Women and children first

With women hard-hit by spending cuts and often invisible in treatment services, DDN reports from a Brighton Oasis Project conference which looked at how women and children could be supported through the austerity agenda.

‘It’s vital to put women’s perspective into the picture,’ Caroline Lucas MP told delegates at the Brighton Oasis Project’s The road to recovery for women and children conference. The government’s austerity measures and cuts to local authority services were hitting women hardest, she said. ‘We’re in the midst of a record 25-year high in women’s unemployment – women are paying a much higher price for the austerity agenda than men.’

When substance use was added to the mix the odds were even more stacked against women, she continued, further exacerbated by the tendency of payment by results to encourage a ‘bulk-buying’ approach. Despite around a quarter of service users being women, services were not designed for them nor did they get a mention in the 2010 drug strategy.

‘The irony is, if you’re just looking to reduce costs it’s the preventative, early intervention stuff that gets results, yet that’s exactly what’s being cut,’ she said. There was also a ‘profound moral’ argument to help people with substance issues, and women’s substance problems were often more complex than men’s, with issues of childcare, domestic violence, stigmatisation, prostitution and more. While parenthood could act as a barrier to treatment for some women it could be a strong motivation to engage with services for others, underling the importance of a ‘truly flexible, partnership-based’ approach, she said.

Working in partnership

One example of partnership working was the Community of Practitioners (CAP) model – groups of professionals with shared concerns or passions, Michelle Cornes of King’s College told delegates. It was vital to work towards longer-term care, she stressed, and her organisation’s Community of Practice Development Programme had set out to determine if CAP could help the move from ‘sequential handovers’ to more meaningful collaboration, as well as support workers in ‘what is an emotionally pressured and stressful job’.

Shared leadership, agreed work priorities and frequent communication were all vital, she said. ‘But at a time of austerity, collaboration is what tends to fall off the agenda. Joint working doesn’t happen on its own – you need to really work at it.’ In the development programme, efforts to get criminal justice, drug and alcohol, mental health, housing and social workers – along with employment and training advisors – around the same table had been ‘really hard’, she said. ‘One group didn’t get beyond meeting three.’ 

Nonetheless, the final feedback had been overwhelmingly positive, with ‘genuine integration’ – often despite, rather than because of, management. ‘What emerged were unofficial, “secret caseloads”, as workers were wary of telling their managers that they’d strayed off their patch,’ she said.

‘One question we asked was “is this just a talking shop – are we wasting our time?” The answer was overwhelmingly “no”. It genuinely kept people engaged and motivated.’ It was vital to be realistic about outcomes, however. ‘It’s about having a system that’s balanced. Maintenance and prevention outcomes linked to resilience and continuous practice over the longer term should be valued just as much as recovery outcomes.’

Inevitable risk

Mary Lagaay, a postgraduate at the London School of Economics and Political Science, described the findings of another research project into long-term support, in this case the experiences of mothers after completing the intensive, 16-week POCAR (Parenting Our Children, Assessing Risk) intervention for maternal substance misuse.

Around 40 per cent of mothers with children in long-term foster care had them returned after the programme, but anxieties about having children removed by social workers had made initial relationships with professionals tense, she said, with feelings of being ‘coerced’ even if women later said they’d ‘wanted to attend all along’. Relationships with social workers tended to remain adversarial, she pointed out, despite an acceptance of why they’d had to intervene, while the women were acutely sensitive to stigma and would try to promote themselves as good mothers even if they later acknowledged the damage they’d caused their children.

Maintaining structure in their lives was seen as a key element of long-term recovery, along with continued strategies around relapse prevention and parenting. However, self-confidence and self-esteem remained barriers to full reintegration, and the research endorsed the need for women-only services and awareness of the ‘complex blend of social, cultural, community and material resources’ that could support or hinder the recovery process. 

One of the most important lessons when it came to safeguarding children when there was problematic substance use in the family was that risk was inevitable, independent social worker Gretchen Precey told delegates. ‘It goes with the territory of child protection. People behave in idiosyncratic and unpredictable ways – we can learn how to improve our practice to manage risk, but we aren’t going to eliminate it.’

A stark illustration of this was a serious case review she’d carried out, the harrowing story of ‘T’. T was a three-year-old girl, the fourth child of ‘entrenched substance users’, who’d died of a drug overdose in 2006, she said.

The case had been closed in 2005 but reopened later the same year after an incident of ‘serious domestic violence’. A shoplifting expedition that ended in a police car chase – with the child ‘bouncing around in the back seat’ – then led to T being taken into police protection and placed in foster care for five days, with the foster mother raising further concerns about the little girl’s welfare. ‘Those five days were the missed opportunity,’ Precey told the conference.

The girl was returned to the care of her mother but ‘things began to deteriorate again’ and she was placed on the child protection register. ‘A legal planning meeting was called in October 2006 as a result of escalating concerns about her care, parental domestic violence and substance misuse, and the decision was made not to take her into care and apply instead for an intensive support package,’ she said. ‘Five days later she was dead.’

One key lesson was to be wary of the ‘start again syndrome – the desire to see every pregnancy or birth as a fresh start’, she stated. This was something workers understandably used as a defence against ‘overwhelming information and feelings of hopelessness’, she said. ‘It’s obviously important not to be fatalistic, but it’s also important to recognise what’s happened in the past – there are judgement calls to be made. Sometimes women are dragging along this rock and feeling that they’re never going to be let off the hook, but we can’t ignore history either.’

There was a growing evidence base that short-term, behavioural approaches were not likely to succeed with families with long-standing, complex problems, she told the conference. ‘One of the other siblings in this case had a head injury at one day old. But the mother told workers that she was “ready to be a mother” this time.’

Preoccupation with eligibility criteria rather than ‘a primary concern for the child or the family’ was also a risk, she warned, and information sharing was often woefully lacking. ‘It’s one thing for information to be accumulated, but having it and knowing what to do with it are very different things.’ Communication problems were common, whether the result of incompatible IT systems or ‘a lack of confidence’ in challenging other agencies around their information. ‘Practitioners need to be encouraged to think critically and systematically about the information they have.’ 

Being constantly faced with neglect could be ‘debilitating’, she acknowledged. ‘Professionals can be overwhelmed by having too many problems to face and too much to achieve. But the risk is that the child becomes invisible.’ In the case of T, ‘nobody ever really knew that child, apart from that foster mother in those five days’. 

Parental problem drug or alcohol use figured in a quarter of child protection register cases, with the children themselves describing ‘uncertainty and chaos, disrupted education, fears of censure and separation and having to become carers themselves’, she said. ‘And children don’t open up easily about these things – there’s a lot of loyalty, as well as shame and fears of being taken into care.’ Drug use could not be tackled in isolation from women’s other needs, she stated. ‘We need to be women-centred and needs-led, with a motivational, harm minimisation, solution-focused approach. And there needs to be trust.’

The stigma associated with substance-using mothers was immense, she stated. ‘Clients feel ashamed, and that’s a shame that doesn’t go away. A man who’s had a drug problem can often pass it off as a bit of a wild past and move on. But it’s a bit more difficult to move on from being a woman who’s had her child taken away – what “cultural capital” do you have then?’ All of this underlined how vital it was to continue thinking about service provision in the context of women, she stressed, as well as to ‘challenge and support’.

‘It’s easy for frontline workers to feel powerless. But we need to keep challenging ourselves and the people responsible for policy. It’s hard, when you’re doing a full-time job, to make the effort to study the evidence and look at new ideas. But I hope people do keep thinking about new developments and what they need to do differently, rather than just what to do with the client in front of them.’

 The DDN/Adfam Families First conference, for families and all those who support them, takes place in Birmingham on 21 November. For further details, and to book, please visit this link: drinkanddrugsnews.com/families-first-conference-2013/