Breaking the cycle of recurrent pregnancies and care proceedings.

The Problem – we are failing the women who repeatedly have children taken into care.

A multi-disciplinary meeting was held at Bristol Civil Justice Centre on 9th July inviting discussion of just two agenda items:

• Address the necessity for the provision of early therapeutic intervention in cases of LA involvement with vulnerable mothers
• Establish a PAUSE project in Bristol Area.

PAUSE is an innovative, dynamic and creative approach designed to address the needs of women who have had multiple children removed from their care. It offers an intense programme of therapeutic, practical and behavioural support through an integrated model to help break this destructive cycle.

See also the research from Dr Karen Broadhurst of Manchester University, funded by the Nuffield Foundation, which looks at the scale of the problem of mothers involved in recurrent care proceedings. 

HHJ Wildblood QC opened the meeting. He was clear that we were not here to either boast about successful projects currently in operation, nor to indulge in handwringing or other doom laden narratives. We were here to discuss the two agenda items and to seek solutions.

The meeting had been galvanised by the case over which he presided and in which Judi Evans had represented the mother. This was reported by Louise Tickle in the Guardian – Are we failing parents whose children are taken into care?

Agenda item 1: Why is early intervention so important?

The tragic circumstances of this case highlighted the need for focused and early intervention. This mother had a very difficult childhood and suffered considerable abuse and trauma. She was not assessed until some 11 months after the referral was first made; the assessment began when she was 8 months pregnant. The Judge considered this timetable ‘an absolute disgrace’. If this mother could have benefited from therapeutic intervention it needed to be obtained at an early stage.

It was much cheaper to provide therapy over 20 weeks than to run care proceedings. If it is to be said that people can’t change, then what is the point of a court process or psychological evidence at all?

 

Agenda item 2: We want to set up a PAUSE style project in Bristol

HHJ Wildblood QC stressed this was not a question of setting up a competing version of their project. The PAUSE project has been tested and validated and is supported by the Department of Education. We are looking to put into effect a Pause model here. Its happening in other areas and we need to keep up. We are driving this forward and anticipate that we will be supported with funding – something can be done.

Judi Evans then introduced the proposed ‘Feasibility Study’. Woman who suffer recurrent removal of their children have usually suffered trauma in their childhoods. Absent therapeutic intervention, change is very rare. Some can be helped. Loss of their child can be a powerful catalyst to enable parents to engage in therapeutic intervention. Some however have complex difficulties and won’t realistically benefit.

We need to identify best practice intervention and identify cohort of parents who could benefit. Primary outcomes of the study will be measure in terms of engagement with intervention, measure of response and assessment of parenting. Then independent follow up at 6 and 12 months. Measure secondary outcomes such as improvement in pre-birth planning by LA and reduction of psychological assessments in PLO process and issue of proceedings.

Pragmatic Matched Case Control – 20 women will receive therapy, 20 will not. Practical considerations need to be addressed. Counsellors appointed and room available, travel costs for parents and funding of research assistant.

Inclusion criteria – parents will have undergone psychiatric assessment which will identify past childhood experiences, how they were parented, history of trauma and maladaptive coping strategies developed as a result. There will follow recommendations for psychological intervention and timescales for improvement.

Matching criteria to match intervention and control groups. Exclusion – those with long term serious mental health illness; personality disorders; persistant substance misuse; evident absence of insight or other poor indicators.

Dr Freda Gardner explained that personality disorders were a complex diagnosis and indicated severe problems which are often ill defined. It is hoped that at some stage those with PD can also be helped but they will have to be excluded from the initial feasibility study or there was a risk their inclusion would simply skew the statistics.

What is proposed for intervention?  First, an initial assessment of level of insight. What changes and development are possible, What capacity does the parent have to engage. Then followed by a brief intervention treatment plan for 20 sessions in PLO process or earlier over 4-5 months. Data collected after birth and at 6 months which will be analysed using appropriate narrative and statistical analysis.

 

The One25 Charity in Bristol

GP Annie Egginton spoke on behalf of the one25 charity who had been galvanised by Louise Tickle’s article. The group had been inspired by reading about PAUSE and visited them in Hackney.  Statistics gathered in Bristol, although limited, support the positive outcomes of the Hackney PAUSE project and indicate substantial savings can be made by avoiding care proceedings.

Hackney PAUSE pilot outcomes were good. They helped 20 women over one year – none conceived. The majority stabilised from previous chaotic lifestyles. £20 million was the estimated potential cost of 246 children being taken into care, savings of £10m were possible.

one25 could host a pilot project in Bristol if funding was in place. Estimated costs of project,  £169,520 to support 20 women a for 2 years as compared with cost of court proceedings at approximtely £1,776,000. Pilot has been proven to give results and is clearly cheaper than court, but it was recognised that commissioning services was difficult as funding came from a variety of different agencies.

The biggest problem for example is housing – the majority of people did not have stable accommodation. PAUSE in Hackney got together with local Housing Departments to deal with arrears. This is one of things we really need to address.

 

Statutory and voluntary agencies need to work together – and we need funding

Jo Morrell from Kids Company agreed this was an exciting invitation for statutory and voluntary agencies working together. The challenge – how do we offer therapy that is meaningful and accessible to vulnerable people.

HHJ Wildblood QC confirmed that we must build bridges between statutory and voluntary agencies. But we need to be organised and we need to be funded. Who will fund us – he is approaching various local charities. All suggestions were welcome – without funding,  we are back to square one. Costs are not just an issue for LAs but cover a wide range of agencies.

Those attending the meeting were invited to express an interest in becoming part of further discussions, primarily to identify and approach suitable sources of funding. There is an urgent need to make both these projects a reality.