Breaking bonds

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karenA new study by the universities of Manchester and Brunel, funded by the Nuffield Foundation, has been looking at the incidence of recurrent care proceedings in family courts and found that approximately one in three care applications concerns a mother who ‘can be described as a repeat client’. Problematic drug and alcohol use – and associated chaotic lifestyles – is a major contributory factor, researchers say.

The research team studied records held by the Child and Family Court Advisory and Support Service (Cafcass) – the only centrally stored source of data linking children, mothers and care proceedings – covering the period from 2007 to 2013, and concentrated on completed cases of recurrent care proceedings issued under section 31 of the Children Act 1989. Its conclusions were that recurrence was a ‘sizeable problem’ for family courts in England.  

Local authorities issue care proceedings when concerns are such that compulsory legal intervention is thought necessary to ensure the safety and wellbeing of a child. While the high volume of annual care applications has led to members of the judiciary raising concerns about ‘repeat clients’ who go on to lose their children to care or adoption, no one has really known the extent of the problem until now. 

During the period covered by the study, 7,143 birth mothers appeared in 15,645 recurrent care applications regarding 22,790 children. Was the team surprised by the findings? ‘No, I think we’ve underestimated the problem,’ Dr Karen Broadhurst of the University of Manchester tells DDN. ‘We can only capture recurrent care proceedings, but children can come into care through other routes – via a section 20 agreement with a parent, or they can bypass care proceedings and relatives can apply for a private law order or residence order, for example. There are more children in care linked to other children in care than we’ve identified.’

The team has now applied for funding for another two years to undertake a large mixed-method study, and it also carried out a pilot study of qualitative interviews with 25 birth mothers, sponsored by one local authority with a high recurrence rate. It
has also started in-depth research into a randomly selected sample to look at points of engagement with services and opportunities for prevention.

The initial findings, however, were picked up by several national newspapers, most of which focused on the extreme examples of women having several children – into double figures, in some cases – removed. ‘One of the things the media’s slightly misrepresented is that there’s a difference between cases of multiple recurrences – one after another after another – and mums who might have a baby, then another one and stop and grow up a bit and come back and keep a child,’ Broadhurst says.

‘There’s a lot of variation behind the big figure, which is quite important in terms of prognosis for change. There are some mums who require some kind of adult protection response – they’re highly vulnerable, with serious mental health problems and learning difficulties, probably in sexually exploitative relationships with no control over their lives, and then there are other mums who are desperately trying to get themselves out and have the wherewithal to do that.’

Around 25 per cent of all children in care proceedings are linked to recurrent cases, the team found, with the average interval between the start of the first and second set ofproceedings 93 weeks, suggesting that women were often ‘pregnant again during proceedings or shortly after’. With mothers who had more than two applications, however, the intervals were even shorter, indicating that ‘the highest risk parents had the least time to change’. It’s essential to address this, say the authors, to give vulnerable mothers the chance to ‘exit this cycle’.

What’s also striking is the age of the mothers. Half of those involved in a cycle of repeat proceedings were 24 or under at the time of the first care application, with 19 per cent aged between 14 and 19. Nearly 60 per cent of recurrent care applications related to infants under 12 months, and 42 per cent of all applications were made within a month of birth.

How much of a role did drink and drugs play in the cases they studied? ‘Major, major,’ says Broadhurst. ‘What we’re seeing with the interviews we’ve done with women is early adolescent drug and alcohol use, usually as a coping mechanism in response to childhood sexual and physical assault and trauma and abandonment – early onset drug and alcohol use from the age of around 12, 13, 14. That tends to then result in adolescence being really quite troubled – homelessness, rough sleeping, maybe sex working, unstable care histories – in a high percentage of cases.’

babyAs the women don’t have time to turn their lives around, or even to properly engage with services, access to treatment is ‘a really key issue,’ she says. ‘There are differences across the country and some very good practice, but one of the problems in some areas is that when mothers are referred to the local authority, the local authority won’t respond early in the pregnancy – it waits until they deem the foetus to be viable and the baby likely to be born. They leave the intervention really late in the pregnancy – say 30, 32 weeks – so essentially the baby’s born before any work’s been done with the mother. So the default position then is removal, issuing care proceedings at birth, or in better cases mother and baby placement in foster care or
residential placement.’

It’s vital to work with drug and alcohol-using mothers early in pregnancy, as this can be a ‘window for change’, she stresses, a ‘time when women think “right, I’ve really got to get my life in order”. Because a lot of local authorities don’t do that there is no window for change, and we’re seeing women generally in these cases with short interval pregnancies.’

This means that another issue that drug and alcohol services should be thinking about is access to
contraception, she points out. ‘That’s a long-standing finding, actually, in relation to mums with problems of drug addiction – that women will not prioritise their reproductive healthcare needs. They’re thinking about “how can I survive and manage my drug habit?” They either think they can’t get pregnant, or it’s secondary, so drug and alcohol workers need to help them
space their pregnancies and access contraception, make it more of a priority. If women do space their pregnancies they’ve got much more chance of keeping their next child.’

Is there anything else that treatment services could be doing to reach out to this population? ‘Obviously, an outreach community-based or homevisiting, proactive approach would be good, because from what we know of these mums they sometimes struggle to leave the house, particularly if they’ve had a child removed. They’ll take to their beds and they can’t function in society at all – they’re desperately suicidal, bereft. They’re not out accessing anything.’

What’s also needed is longer-term support, she says, citing the example of the US-based PCap (parent-child assistance) program, a recoveryfocused service that offers support for three years and tries to keep mother and baby together. ‘The view is that if you can do that in as many cases as you can, that mum won’t have another baby,’ she says. ‘It’s an incentive not to get pregnant again in the short term.’

One issue, of course, is that in the UK funding for many wraparound services and family support is being cut. ‘Vulnerable parents are really up against it in terms of getting help, and people are less sympathetic towards them – there’s been a punitive shift,’ she states. ‘A lot the basic infrastructure for family life is being so cut back – housing, community services, everything. But it’s not a cheap option to put people in care, and the outcomes are not guaranteed.’

Is there anything else that the family courts themselves could be doing? ‘A lot of these mothers are very young – 24 or under, or 14-19 in the case of 19 per cent of them – and I just think a lot of them will find the court a completely alien place. I also think the quality of legal help they get is very variable. The problem-solving approach to court is much better. The FDAC [Family Drug and Alcohol Court] model guarantees – or goes as far as it can to ensure – a coordinated approach to treatment at the start of proceedings, whereas what generally happens is that recommendations can come part-way through or late.’

What’s more, new timescales of a 26-week deadline for care proceedings introduced under the Children and Families Act 2014 could make things worse, she says. ‘It will be really hard for these parents to turn their lives around in six months, particularly if they don’t get help from the outset of legal proceedings, and with the standard court model that’s not guaranteed. They can be referred for help, go on a waiting list – they’re queuing.’

It amounts to ‘a breach of social justice’, she believes. ‘The treatment recommendations that are made at the final hearing will often be something like 18 months psychotherapy, because the mother has borderline personality disorder, and no one wants to pay for that. We’ve seen mothers who are paying for the treatment themselves, they do ten weeks psychotherapy and the court says, “I’m sorry, that wasn’t enough.” Often the parents in our sample fell below the thresholds for disability and mental health services, so the court makes recommendations – says “you must do this” – and the parent can’t access that help. That seems very unfair.’

The team now hopes to produce as many rich-detail qualitative findings as possible over the next two years to inform frontline practice, she says, particularly around what could help facilitate change. ‘Obviously we shouldn’t be naïve and think we can fix everyone, because we can’t. But these young parents have got a lot of scope to grow up and change.’