10 Lessons from 10 years on the Frontline: 8, Some parents need long term support

By Richard Devine (09.09.2020)

Lesson 8: Some parents need long term support

Introduction: 

This is the most recent lesson I have learned. If I would have read this blog during the first few years of being a social worker, I would have dismissed the idea as fanciful, unrealistic, and probably proposed by someone disconnected from the realities of frontline child protection social work.  On reflection, I think this is a consequence of working in a child protection system under an era of austerity coupled with the proliferation of ‘evidenced-based’ courses. Each issue a family may experience could now be designated to a specialist service or ‘evidenced-based’ course. For example: 

Parenting issues = Parenting Course 

Parental Mental health = GP (to be medicated), 6 sessions of counselling and/or Mental Health Services

Parental Substance misuse = Drug and Alcohol Service 

Domestic Abuse = Female; Victim Course (i.e. Freedom Programme) / Male: Criminalized and/or Perpetrator programme  

Child issues = Parenting Course and/or CAHMS

Failure to engage in these services, irrespective of how useful or relevant they are, could lead to a negative judgment being made and an escalation in social care involvement (Devine, 2017). Sometimes escalation of social care involvement is necessary, however, sometimes it reflects an over-reliance on processes when it’s unclear how to help a family. Underlying this approach is the belief that each issue constitutes a separate entity that is situated within the individual and can be remedied by a specific piece of intervention. Perhaps in the same way a medical illness can be diagnosed and resolved, or at least the symptoms ameliorated by medication. However, there were some families that despite a wealth of these support services being provided change was not forthcoming. Being repeatedly faced with this dilemma, as well as an increased understanding of how severely children’s wellbeing is compromised by removal from their parent’s care, which was sometimes the only safe alternative, I began searching for different approaches.  

Researching what helps:

I was impressed by the findings from research into interventions being provided for women subject to recurrent care proceedings. The key finding, in terms of providing women support that would prevent their children being subject to recurrent care proceedings and removed, was the importance of the mother being provided a reliable, highly supportive, emotionally attuned, and practically helpful relationship (Roberts et al, 2018: Barnard 2017: Broadhurst et al 2017: Cox et al, 2017). Broadhurst et al (2017: 15) found from ‘a wealth of international literature that the following ingredients are critical in promoting change: (a) consistent relationship-based help, (b) informal support, and (c) learning from experience’. At the same time, I encountered the work of Hilary Cottam who in the process of her innovative work derived similar conclusions, detailed in her brilliant book Radical Help (2018). Synthesising these findings with Crittenden’s Dynamic Maturational Model led to a different approach being explored.

An (anonymised) case example:  

Background:   Sarah’s care of her children was extremely neglectful, primarily as a result of her poor mental health (low mood), substance misuse (long term cannabis use), and domestic abuse. Lengthy child protection plans and a range of services such as parenting courses, weekly family support, house cleans, mental health support group, and several grants to clear debt and buy furniture, yielded no lasting change.  The social work team had entered into pre-proceedings but were ‘stuck’.

Dynamic Maturational Model Adult Attachment Interview findings: Sarah’s low mood, substance misuse, and difficulty protecting her-self in intimate relationships were considered adaptations developed because of her own neglectful and abusive childhood. That is, as a result of pervasive neglect she learned to suppress and inhibit her negative feelings and assume a role reversing caregiving position with her mother. Having her feelings pervasively ignored and unacknowledged, left her feeling unimportant, worthless, and futile; in her own words ‘everyone lets you down in the end, come to rely on myself and I trust no one’. Therefore her low mood reflected her despondency about her ability to change her situation in the context of uniformly disappointing relationships; the cannabis use functioned to alleviate her from the distress associated with her past and cope with the social isolation; and her tendency to dismiss her feelings and prioritize others in adult intimate relationship left her vulnerable to abuse and manipulation by others. Furthermore, her own experiences had left her with limited knowledge and skills to co-ordinate a functional home with two young children. 

Functional Formulation: Sarah needed but did not want to access psychological therapy. Even if she did, there would be limited utility in addressing the way she thinks and feels for 90 minutes per week, when she then has to return to a home that she struggles to manage, with accruing debt, and the demands of two young children with few people to support her. That is, psychological therapy would potentially undo the self-protective strategy that helped her cope in the past, but which also helps her in her current environment. Unless she is supported to change her environment to which she adapted to, either before, or at least alongside the therapy, such an approach is ethically questionable.

With that said, she wanted to do the ‘right thing’ by her children and she expressed a desire, albeit a rather futile one, to improve her circumstances for her children. Therefore, acknowledging Sarah’s’ difficult history, isolation and inherent challenges of caring for 2 young children, it was assessed that Sarah could look after the children if someone looked after her. It was suggested a ‘transitional attachment figure’ (Crittenden, 2016) could help Sarah with practical and emotional help, but it would need to remain in place long term; Sarah’s challenges could not be quickly and easily remedied. Sarah’s engagement was excellent and with the support, she improved the cleanliness of her home, applied to charity’s and changed furniture, attended appointments, addressed her debt, and was able to build a relationship in which she could begin to talk about her past experiences and how she has learned to cope. The support was predominantly practical, however, the relationship provided Sarah with consistency, reliability, and empathy, and in this context, she was able to begin exploring her past and current functioning. As a result, the children lived in a more organized, tidier, and cleaner home and they experienced a mother who was slightly less depressed and more motivated.

The assessment concluded that Sarah could not safely care for the children, but with support, she could provide good enough care (perhaps like every parent!). That is, if the support was removed and/or Sarah declined to engage, then the level of care would probably constitute significant harm, and care proceedings and removal would almost be inevitable. Such an approach has been drawn from Crittenden’s (1992) Level of Family Functioning (Independent and Adequate: Vulnerable to Crisis: Restorable: Supportable: Inadequate). Crittenden (1992) defines a supportable family as: 

^{‘There are no rehabilitative services which can be expected to enable these families to become independent and adequate.  With specific ongoing services, the family can meet the basic physical, intellectual, emotional, and economic needs of their children.  Services, and management of those services, will be needed until all the children are grown’.}

Costs: 

The cost of the support package should be offset against any costs incurred should the support not be offered. It is important to note that despite lengthy child protection plans, a range of services such as parenting courses, weekly family support, house cleans, mental health support group, and several grants to clear debt and buy furniture, no lasting improvement was made. Therefore, offering the services typically available to family’s subject to child protection and pre-proceedings would unlikely yield any change because they had all been provided (and Sarah showed excellent engagement in them all) with little effect. Given that no one in her family could care for the children, foster care would have been a likely outcome in the event it was agreed that alternative care was required. Removal from biological parents incurs substantial risk – not only to the child (Crittenden and Farnfield, 2007) but also the parent, both psychologically and socially (Broadhurst and Mason, 2017).

The financial cost of removal and placement per child is estimated by Pause (2017) at £57,102 per year or £1,013 per week. Therefore, the cost of removing Sarah’s children and placing them into alternative care is £2026 per week for both children. 

The cost of 20 hours per week of practical and emotional support amounts to approximately £600 per week, which if offset against the alternative option, creates a saving of £1426 per week. If this plan is successful throughout the children’s life’s the savings will be greater. The total cost of them being placed into Local Authority care until adulthood is £1,470,876. The Total cost of 20 hours per week until the children are 18 is £482,400. The total saving is therefore £988,476. 

Conclusion: 

This is undoubtedly an unusual plan. Although it is in keeping with the literature on achieving effective change, it is contrary to the current child protection paradigm in which short term interventions targeting specific issues (i.e domestic abuse, mental health, substance use) are favoured. Featherstone et al (2018) argue persuasively that targeted support has contributed to the fragmentation of family support, and families are expected to attend a variety of different courses, in different places, with different agencies, within pre-determined timeframes. However, as highlighted in a report by the Early Intervention Foundation (2018, 28) ‘we need to recognize that supporting children and families with complex problems require a resource-intensive long term response’. 

This wouldn’t be feasible for every family. However, if the only other option is removal, or that is being given serious consideration, then I think we have a moral and ethical duty to explore it. Another finding from the recurrent care proceedings literature that I think is noteworthy is that there is a reduction in risk of returning to court as a respondent in care proceedings as the mother aged, evident in the reduction for women over 25 which then reduced again after aged 30 (Broadhurst et al 2017). Broadhurst’s et al (2017) qualitative research with women revealed that women had learned with experience and maturity as well as gained insight into patterns of behaviour that were unhelpful.  In its simplest terms, the older the mother, the less likely she was to have her child removed from her care.  This finding reflects my practice experience. Some, if not most parents mature out of their difficulties. Therefore, it may be that long term support need not be ‘long term’ rather for a period of time during early adulthood whereby a parent may need access to a ‘transitional attachment figure’ until such a time that maturation has allowed for the concerning aspect of their functioning to be less pronounced. 

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Bibliography : 

Barnard, A (2016). ‘Project’: Experiences of a support service for parents who have had children removed from their care. A dissertation submitted to the University of Bristol in accordance with the requirements of the degree of MSc in Social Work in the Faculty of Law and Social Sciences.

Broadhurst, K. & Mason, C. (2017). Birth Parents and the Collateral Consequences of Court Ordered Child Removal: Towards a Comprehensive Framework. International Journal of Law, Policy and The Family. 31. Pp: 41-59)

Broadhurst, K., Mason, C., Bedstone,S., Alrouh,B., Morris, L., McQuarrie, T., Palmer, M., Shaw,M., Harwin,J and Kershaw,S. (2017) Vulnerable Birth Mothers and Recurrent Care Proceedings: Final Summary Report. Centre for Child and Family Justice Research

Cox, P (2012). Marginalized mothers, reproductive anatomy and repeat losses to care. Journal of Law and Society. 39.4. Pp. 541-561

Cox, P., Barratt, C., Blumenfeld, F., Rahemtulla, Z., Taggart, D & Turton, J (2017). Reducing recurrent care proceedings: initial evidence from new interventions. Journal of Social Welfare and Family Law. 39:3. Pp:332-349

Cottam, H (2018). Radical Help. How we can remake the relationships between us and revolutionise the welfare state. Great Britain. Virago Press.

Crittenden, P.M. (1992). The social ecology of treatment: Case study of a service system for maltreated children. American Journal of Orthopsychiatry, 62, 22-34.

Crittenden, P. M., & Farnfield, S. (2007). Fostering families: An integrative approach involving the biological and foster family systems. In R. E. Lee & J. B. Whiting (Eds.) Handbook of Relational Therapy for Foster Children and their Families. (pp. 227-250). Washington, D.C.: Child Welfare League of America.

Crittenden, P.M. (2016) Raising Parents: Attachment, Representation and Treatment,(2^nd ed.) Abingdon, Oxon: Routledge

Crownem S., Gonslaves, K., Burrell, L., McFarlane, E., and Duggan, A. (2012) Relationship between birth spacing, child maltreatment, and child behaviour and development outcomes among at risk families. Maternal and child health journal. Vol.16 No.7. Pp. 1413-1420

Early Intervention Foundation (2018). Realising the Potential for Early Intervention. Available at:https://www.eif.org.uk/files/pdf/realising-the-potential-of-early-intervention.pdf (accessed 05th November 2018)

Featherstone, B., Gupta, W., Morris, K & White, S. (2018). Protecting children: A social model. Bristol: Policy Press.

McCracken, K., Priest, S., FitzSimons, A., Bracewell, K., Torcia, K., Parry, W. & StanleY, N. (2017) Evaluation of Pause: Research Report. Department of Education 

Pause (2015b) Pause. Creating space for change, national launch conference briefing. London. Pause 

By Richard Devine (09.09.2020)