that has taken place over the last few days there is a clear structure in place outside of the norm for those two. One young person is in single separation and has been for a number of days. Staff have been going in and engaging with him, trying to establish a plan and to move this young person on. He has very complex needs. Every day we evaluate what is the approach, what is the individual crisis management plan, what is the staff relationship and how it can be moved on. We have policies and procedures but we are focused on the practice and making sure it reflects what is best practice and that the young person is at the centre of it.

The care, education, health, offending behaviour and preparing for release, CEHOP, framework, which was developed by me over the past few years, is based on the focus of young people. Everything we do focuses on the care, education, health, well-being and offending behaviour of the young people and how we can prepare them for leaving. The centre of all that we do is the young person and to support that, our placement planning is key. We look at the young person's needs and decide how we can put a plan in place that is specific to that young person. The plans are not generic or all in one, because the young people who come to Oberstown all have different experiences and challenges. From that perspective, I make the point that everything that we do on the campus places the young person at the centre.