LCQ15: Family and child protective services

     Following is a question by the Hon Cheung Kwok-che and a written reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (July 13):
     A child abuse case heard by the Coroner’s Court recently in which a five-year old boy with mental disability died after ingesting methamphetamine has aroused wide public concern.  Regarding child protection, will the Government inform this Council of:

(1)  the details of cases of parental substance abuse, including:
(i) the number of pregnant women found to be substance abusers in the past five years;
(ii) among the cases handled by the Comprehensive Child Development Service (CCDS) in the past five years, the number of those in which the parent(s) of the children concerned was/were suspected substance abuser(s); the follow-up actions taken on such cases and the latest situation of them;
(iii) the number of children currently under the care of CCDS whose parent(s) has/have been confirmed to be substance abuser(s);
(iv) among the multi-disciplinary case conferences (MDCCs) held last year on protection of children whose parent(s) was/were suspected substance abuser(s), the respective numbers of them attended and not attended by medical practitioners, psychiatrists or psychologists;
(v) where the parent(s)/carer(s) of a child has/have been found to be substance abuser(s), whether such a case is defined as child abuse case under the existing legislation; the policies and systems currently in place to protect children living under such circumstances; how the authorities define and assess the level of risk to which a child whose parent(s) has/have been found to be substance abuser(s) is exposed; the implications of the relevant assessment outcome on the follow-up actions to be taken by the authorities;
(vi) as the Law Reform Commission of Hong Kong is currently considering the reference on causing and allowing the death of a child, whether the Commission will consider giving a legal definition to “child abuse” when carrying out the relevant work;
(vii) whether the Government will conduct a full and independent case review of the aforesaid child abuse case, apart from taking follow-up action on it under the existing child fatality review mechanism;
(viii) as the “Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence”, released by the World Health Organization in 2009, points out that when a person’s substance abuse poses a risk to others, such a consideration may override his/her freedom of choosing whether to participate in treatment, whether the Government has plans to explore the implementation of mandatory detoxification for parents and pregnant women who have been found to be substance abusers; and
(ix) how the Government coordinates the efforts of various government departments and non-governmental organisations in addressing the problem of parental substance abuse at present;

(2)  the details of MDCCs, including:
(i) the respective numbers of telephone calls, written referrals and internal referrals with respect to child abuse concerns received respectively by Social Welfare Department, social services organisations and public hospitals in each month since January this year and in each of the past five years (with a tabulated breakdown by the subject of concern); and
(ii) the numbers of referrals received by case managers of MDCCs and the numbers of MDCCs conducted in the first quarter of this year and in the past five years;

(3)  the details of Care or Protection (COP) Order, including:
(i) the number of occasions in the past five years on which MDCCs recommended the Director of Social Welfare (DSW) apply to the court for a COP order;
(ii) the respective numbers of applications for COP orders made by DSW in the past five years upon MDCC’s recommendations and otherwise; and
(iii) whether the Government will consider the introduction of mandatory treatment for parents with substance abuse as a pre-requisite for returning their children to them; and

(4) the details of residential child care services (RCCS) (both institutional and non-institutional care), including:
(i) the current number of children, for whom COP orders have been made and a consensus on the removal of whom from their parents who have been found to be substance abusers has been reached by the relevant MDCCs, are still living with their parents because of a lack of placement options;
(ii) the respective current numbers of places in various types of care centres for children to receive RCCS, including emergency residential care, small group homes, emergency foster care, foster care, boys’/girls’ homes, boys’/girls’ hostels, children’s homes, residential child care centres and other types of care, and the numbers of children currently occupying such places (with a tabulated breakdown by special needs, health conditions and age group (i.e. 0-5, 6-12 and 13-18) of such children);
(iii) the conditions under which the authorities will draw up permanency plans for children currently receiving RCCS, and the current number of such children for whom permanency plans have been drawn up;
(iv) the current number of children whose permanency plans include the options of family reunion and adoption;
(v) among the children who received RCCS in the past five years, the respective numbers of those children who remained in care until they reached 18 years of age, were adopted, transferred to other types of care services and returned to their families;
(vi) the current average length of time for which children wait for places of various care centres (with a tabulated breakdown by age group (i.e. 0-5, 6-12 and 13-18));
(vii) the number of children under five years old who are currently in institutional care and for how long they have been receiving such care;
(viii) the current number of children who are waiting for institutional care (both emergency and non-emergency care) and for how long they have been on the waiting list; and
(ix) the respective percentages of parents having (a) regular, (b) irregular and (c) no contacts with their children who are currently receiving RCCS and whose permanency plans suggest family reunion?
     Having consulted the relevant Bureaux/Departments, my reply to the four parts of the question raised by the Hon Cheung Kwok-che is provided below:
(1)(i) The Government does not have information on the number of pregnant women found to be substance abusers.

(ii) and (iii) The Comprehensive Child Development Service (CCDS), jointly implemented by the Labour and Welfare Bureau, Education Bureau, Department of Health (DH), Hospital Authority (HA) and Social Welfare Department (SWD), aims to identify at an early stage various health and social needs of children (aged 0 to 5) and those of their families and to provide the necessary services to foster the healthy development of children.  Through the Maternal and Child Health Centres of DH, hospitals of HA and other relevant service units, such as Integrated Family Service Centres, Integrated Services Centres and pre-primary institutions, CCDS identifies at-risk pregnant women (including those parent(s) who was/were suspected to be substance abuser(s)), mothers with postnatal depression, families with psychosocial needs, and pre-primary children with health, developmental and behavioural problems.

     Needy children and families identified will be referred to relevant service units for appropriate health and/or social services with a view to strengthening family’s capability in caring for children and offering assistance to those parents and carers who have difficulties in taking care of and parenting children for improving the care quality.
     The Government does not have information on the number of cases under CCDS where the parents of the children concerned were suspected substance abusers.

(iv) In 2015, the total number of newly reported child abuse cases was 874, out of which 821 multi-disciplinary case conferences on protection of child with suspected abuse (MDCCs) were held.  More than one multi-disciplinary case conference on protection of child with suspected abuse (MDCC) might be held for some of the cases as appropriate.  The social worker responsible for handling the case and other relevant personnel will attend MDCC.  Depending on the circumstances of each case, the MDCC will be attended by, among others, medical professionals, psychiatrists and clinical psychologists, as appropriate.

(v) and (ix) According to the “Procedural Guide for Handling Child Abuse Cases (Revised 2015)” (Procedural Guide), child abuse is defined as any act of commission or omission that endangers or impairs the physical/psychological health and development of an individual under the age of 18.

     When encountering suspected cases of child abuse (including those cases where the parents of the children concerned were suspected substance/drug abusers), different professionals, including the personnel engaged in social services, health services, education services and law enforcement, and those whose duties bring them into close contact with children, will carry out the necessary immediate assessments and intervention, social enquiries, convene the MDCC and follow-up welfare plans according to the Procedural Guide.  When conducting a detailed social enquiry, the case manager will conduct risk assessments on related factors according to the Procedural Guide.  The assessments will include the physical, mental and psychosocial conditions of the child and those of the carer, the attitude of the abuser, any undesirable habits of the abuser (e.g. substance/alcohol abuse), the growth and developmental needs of the child, the family’s ability to take care of the child, the parent-child relationship, the child care arrangements, and the availability of support in the family network.  If the case involves a criminal offence, social workers or other professionals will refer the case to the Police for investigation.

     If the MDCC considers that the family is not suitable for taking care of the abused child for the time being, the case manager will place the child under the care of relatives as far as possible.  If care by relatives is not feasible, suitable residential care service will be arranged according to the child’s welfare needs.  The MDCC may, taking into account the actual situation, set out targets and implementation plans to help the drug-abusing parents refrain from drug abuse and facilitate reunion of the child with his/her family.
     If the case is classified as child abuse or the child concerned has a high risk of being abused, social worker from SWD’s Family and Child Protective Services Unit (FCPSU) will provide comprehensive follow-up services.   The social worker will provide appropriate services to the affected child and to other family members (including the abuser), including regular visits, counselling services (such as emotional control and counselling, parenting skills, parent-child relationship), financial assistance, referrals for psychological counselling services, residential care services, etc., to protect the well-being of children.  In addition to the casework counselling services, social worker of SWD’s FCPSU will also provide group counselling and developmental programmes for the affected child and the family to help them overcome the negative impacts of the incident, enhance personal resilience, build up self-confidence and develop positive attitudes towards interpersonal and family relationships.
(vi) The scope of the Law Reform Commission’s study on causing or allowing the death of a child is to review the law, both substantive and procedural, relating to the criminal liability of parents or carers of children and vulnerable adults when the victim dies or is seriously injured as a result of unlawful conduct while within their care, and to recommend such changes in the law as may be thought appropriate.  As part of this review, the sub-committee set up to undertake the study is considering a range of legal concepts and definitions which may be relevant in this area (having particular regard to reforms in other jurisdictions) and will endeavour to issue a consultation paper on its proposals for reform within this year.

(vii) A coroner has already heard the fatal case of the 5-year-old boy and given the verdict in accordance with the legal procedures.  The coroner has recommended that if any carer is suspected of having a condition of substance/drug abuse, consideration should be given to the way the substance/drug abuse is carried out  : whether it takes place at home, where the carer stores the substance/drug and whether the place of storage is easily accessible by children, and the appropriate measures should be included in the risk factors and assessment matrix set out in the Procedural Guide.  The Child Fatality Review Panel (the Review Panel) will also review the case.  Priority will be given to this case and the review will be conducted once the findings of the Coroner’s Court and other information are available.

     The Review Panel is independent of the Government.  Its members come from various fields, including medical, social welfare, psychology, legal, education, academia and parents.  As the Coroner’s Court has inquired into the case and the Review Panel will also review the handling of the case and the system concerned, SWD considers that there is no need to conduct yet another review of this case.

(viii) Possession and consumption of dangerous drugs constitute offences under the Dangerous Drugs Ordinance (Cap. 134).  If considered suitable by the court, convicted persons who are drug abusers may be required to undergo the compulsory treatment programme at the Drug Addiction Treatment Centres run by the Correctional Services Department.  The court may also order convicted persons who are drug abusers to be placed under probation supervision by SWD and to be referred to suitable residential drug treatment and rehabilitation services provided by non-governmental organisations.

     To cater for the varying needs of different drug abusers, Hong Kong adopts a multi-modality approach in the provision of drug treatment and rehabilitation services.  The Government helps drug abusers/suspected drug abusers to refrain from drug abuse through various channels, e.g. methadone clinics, substance abuse clinics, drug treatment and rehabilitation centres and counselling centres for psychotropic substance abusers (CCPSAs).  SWD also provides subvention for 11 CCPSAs and two centres for drug counselling run by non-governmental organisations to provide drug counselling services for drug abusers/suspected drug abusers in the community.  Social workers of the centres will assess their family circumstances and needs and, after obtaining their consent, refer them and their family members (including their children) to appropriate service units for follow-up.

(2)(i) and (ii) SWD has set up the Child Protection Registry (CPR) to collect statistics on the relevant child victims and abusers in the cases of child abuse and child at risk of abuse.  Since not all referral cases of suspected child abuse will be defined as child abuse after thorough investigation, such information will not be registered in the CPR.

     The total number of newly reported child abuse cases in the CPR and the respective number of MDCC held are provided at Annex 1.

(3)(i) and (ii) The Director of Social Welfare fully considers all relevant factors, including the views of MDCC, in deciding to apply to the court for Care or Protection Orders.

(iii) Before returning the child concerned to the carer who has the habit of drug abuse, SWD conducts comprehensive assessment of the ability of the carer in taking care of the child, including his/her drug abuse habit and the progress of drug treatment. Upon conducting the comprehensive assessment, if the carer is considered not suitable for taking care of the child due to drug abuse and/ other problem, SWD will continue to follow up on the child care arrangements and monitor the progress of the case, in order to protect the best interests of the child.

(4)(i) SWD does not have the relevant information.

(ii) Generally speaking, children admitted to residential child care services must be medically fit to receive such services.  The number of places of various types of residential child care services and the number of children receiving such services, as at March 31, 2016, are provided at Annex 2.

     According to the information collected through the applications for services, the number of children with special needs (e.g. attention deficit/hyperactivity disorders, autism, specific learning difficulties, limited intelligence and mildly mentally handicapped, etc.) who were receiving residential child care services as at March 31, 2016 is provided at Annex 3.

     The number of children with behavioural/emotional problems who were receiving the services of boys'/girls' homes with school for social development on site (some might be children with special needs) as at March 31, 2016 is provided at Annex 4.

(iii) Having regard to the circumstances of individual cases and with reference to the long-term well-being of the children concerned, caseworkers work out appropriate care arrangements and a permanency plan for each child receiving residential child care services, including the arrangement of an appropriate type of residential care service and the duration of service, as well as formulating other long-term arrangements (e.g. family reunion, adoption, independent living) etc.  Caseworkers strive to facilitate the reunion of the children concerned with their families or other relatives, when it is feasible and is in the best interests of the children.

     Caseworkers regularly follow up on the condition of the children concerned from the perspective of their welfare needs. Caseworkers conduct case review meetings with the children, their families and the social workers of the relevant residential child care services to assess and discuss the welfare needs so as to refine and adjust their permanency plans in accordance with the children's best interests.

     Besides, according to the existing mechanism, caseworkers and the management officers concerned will review the welfare cases of the children receiving residential child care services every three to six months from the case management perspective, including the implementation schedules of permanency plans, progress, as well as the direction of handling cases, and adjust the children's permanency plans based on the circumstances of individual cases.

(iv) SWD does not have the relevant breakdown of the information.

(v) The breakdown of the numbers of the children concerned in the past five years is provided at Annex 5.

(vi) The average waiting time for various types of residential child care services in 2015-16 is provided at Annex 6.

(vii) As at March 31, 2016, there were 201 children aged under 5 staying in general residential child care centres that provide institutional care services.  Their average duration of stay in residential care was 15.4 months.

(viii) As at March 31, 2016, there were 621 applications for various types of residential child care services, including residential child care centres, foster care, small group homes, children's homes, boys'/girls' homes and boys'/girls' hostels.

     In 2015-16, the average waiting time for residential child care services was about three months.

     The mechanism of the central waiting list does not apply to emergency residential care services.  Based on the urgency of individual cases, caseworkers may directly approach the service providers of emergency residential child care services for enquiries and referrals so that the children concerned can be admitted to the relevant facilities as soon as possible.

(ix) SWD does not have the relevant information.

Ends/Wednesday, July 13, 2016
Issued at HKT 17:42