Rebecca Brown Coventry LSCB presentation

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Rebecca Brown Coventry LSCB presentation Powered By Docstoc
					Infants Suffering or Likely to
 Suffer Significant Harm: a
  Prospective Longitudinal
            Rebecca Brown, Harriet Ward and David Westlake

    Centre for Child and Family Research, Loughborough University, UK.
• Longitudinal study tracing a sample of babies
  until their third birthday.
• All babies were identified as being at risk of
  significant harm before their first birthday.
• Trace the decisions that were made about their
  care and the impact these had on their
  subsequent experiences.
• Sample comprised 57 children whose parents
  agreed to take part in the study.
• 43 children were traced from birth (or pre-birth)
  until their third birthday.
• There were many difficulties in obtaining and
  maintaining the sample.
• Data were collected from information held on
  children’s social care case files for each child
  over the three years.
• Annual interviews about each child’s case were
  carried out with birth parents, carers (where
  relevant), social workers and social work team
• Additional generic interviews were completed
  with judges, magistrates, health visitors, local
  authority solicitors and local authority senior
• Only about 4% of eligible children were recruited
• All children in the sample were at risk of
  maltreatment and were significantly at a higher
  risk than the eligible population.
• Majority from families already known to
  children’s social care through involvement with
  older siblings
• 65% identified before birth; almost all before six
• Neglect was the most common form of
  maltreatment, often compounded with exposure
  to intimate partner violence
• Twenty mothers and an unknown number of
  fathers had already been permanently
  separated from at least one older child
• Risk factors included intimate partner violence,
  substance misuse issues, mental ill health,
  experiences of abuse in childhood, experienced
  the removal of older children, housing problems
  including homelessness, financial problems
  including bankruptcy, and learning disabilities.
Classifying families at risk of harm
• Based on systematic review of evidence
  concerning risk and protective factors and the
  likelihood of abuse or its reoccurrence (Hindley,
  Ramchandani and Jones, 2006)
• Each child classified according to the level of
  risk of maltreatment or its recurrence
• Classification used data at identification by
  children’s social care (Time One) and at age
  three (Time Two)
• Particular weight given to evidence of parents’
  capacity for change.
Classifying families at risk of harm
• Position at identification
   – Severe risk (12:28%): Risk factors, no protective
     factors and no capacity for change.
   – High risk (7:16%): Risk factors, protective factors and
     no capacity for change.
   – Medium risk (21:49%): Risk factors, protective
     factors, capacity for change.
   – Low risk (3:7%): No risk factors (or previous risk
     factors addressed, protective factors and capacity for
     change. Includes two outliers
           Position at age three
• By age three the children who were traced
  (n=43) could be classified into three groups of
  roughly similar size.
   – Low risk: Living at home, no ongoing concerns
   – Medium, high and severe risk: Living at home,
     ongoing concerns (12:28%)
   – Permanently separated from parents (15: 35%
     children): two unsatisfactory placements, others
     showing signs of strain
                At age three
• Over half (57%) displayed developmental
  problems or substantial behavioural difficulties
• At least four were so aggressive as to be a risk
  to other children
• Delayed speech was common
• Developmental/behavioural problems more
  evident amongst children who were maltreated,
  often while professionals waited fruitlessly for
  parents to change
         Delayed decisions
• Following core assessment 31 children
  remained at home and 12 were separated – 6
• Almost all initial decisions were temporary - on
  average it took fourteen months for a definitive
  decision resulting in a viable permanence plan
• Six more months for this to be completed
  (longer for adoption)
       Delayed decisions cont…
• 15 children were permanently separated by the
  age of three.
  – 6 were separated at birth
  – 9 experienced ‘double jeopardy’ and their wellbeing
        Why did it take so long?

• Focus on supporting birth parents and
  safeguarding family rather than individual
  children within it
   – Tensions between adult and children’s
   – Expert witnesses
   – Repeated parenting assessments
   – No specialist paediatric assessments
   – Inadequate feedback
Why did it take so long? Cont…
– Parents who had been looked after
  themselves as children received extensive
– Gaps in knowledge and understanding
– Involvement of extended family
– Social worker confidence low – impact of
  media attention following high profile cases
– Rule of optimism and faith in parents’
  capacity to change
    Factors indicative of parental
• However – just over a third of parents (16: 37%)
  did successfully overcome adversities to meet
  the needs of their children within appropriate
• What can we learn from these parents?
• What are the key differences between parents
  who overcame adversities and those who did
      Factors indicative of parental
• Parents who successfully changed were:
   – Less likely to have experienced abuse in childhood and
     substantially less likely to have experienced childhood sexual
   – More likely to overcome external than internal risk factors
   – Able to come to terms with the removal of older children
   – Able to acknowledge the risks posed by their destructive
     behaviour patterns
   – Able not simply to engage with services but also to make
     positive use of the support they offered
   – Able to develop supportive informal networks
The birth of a child as a catalyst for
• No parent overcame substance misuse if they continued
  to use drugs after the child had been born.

• All but one set of parents who made and sustained
  sufficient changes, had addressed all known risk factors
  by the time the child was six months old.

• A number of parents, including four of those who
  overcame substance misuse, spoke of a ‘wake-up call’
  that acted as a catalyst for change. No parents in the
  insufficient change group spoke of such an epiphany.
          Underlying issues
• Parental rights vs children’s rights

• Parental responsibility and its limitations

• Acceptable (and unacceptable ) parenting
  in a civilised society
 Parental responsibility: limitations
• The least intrusive interventions for the
  minimum duration
• c25% cases closed within a year; half of child
  protection plans were for 32 weeks or less
• No continued monitoring or referral to lower
  level services
• Enforcing parental responsibility could rebound
  on the child
• 42% of written agreements breached
   Acceptable and unacceptable
   parenting in a civilised society
• Nobody died
• BUT the sample included infants who:
  –   Were not fed for so long that they ceased to cry
  –   Could explain how to prepare heroin for consumption
  –   Were allowed to taste illicit drugs from a spoon
  –   Were left to forage for food in the waste bin
• Children’s development and long-term wellbeing
 References and contact details
Jones, D., Hindley, N. and Ramchandani, P. (2006) ‘Making plans:
   assessment, intervention and evaluating outcomes’ in Aldgate, J.,
   Jones, D. And Jeffery, C. (eds) The Developing World of the Child,
   London: Jessica Kingsley Publishers

Van den Dries, L., Juffer, F., van Jzendoorm, M. and Bakermans-
   Kranenburg, M.J. (2009) ‘Fostering security? A meta-analysis of
   attachment in adopted children’, Children and Youth Services Review,
   31 (3) 410-421
Happy to answer any questions…

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