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July 2014 |
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proceedings 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.’
As 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 home-
visiting, 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 recovery-
focused 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.’
‘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...’