Care Proceedings Research Articles

Effective components of services for recurrent care experienced parents: A literature review of what works

Recurrent care services aim to reduce the number of repeat removals amongst birth parents who have already ‘lost’ a child through care proceedings. This literature review aimed to identify published evidence about effective components of services to support parents who have experienced repeat removals of their children to care.Searches identified 19 studies that included content relating to the components of service provision within recurrent care services. Across all studies, a range of perspectives were included: birth parents (n = 425); practitioners (n ≥ 151); other professionals (n = 109).The evidence reviewed indicates the importance of relationship-based practice, building a trusted relationship between parents and practitioners, continuity and tenacity in engaging with mothers and a non-judgemental approach. Services should be flexible, holistic and client led, with a long duration of support and a flexible end date. Services should: have a trauma-informed approach; recognise unresolved loss, complex grief and trauma experienced by mothers who have ‘lost’ their children through care proceedings; and provide emotional support, therapeutic support, practical support and advocacy. Services need to have a skilled and multi-disciplinary workforce with robust supervision and ongoing training.

Variation in 10 year birth trajectories of mothers involved in family court care proceedings and their peers in England.

ObjectiveFamily court (FC) care proceedings decide on removing children from parental care in response to concerns about risks of harm. Courts and social care report frequent births, often after short birth intervals as a key problem among mothers presenting to FCs. ApproachWe used a cohort of mothers with a first live birth (FLB) between 2007 and 2019 to estimate the cumulative incidence of FC within 10 years and compare birth trajectories with peers. Results3,118,327 women (15-50 years) had a FLB, of whom 34,062 had FC involvement. Cumulative incidence of FC within 10 years from FLB was 1.3% (95% Confidence Interval [CI]; 1.3-1.3) overall but highest in mothers who were younger (6.7% if <20 years), more deprived (2.5% in most deprived areas) and with morbidity (22.7% with learning or multiple disability, 12.8% with adversity-related injuries or 5.7% with mental health admissions). If followed for 10 years from FLB, 58.4% (8,889/15,229) of women with FC involvement had ≤2 deliveries, compared to 82.2% otherwise (1,007,365/1,225,163). If <25years at FLB, women involved in FC had more deliveries than their peers (3+ deliveries: 47.8%, 5,853/12,255 vs 29.5%, 123,092/416,904), however, if 25+, they had fewer deliveries if involved in FC (1 delivery: 49.6% 1,475/2,974 vs 39.2% 316,976/808,259). Conclusions and ImplicationsAt-risk mothers may benefit from early, targeted health and social care interventions to prevent FC involvement. Birth data highlights variation in birth trajectories and dispels the stereotype of women involved in FCs having many children, particularly if older at FLB.

Increased mortality among mothers involved in family court care proceedings compared with their peers in England

ObjectiveResearch has called for Family Courts (FC) and social care services involved in removing children from parental care to consider and address the health of the mother. ApproachWe linked England FC and healthcare data to compare the 10-year mortality risk and cause of death after a first live birth (FLB) for mothers who were involved or not in FC proceedings in England. Results3,072,946 mothers (15-39 years) with a FLB between 2007 and 2019 were followed for up to 10 years (median:8.7 years, IQR: 5.4-10), during which 33,759 were involved in FC. Ten-year cumulative mortality was higher among the FC mothers (1.7 vs 0.3%) and the age-adjusted mortality rate ratio was 7.8 (95%CI: 7.00-8.6). The majority of maternal deaths in both groups met criteria for avoidable death (FC 82.9% vs no-FC 66.8%). Injury was the leading cause of death (204/420; 48.5%) in mothers involved in FCs and cancer (2,823/6,208; 45.5%) in mothers in the no-FC group. Compared with no-FC mothers, more deaths were related to drug use (35.0% vs 6.0%), suicide (14.5% vs 8.4%) or alcohol (9.8% vs 3.5%). Among mothers involved in FCs, maternal mortality was higher in cases when children were placed into out-of-home care (1.65%, 463/28143), than when placed at home (0.94%, 53/5563) at first FC proceeding. Conclusions and ImplicationsAddressing high rates of avoidable mortality among mothers involved in FCs is important for children and parents and could be monitored using routinely linked healthcare, social care and family court data.

FAMILY COURTS AND CARE PROCEEDINGS

The family court deals with some of the most sensitive cases involving vulnerable families, overseeing care proceedings, ensuring parents receive support and that decisions taken are in the best interests of children

Linkage of administrative family court care proceedings and hospital records for mothers in England: linkage accuracy and cumulative incidence of family court care proceedings after a first live birth

IntroductionLinkage of public law family court care proceedings (CP) data to all women giving birth in NHS hospitals in England allows calculation of the cumulative incidence of CP involvement for mothers with first children born. ObjectivesTo assess linkage accuracy and determine the 10-year cumulative incidence of CP after a first live birth (FLB) for population subgroups. MethodNHS England linked records for mothers in Cafcass (Children and Family Court Advisory and Support Service) involved in CP (2007-2021) to all mothers with a delivery in England using Hospital Episode Statistics (HES: 1997-21). We calculated match rates and assessed indirect evidence of potential false positive and missed links. We used survival analyses to estimate cumulative incidence of CP within 10 years overall and for five-year maternal age groups at first live birth. ResultsOf 120,937 mothers involved in CP, 6.6% (n = 8,010) were excluded due to missing postcode or date of birth, or age < 15 or > 50. Of the remaining 112,927 mothers, 92,891 (82.8%) were linked to a HES delivery record. Match rates were lowest for mothers with an ethnic minority background, older at first case, or residing in Greater London, but improved over time. Of 3,572,737 mothers with a FLB, 38,462 had CP involvement. The cumulative incidence of CP at 10 years from FLB was 1.31% (95% Confidence Interval [CI]; 1.29-1.32) overall and highest in mothers aged 15--19 years (6.79%, 95% CI: 6.69-6.89) and those living in the most deprived areas (2.47%, 95% CI: 2.43-2.51). ConclusionOne in 77 of all mothers and one in 15 aged less than 20 at first live birth were involved in CP within 10 years. Linkage error may underestimate the incidence of CP for mothers in London or with an ethnic minority background.

Health service use of infants involved in family justice care and supervision proceedings in Wales: a data linkage study

IntroductionWhen a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989). ObjectivesWe compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),to that of a comparison group of infants not subject to s.31 proceedings (n = 204,417), between January 2011 and February 2020. MethodsPopulation-based e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. Infants in s.31 proceedings were identified using the Children and Family Court Advisory and Support Service dataset. This was linked to demographic and healthcare datasets, to identify General Practice (GP) visits, emergency department (ED) attendances, and hospital admissions (emergency and elective); before the study end date or the child's first birthday for the comparison group, orbefore the s.31 application date.Regression analysis calculated event rate ratios [RR] and incidence rate ratios [IRR] for healthcare events, adjusting for widerdeterminants of health (e.g. perinatal factors, maternal mental health, deprivation), and investigated reasons for healthcare use. ResultsInfants in s.31 proceedings had ahigher number and incidence of healthcare events compared with the comparison group, across all healthcare settings. Differences were greatest for emergency hospital admissions (IRR = 4.03, 95% confidence interval [CI] = 3.53 - 4.59; RR = 4.60, CI = 3.90 - 5.41). "Injury and poisoning" was the main reason for emergency admissions amongst infants in s.31 proceedings. For ED presentations, emergency hospital admissions, and GP visits, there were proportionally more events for these infants across all top ten reasons for healthcare. ConclusionsFindings highlight greater healthcare utilisation for infants involved in s.31 proceedings in Wales, helping to build a better understanding of their needs and vulnerabilities.

Impact of Family Group Conference Referrals at Pre-Proceedings Stage on Child Outcomes: A Randomised Controlled Trial

Abstract Previous evidence on the impact of Family Group Conferencing in the UK cannot establish causality. This article presents results from the first UK randomised controlled trial of Family Group Conferences. All families entering pre-proceedings between September 2020 and May 2022 in twenty-one local authorities in England were eligible for inclusion in the trial. In total, 1,511 families were randomised and child outcomes were collected from administrative data until up to twenty-one months post-referral. Half of the families were randomly allocated to be referred for a Family Group Conference, on top of usual practice during pre-proceedings. The (pre-registered) primary outcome is the child’s looked-after status twelve months after the pre-proceedings letter. This was 8.6 percentage points lower among referred families (36.2 percent vs 44.8 percent). Children were also less likely to have care proceedings issued (59.2 percent vs 71.7 percent) and spent less time in care (87 vs. 115 days). However, there was no significant difference in whether a child’s living arrangement remained the same or changed in the months after the decision. These findings have implications for the support given to families during pre-proceedings; they provide evidence in favour of Family Group Conferences as a way to reduce the chances of children going into care.

Working toward reunification in New South Wales: Professional perspectives on navigating complex systems

AbstractAchieving timely “permanency” for children after statutory child removal has become a key policy driver internationally. In New South Wales, child protection reforms include prioritising reunification; introducing time frames for resolution of legal proceedings; and outsourcing a substantial proportion of casework to the non‐government sector. In assessing the viability of reunification, courts place responsibility for behaviour change on parents and obscure the role of systems in supporting these changes. Professionals, as actors within a complex system, have an insider perspective on factors that influence reunification. A qualitative study was undertaken to elicit the perspectives of professionals working with parents involved in care proceedings. A total of 29 caseworkers and lawyers took part in focus groups. Complexity theory was used as an interpretive framework, and thematic analysis was completed. Themes about barriers to reunification exposed the unintended consequences of change in a complex adaptive system. Far from making reunification more achievable by streamlining the legal process, changes introduced impediments in the form of role, goal and process confusion and low levels of professional confidence in their capacity to help parents and achieve predictable legal outcomes. These results strengthen calls for a different approachto confront system‐induced barriers. Embedding interagency collaboration, challenging risk narratives about parents and offering them dedicated services are areas that demand urgent attention in order to ensure no child, whose safety and best interests could be met by reunification, remains in care.

Child protection proceedings for infants: Analysis of court files to identify court outcomes and requirements for families in child protection safety plans

Given the increasing involvement of families in child protection processes pre-birth and during infancy, it is imperative that we have greater evidence of child protection processes during this period. A court file review was used to determine the characteristics and issues for families who are going through care proceedings for their infants, the outcomes of court proceedings and the safety plans required for families. Of the 39 court files analysed 36 % of the families were reported to child protection prenatally and 64 % were reported postnatally. One in five infants were removed into care directly from the maternity ward with the average age of removal being 4.9 months. The main child protection concerns related to domestic violence (51 %), drug and alcohol use (49 %) and mental health issues (41 %). The majority of these cases resulted in final orders with a large proportion having until 18 protection orders (41 %), and 23 % having orders revoked or withdrawn allowing the infant to be reunified to the family. The complexity of issues of the cases in these care proceedings highlights the need for greater sophistication in strategies to support these families who cross multiple service systems to enable reunification of families and prevention of removals.

Cafcass sets out plan to address delays in family court system

The boss of the children's guardians body wants to work collaboratively with local authorities to reduce the length of care proceedings and strengthen social work practice as it launches its refreshed strategic plan

Quicker care proceedings can give children certainty

Quicker care proceedings can give children certainty

Maintenance of dental records and awareness of forensic odontology among pakistani dentists: a mixed-method study with implications for dental data repository

ObjectiveDental records and forensic odontology play an important role in both healthcare and the legal system, aiding in personalized patient care, human identification, and legal proceedings. This study aims to investigate dental record-keeping practices and assess the awareness of forensic odontology among Pakistani dentists over 12 months. This study aims to collect data from 500 dentists, identify areas for enhancement, and develop a strategic action plan to improve record-keeping quality and forensic odontology application, culminating in a comprehensive dental data repository to support legal and criminal investigations in Pakistan.MethodologyThis study employed a mixed-method approach conducted at Hamdard Dental College from January to March 2023. The quantitative phase involved distributing questionnaires to 463 dentists, chosen through stratified random sampling. Out of these, 413 responded, yielding an 86% response rate. These questionnaires focused on dental record-keeping practices and dentists’ awareness of forensic odontology. Subsequently, based on the questionnaire results, face-to-face interviews were conducted with 20 purposively selected dentists to gain deeper insight into the challenges and potential solutions. Data from both phases were integrated and analyzed accordingly.ResultsThe study included 413 participants, mainly females (79%), with ages ranging from 27 to 65 years and an average age of 46.4 years. Most dentists had 5–20 years of work experience (53%), and most (87.4%) were practicing in private clinical settings. All the dentists generated medical and dental records, but the duration of their record-keeping varied, with some maintaining them for up to a year and others for two years or longer. Five themes were generated from the qualitative content analysis. These themes were dentists’ perceptions, barriers and challenges, knowledge and awareness, and improvement strategies.ConclusionOur study revealed that local practitioners in Pakistan exhibit subpar practices in dental record-keeping and maintenance of patient history, irrespective of whether they use a digital or traditional file-based system. Even though dentists are cognizant of the importance of record-keeping, they do not actively maintain comprehensive records. This suggests the need for improved training and system improvements to address the gaps in record-keeping practices.

Working with women affected by children’s social care involvement in pregnancy and early motherhood: Insights from recent Birth Companions work

Children’s social care (CSC) involvement during pregnancy and the first two years of a child’s life – the period known as the ‘1001 critical days’ – can have a significant impact on the mental health and wellbeing of both mothers and infants. By putting bonding and attachment between mothers and their babies at risk, this can pose long-term implications for children’s emotional and psychological development.Drawing on findings from Birth Companions’ recent projects with women with lived experience of CSC involvement, this article offers insight into the mental health impacts of assessment and/or care proceedings during the first 1001 days.The article also outlines key principles for all those working with women in these circumstances, published in the form of theBirth Companions Birth Charter for women with involvement from children’s social care(2023c). This aims to embed improved practice across all systems and services working with women with CSC involvement.Key recommendations focus on the significance of trauma-informed care for women, and the centralisation of pregnancy and early motherhood in multi-agency practice. Birth Companions is calling for this to be driven forward in the form of a joint national health and social care pathway for pregnant women and mothers of infants who are subject to pre-birth or parenting assessment, or child protection proceedings, to guide the care and support they receive up to their child’s second birthday.

Risk factors for involvement in care proceedings for mothers receiving treatment for substance use: A cohort study using linked and administrative data in South London

BackgroundMaternal substance use is considered a significant risk for child maltreatment and neglect, and thus, a common feature in care proceedings (Family Courts). It is important to better understand how the complex needs of these mothers impact on care proceedings’ outcomes. The present study explored individual and clinical characteristics of mothers receiving treatment for substance use to describe who the mothers involved in care proceedings are, and explore what factors are associated with out-of-home placement of their children. MethodsData were extracted from electronic health records (EHRs) of 1587 mothers of dependent children (age < 18 years old) who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2007 and 2019. Clinical service records of 480 mothers (30 %) were linked to family court records. ResultsThe number of care proceeding cases decreased during the study period. Most mothers involved in care proceedings (79 %) were known to SLaM before care proceedings began. Compared to mothers who were not involved in care proceedings, mothers who were involved, were more likely to be younger, from a non-white background, to be socially deprived, to experience housing problems, to be pregnant, to have a longer duration of treatment for substance use, to use opioids and/or crack-cocaine and to report lifetime domestic violence victimisation, be at risk of suicide, and report poorer quality of life and psychological health. The median length of care proceeding cases was 37 weeks. Eighty-two percent of mothers had care for their child terminated by the court. Mothers’ younger age, housing problems, use of opiate and/or cocaine/crack-cocaine and poorer quality of life increased the odds of out-of-home placement of the children. The participation of the child’s father in the proceedings was a protective factor for maintaining care of the child for those mothers that were receiving substance use treatment at the time of the proceedings. Attending treatment for substance use during the proceedings was not associated with the child placement outcome. ConclusionFindings highlight that current substance use treatment services are not designed to support mothers retain the care of their children. Understanding and addressing the range of needs of these mothers has implications for both substance use treatment and child welfare.

The adoption paradox: Exploring the role of ethnicity, deprivation, and co-ethnic density in care proceedings in England

The study objectives were to (1) examine the association between children’s ethnicity and final legal orders at the end of family care proceedings (section 31 of the 1989 Children Act), and (2) test whether residential context, such as co-ethnic density and area-level deprivation, moderates this association.&#x0D; Two sources of data were used for this study. The first consisted of records routinely generated by Cafcass (England) and stored in the Secure Anonymised Information Linkage (SAIL) databank, and the second was the 2021 England Census. The focus was on children whose initial care proceedings took place between 2015/2016 and 2020/2021 and concluded with a recorded final legal order outcome (N = 98,161). Three-level logistic regression models were employed to estimate the relationship between children's ethnicity and adoption, along with the potential moderating effects of co-ethnic density and area-level deprivation.&#x0D; Children's ethnicity is significantly associated with placement for adoption, with white children being more likely to be subject to placement orders compared to children from all other ethnic groups combined (Asian, black, mixed or multiple, and other ethnic groups). Higher local authority co-ethnic density considerably reduces the likelihood of adoption for children of other ethnicities besides white, but not for white children. Moreover, white children living in the most deprived LSOAs are more likely to be placed for adoption than those residing in the least deprived LSOAs. However, the likelihood of placement for adoption remains consistent across all LSOA deprivation quintiles for children from ethnicities other than white. Local authority-level deprivation does not appear to moderate the relationship between children's ethnicity and adoption.&#x0D; This study sheds light on the intricate relationship between ethnicity, residential context, and adoption. While previous research has indicated that white children are more likely to be adopted, the findings enhance our understanding of the underlying mechanisms influencing adoption, paving the way for a more equitable family justice system.

Keeping children within the family: Changing patterns in the use of special guardianship orders

Special Guardianship Orders (SGOs) provide family courts with an alternative to adoption, typically through permanent placement within the extended family. Using court administrative data, this study charts the use of SGOs as a way of promoting stability and recovery for these vulnerable children who cannot remain safely with their parents.&#x0D; The study cohort is based on administrative population data produced routinely by Cafcass and accessed via the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University. The unit of analysis is children subject to s.31 care and supervision proceedings in England between 2007/08 and 2021/22, providing a retrospective observational window of fifteen years. Descriptive statistics were used to compare SGOs to other permanency final legal orders (placement, child arrangements, supervision and no order), and survival modelling was employed to look at stability over time and return to court. Finally, regional and over time variations in the data were examined.&#x0D; The percentage of children placed on a SGO as a proportion of all children subject to s.31 proceedings rose from 12% to 18% between 2011/12 and 2021/22. Over the same period the percentage of children with a placement order that frees the way for adoption fell from 24% to 14%. This shift in pattern was more pronounced than for any other legal order we examined for children unable to remain with birth parents. The highest usage per region was in the North East and London and the lowest was in the Midlands. We estimate that 9% of children on SGOs would return to court within 10 years. Older children (5-17 years old) were more likely to return to court after SGOs than younger children.&#x0D; The study showed that SGOs have become a main route out of public care, outstripping the use of placement orders. These findings have major implications for policy and practice. They demonstrate that special guardianship provides a stable and sustainable permanency option for children unable to remain with their birth parents.

Protect women in pre-birth care proceedings

Protect women in pre-birth care proceedings

Mental health and ACEs for adults in child protection and care proceedings: Audit of psychology service in Southeast England

Limited research has been conducted about the prevalence and impact of Adverse Childhood Experiences (ACEs) and mental health difficulties on those with children’s services involvement in the UK. Audit data were taken from 111 cognitive and psychological assessment reports in adults aged 18 to 55 within SWIFT specialist family service in Southeast England between May 2019 and April 2021. Descriptive analyses were conducted to show ACE type and prevalence, gender, and mental health (depression and anxiety levels) using self-report and measures such as the Generalised Anxiety Disorder questionnaire (GAD-7), Patient Health Questionnaire (PHQ-9), and Hospital Anxiety and Depression Scale (HADS). Our cohort displayed higher levels of difficulties than the general population, i.e. experiencing multiple ACEs (53.2 per cent). The female participants in our cohort expressed a higher number of ACEs and reported greater symptoms levels of depression than males. Ensuring the provision of trauma-informed therapeutic intervention may aid these individuals with making and sustaining meaningful change and escaping the intergenerational trauma cycle. Future research exploring causation and identifying potential therapeutic provisions with this population is necessary.

‘When they were taken it is like grieving’: Understanding and responding to the emotional impact of repeat care proceedings on fathers

AbstractThere is growing recognition, in the UK and internationally, of the huge costs of recurrent appearances of parents in local authority care proceedings. This paper contributes to pressing policy and practice concerns to reduce recurrence. It presents qualitative longitudinal data from the first study of fathers' experiences of recurrent care proceedings in England. Demonstrating the emotional impact of repeat proceedings and successive loss of children on fathers, in terms of grief, loss and shame, we highlight the trauma and abuse in their developmental histories. We consider complex connections between anger and shame for these fathers, including within the arena of family justice. With the use of literature on complex trauma, shame and parental disengagement, we explore ideas for re‐framing fathers', and professionals', resistance to engagement and for better understanding fathers' intense emotions. We suggest that the link between shame and complex trauma and the value of shame reducing, dignity promoting practice in response provide a valuable way forward for working with fathers. As is recognized to be the case for mothers, without holistic, empathic interventions to address the vulnerabilities of such fathers, the risks for children, mothers and fathers are unlikely to reduce.

Social workers' perspectives on the role and function of independent experts in care proceedings in Norway: Contributions and devaluation

AbstractIndependent experts are commonly used in child protection care proceedings to assess families and contribute to a sound basis for care order decisions. Yet the role and function of these experts varies across contexts, with issues raised concerning the quality and impact of their reports. Based on six focus group discussions (FGDs) with child welfare service (CWS) social workers in Norway, this study aims to advance the understanding of how independent experts are used when it comes to child protection. Reflexive thematic analysis was conducted, which revealed that the social workers mostly found the experts' contributions useful in that they provide a fresh pair of eyes and reduce the complexities in a case. However, the use of independent experts also had some negative aspects. The social workers experienced that their competence was undermined in court and had some experience working with experts whose work was of poor quality, which was unrecognized by quality control measures. This study raises timely questions about the role of the expert and suggests a clearer distinction between the function of providing expert knowledge to complement the social workers' assessments and the function of providing an independent assessment of the family on behalf of the courts.