SYMPTOMS OF Jamaica's worsening child-care system had been evident for some time according to a two-year-old study commissioned by the Health Ministry which pointed to problems of inadequate specialist and medical care, poor staffing, the absence of any clear child care policy and sustained neglect of children who suffered sexual or physical abuse and disabilities.
The damning report, Faces of Residential Care in Ja-maica, a joint study between the Ministry of Health's Children's Services Division, UNICEF Jamaica and NCH Action for Children (UK), was completed in 1999 and had recommended an urgent review of childcare services in the island. It included responses from the island's 52 places of safety and homes islandwide, as well as interviews with more than 200 children and their caregivers.
The research found among other things that even though 10 per cent of wards in residential care had been victims of sexual and physical abuse, with another 35.7 per cent admitted to the institutions due to abuse (physical, sexual) and neglect, this issue had been largely ignored in care.
It concluded that there was still 'no provision in place for sustained treatment and rehabilitation' of children who have suffered abuse.
Recently, however, some psychlogists like Dr. Ruth Doorbar have admitted to being called in occasionally to evaluate cases at some of the island's institutions.
In addition, the Ministry of Health's Child Guidance Clinic under director Dr. Pauline Milbourne, is recognised as the main provider of mental health services to children. The facility works closely with agencies such as the Children Services Division and accomodates wards in care. There are nine specialist clinics islandwide which evaluate children and adolescents who have behavioural and emotional problems.
The first of its kind, Comprehensive Health Centre in Kingston was opened under a national Maternal and Child Health programme in 1986.
The clinics offer a walk-in treatment programme, but most children are referred by probation or police officers, health professionals and teachers. The research team reported however that it found little or no evidence of any policies on the management of abused children from the sample surveyed.
"There appears to be a near total disregard for the emotional consequences, the educational under achievement and the capacity for abusing other children often exhibited by these children."
"...the team was very concerned at the lack of clear policy and procedures to help ensure that children are protected from further abuse, and helped therapeutically."
The study also pointed to gaping holes in a system where high numbers of preschool or primary school children (96 per cent) were admitted into residential care, yet with inadequate attention to their educational and developmental needs.
Of the Homes surveyed 394 children or 19. 4 per cent of the population were found to have or diagnosed with a learning disability. Meanwhile a total of 708 children, 36.5 per cent of the sample were reported to have a disability of some degree, ranging from mental to physical, including speech, hearing and visual impairment. Of these the majority reported having more than one type of disability.
Of the 328 children showing signs of mental disability, 245 had physical disabilities, 308 were speech impaired, while 108 had multiple disability.
Despite this the study found that medical care in the residential homes 'did not always follow the guidance set out in in the Juveniles (Children's Homes) Regulations 1951, which states that medical examinations should be carried out upon admission and yearly.
There was no written policy which explicitly stated how the health of children is to be monitored. The survey showed that some children had more than one condition, 24 (1.2 per cent) had HIV/AIDS, 18 (9 per cent) with sickle cell disease and 190 (9.3%) with behavioural problems.
"These children urgently need therapeutic intervention, supportive counselling and rehabilitation services to help ameliorate some of the traumas and life of disadvantage they have suffered. The evidence from this research shows a worrying low level of human and other resources which make this help limited if not impossible at the present time.
"Backup specialist psychological, mental health and other services are inadequate and in many instances they are not easily mobilized due to an absence of joint planning and partnershp collaboration with other key stakeholders," the report stated.
The questionnaire responses from 37 out of 39 homes showed that 34 homes were arranging medical examinations for the children in their care. Three homes said their children received no medical examinations at all. While only 13 of these homes said children received medicals upon admission, and six said 'once a year'.
The Children's Services Division (CSD) came in for criticism as well. The study pointed to the absence of any strategic plan within the Division to outline the function of Children's Homes and Places of Safety. This it said was 'hampering the provision of and direction of service on a day to day basis'. "Government must also consider and eventually determine, in conjunction with the private sector and other stakeholders, the true role of residential care services to children."
The team recommended that the CSD revamp the processes by which groups and organisations are registered to deliver residential care.
G. A.
