Capturing the scale and pattern of recurrent care proceedings: initial observations from a feasibility study

23 JUN 2014

Karen Broadhurst, Judith Harwin, Mike Shaw and Bachar Alrouh

The research team would like to acknowledge the contribution of Dr. Mark Pilling from the University of Manchester, statistical advisor to the research team.

This project is funded by the Nuffield Foundation: http://www.nuffieldfoundation.org/recurrent-care-proceedings-feasibility-study

The below article has been taken from the August 2014 issue of Family Law and made available ahead of print.


Introduction

This article reports the initial findings of a feasibility study that has captured the scale and pattern of recurrent care proceedings. Although frontline professionals have reported long-standing concerns about the repeat clients of public law proceedings, prior to the study we report, the scale of the problem has been unknown. With funding from the Nuffield Foundation and, support from the Child and Family Court Advisory Service (Cafcass) and the President of the Family Division, the research team has arrived at a first estimate of prevalence, confirming that recurrence is a sizeable problem for the English family court. Based on cases that completed during the observational window 2007-2013 (calendar years), 7,143 birth mothers appeared in 15,645 recurrent care applications concerning 22,790 infants and children. Moreover, the study most likely underestimates recurrence, because reliable data concerning completed cases is not available before 2007. Initial observations are that the spacing between recurrent care proceedings is very short, which raises searching questions about prevention. Where episodes of care proceedings follow in swift succession, most likely prompted by the birth of another infant, this affords mothers little opportunity to effect change. Unless, this ‘status quo’ is tackled, it is difficult to envisage how vulnerable birth mothers can exit this cycle. From the profile of final legal outcomes that we have established, we can infer that only a small percentage of infants or children appear reunified with birth mothers. Preliminary recommendations are made in respect of policy and practice change.

Using Cafcass administrative data to profile recurrence: challenges and initial findings

Cafcass collects administrative data pertaining to all cases of s 31 care proceedings. Electronic data concerning the total population of parents and children in care proceedings is held in the agency’s Case Management System (CMS) and more detailed records are held as Electronic Case Files (ECF) files. Working in close collaboration with Cafcass data management personnel, de-identified administrative data was exported from CMS to software that enabled data to be restructured to answer questions about recurrent care proceedings. There is increasing recognition internationally of the value of re-using administrative datasets for research purposes, given that studies can be based on very large sample sizes, the scale of which is difficult to achieve through new primary data collection (UK Administrative Data Research Network, 2012). A restructured database has now been developed. It contains anonymised records pertaining to 46,094 mothers in care proceedings, 7,143 of whom are ‘recurrent mothers’ (15.5% of the sample) during the observational window 2007-2013.

The team has focused specifically, on completed cases of recurrent care proceedings issued under s 31 of the Children Act 1989. Cases were included in our restructured dataset where they completed (final care order outcome recorded) between 2007 and 2013. To achieve our samples, a set of filters was applied to identify the total population of unique (ie not duplicate) mothers within care proceedings and the total sub-set of ‘recurrent mothers’ within the larger sample. Birth mothers who record a recurrent profile are linked to more than one care application over time. Taking into account, first and subsequent care applications, 29% of all care applications are linked to recurrent mothers. In some areas of England, this percentage is significantly higher with the national range extending to 39%. Birth mothers can be linked to more than one child at each care application and, as already noted, we found that 22,790 infants and children were linked to recurrent cases, equating to 25% of all children in care proceedings. As stated, our observational window concerned cases that completed between 2007-2013. Work is ongoing to add cases that have completed in 2014 to our dataset. Over time, the value of retrospective longitudinal datasets increases as new waves of data are collected. It will be important to revisit questions about recurrence in light of the Children and Families Act 2014 because the introduction of a shorter 26-weeks deadline for care proceedings resolution may impact on recurrence rates.

A key finding to emerge from the study was that intervals between recurrent care proceedings are short. We discovered that the average interval between the start of the first set of proceedings and the start of the second, was 93 weeks (median was 75 weeks). As many cases of care proceedings in our sample concerned infants, this suggests that in the majority of cases, women were pregnant again during proceedings or shortly after. The intervals between care applications were even shorter when mothers had more than two applications. This suggests that the highest risk parents had the least time to achieve change. The average duration of the first set of care proceedings was 57 weeks (median was 51 weeks) but the average duration of the second set of proceedings was 37 weeks (median was 32 weeks), clearly indicating decreasing opportunity for change. Given that our dataset is based on cases that completed between 2007 and 2013, it is unlikely that changes brought for with the introduction of the revised Public Law Outline in 2013 or the Children and Families Act 2014 can fully account for this pattern of decreasing case duration. Further sensitivity analyses will be run to examine the impact of legislative change.

While the value of administrative data lies in sample size, the range of variables against which frontline personnel routinely record case information may be insufficient to address the full range of questions that research teams seek to answer. In respect of the CMS records held by Cafcass, information about ethnicity or disability could not be mined at the level of the total population. Neither was it possible to report on placement outcomes. However, sufficient information was collected with a very high degree of completeness to enable other important population characteristics and final legal outcomes to be established.We were able to ascertain that 50% of birth mothers caught in a cycle of repeat care proceedings were very young, aged 24 years and under at the first care application, and 19% were aged 14 to 19 years of age. Recurrent mothers were younger than those who only had one care application and this was statistically significant. Moreover, a high proportion (58%) of all recurrent applications concerned infants under the age of 12 months. In addition, in 42% of all applications, the application was made at/close to birth (within one month).

The initial findings indicate that a range of legal orders resulted from recurrent care proceedings, although care orders predominated. It was noteworthy that, where data were recorded, a Supervision Order only was made for 9% of all children in recurrent applications. This suggests that in a small percentage of cases, children returned or remained at home. Furthermore, 10% of all children in recurrent applications were subject to Special Guardianship Orders, indicating that kin play an important role in providing long-term care for infants and children in recurrent cases. It is now important to look behind these statistics to establish how and why different legal outcomes result from recurrent cases.

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Conclusion

Work to restructure care proceedings data held centrally by Cafcass began in November 2013 and is ongoing. In particular, further work as part of this feasibility study will establish what can be learned about fathers in these cases. Our initial qualitative review of a sample of randomly selected Cafcass ECF (qualitative) files has already shown that in some cases the same mother and father appear as a couple before the family court in successive proceedings. In addition, distribution of recurrence by local authority and court area will be established. Given very large sample sizes and that analysis can be based on population-wide data, the research team can make use of more powerful statistical techniques to confirm and extend the initial observations we draw. The research team is also undertaking an exploratory exercise with the Department for Education to establish whether the care backgrounds of mothers and fathers within the sample of recurrent cases, can be profiled.

The initial results suggest some important practice and policy implications. It is clear that in order to assist mothers to exit a cycle of recurrent care proceedings, attention must be paid to the dynamic which sustains recurrence. This dynamic is sustained by short interval pregnancies and short interval care proceedings. As part and parcel of a multi-faceted recovery-focused approach to intervention, birth mothers must be helped to extend the window between pregnancies. The health implications of multiple short interval pregnancies for mother and infant have been substantially discussed within the medical literature (Wendt et al, 2012) and given the new evidence we present, preconception care for high-risk birth mothers should become a priority. Where the local authority is notified that a subsequent pregnancy has occurred, co-ordination of midwifery and children’s services as early as possible will be imperative to ensure both assessment and individualised support. Here, treatment recommendations made in a previous set of care proceedings must be addressed. Excellent grassroot initiatives that aim to tackle recurrent care proceedings have already been piloted, such as Salford City Council’s ‘Strengthening Families’ project (Warrington, Gardner and Garraway, 2014) or Suffolk County Council’s ‘Positive Choices’ (Suffolk Children and Young People’s Service, 2010). These initiatives are delivering promising results. Much can be learned from the successes of the Family Drug and Alcohol Court (FDAC) about how engagement with parents can be maximised through a problem-solving approach (Harwin et al, 2014). This might be particularly helpful for teenagers and very young parents attending court for the first time who could benefit from the individualised ongoing support provided within this model.

Further research is needed to identify the detail behind the statistics we present. As innovative projects continue to emerge across England they will benefit greatly from a fuller understanding of the needs, risks and prognosis for change of recurrent mothers based on large-scale data sets. Mothers who appear and re-appear before the family court are unlikely to generate much public sympathy (Broadhurst and Mason, 2013), however, the scale of the problem that we have evidenced indicates the need for a concerted, national policy response. The age profile of this population is very concerning given that 50% of mothers are aged 24 years or less at first care application. Where a negative cycle of recurrent proceedings is neither anticipated nor interrupted, it is likely that the damaging effects of care proceedings (Freeman and Hunt, 1998), which in these cases are multiplied, may serve to extinguish the possibilities for recovery that maturation might otherwise bring for this group of women. Society pays a heavy price for neglect of this problem.

References

K Broadhurst and C Mason, (2013) ‘Maternal Outcasts: Raising the profile of women who are vulnerable to successive, compulsory removals of their children – a plea for preventative action’ (2013) 14 Journal of Social Welfare and Family Law 291.

J Harwin, B Alrouh, M Ryan and J Tunnard, Changing Lifestyles, Keeping Children Safe: an evaluation of the first Family Drug and Alcohol Court (FDAC) in care proceedings (Brunel University, 2014), http://www.brunel.ac.uk/fdacresearch

P Freeman and J Hunt, Parental Perspectives on Care Proceedings (TSO, 1998).

Suffolk Children and Young People’s Service (CYPS) (2010). Support for birth mothers and fathers whose children are subject to permanency arrangements. Unpublished Report, paper available via authors.

UK Administrative Data Research Network (2012) The UK Administrative Data Research Network: Improving Access for Research and Policy. Report from the Administrative Data Taskforce, http://www.esrc.ac.uk/_images/ADT-Improving-Access-for-Research-and-Policy_tcm8-24462.pdfhttp://www.esrc.ac.uk/_images/ADT-Improving-Access-for-Research-and-Policy_tcm8-24462.pdf

W Warrington, J Gardner and J Garraway, Salford Strengthening Families Project: symposium paper (Tavistock Centre, 6th of June 2014). Available from authors: wendywarry@hotmail.co.uk

A Wendt, CM Gibbs, S Peters and CJ Hogue, 'Impact of Increasing Inter-pregnancy Interval on Maternal and Infant Health' (2012) 26(1) Paediatric and Perinatal Epidemiology 239-258.


Dr Karen Broadhurst (Principal Investigator)

Dr Karen Broadhurst is Senior Lecturer in Socio-Legal Studies at the University of Manchester. Karen has a long-standing interest in prevention where children are on the 'edge of care'. Karen has led or served as co-investigator for studies funded by the Nuffield Foundation, DfE, Cafcass and the Economic and Social Research Council. Reflecting her interest in vulnerable adolescents in care, she currently serves on the Children's Homes Workforce Development Group at the DfE.

Dr Mike Shaw (Co-investigator)

Dr Mike Shaw is Consultant Child & Adolescent Psychiatrist in the Child & Family Department at the Tavistock and Portman NHS Foundation Trust where he is Clinical Lead for the Family Drug & Alcohol Court which is a collaboration between the Tavistock and Coram. His work is partly funded by grants from the Monument Foundation and the DfE. He has a longstanding interest in child mental health and the law including autonomy, protection and fairness.

Professor Judith Harwin (Co-investigator)

Judith Harwin is Professor of Social Work at Brunel University and directs the Centre for Child and Youth Research. She has a particular interest in outcomes for children in public care, parental substance misuse and child welfare and has held grants from the Nuffield Foundation, Department of Health, EU and UNICEF. She has recently published with a team at Brunel University the final evaluation of the Family Drug and Alcohol Court: Changing Lifestyles, Keeping Children Safe (J Harwin, B Alrouh, M Ryan, and J Tunnard (www.brunel.ac.uk/fdacresearch)). She is a member of the BAAF Research Group Advisory Committee and served on the DfE Returning Home from Care Expert Group.

Dr Bachar Alrouh (Research fellow)

Dr Bachar Alrouh is a Research Fellow at Brunel University. Bachar's doctoral studies were in data security and he also has particular expertise in quantitative research and computing. Prior to joining the team, Bachar was a researcher on the Family Drug and Alcohol Court Evaluation and is a co-author of reports on FDAC.