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The sky is falling, the sky is falling – balance, and yes, more neuroscience

A lot of television and radio shows, particularly news or discussion shows, approach things on the principle of balance. You’ve got to show both sides of the debate and give them equal air-time.

So you get expert number one, Chicken Little, come on and say “The sky is falling, the sky is falling”

Expert number two, puts the counter position “The sky isn’t falling, the principles of gravity don’t work that way, and in the unlikely even that the sky was ever to fall, here would be some catastrophic signs and evidence that we would get”

And then the presenter wraps up, often with the expression “Well, the controversy rages on”

So the listener/viewer doesn’t learn much more than that some people think the sky is falling, others think it isn’t.  Some people think that Evolution is a load of nonsense and that the existence of bananas prove that*, others think it isn’t.  Some people think that the Holocaust is a fake Jewish conspiracy and it never happened, some people don’t. Some people think we should intervene militarily in Syria, some people think we shouldn’t.

[*Re – Bananas disprove evolution. I am not kidding, this is actually an argument]

The overwhelming message is that there are two sides to every story, there are no right or wrong answers.

What we don’t get is any analysis of whether Chicken Little is someone to be relied upon, or whether a detailed look at Chicken Little’s claims mean that almost anyone with an informed view would disagree.

And so you end up with Chicken Little’s views being just as much air time and weight as the counter-opinion, in order to have ‘balance’

I’m all for balanced debate when the issues are balanced – you can learn a hell of a lot from listening to people who have a contrary view. But it is helpful to know whether the debate is actually balanced (the Syria thing there are genuinely good and awful points on both sides, and though I might have views I wouldn’t say that the other camp is wholly wrong) or whether frankly one side is just wrong (The Holocaust really did happen, Evolution is not nonsense, the sky is not falling)

Long-term readers of the blog may well be aware that the Family Justice Board published some research on the neuroscience behind neglect – it’s all available and discussed here:-

http://suesspiciousminds.com/2012/11/05/taking-neglect-seriously/

And then Wastell and White published a critique of that research, essentially saying that it is being misused to make political decisions and justify a direction of travel that the individual studies simply don’t support

http://suesspiciousminds.com/2013/01/14/semantics-pedantics-and-neuro-mantics/

In very brief summary (the two articles tell you much much more, as do the source papers cited within them), there are two camps on what the neuroscience says. The FJB camp says that the neuroscience shows that there is hard evidence that neglect is very damaging to the underlying structure of children’s brains and that this neglect is difficult or not possible to recover from and that timely intervention and stopping the neglect early is thus vital. The Wastell/White camp say that the scientific evidence for these assertions is simply not there, that the studies the FJB camp rely on are either irrelevant or have been wildly overstated and that in particular, there is neuroscientific evidence that brains are more ‘plastic’ than the FJB camp claim – i.e that where damage occurs, the brain recovers and repairs that damage.

I candidly said in the second piece that not being a neuroscientist, I have no idea whether Wastell and White are correct in their demolition of the FJB research, or whether they are wrong.

I don’t know who “Chicken Little” is in this scenario, or whether either of the camps are “Chicken Little”, but that given that the FJB research has been an important underpinning “child-focussed” reason for the drive towards faster intervention and faster resolution of care proceedings, it is rather important that people who ARE in a position to say :-

(a)   The FJB camp are right

(b)   Wastell and White are right

(c)   One of them is probably more right than the other, but there are some real gray areas that need more studies and better evidence to be confident about deciding the issues

Are asked to say so.

If we are going to make policy decisions, or case decisions, we really do need to know if there is genuine doubt here and the extent to which that doubt impacts on how confident one can be about the research, or if one of the camps is a Chicken Little.      [For what it is worth, I really don’t believe that Wastell and White are Chicken-Littling here.  But I am no neuroscientist]

What I learn recently is that whilst the judiciary were all of course sent the FJB research (on the basis that finally, the Courts were going to be given some research on which decisions could safely and properly be taken)

they have now also been sent, without comment, the counter critique of Wastell and White.

Specifically, they were sent THIS document, which was produced for a conference organised by counsels chambers, 14 Grays Inn. As what I am doing here is linking to their website featuring it, and naming that 14 Grays Inn produced it and Wastell and White authored it, I don’t believe I am treading on anyone’s toes re authorship or copyright (but will take down the link if people object)

I think it is pretty important that people who are arguing cases in front of Judges know what research material the Court has been sent, and it may help to know that all Judges have been provided with access to both the FJB research AND this paper from 14 Grays Inn which critiques it.

http://www.14graysinnsquare.co.uk/The_childs_time_frame_%20a_neuro-scientific_perspective.pdf

What of course they DO NOT have, is any objective independent peer review of both documents, to answer the questions I have set out before. Which effectively makes the research fairly useless. We are left with the stereotypical TV presenter summary of “well, the controversy rages on”

I wonder if the same is going to be true once the FJB publish their research on the level of contact which is desirable for children (yes, it will), or the impact of drug misuse on family life and the ability of parents to recover from drug misuse (yes, probably)  and whether if all the Judges are getting are a set of controversial research papers and effectively being told that the science is controversial on all these issues, whether there is any value to it at all?

I was very supportive of the FJB producing some framework research which would answer some vital underpinning questions in child protection, but it seems to me that this has value only if the Courts who are potentially relying on that research have clear understanding of whether that research represents accurately the mainstream thinking of professionals within that field, and where any gaps are that  result in the need to be more cautious about certain aspects.

[The 14 Grays Inn paper is worth reading in any event, and I would urge you to do so, if you can find the time. A lot of the neuroscience is similar to already linked to on my earlier two blogs, but there is some new stuff. The “Error at the Door” piece about initial assessment is really very good]

“I’m on the edge, the edge, the edge, the edge…”

The Judith Masson (et al) research on families on the edge of care proceedings is now available 

http://www.bris.ac.uk/law/research/researchpublications/2013/partnershipbylaw.pdf

 It is a long and dense piece of research, but no less interesting for that. As ever with Judith Masson’s research, the paper itself is a lively read and if you wanted to get a real sense of context of the whole system of family justice, it would be a very good starting point.

 It really tackles the “pre-proceedings” element of intervention and working with families, which is going to become more and more important as the new changes come into force.

 Masson highlights how wide-ranging the participation in pre-proceedings work varies across authorities and indeed how wide-ranging the underpinning philosophies and aims of it are, from being a chance to bring about change, to an opportunity for parents to turn away from a course of action or get the help they need, to a recognition that it is fair and ‘right’ for parents to be warned of consequences, right through to it being ‘a mandatory’ step which has to be gotten through.

 

The research also shows how we ended up with this disparity and range of views, given that what happened was a top down imposition of requirements to have a meeting and a letter and to file a record of the meeting, but without there being any guidance or philosophy as to what was to be achieved.

 

The real headline from it is one which most professionals will recognise, that the Courts did not recognise or value pre-proceedings work,

 

 They [Judges}  preferred cases to come direct to court so that they could control what was done, and felt that the pre-proceedings process would only serve to delay cases which would inevitably need to come to court.

These judges were aware that local authorities were discouraged from undertaking assessments in advance of proceedings by court decisions to order further assessments and, particularly, to expect the local authority to contribute, financially, towards these. However, they felt constrained to allow parents to obtain further assessments, so the local authority’s assessment could be tested in a fair hearing; because they felt that local authority social workers’ assessments were not of the required quality and often merely reflected what their managers wanted; and to prevent their decisions being overturned by the Court of Appeal:

 

‘[The process] would work much better if there was a mechanism in court for us to say more robustly than we have in the past: you don’t need another assessment.’ Judge 6

 

‘[I]t’s so much easier to, say, spend £5,000 doing another assessment and the appeal won’t occur.’ Judge 7

 

These judges were not unique in mentioning the spectre of the Court of Appeal (Pearce et al. 2011). Indeed, the former President of the Family Division sent a letter to judges on case management in response to concerns hehad heard about the need to order further reports to avoid criticism of their decisions (Wall 2010).

 

and that as a result of Judges routinely commencing fresh assessments rather than actively considering the existing assessments, there was no real discernible difference in the time it took to conclude care proceedings in cases where there had been active and detailed pre-proceedings work from the ones that were issued with no pre-proceedings work.

 

And when Masson adds the work done pre-proceedings (after a formal meeting with parents and their solicitors) to Court proceedings, then it turns out to take nearly 70 weeks to get a decision for children if you do pre proceedings work, and around 45 if you don’t bother doing any.

 

She highlights this as being a core issue, going to the heart of care proceedings.  Is the purpose of proceedings to explore solutions to the problems of parenting through ‘investigation, assessment and management of change’” (Hunt 1998)  OR is it “to determine matters by assessing the application, in the light of the evidence presented and the parents’ response”

 

I think either course is a valid approach for the State to take, and I would suggest that at the moment, we have currently the former, and may be about to move to the latter.  Personally, I think that there would have been a place for a proper debate about those issues, and it would have been nice for these to be transparent and up front, rather than a fresh approach being sidled in.

 

Masson also touches on the fierce debate about whether the removal of children is “too few, too late”  or “too many, too fast”  – she seems to me to come down more on the former, whilst recognising that much more intervention and support could be provided and properly targeted.

 Regardless of where you stand on those issues – I know many of my readers are on the “too many, too fast” side of things, it is interesting to see someone actually identifying that this is a genuine debate, with value on both sides and that the State really needs to decide what it wants from a child protection system.

 There are some really sound conclusions to the research, I hope some of them get followed   (better funding for parents solicitors so that they can devote the pre proceedings work the time it needs is particularly important)

 I was taken, particularly, with Masson’s comments about how large changes in the family justice system occur. Of course, she approaches this from the viewpoint of an academic and researcher, but it is a perspective I’ve not heard or considered before, and so I wanted to share it with you [underlining is my own, for emphasis]

 Many of the changes to care proceedings practice since the implementation of the Children Act 1989 have been made not as a result of research evidence or interagency consultation but through litigation. The removal of children under interim care orders, the requirements for without notice EPOs and the contact regime where new babies are not in their parents’ care have all been the subject of ‘guidance judgments’. These have imposed standards or procedures which have had major implications for local authorities, the police, carers and children.

The close consideration a judge gives to an individual case gives him or her the detailed knowledge of the factual scenario necessary to make a decision. It is neither designed nor intended to provide a wide understanding of the range of circumstances where similar issues arise. Moreover, in our adversarial system, the information the judge receives is not simply an objective account but is intended to influence the decision. For these reasons, it would be better if judgments which were intended to shape the operation of family justice were subject to review and discussion before they were published.

 

Research has a contribution to make to law reform. Understandings from theoretical work and experience in other jurisdictions can provide some indication about what might work, the problems and limitations etc. Empirical study of the operation of laws and legal procedures can provide knowledge about practice from a range of perspectives including from litigants themselves, countering beliefs based on anecdote, information derived from the unusual cases that feature in law reports, and from the most vocal in the system. It can supplement the limited information available from case management systems and reach parts of the process that such recording cannot reach. Without research evidence it will not be possible for the Family Justice Board to secure major improvements to the family justice system, or know whether many forms of improvement have actually been achieved.

 

 Now, if you’ve been following this blog at all, you’ll have picked up what a caselaw geek I am, but I think this makes a really important point.

 If you take as an example the contact case Masson raises, the decision that our now President made in judicial review case effectively (at least for a period of some years) overnight transformed the amount of contact that babies placed in foster care should have with their parents, and did so dramatically.  And that case, which had massive implications for family after family, child after child, local authority after local authority, was decided without hearing any evidence about what was best for a child, it was just what the Judge at the time, considering that case, felt was best.

 (Now, as we know, the current research on quantum of contact for babies is pretty fraught, and it is a hot potato; but people on both sides of that debate have at least attempted to research and establish whether contact twice a week is better or worse for infants than contact five times a week, rather than determining it on the basis of listening to four adversarial submissions and concluding which is better.  It is quite possible that overall  the lives of children were made much better by the President’s decision, it is quite possible that overall they were made worse, it is possible perhaps even likely that for some children having more contact was good and for some it wasn’t so good, but we had no way of knowing at the time, the whole system had to embark on a sea change in contact regimes as a result of one judicial opinion in one case)

 That gave me some food for thought.

 

 

imPPPossible, surely? New research shows that Triple P has no effect on parenting

 

If this week’s blogging has taught us nothing, it is to be wary of what the headlines of research tell us and read the whole thing. (Unless it is research into what meat is in the burgers you ate last night, in which case best not to read it)

 

This is research published in the International Journal of Conflict and Violence, which sounds like bedside reading for a ruler of a Middle East country, but I assume is broadly anti conflict and violence, rather than photoshoots of girls with kalashnikovs. I daresay that they still have a hard time booking a venue for a Christmas party though.

http://www.ijcv.org/index.php/ijcv/article/view/263

 

But this is some research into whether Triple P, which has a lot of Government goodwill backing, takes a lot of public money, and which I spend hours per week hearing people whine about needing a referral to Triple P, actually makes any difference, and it suggests (at least in the headlines) not.  An important word in research terms, randomised, comes up, which is promising.  You need the study to be randomised so that the researchers didn’t come in with an agenda and pick the hundred best clients Triple P had, or the worst.

 

[Of course, as these were studies in Birmingham, perhaps it doesn't tell us much more than one of  (a) The parents who use Triple P in Birmingham aren't responsive to it, (b) the social problems in Birmingham don't respond all that well to Triple P  - and as I recall substance misuse and crack cocaine were pretty frequent issues in cases there or (c) The Triple P deliverers in the Birmingham area are not doing it quite right. ]

 

But let’s read more.

 

The Impact of Three Evidence-Based Programmes Delivered in Public Systems in Birmingham, UK

Michael Little, Vashti Berry, Louise Morpeth, Sarah Blower, Nick Axford, Rod Taylor, Tracey Bywater, Minna Lehtonen, Kate Tobin

 

Abstract

 

 

 

The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on “what works,” and included the implementation and evaluation of three evidence-based programmes in regular children’s services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four–six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four–nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children’s behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children’s relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience.

 

I’m not familiar with the Incredible Years model, but that seems to be pretty good, PATHS not too bad, and Triple P negligible.  Now, if that turns out to be a reputable and replicable study  (by which I mean someone else using those methods anywhere else in the country would get similar results) that’s a big deal. Firstly, as I said, Triple P gets a lot of State funding, and is a regular go-to resource. Secondly, parents pretty much only get one shot at an intervention to improve their parenting, so if what we’re sending them to isn’t as good at making a difference as it should be, that’s pretty important.

 

All this with the caveat that I am not a qualified interpreter of research – I am feeling more and more that we need a Ben Goldacre type to tackle the research that’s going around in family justice to tell us whether the conclusions are robust and fair.

 

As we know, Birmingham is a very large local authority, the biggest in the country, and it has a range of social problems, so it doesn’t seem like a bad pick for the area. It’s not like it has been skewed by picking Saffron Walden say and claiming that this is representative of the country at large.

Another telling thing is that this research is published, which means it is peer-reviewed and checked over, rather than just being something these guys have written and sent out a press release about. That makes me feel more reassured – the first 4 things I look for are :-

 

1. Is it peer reviewed

2. Is it randomised?

3. Did the initial sample get skewed?

4. Was it funded by someone with a vested interest in outcome?

And none of those red alarm bells are set off

 

My next concern is whether you can objectively measure a change in parenting or behaviour, or whether that is by its nature subjective, and if the latter, who is measuring it?

 

Lets see what they say:-

 

All of the evaluations applied the “intention to treat” principle, meaning that results include those children, parents, or schools that dropped out of the study. The findings therefore
reflect what happens in real-world situations, with many intervention recipients either not starting or not completing an intervention paid for by the local authority. Each
of the trials used a “waiting list” design, meaning that children or schools not receiving the intervention were given priority to receive it in future if the results of the evaluation
were positive. Children in the control conditions received “services as usual”, which in some cases involved substantial support – for example, the SEAL (Social and Emotional Aspects
of Learning) programme in the case of the PATHS trial. Participants in the programme groups could also continue to receive services as usual – that is, no services were
withdrawn – although it is acknowledged that logistically this may have been difficult (for example, if PATHS lessons
used curriculum time previously allocated to SEAL).

Typically, experimental evaluation is expensive. In order to reduce costs, the Social Research Unit sought only to replicate the findings established in other trials, thereby collecting considerably less data than is usually the case. The experimental approach was taken, randomly allocating units to control and intervention groups. Sample sizes reflect
a calculation of the statistical power needed for any programme effect identified by the evaluations to be greater than chance. Robust measurement was also required. These elements are typical of a good RCT. The focus on replicating findings from other trials offers a different angle, however. Specifically, the data collection was restricted to the factors in the logic model underpinning the evidence-based programme, including the risks targeted, the fidelity of implementation of core elements of the intervention, and the outcomes sought. Other hypothesised
moderators and other contextual information are excluded. The net result is a high-quality evaluation with less data and therefore less cost.

 

Well, the important thing here is that they didn’t discount those who dropped out – a common trick with research is to not include anyone who doesn’t finish the course of treatment, which of course skews out those people who didn’t feel it was working or had unpleasant experiences. I don’t know enough to know that this is bulletproof, but it is not yelling out at me that there are massive holes in it.

The evaluation of Triple-P was a parallel randomised controlled trial, with pre-post test design. It involved 146 children aged four–nine years whose symptoms indicated a
potential social-emotional or behavioural disorder, determined using the “high need” threshold on the SDQ “total difficulties” score (17 or above out of 40). The sample
comprised 105 boys and 41 girls. The mean age was 82 months (SD = 21). The sample also comprised a high proportion of low-income families: 62 percent of children
were entitled to free school meals compared to 33 percent for Birmingham as a whole.

The parent(s) of half (73) of these children were randomly assigned to attend Triple-P parenting groups, with the remaining half placed on a waiting list and receiving services
as usual. Researchers performed the randomisation foreach eligible child using an online programme, designed by NWORTH. Children were randomised on a 1:1 ratio, using
a dynamic allocation method, stratified by age and sex.

Baseline (Wave 1) data was collected on all children. Follow-up (Wave 2) occurred six months after baseline and included 137 children.2 The programme was delivered to
intervention group parents at some point during those six months. The missing nine cases (three control, six intervention) were made up of two formal withdrawals from the study and seven that could not be contacted. The primary outcome instruments were the SDQ and ECBI. Parenting behaviour was measured using the Arnold and O’Leary Parenting Scale (APS). Estimated mean differences were used to calculate the impact of Triple-P. ANCOVA tests controlled for children’s start scores on respective measures, the age and sex of the child, and the area from
which families were recruited.

 

I won’t put the figures in, because they’re a bit complex, without reading the whole report for yourselves.

But this is the telling paragraph in relation to Triple P

 

4.3. Standard Level-4 Triple-P
As Table 3 illustrates, the results for this programme are not promising. Children of parents attending Triple-P sessions improved their behaviour and were happier sixmonths after the course concluded, but at roughly the same rate as children in the control group receiving services as normal. These results are not consistent with most other Triple-P trials around the world. However, as far as we are aware, only four randomised trials (including this one) have been undertaken independent of the programme originator (see also Gallart and Matthey 2005; Hahlweg et
al. 2010; Malti, Ribeaud, and Eisner 2011). When these four studies are viewed together, the evidence of impact on child development is equivocal.

 

What that is obliquely saying is, that although there might be a great deal of research that Mars bars are really good for you, if you strip out all the research commissioned by Mars, it turns out the research shows that they’re not that good for you.

Their results were that the improvements and changes were no better in the Triple P group than in the group who didn’t have it – a PPPlacebo effect perhaps?  Food for thought at least.

Semantics, pedantics and Neuro-mantics

A discussion of the  fascinating “Blinded by neuroscience – social policy, the family and the infant brain”  paper by David Wastell and Sue White

I was sent this compelling and interesting paper by a colleague, and it makes an interesting companion piece to the official family justice research paper on neglect, which I blogged about here :-

http://suesspiciousminds.com/2012/11/05/taking-neglect-seriously/

The paper can be found here :  -    (you need to click on the PDF to read it, but it is free)

http://www.ingentaconnect.com/content/tpp/frs/2012/00000001/00000003/art00008?token=005015070f39b6e58654624315142576b7921766b3c252e5e4e2663433b393f6a333f256698c60b5

Now, why this is interesting generally, rather than just specifically because it is an interesting paper, is because the authors are positing that the Government is about to go in a direction based on scientific research that neglect :-

(a)   causes much more long-standing damage on children than previously understood

(b)   that poor quality of care in the early years of a child’s life causes damage to the structure of the brain which is hard to overcome

(c)   and that as a result, earlier intervention, and where necessary removal is the way to tackle this

And of course, the very first piece of research published by the Family Justice Review team is on these very issues, and although it doesn’t advance as far as (c) explicitly, it certainly comes up to the shoreline and says that speed of decision making is critical and that children under two can’t wait for decisions. It certainly endorses unequivocally the viewpoint that science has demonstrated (a) and (b)

What this article does, is question the scientific studies and research that lead to (a) and (b) and suggests that a careful analysis of the source material suggests that it is not so concrete as the FJR research suggests. And if (a) and (b) are not solid foundations, moving to (c) as the public policy seems to be doing at present may be even more risky than it appears.

[As a sidebar, this argument of if (a) and (b) are right, is (c) right, reminds me of Lewis Carroll's dialogue between Achilles and the Tortoise, and you can find that here, and shows that you simply can't prove anything at all with logic, if you are arguing with a smart-arse :-   ]

http://www.ditext.com/carroll/tortoise.html

achilles

In detail, the authors of this paper suggest that the thinking the Government are working on, that the infant brain is readily susceptible to permanent and irreversible damage from poor care, is wrong and that the truth is rather that the infant brain is resilient and has a plasticity  (by which they mean it is flexible and can adjust and will recover from early delays)

Initial caveat  -  I was concerned by the strident tone of this paper, and I was also concerned that neither of the authors (eminent and smart as they obviously are) are actually neuroscientists.   [That will teach me to judge by the titles that people give at the end, have been contacted by one of the authors, who very politely tells me that he is indeed a neuroscientist - ignore every other time I say that in the piece]

I would be terribly interested to learn whether this is a genuine schism in the field of neuroscience as it relates to children, neglect and brain development in infants, or whether one side or the other is cherrypicking data and quotes.  I simply don’t know. I’m not a neuroscientist, and though I can make sense of what is said by both sides, I am in no position to weigh up who is right.

Having critiqued the strident tone, I suppose that if the authors are right, and the Government is about to lurch into a public policy on neglect, child protection and quick adoptions based on ‘hard science’ when what they believe the ‘hard science’ says is wrong, I might be pretty forceful in my tone too.

Let’s have a look at some detail

We argue that the neuroscientific claims supporting current policy initiatives have receivedlittle critical commentary. They appear to be operating as powerful ‘trump cards’ in what is actually very contentious terrain, suppressing vital moral debate regarding the shape of state intervention in the lives of children and families.

 

In this article, we interrogate the nature of the scientific claims made in key documents and the ideological thrust of policy that they have engendered. We examine Allen’s first report in detail first, before developing a more general critique of what Tallis and others have dubbed neuromania: ‘the appeal to the brain, as revealed through the latest science, to explain our behaviour’ (Tallis, 2011: 5; Legrenzi and

Umilta, 2011). Bruer’s (1999) deconstruction of the ‘myth of the first three years’ will feature prominently in our argument, paving the way for a broader critical analysis of the ‘new’ brain science and its influence on policy. We contend that neuroscience is re-presenting an older ideological argument about the role of the state in family life in terms of a biologically privileged worldview. We suggest that there is a great

deal of difference between ‘early intervention’ as defined in the Allen report and what Munro (2011: 69) refers to as ‘early help’, which includes a much wider range of family support activities. Neuromania, we conclude, is the latest of modernity’s juggernauts reifying human relations into ‘technical objects’ to be fixed by the state (Smith, 2002), which always ‘asks nothing better than to intervene’ (Ellul, 1964: 228).

 

 

Strong words there, and the phrase at the end that the State generally seeks reasons to intervene is resonant.  I feel personally that the State has moved much more towards a paternalistic approach to the lives of its citizens and away from a broad principle that people are autonomous and best placed to make decisions for themselves save in very narrow circumstances, and that the law has done the same in recent years.  People’s freedom to make bad, foolish and downright idiotic decisions for themselves has to an extent been eroded.

Criticising Allen’s report, on which a lot of the foundation of the neglect causes irreversible damage in infants is based, the authors say   (their quotes from Allen are in italics)

The importance of secure attachment is invoked:

 

“Children develop in an environment of relationships.… From early infancy, they naturally reach out to create bonds, and they develop best when     caring adults respond in warm, stimulating and consistent ways. This secure attachment with those close to them leads to the development of empathy, trust and well-being. (2011a: 13)”

 

Predictive claims quickly follow regarding the long-term effects of such early attachment patterns, especially the beneficial effects of secure attachment and the dire impact of the failure to cement such bonds:

 

“Recent research also shows insecure attachment is linked to a higher risk for a number of health conditions, including strokes, heart attacks … people with secure attachment show more healthy behaviours such as taking exercise, not smoking, not using substances and alcohol, and driving at ordinary speed.

(2011a: 15)”

 

Two studies are cited as the basis for these ominous claims. But again the evidence cited is perplexing. These are not studies of children, but adults; both use ‘attachment style’ as a way of measuring the adult personality with self-report questionnaires. Neither study shows, nor purports to show, any link between early childhood experiences and

problems later in life. In subsequent paragraphs, damaged emotionality and damaged brains are soon united, and the perpetrator of all this devastation is unflinchingly denounced.

 

Parents are to blame:

 

“Parents who are neglectful or who are drunk, drugged or violent, will have impaired capacity to provide this social and emotional stability, and will create the likelihood that adverse experiences might have a negative impact on their children’s development … the worst and deepest damage is done to children when their brains are being formed during their earliest months

and years. (2011a: 15)”

 

 

If the authors here are right about the studies of attachment and impact on later life, and the flaws that they claim, my faith in the FJR research does wobble.  Again, I am not a neuroscientist, and neither are the authors, but if we are going to be taking the FJR research as agreed research on which the judiciary can base conclusions and decisions, we need to know whether the foundations are solid or built on sand.

Returning to Allen’s report, the following excerpt summarises the final

step of his neurobiological argument:

 

Different parts of the brain develop in different sensitive windows of time. The estimated prime window for emotional development is up to 18 months, by which time the foundation of this has been shaped by the way in which the prime carer interacts with the child…. Infants of severely depressed mothers show reduced left lobe activity (associated with being happy, joyful and interested) and increased right lobe activity (associated with negative feelings).

 

If the predominant early experience is fear and stress, the neurochemical responses to those experiences become the primary architects of the brain.

 

Trauma elevates stress hormones, such as cortisol. One result is significantly fewer synapses. Specialists viewing CAT scans of the brains of abused or neglected children have likened the experience to looking at a black hole.

 

In extreme cases the brains of abused children are significantly smaller than the norm. (Allen, 2011a: 16)

 

Those damaged brains again. For the claim of lasting damage from fear, stress and trauma, Allen cites no specific scientific support. A significant body of work does, however, exist on the possible damage caused by post-traumatic stress disorder, reviewed by Wang and Xiao (2010). Although there is evidence of reduced volume in one brainstem structure (the hippocampus), the seminal research involves war

veterans, not children; follow-up studies have not shown lasting hippocampal damage, and the scant imaging research on children has failed to find such impact. A recent authoritative review (McCrory et al, 2012) comes to much the same conclusion regarding the hippocampus, and another much-mentioned brainstem structure, the amygdala; only under conditions of prolonged rearing in orphanages is diminished

brain size evident (see below).

 

Digging into the specific (frontal) lobe evidence invoked by Allen, he cites a paper by Dawson et al (1994), which reviews psychophysiological studies of the children of depressed mothers. Dawson’s evidence, however, actually goes in the opposite

direction to that claimed in the Allen report. Referring to a study on the reactions of children when mothers left the room: ‘the infants of symptomatic mothers exhibited an unexpected pattern of greater left than right activation during the maternal separation condition’ (Dawson et al, 1994: 772). More ‘positive’ emotion it would seem. In truth, there is a vast gallimauphry of neuroscience research, but little settled knowledge. Evidence for policy making does not simply repose in journals ‘ready to be harvested’ (Greenhalgh and Russell, 2006: 36). Rather, it is ‘rhetorically constructed on the social stage so as to achieve particular ends’ (Greenhalgh and Russell, 2006: 37). This seems an apt enough description of Allen’s modus operandi.

 

Although ‘journal science’ is invoked, he seems not much interested in what it actually says. This is ‘prejudice masquerading as research’ (Furedi, 2001: 155), of science being enrolled to legitimate an a priori ideological position favouring a larger arena for public intervention in the lives of families.

 

(and later)

 

It should now be clear that neuroscientific knowledge is at an early and provisional stage. As Bruer (1999: 98) avers, after more than a century of research we are still ‘closer to the beginning than the end of this quest’.

 

This point was reinforced recently by Belsky and de Haan (2011: 409–10): although the brain ‘packs a punch’ for policy makers, they conclude that ‘the study of parenting and brain development is not even yet in its infancy; it would be more appropriate to conclude that it is still in the

embryonic stage’. Neuroscientists may know the limitations of their research, but such caveats are not what politicians and proselytisers wish to hear;

Again, I am in no position to judge whether what the author’s say of Allen’s report is accurate, fair comment, or a scurrilous attack. I simply don’t know and can’t say.  But what does seem clear to me is that simply ignoring the counter arguments and pressing ahead on the basis that there is clear research with firm conclusions on which future plans can be built is problematic unless that research addresses the criticisms of it head on.

We have much the same problem with the vexed issue of contact levels for infants in care.  I have blogged before about this being presented in the Family Justice Review research as being strong, almost overwhelming views about how high levels of contact are detrimental to infants, and this underpinned entirely the Government consultation on contact, and how there is a contrary view out there and criticism that the research just isn’t robust enough to bear the weight that is being placed upon its branches.  Particularly Dr Peter Dale’s critique of the original research

[See http://suesspiciousminds.com/2012/09/11/family-preservation-versus-child-rescue/                            ]

Again, I am not a scientist or researcher practising in this field, so I can’t resolve those debates and come to a firm conclusion about who is right. But that may well be the problem – neither are the politicians who are setting the course, or the Judges who will be deciding individual cases.

We need clarity as to whether the science on infant brain development is as claimed in the Family Justice Research, or as claimed here, or whether it is simply too early to tell, likewise with the impact of contact on children.

It also raises broader and deeper questions  – when, as the Family Justice Review intends, we collect research with a view to identifying the current state of play in a particular area and what that means for us, how are we, as lawyers, social workers, judges, politicians, in a position to assess whether that research actually shows what the headlines suggest ?   Do we have to get under the bonnet of the individual studies to realise that what was being tested was NOT the central hypothesis, but some ancillary matters from which large extrapolations are being drawn?

I don’t think it is controversial to say that neglect is harmful to children, but if we are working on the basis that science has proven that neglect is not only harmful to children but that such harm carries on into adult life and that harm caused by neglect in the first two years is irreparable, so decisions have to be made very quickly, then we had better be confident about that proof.

I’m not at all saying that the authors here have overturned the research – they are, as I have emphasised a lot, not neuroscientists. But what they have certainly done is gone up to the duvet and said “are you sure that’s someone asleep under there, rather than just some pillows?”

If you do happen to be a neuroscientist, I’d love to have a discussion about this, though it will need to be taken slowly – I’m strictly an amateur.

I’ll conclude with some wise philosophical words, from Descartes via 1980s Manchester

Does the body rule the mind, or does the mind rule the body? I dunno

Taking neglect seriously

 

 

Some interesting research about children’s timescales and the Court process, which has been conducted by the Childhood Wellbeing Research Council. It is the first piece of the research that was commissioned under the Family Justice Review, and therefore worthy of attention.  (More attention than it has received)

 

It is heavy, and I can’t say yet whether its conclusions will necessarily be unchallenged, but it is, I think, for the first time, a proper drawing together of all of the important research on delay, decision-making, impact of neglect on children and attachment issues.  If the other pieces of FJR research are going to be as important as this, I will be a very happy law geek.

 

 

http://www.cwrc.ac.uk/news/documents/Decision_making_within_a_childs_timeframe_Oct_2012_CWRC_WP_16.pdf

 

 

It is long and detailed, so my cursory summary of it is absolutely no substitute for reading it.  It also contains some important research about the impact of child abuse, particularly neglect, on children.  A lot of it is pulling together of research that is already out there, but might be less widely known than it should be.

 

 

 

1.1 This overview of research evidence has been commissioned in response to the Family Justice Review recommendation for consistent training and development for family justice professionals, including a greater emphasis on child development. It aims to bring together key research evidence to facilitate understanding among professionals working in the family justice system in areas relating to:

  • · neuroscience perspectives on children’s cognitive, social and emotional development;
  • · the implications of maltreatment on childhood and adulthood wellbeing;
  • · evidence concerning the outcomes of interventions by the courts and children’s social care; and
  • · timeframes for intervening and why they are out of kilter with those for children.

 

 

I am hoping to whet your appetite to read the research, because this is some big important stuff.  (I will stop nudging you in the ribs at some point, but really, this needs to be read)

 

 1.19 While the issues covered in this chapter are intended to help the reader develop a critical approach to the understanding of research findings they should not detract from the value of the research itself. The following chapters consider robust findings from a number of well received research studies into parents’ problems and the impact of abuse on early childhood development; family justice professionals need to be aware of this research, particularly because it points to the importance of making timely decisions when children are suffering, or likely to suffer, significant harm.

 

 

We start with some basic principles  (the first few are of the “no-s*** Sherlock variety, but the last two are perhaps startling to see in such stark form)

 

 

Summary points

  • · Children growing up with parents who experience problems such as mental illness, learning disability, substance misuse and domestic violence are at greater risk of being maltreated.

 

  • · Not all parents with these problems will abuse or neglect their children; however these factors interlock in complex combinations which substantially increase the likelihood of maltreatment.

 

  • · Protective factors such as the presence of a non-abusive partner and/or a supportive extended family, parents’ ability to understand and overcome the consequences of their own experiences of childhood abuse, their recognition that their adverse behaviour patterns constitute a problem and their willingness to engage with services can substantially reduce the likelihood of maltreatment.

 

  • · Where insufficient protective factors are present, parents’ problems can undermine their ability to meet the needs of their children and inhibit the child’s capacity to form secure attachments.

 

  • · Healthy child development depends on the child’s relationships, and particularly their attachment to the primary caregiver.

 

  • · The process of attachment formation begins at birth. The four basic attachment styles: secure, insecure ambivalent, insecure avoidant and disorganised illustrate different adaptive strategies in response to different types of caregiving.

 

  • · Up to 80% of children brought up in neglectful or abusive environments develop disorganised attachment styles. These children behave unpredictably and have difficulty regulating their emotions.

 

  • · Disorganised attachment is strongly associated with later psychopathology.

 

 

 

 

 

This is interesting :-

 

 

The risk of recurrence (of child abuse) was reduced when medical and/or legal services were involved.

 

So the PLO may have been onto something, when they wanted to draw lawyers for parents into the process earlier – it is just a shame that the funding system means that they really can’t come in until proceedings are almost inevitable, rather than at the Initial Assessment process, when legal advice could make a real difference.

 

  

The mitigating value of protective factors

2.10 There is substantial evidence that certain protective factors can interact positively with parental problems to mitigate their impact, thus reducing the likelihood of maltreatment and improving the chances of better long-term outcomes for children. Jones and colleaguesidentified the following factors to be particularly pertinent: the presence of a non-abusive partner; the presence of a supportive extended family; parents’ adaptation to their own experience of childhood abuse; parents’ recognition that there is a problem and their willingness to take responsibility for it; and parents’ willingness to engage with services.

 

 

Whilst these are all things that we intuitively look at in care proceedings, it is helpful to see that the things we take for granted as common sense protective factors actually are.  And the phrase ‘insight’, which we hear so often, really is instrinsically bundled up in this.

 

 

[I do wonder, on a 26 week timetable, how the “Ostriches”  - those parents who bury their heads in the sand and pretend none of this awful situation is happening to them, before finally realising, will fare.  I suspect that there will no longer be enough time to turn the Ostrich cases around to a positive outcome]

 

2.11 Cleaver and colleagues40 have provided a comprehensive analysis of the manner in which, where there are insufficient protective factors, parents’ problems can impact on parenting capacity and trigger maltreatment and poor child outcomes. To summarise:

 

  • · Parental mental illness can seriously affect functioning. For example someone suffering from schizophrenia can experience delusions and hallucinations and be preoccupied with a private world. A person who is depressed can have feelings of gloom, worthlessness and hopelessness, which may mean that everyday activities are not carried out. Mental illness can blunt parents’ emotions and feelings towards their children, cause them to be emotionally unavailable or behave unpredictably, or occasionally cause them to be violent.

 

  • · Learning disability can affect parents’ capacity to learn and retain the new skills that are necessary to parent a child. Parents with a learning disability may also have had a negative experience of their own childhood which can leave them with low self-esteem and a poor sense of self-worth. Consequently, parents with learning disabilities and their children are vulnerable to financial and sexual exploitation, domestic violence, harassment and bullying.

 

  • · Parents who abuse drugs and/or alcohol can be subject to erratic mood swings, paranoia and hallucinations, or feelings of elation and calm, diminished concentration, memory impairment and a loss of consciousness. This can leave them unable to: meet the basic needs of their children, be emotionally available to them or at times keep them safe.

 

  • · Being the victim of domestic violence is likely to undermine parents’ self-esteem and confidence in their parenting skills. Such parents may have their attention focussed on the necessity to placate the perpetrator rather than on their children’s needs. They may not be able to protect those of their children who get caught up in or witness an attack from physical abuse and emotional trauma. Perpetrators of domestic violence are likely to cause physical and emotional harm to their children as well as to their partners.

 

2.12 Behaviour patterns such as these undermine a parent’s ability to meet their children’s needs. They have a particularly damaging impact on the child’s emerging capacity to form attachments.

 

 

The report then goes on to specifically look at attachment issues – I think lawyers (and perhaps some others in the family justice system) are often a bit muddled about attachment, and what the significance or otherwise of it is.  I often see it being conflated with an concept of whether the parent loves the child and vice versa. If you know a bit about attachment theory, not much of this is new, but it is helpful to have it pulled into one place and be able to take the Courts to this one document.

 

 

The importance of a secure attachment base for healthy child Development

 

Young children experience their world as an environment of relationships, and these relationships affect virtually all aspects of their development – intellectual, social, emotional, physical, behavioural, and moral.

 

 

2.13 Healthy child development depends on the establishment of these relationships. Early secure attachments contribute to the growth of a broad range of competencies, which can include: a love of learning; a comfortable sense of oneself; positive social skills; multiple successful relationships at later ages; and a sophisticated understanding of emotions, commitment, morality, and other aspects of human relationships.

 

2.14 Howe asserts that, biologically, attachment is a means of survival. It is defined as proximity seeking behaviour to an attachment figure, the primary caregiver, by a baby or child when he or she experiences discomfort such as pain, fear, cold or hunger.This behaviour is instinctive and is based on the assumption that the primary caregiver will be able to reduce the discomfort.

 

The baby gradually constructs an internal working model of themselves and of their primary caregiver on the basis of their caregiver’s responses to their attachment needs:

These mental representations refer to the kind of memories, experiences, outcomes, feelings and knowledge about what tends to happen in relationships, particularly with attachment figures at times of need.

 

2.15 Thus, the primary purpose of an internal working model is to help regulate the negative emotions of fear, distress and anxiety triggered when a child feels insecure.

 

2.16 The process of attachment formation begins at birth. A newborn infant seeks care and protection through proximity to their attachment figures. Following birth, a baby is instantly alert to messages they receive about the world around them, such as those reflected in the face of their caregiver(s) and the way in which their urgent needs are met. From about the age of three months a baby is increasingly selective and begins to smile less readily for strangers, tending to target their attachment behaviours more accurately towards their significant carers. By the age of six to seven months, an infant can generally show a clear cut attachment to their primary caregiver(s), and will show distress and anxiety about being separated from them. For instance, infants of this age become less likely to tolerate being held by strangers. However, from this point onwards a securely attached infant is able to use their caregiver as a secure base for exploration.

 

2.17 During toddler and pre-school years children learn to define themselves and others in increasingly sophisticated ways. They develop their locomotive skills, their cognitive capacity, their communicating and negotiating abilities, and increase their knowledge and understanding of the perspectives of others. A child’s secure foundations from infancy help them to achieve these developments.

 

2.18 Researchers have identified four basic attachment styles, each relating to the type of caregiving received. These are: secure, insecure ambivalent, insecure avoidant and disorganised. Each of these styles of attachment illustrates different adaptive strategies in response to different types of caregiving, and are developed by children to enable them to ‘stay close and connected to their attachment figures at times of intense negative arousal’.

 

Whilst these categories are very useful in facilitating understanding of different attachment styles, it should be noted that in real life they are not entirely discrete entities; whilst some children will fall exclusively into one category, many children will show a mixed pattern of attachment behaviours, with elements of several styles present.

 

2.19 Children who are securely attached to their caregiver(s) have a relationship that is characterised by sensitive, loving, responsive, attuned, consistent, available and accepting care.51 Securely attached children have the ability to regulate their distress, either by themselves or by the knowledge that they can get help from their attachment figure should they need it.

 

2.20 These children develop internal working models in which they see other people as positively available and themselves as loved and likeable, valued and socially effective.Secure attachment styles are found in about 55% of a non-clinical population.

 

2.21 Conversely, insecurely attached children experience anxiety about the location of their caregiver at times of need, as well as uncertainty about the type and sensitivity of the response they will receive.55 There are three types of insecure attachment patterns, the avoidant, the ambivalent and the disorganised.

 

2.22 Children who develop an insecure, ambivalent pattern of  Attachment experience inconsistent caregiving. Their caregiver(s) tend to be preoccupied with their own emotional needs and uncertainties, and can be unreliable and emotionally neglectful. These children will exaggerate their attachment behaviour in an attempt to be noticed; in this they are not always successful, and their ambivalence reflects their simultaneous need for and anger with their attachment figures.56 About 8% of children in a non-clinical population display insecure ambivalent attachments.

 

2.23 About 23% of children develop insecure, avoidant attachment patterns.These children tend to experience parenting that is hostile, rejecting andcontrolling. They come to see themselves as neither loved nor loveable.They adapt to their caregivers’ rejection by over-regulating their emotions,and are anxious that any display of need, longing, vulnerability or emotionmight drive their caregiver(s) away.59

 

2.24 Some caregivers cannot regulate their child’s responses to stressful circumstances; as a result, their children experience feelings of danger and psychological abandonment.60 Children who are cared for by people who are frightening, dangerous and/or frightened develop disorganised attachments.61 These children may be fearful of approaching their caregivers because they cannot predict the response: sometimes they may be picked up and cuddled, but at other times they may be shouted at or smacked. As a result, these children are not able to ‘organise’ their own behaviour, and have difficulty regulating their emotions. Like their parents they may behave unpredictably. They develop highly negative and inconsistent internal working models in which they see other people as not to be trusted.

 

Disorganised attachment is strongly associated with later psychopathology.

 

There is consistent evidence that up to 80% of children brought up in neglectful or abusive environments develop disorganised attachments, although these are evident in only 15% of a non-clinical population.The effects of maltreatment on attachment behaviour will be discussed further in Chapters Three and Four.

 

 

 

Chapter 3 gets stuck into the neuroscience – what is happening with a child’s brain during early years and what are the effects of neglect upon child development?     I’ve felt for a while now that neglect is the poor cousin of child abuse  – it is really easy to understand and grasp the risks of sexual abuse, or a fractured skull, but neglect is so easy to minimise and belittle and so hard to get a firm grasp on  ‘what will happen to the child if this situation persists rather than improves?’

 

A lot of the neuroscience bit may be a bit fresher than the attachment theory previously discussed, and I think it is very important in the way we look at neglect. It may help Courts take neglect as seriously as it needs to be taken.

 

How the child’s relationships shape the development of the brain and the stress response system

Summary points

  • · Much of the development of the brain and central nervous system takes place after a child is born, within the first three years of life.

 

  • · The child’s environment of relationships – and in particular the relationship with the primary caregiver – plays a critical role in shaping the development of the overall brain architecture.

 

  • · Negative experiences, and in particular insufficient stimulation, adversely impact on the construction of neural connections which form the basis for cognitive and social development.

 

  • · By the time children are two, the foundations for their ability to speak and understand language, to reason and make plans have already been laid.

 

  • · Executive function skills, necessary for both learning and social interaction, begin to develop shortly after birth, with dramatic growth occurring between the ages of three and five years.

 

  • · There is a short window of opportunity for certain types of development. If the types of experience upon which they depend do not occur within a predetermined timeframe, children will not move on to the next stage of development and their long-term wellbeing will be compromised.

 

  • · Early interactions between the primary caregiver and the baby play a significant role in establishing the normal range of emotional arousal and in setting the thermostat for later control of the stress response.

 

  • · Both very high and very low levels of cortisol are indicative of abnormal development of the stress response and can cause long-term physiological and psychological damage.

 

 

[This last one is interesting, because it raises the possiblility of a biological/chemical test for neglect, that there’s a chemical which can be measured and considered whether it is in normal parameters - and I suspect Trimega and Trichotech are already contemplating the marketing for their Cortisol tests…  Are we ready for neglect to be determined by science?  There’s an entire blog post all on its own, I think]

 

3.14 The process of creating and strengthening or discarding synapses is the brain’s means of learning and the way in which a child responds to their environment. This process is often referred to as ‘plasticity’, a term that indicates the brain’s ability to change in response to repeated stimulation.

 

These repeated adaptations are made in response to a combination of genetics and experience. The brain is genetically pre-programmed to expect certain experiences and forms certain neural pathways to respond to them; the more the child is exposed to these experiences, the stronger the pathways become. For example, a baby’s brain is genetically preprogrammed to respond to voices. When a baby is spoken to the neural systems which are responsible for their speech and language receive the necessary stimulation to strengthen. If, however, they are not exposed to adequate stimulation through exposure to speech, the pathways which have been developed in anticipation of this exposure will be discarded:

 

All children need stimulation and nurturance for healthy development. If these are lacking – if a child’s caretakers are indifferent or hostile – the child’s brain development may be impaired. Because the brain adapts to its environment, it will adapt to a negative environment just as readily as it will adapt to a positive one.83

 

3.15 A child’s experiences greatly shape the quality of the architecture of the developing brain. Positive experiences, particularly in the first year of life, produce more richly networked brains. More neuronal connections produce better performance and more ability to use particular areas of the brain.

 

Conversely, as Chapter Four shows, negative experiences, and in particular insufficient stimulation, adversely affect the development of neural connections and have a negative impact on children’s cognitive and social development, their speech development and their learning and memory.

 

3.18 The sequence of brain development follows a logical pattern. Development of the higher regions does not commence before the connections in the lower regions have been completed.92 This is because the higher levels in the hierarchy depend on reliable information from the lower levels in order to accomplish their functions.93 Impaired development in the lower regions of the brain will therefore have a negative impact on the development of the functions of the higher regions, such as language, empathy, regulation of emotions and reasoning.

 

 

This, for me, is a big deal.  The research establishes that a major part of the formation of basic brain structure happens in the first few years of life, that positive experiences enhance this and negative ones hinder it, and that higher brain functions don’t get formed until the basic ones are completed.  So a baby that is being understimulated or mistreated will have serious consequences on that emotional development in later life.

 

This next bit also interested me

 

3.24 There are specific periods when the development of a child’s brain is more strongly affected by a certain type of experience than at other times. These periods are widely referred to as sensitive periods. At certain times the impact of experience on development can be irreversible: these are a special class of sensitive period known as critical periods.

 

 

This is then the pulling together of research on the impact of stress and how it affects children. It is sciency but important

 

 

3.34 Everyday life involves responding and reacting to varying degrees of stress.

 

When an individual experiences stressful events, their body responds physiologically to restore a condition of equilibrium, or homeostasis.114 The body’s stress response activates several interlocking biological systems designed to prepare an individual for events that may threaten their wellbeing.The hypothalamus, which is located in the centre of the brain, is involved in maintaining homeostasis, including responding to stressful events which upset regulatory rhythms. The amygdala reacts to social situations that generate uncertainty or fear by releasing chemical messages in various directions. The hypothalamus is activated by these messages, and in turn triggers the hypothalamus-pituitary-adrenal (HPA) axis: the core stress response system.

 

3.35 The stress response involves activation of the pituitary, which in turn triggers the adrenal glands to produce extra cortisol. This allows the body to generate extra energy to focus on the stress and to put other bodily systems ‘on hold’ while this is being dealt with.

 

3.36 Chronically high levels of cortisol have detrimental effects on health. Therefore feedback loops are present to modulate the responsiveness of the HPA axis which returns the system to homeostasis. This feedback loop is mediated by receptors located, in the main, in the hippocampus. The purpose of this regulation is to produce adaptive responses to social and psychological stressors. These prepare the body to anticipate and respond optimally to threat but return efficiently to a homeostatic balance once the body is no longer challenged.

 

3.37 The stress response system is not fully mature at birth. It requires an extended period of development whereby experience plays a crucial role.

 

An important component of this development is a baby’s attachment to their caregivers.When babies express feelings of distress or discomfort, they are dependent on their caregivers to notice these signals and to respond by providing the type of care which maintains their equilibrium, such as sensitive touch, feeding and rocking.122 A baby’s stress response system is unstable and reactive; it will produce high levels of cortisol if the baby’s needs are not being met, or if the baby is in an environment which is aggressive or hostile. Persistent and unrelieved chronic stress in infancy results in the baby’s brain being flooded by cortisol for prolonged periods.

This can have a toxic effect on the developing brain, with detrimental consequences for future health and behaviour. Please see Chapter Four paragraphs 4.38 to 4.44 for further discussion relating to the toxic consequences of chronic stress.

 

3.38 In some children, however, prolonged exposure to stress may be linked to abnormally low levels of cortisol. This is particularly evident in those who have experienced low-grade, frequent emotional (and sometimes physical) abuse and neglect in very early childhood and is associated with early indications of anti-social behaviour in boys.

 

3.39 Both very high and very low levels of cortisol are indicative of abnormal development of the stress response, and cause long-term physiological and psychological damage.

3.40 A normal adult pattern of cortisol production is highest in the morning, and then gradually declines through the day to be at its lowest in the evening.

Babies who have secure attachments to their caregiver(s) will begin to form this pattern between three to six months old; however it takes until about the age of four years before it is fully established.126 Early interactions between primary caregiver and baby therefore play a significant role in how a child develops the capacity to respond appropriately to stressful circumstances and the ability to regulate their own negative emotions if and when these occur, such as following an immunisation injection, an injury, or on the first day at school.

 

3.41 This chapter has shown how the brain and stress response systems develop in early childhood and are shaped by the relationship with the primary caregiver. There are indications that when the caregiver does not respond appropriately to the child’s needs, development can be impaired

 

 

 

Chapter Four then gets heavily stuck into the impact of child abuse on children and their development. Traditionally, this has been a difficult area, because there are obvious ethical reasons why you can’t get a bunch of children and mistreat them under scientific conditions to see what happens, and you can never be certain when looking at children you suspect have been neglected exactly what did happen to them. But there was a group of children who we knew exactly how neglected they were, and those were the babies who grew up in Romanian orphanages that were effectively given very minimal care and no stimulation.

 

So some of the research is drawn from that. I haven’t really discussed any of that, because it involves palpably worse neglect than we are used to seeing in a family court environment  – the Romanian orphanages had a staffing ratio of 1 carer to every 20 children, and it is clear that one twentieth of a carers time (or 1 hour 12 mins per child per day), even if they are very dedicated and devoted and hardworking, isn’t going to be enough for a baby, and even the worst of our neglectful parents must spend more than an hour and twelve minutes a day interacting with their baby.

 

Here is the summary for chapter four – note the last point about the correlation between childhood neglect and adult dysfunction.  [To be balanced, no doubt a parallel could be drawn about children in the care system and adult dysfunction…]

 

 

Summary points

  • · Exposure to domestic violence and/or parental substance misuse in utero can have a long-term negative impact on the unborn child.
  • · High quality care can determine the extent to which children who are genetically predisposed to mental illness or learning disability, or who are exposed to abusive or neglectful parental behaviours, are affected.
  • · Chronic exposure to trauma through aggressive, hostile or neglectful parenting can lead to stress system deregulation. Exposure to toxic stress in early childhood can cause permanent damage to the brain and have severe and long-term consequences for all aspects of future learning, behaviour and health.
  • · Neglected children may experience chronic exposure to toxic stress as their needs fail to be met. This is compounded by a lack of stimulation and social deprivation.
  • · Severe global neglect (i.e. severe neglect in more than one domain) during the first three years of life stunts the growth of the brain.
  • · Adults who have been physically abused in childhood show poorer physical and intellectual development, more difficult and aggressive behaviour, poorer social relationships and are more frequently arrested for violent crimes than their peers.
  • · Children who have been sexually abused may experience sleep problems, bedwetting or soiling, problems with school work or missing school, and risk taking behaviour in adolescence including multiple sexual relationships.
  • · Adolescents who have experienced abusive or neglectful parenting in childhood are more likely to engage in risk-taking behaviours such as substance misuse and criminal activity.

 

 

 

There’s a discussion on emotional abuse which (perhaps appositely) is the most emotive form of reasons for State intervention in family life and the one which gets people hot under the collar, and is the one which opponents of the Family Justice system consider to be a trivial and unwarranted justification for State intervention.   Note my underlining.

 

Emotional abuse and neglect

4.17 Emotional abuse is described as:

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or making fun of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber-bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

 

4.18 Emotional abuse is often considered to be the most damaging of all forms of maltreatment in early childhood because the perpetrator is almost always the primary caregiver, and their abusive behaviour represents a direct negation of the child’s ‘need for safety, love, belonging and self esteem’.

The chapter discusses the professional difficulties in determining when neglect or emotional abuse reaches the stage when intervention is required. There are some big strong statements in here, which I have underlined.

 

 

4.20 Findings from the studies in the Safeguarding Research Initiative154 showed that practitioners found it difficult to identify emotional abuse and neglect and to decide when a threshold for action had been reached. These difficulties arose for a number of reasons:

• Both types of maltreatment are heterogeneous classifications that cover a wide range of issues.

• Both emotional abuse and neglect are chronic conditions that can persist over months and years. Professionals can become accustomed to their manifestations and accepting of the lack of positive change.

Both types of maltreatment can persist for many years without leading to the type of crisis that demands immediate, authoritative action.

Without such a crisis it can be difficult to argue that a threshold for a child protection plan or court action has been reached.

• Both types of maltreatment are also closer to normative parental behaviour patterns than physical or sexual abuse, in that most parents will, on occasion, neglect or emotionally maltreat their children to a greater or lesser degree. It is the persistence, the frequency, the enormity and the pervasiveness of these behaviours that make them abusive.

 

4.21 Two systematic reviews of literaturethat explored the evidence in relation to neglect and emotional abuse concluded that these types of abuse are associated with the most damaging long-term consequences, yet they are also the most difficult to identify. Furthermore, relative to physically abused children, neglected children have more severe cognitive and academic deficits, social withdrawal and limited peer interactions, and internalising (as opposed to externalising) problems.

 

4.22 Child maltreatment is a public health issue, in that its prevalence has a negative impact not only on the individuals concerned, but also on the welfare of society as a whole. The consequences of child maltreatment can last over the course of a life time and negatively affect parenting capacity, with detrimental consequences for the next generation.

 

A consideration of when changes would be made is the next discussion

 

4.30 Ward and colleaguesstudied the life pathways of 43 infants who had been identified as likely to suffer significant harm before their first birthdays; two thirds of them had been identified before birth. This study found that those parents who were able to overcome issues affecting parenting capacity, such as substance misuse and domestic violence, had begun to address these during the pregnancy. This was often as a result of a revelatory moment when they realised they needed to make substantial changes to their lifestyles in order to protect their unborn child, and indeed to prevent the local authority from removing the baby from their care immediately following the birth. Those parents who were able to address all of their difficulties before their child was six months old were able to maintain these changes in the longer term – up to at least their child’s third birthday. Parents who were interviewed as part of the evaluation of the Family Drug and Alcohol Court pilot also identified the birth of a child as a catalyst for overcoming adverse behaviour patterns.176 The findings from these studies suggest that there is a window of opportunity for social work and legal interventions during pregnancy and in the first few months following birth when parents may be more open to address adverse behaviour patterns.

The portions on “Toxic Stress” are interesting  – this is a new term to me, and I suspect I will be hearing it more in the future.   I’m starting to wonder whether paediatric neuroscience is going to be an expert discipline which has much more to tell us about neglect than the traditional psychological assessment that tells you nothing at great expense and delay.

 

 

Toxic stress

4.38 In addition, if inadequate or damaging parent-infant interactions persist, a child’s stress response system can be activated over prolonged periods, producing chronically high levels of the stress hormone cortisol. Brief periods of moderate, predictable stress are not problematic. In fact, they are protective and essential for survival. However excessively high levels of stress and prolonged exposure to raised cortisol levels are harmful and have toxic consequences for the developing child’s brain.186 A child’s stress response system can be activated over prolonged periods if they continually feel threatened by aggressive or hostile parenting, including witnessing or hearing violence between caregivers, or if, as a result of neglectful parenting, their basic needs for food, warmth, nurture, care and affection are not met.

The stress response system starts to self-regulate at around six months, and persistent maltreatment may lead to poor emotional regulation and a maladaptive response to stress. 

Toxic stress can result from strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive adult relationship.

 

4.39 Brain development can be altered by this type of stress, resulting in negativeconsequences for children’s physical, cognitive, emotional, and socialgrowth.The ability of a child’s brain to adapt to its environment,particularly during the first three years of life (and especially during the firstyear) makes it particularly sensitive to chemical changes. Therefore,persistently high levels of stress hormones, such as cortisol, can disrupt itsdeveloping architecture.190 Because the brain develops in certain setsequences (see paragraphs 3.16 to 3.18) early development impacts uponlater brain development. Therefore stress exposure early in life has thehighest potential for long-term dysfunction in neurobehavioral systems that mediate emotional responses, abstract thinking, and social interaction.

 

4.40 As Chapter Three has shown, the amygdala, hippocampus and prefrontal cortex regions of the brain are particularly sensitive to chronic stress (see paragraphs 3.34 to 3.41). This is because they contain an abundance of stress hormone receptors.Exposure to high levels of cortisol can cause cell damage which is reversible when exposure is brief, however when exposure is prolonged it can lead to cell death. Therefore permanent damage can be caused to these areas of the brain when a child is exposed to toxic stress.

 

4.41 Damage to the hippocampus can lead to impairments in memory and mood related functions, and limit the ability of the hippocampus to promote contextual learning, ‘making it more difficult to discriminate conditions for which there may be danger versus safety, as is common in post-traumatic stress disorder’.It can also lead to problems in the development of linguistic, cognitive and social-emotional skills.

 

4.42 Chronic stress is also associated with over activity in the amygdala which then activates the stress response system. This can result in an increase in the potential for fear and anxiety. One task of the prefrontal cortex is to suppress amygdala activity, allowing for more adaptive responses to threatening or stressful experiences. However exposure to chronically elevated cortisol levels can damage the neural pathways between the prefrontal cortex and amygdala, limiting the ability of the prefrontal cortex to inhibit amygdala activity. As a result, children may appear, ‘to be both more reactive to even mildly adverse experiences and less capable of effectively coping with future stress’.

 

 

 

The brain scans comparing a neglected child with a non-neglected child are staggering. I can’t reproduce them here, but go and look at them.

 

The last sentence of this next section is also staggering. I had never contemplated childhood neglect having a correlation with the  serious adult illnesses described here

 

Impact of maltreatment in later childhood and adolescence

4.50 Child abuse and neglect typically begin early in childhood; however the damage these experiences cause to all areas of development can have a cumulative effect on subsequent behaviour and health in later childhood and adolescence. Unsurprisingly, socially, emotionally and behaviourally impeded development attributed to abuse and neglect in the early years continues into middle and later childhood. Maltreated children may experience difficulties in coping with the social and academic demands of school and neglected children in particular may fall behind in their language and reading skills.Because subsequent development builds on previous milestones, abused and neglected children can continue to be challenged by normal developmental tasks.

 

4.51 During middle to late childhood caregiver(s) need to be good role-models and actively encourage sociable behaviour alongside firm and calm limit setting to promote good adjustment.212 Parenting which is harsh, rejecting or inconsistent is associated with poorer outcomes.213

 

4.52 Adolescence is a period of preparation for adulthood, when several key developmental tasks are encountered. These include physical and sexual maturation; movement towards social and economic independence; the development of identity; the acquisition of skills needed to carry out adult relationships and roles; and the capacity for abstract reasoning.

 

Adolescence can be a time of tremendous emotional, social and physical growth and potential, however for young people who have experienced abuse and neglect either in their past or present, this is a time of particular vulnerability.

 

4.53 The neglect of adolescents is a major issue that frequently goes unnoticed.Adolescents can be neglected by services as well as by their families. It is clear that neglect is age-related, and as children grow older it is defined not only by parental behaviours but also by the way in which young people experience them. Davies and Ward216 argue that some fundamental questions have barely been considered. For instance, there is little public debate or consensus as to what constitutes an acceptable level of supervision as children grow older. Furthermore, teenagers are the second most likely group of children to be the subject of a serious case review.

 

4.54 As children grow and develop into young adults, the cumulative effects of child abuse and neglect can have detrimental consequences for their health and welfare. Growth in the frontal lobe of the brain may be under developed in young people who have experienced abusive or neglectful parenting during their childhood. This may mean that they are more likely to engage in risk taking behaviour and live a generally unhealthy life style (see paragraph 3.17). For instance, abused and neglected adolescents are more likely to start drinking alcohol at a younger age and more likely to use alcohol as a way of coping with stress than for other social reasons.Exposure to maltreatment during childhood is also associated with tobacco use, illicit drug use, obesity and promiscuity in adolescence.

 

4.55 Young people who have been maltreated in childhood are also more likely to have trouble maintaining supportive social networks and are at a higher risk of school failure, gang membership, unemployment, poverty, homelessness, violent crime, incarceration, and becoming single parents.Additionally, if they become parents themselves, they are less likely to be able to provide a stable and supportive environment for their children. This creates an intergenerational cycle of adversity.221

 

4.56 There may also be physiological disruptions in later life as a consequence of abuse and neglect during childhood. For example, the manifestations of toxic stress can cause alterations to the body’s immune system and increases in inflammatory markers which are known to be linked to poor health outcomes.These include cardiovascular disease; viral hepatitis; liver cancer; asthma; chronic obstructive pulmonary disease; autoimmune disease; poor dental health; and depression.

 

 

The fifth chapter deals with Timely decision-making.  This is the first time that the Pro 26 week evidence has been properly set out, and in this context, it becomes more compelling  (I remain troubled by what it means for justice – I think Judges should decide on what the right timeframe for decision-making is, based on the case before them)

 

Summary points

  • · One of the most important issues to confront in promoting better outcomes for abused and neglected children is a mismatch between three timeframes: those of the developing child; those of the courts and those of the local authority.
  • · The birth of a baby is often a catalyst for change. Children who remain with parents who have not made substantial progress in overcoming adverse behaviour patterns and providing a nurturing home within a few months of their birth may continue to experience maltreatment for lengthy periods.

 

  • · Social work decisions concerning permanence are made after lengthy and meticulous deliberations. There is a tendency for delays to occur once a temporary solution has been found and the pressure to resolve a crisis has been relaxed.

 

  • · The Children Act 1989 embodies the principle enshrined in human rights legislation and policy that children are best brought up by their own families. Identifying the very few children whose parents will not be able to meet their needs within an appropriate timeframe requires professionals to set aside much of the culture of their training and practice.

 

  • · On average, care proceedings take a year to complete; data collected between 2008 and 2011 indicate that courts in only eleven local authority areas meet the previous target of 40 weeks.

 

  • · Factors that contribute to delays in completing care proceedings include: resource issues; waiting for parenting assessments and the results of attempted placements with parents; resolution of disputes and changes of plan.

 

  • · Repeated assessments of birth parents are a major source of delay, as are sequential assessments of different groups of relatives. These are sometimes undertaken in spite of obvious contraindications. There is a stark contrast between the frequency of parenting assessments and the paucity of paediatric assessments to ascertain the impact of abuse and neglect on children’s development.

 

  • · The more complex the case, the greater the proliferation of expert assessments and the longer the delay.

 

  • · Professionals encounter numerous difficulties in trying to retain a focus on the best interests of the child: attempts to ensure that parents’ rights and needs are respected can conflict with those of their children.

 

  • · Most children placed for adoption are aged two or older before they reach their adoptive families. This timeframe is at odds with research evidence that indicates that babies who are placed early for adoption are most likely to form secure attachments with new carers.

 

  • · Delayed decisions mean that children experience the cumulative jeopardy of lengthy exposure to abuse and neglect; disruption of attachments with temporary carers; unstable placements at home or in care; and prolonged uncertainty about their future.

 

  • · There is a relatively short window of opportunity in which decisive actions should be taken to ensure that children at risk of future harm are adequately safeguarded. Delays close off those opportunities

 

 

 

This is interesting, gathering some research on when and how interventions work  – the importance of gripping neglect cases early and avoiding drift is really apparent from this  – the longer the neglect has gone on, the less chance there is on intervention making a difference.

 

 

In families where children are abused or neglected, social work interventions can be effective if they are decisive and proactive and if they fit in with children’s developmental timescales.230 Actions reinforced by court orders can be more effective than those that are less intrusive, particularly where parents are reluctant to engage with support services or social workers have competing priorities.231 Where parents do not have the capacity to overcome entrenched, adverse behaviour patterns that damage their children’s welfare, placement in the care of the local authority is generally more beneficial for children than remaining at home (or returning there),232 and adoption is likely to lead to the best outcomes for very young children.233 A number of intensive, evidence-based interventions have been shown to be effective in other countries and the results of some UK pilots look promising.234

  However one of the key messages from this wide body of research is that the longer that children experience abuse and neglect without sufficient action being taken, the less effective are even the most intensive and intrusive interventions in promoting their long-term wellbeing.

 

 

 

 

5.7 The prospective study of infants suffering significant harm also showed that 93% (13/14) of the parents who were able to overcome adverse behaviour patterns sufficiently to provide a nurturing home did so within the first six months of the birth. Where children remained with birth parents who had not made substantial progress within this timeframe (12 cases), concerns about maltreatment persisted and were still evident at the child’s third birthday.

 

 This finding has obvious implications for timescales for decision-making and for intensive interventions. However it is drawn from the experiences of a very small number of children in what is already a relatively small study. It needs testing out with a larger sample

 

 

 

The research is interested in a concept called Cumulative jeopardy, where the child development, already harmed by poor parenting, is compounded by the legal process aimed at protecting them

 

Conclusion: Cumulative jeopardy

5.26 There is a complex interaction between child development timeframes and delayed actions by local authorities and the courts. Firstly, research on child development and the consequences of abuse shows that the longer children are left inadequately protected from all forms of maltreatment (emotional abuse and neglect, as well as physical and sexual abuse) the greater the chance that their long-term wellbeing will be compromised. Three recent English studies that explored the consequences of professional decision making in neglectful and/or abusive families all found that a high proportion of maltreated children are left in very damaging circumstances with inadequate action being taken to safeguard them, and with adverse consequences for their health and development.

 

Intensive interventions such as the Family Drug and Alcohol Courtscan make a difference in families, prevent recurrence of abuse and neglect and enable children to remain safely at home. They are also able to show where parents are not able to change within a child’s timeframe, so that decisions concerning alternative routes to permanence can be made in a timely fashion. However such interventions are not yet widely available in this country.

 

5.27 Secondly, a number of studies have shown that, once children are removed from abusive families they often spend lengthy periods in temporary placements before long-term plans are made for their future.Young children can become closely attached to interim carers, only to experience further loss when this attachment is disrupted as they move to a permanent home. Ward, Brown and Maskell Grahamfound that infants who had experienced this double jeopardy (six months or more in an abusive environment followed by a short period of stability and then a disrupted attachment) were showing severe developmental and behavioural difficulties by the time they were three, and that these persisted as they entered formal education. Again, evidence based interventions were not available for these children, and indeed some carers had difficulty in accessing any psychotherapeutic or behavioural support for them.

 

5.28 The long-term wellbeing of abused and neglected children can be jeopardised in other ways. Frequent changes of placements are one of the most problematic aspects of the current care system in England, as each change can have a negative impact on children’s developmental progress, and particularly their capacity to form secure attachments. Studies by Masson and colleagues284 and Ward, Munro and Deardenboth identified a relationship between delayed decisions and placement instability when children are looked after away from home. Masson and colleagues found that ‘the longer the case lasted the more likely it was that the child would move’:children moved during the proceedings in over 80% of the cases in this study. Ward, Munro and Deardenfound that very young children move at least as frequently as teenagers, and that instability is closely related to the provisional nature of decisions, as children move back and forwards between temporary, short-term foster homes and placements with own parents or new carers while they wait for permanence plans to be made.

 

5.29 Finally, there is also a relatively short window of opportunity in which decisive actions can be taken to ensure that children are adequately safeguarded. Delays close off these opportunities. If children are to remain at home, proactive engagement with social workers needs to begin early, particularly in view of evidence that case management becomes less active after they reach their sixth birthdays. There is a body of research evidence to show that if abuse and neglect are not adequately addressed at an early stage, as children grow older they may benefit less both from specialist interventions to address its consequences and from separation to prevent its recurrence.Early intervention is also urgently necessary where there are concerns that a child might need to be placed for adoption, for not only do children become increasingly difficult to place as the consequences of long-term exposure to abuse and neglect become more entrenched, but also adoptive carers are harder to find for older children.

 

 

5.30 The following timeline, showing best and worst case scenarios related to child development timescales where children remain with their birth parents and where adoption is the conclusion illustrates how these issues intertwine.

 

 

[I can’t reproduce that timeline, but it is well worth seeing, and probably having a copy at Court for most hearings. It has the potential to be extremely helpful and might actually start making that god-awful phrase “The timetable for the child” have some actual meaning]

 

“Returning home from care” – an analysis of the NSPCC research on rehabilitation of looked after children

The NSPCC have published their research into outcomes for looked after children who are rehabilitated to the care of their parents. The report can be found here: -

http://www.nspcc.org.uk/Inform/resourcesforprofessionals/lookedafterchildren/returning-home-from-care_wdf88986.pdf

Their big headline figure is that over 70% of the children in that situation they surveyed said that they weren’t ready to go home.

That initially made me blink, and wonder why the children had said that to the NSPCC but hadn’t said it to their Guardians, but then I realised that the pool of children concerned were probably the older children who were going home from s20 care rather than care proceedings.

There are still some startling figures in the report, however. In 2011, 90,000 children were looked after in England. 39% returned home (about 10,000 children, compared to the 3,050 who were adopted) Of the children who return home, between a third and a half come back into local authority care because the rehab breaks down, and around half suffer further abuse at home.

The NSPCC suggest that variance in Local Authority practice plays more of a part in whether a child is rehabilitated and whether that rehabilitation is successful than the child’s needs.

The report is quite critical of whether the family Courts have skewed the protection of children as against parental rights and article 6 too much in favour of parents.

“For children on care orders, family courts play a central role in assessing whether a child should return home. Their involvement can lead to improved planning and service provision26. However, courts have been shown to favour parents’ rights over those of the child27,28. Interviewees told the NSPCC that courts often instructed reunification, even when it was not in the best interests of the child, with decision making tipped in favour of the parents rather than the child.”

The tiny footnote there is referring to the Farmer research published in 2011, which is also worth a read.

The NSPCC recommendation in this regard is :-

Action must be taken to ensure that court decisions are always based on the child’s best interests. The new Family Justice Service must ensure that members of the judiciary specialising in family law receive training in child development and the implications of returning home from care. Information made available to the courts must enable members of the judiciary to receive better feedback on the outcome of their decisions.

To an extent, this strikes a chord with the Justice Ryder modernisation campaign, with its suggestion that the Family justice system should commission and take notice of some agreed research, rather than operating in a vacuum. I have to say, that for many years, my default reaction to seeing research quoted in a social work report is to reach for the red pen (or now, the ‘strikethrough’ button) as I know how unpopular it can be with the bench or judiciary to have a lot of research spouted to them -it tends to be either a statement of the bleeding obvious, in which case, why bother, or something which supports a proposition which is controversial (such as – the odds are that this child you’re thinking of sending home is 50-50 to suffer abuse at home as a result, or having five sessions of contact with a parent per week isn’t actually good for a baby) in which case nobody trusts it.

But you know, if all of the time and money we spend in trying to reach the right outcomes for children is resulting in half of the children we send home after that exhaustive process being abused, then we might want to recalibrate.

(of course, from the other side of the coin,  there’s something of a paucity of research as to the number of children who get long-term fostered or adopted when the Court and professionals were wrong and they could  successfully have gone home – that’s probably a harder piece of research to work out – probably working on the parents who go onto have another child and successfully care for that later child)

It is a bit hard to totally trust research commissioned by the NSPCC – I’m not questioning their integrity in the slightest, but when it comes down to working out where they stand on the “Keep children safe at all costs” versus “keep families together at all costs” spectrum (or the Cleveland-Haringey axis, if one is being unkind) it doesn’t take long to spot that they come with an agenda.

(Not necessarily a bad agenda – I wouldn’t claim to be precisely on the fulcrum of that particular see-saw myself – but it makes it harder to rely on their research as probative. It’s like seeing a report from Benson and Hedges about passive smoking – you sort of suspect there’s a starting point there)

 I liked this quote from a senior social work manager, though :- “Support is crucial. [But] we have to take a pragmatic approach as often the support that has been suggested by the courts or experts is simply not available.”

 Very true – an awful lot of expert reports which recommend that the door to rehab is not shut do so in complete absence of context about just how feasible it is that the parents GP will commission six months of therapy for them, and that that can start without delay.

The first bit of this next quote is blindingly obvious, the second part much less so.

Poor parenting, drug or alcohol misuse, domestic violence, and parental mental health problems, all increase the chance of harm when the child returns home. Farmer et al found that 78 per cent of substance-misusing parents abused or neglected their children after they returned from care, compared to 29 per cent of parents without substance misuse problems29

 

78% of rehabs involving substance-misusing parents result in further abuse or neglect. Being a maths guy, that suggests to me that rehab to parents who misuse substances is more likely than not to result in the child being abused or neglected if rehabilitated to their care. (of course, what you argue in any individual case is that for this particular parent, these are the factors that mean the Court can be confident that they are one of the 22% who won’t abuse their child; but that context of how prevalent the risks are to that subject-group remains important.)

 The challenge of rehab to a substance-misusing parent is significant – on the one hand, if you can resolve the drug problems there’s often a good parent underneath, but on the other it is so easy to be over-optimistic about an upward curve on a graph of peaks and troughs being a sign of a genuine change – being too close to the graph to see the pattern as being anything other than up, up and up)

From a bit more of a parental perspective, I think this is probably a valid and fair criticism of LA support.

Where support is provided it is often removed after a short period of time, before a problem has been sustainably addressed. Alongside resource constraints, support can be removed due to a belief that parents need to be able to shoulder their responsibilities and not become dependent on services33. Support is often discontinued once a child returns home without any assessment of whether the families’ problems have diminished. This results in further instability and an increased risk of harm to the child. Parents also report concerns about the short-term nature of interventions designed to support them.

Some more recommendations – all of which make sense to me

Decisions about whether a child should return home must always be led by what is in their best interests.   [Of course, it already is, it is just that what one body thinks is in the child's best interests isn't necessarily the same as what another body thinks]

Support for children and their families prior to and following reunification must improve. 

 The government should ensure there is sufficient support for parents who abuse drugs and alcohol, who are victims of domestic violence, who have mental health difficulties or who have other issues which could affect their ability to parent effectively when their child returns from care. Local services must be incentivised to provide sufficient support for these parents. 

 Local authorities must ensure that the support provided to children and families matches the needs identified in a child’s risk assessment. This information should be used to inform local commissioning and investment decisions. •

Local authorities must ensure that foster carers and residential care workers are involved in the process of a child returning home from care and are supported to help the child prepare for a return home, where that is in their best interests. 

 Guidance on designated teachers for looked after children should be revised to include children who return home from care, even if they cease to be looked after on their return. The support provided by the school can play an effective part in successful returns home.

The very last bit of the report sets out a new method of classifying risk, which the NSPCC are working with 8 local authorities on. To my cynical eye, it looks somewhat simplistic given how complex the variables are in child protection cases, but it’s not bad as a benchmarking exercise. I’m not sure I’d place quite as much weight on them as the child’s wish to return home being an element that allows you to consider the risk is lower. (It seems to be about a third of the factors in weighing the risk, which appears to my untrained eye to be far, far, far, far, too high)

Classifying the risk of reunification – a tool to support decision making about children returning home from care, adapted from Safeguarding Babies and Very Young Children from Abuse and Neglect (Ward, Brown and Westlake, 2012) 

 Severe risk

 • Risk factors apparent and not being addressed, no protective factors apparent.

 • No evidence of parental capacity to change and ambivalence or opposition to return home by child or parent.

High risk

 • Risk factors apparent, and not being addressed. At least one protective factor apparent.

• No or limited evidence of parental capacity to change and ambivalence or opposition to return home by child or parent.

Medium risk

• Risk factors apparent or not all risk factors addressed. At least one protective factor apparent.

 • Evidence of parental capacity to sustain change. Parents and child both want return home to take place. 

 Low risk

 • No risk factors apparent, or previous risk factors fully addressed, and protective factors apparent.

• Evidence of parental capacity to sustain change. Parents and child both want return home to take place.

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