Education Committee - Children first: the child protection system in EnglandWritten evidence submitted by Centre for Family Policy and Child Welfare, Bristol University

THE REUNIFICATION OF LOOKED AFTER CHILDREN WITH THEIR PARENTS:
PATTERNS, INTERVENTIONS AND OUTCOMES

Reunification in the UK has for long suffered from neglect in policy, practice and research. This study aimed to fill some of these research gaps by means of a two-year follow-up of a sample of 180 looked after children who were aged 0 to 14 when they returned to their parent/s during a one year index period.1 The sample was drawn from six local authorities and data collection was by means of case file reviews, followed by interviews with a sub-sample of 34 parents, 19 children and 22 social workers. At the point of the returns 30% of the children in the study were under 5, 21% 5–10 and half (49%) aged 10–14.

Key Findings

The Children in Care

Half (53%) of the children entered care because of abuse or neglect and a quarter (28%) because of the children’s behaviour. Before returning home, the majority of the children were voluntarily accommodated (60%). By the time of the return, the remainder were subject to Interim or Care Orders (36%) or Supervision Orders (4%). As expected, children subject to court orders were significantly younger than those voluntarily accommodated.

Most children returned home from foster (71%) or kinship care (8%), but 13% did so from residential units or schools whilst a small group (8%) returned to the community with their parent/s from mother and baby foster placements or residential family assessment centres. Some of the parents interviewed were dissatisfied with residential care since their children’s behaviour had rarely improved and had sometimes worsened there; whilst 9% of the children were abused in care (by caregivers or other children), which could lead parents to remove children from placement, judging that care was unsafe.

Initial Care Plans

There were four distinct groups of children in terms of the relationship between their initial care plans and the time it took before they returned home. At one extreme were young people (6% of the sample) who absconded home or were removed soon after placement by dissatisfied parents before any plan had been made for them? A second group of children (41%) whose initial plan was “return home” were mostly accommodated adolescents who returned within an average of six months. In contrast, younger children whose initial plan was “time-limited assessment” (45%) were generally on Care Orders, considered at risk and took twice this long to get home. A final small group (8%) returned to their parents after an average of three years in care because the permanence plans made for them had not been fulfilled. The first two groups (like the others) had adverse backgrounds but they had also experienced a high number of previous returns home, yet monitoring and services for them were relatively sparse.

Assessment and Intervention

43% of the children returned to a parent without any in-depth assessment of their situation (and a third were never assessed before or during the return). Assessment was linked to service provision and to return stability. More specifically multi-agency assessments—which often led to services—were linked to the resolution of the problems that had led to care and multi-agency work to return stability.

Specialist professionals saw a third (34%) of the children and almost half (49%) of the parents before the children returned home, but in other cases (20% of parents and 9% of children) referrals had been made to mental health or other professionals but did not eventuate, because the service was unavailable or parents did not keep appointments. In addition, social workers conducted direct work with a fifth of the parents (22%) and children (19%).

Conditions for the return were set in just over a third of cases (37%) and were mostly set when children were younger, the family situation had been assessed and when the return took place during care proceedings. Where no work was provided for any family member (23% of cases), problems tended to persist into the return.

The Children’s Pathways Home

The Decision for Return

For most children (61%), the decision to return them to a parent had been made (and recorded) within six months of them being in care. The remainder waited a year (10%) or more (11%) before the return decision was made.

Planning and Pressures for Return

The returns had been officially planned in three quarters (73%) of cases. Whilst improvements in the family situation, or more rarely the child’s behaviour, accounted for almost half (48%) of the primary reasons for the planned returns, pressures from the parent, child, placement or the court accounted for another quarter (28%).

Over a quarter (27%) of the children returned home even though no official plan for reunion had been made. They returned to a parent because: they had absconded there; been removed from voluntary accommodation by their parents; their placement had broken down or the social worker had agreed under pressure to a return home. Moreover, pressures for reunification were evident in ¾ of all the cases. When children pressed for reunification or their return was accelerated because of placement or other problems (often connected with difficult child behaviours and sometimes with absconding home) there were more return breakdowns.

Reservations about the Returns

Professionals expressed concerns about as many as a third (35%) of the returns (including social work reservations in 26% of cases). In the interviews parents often said that they too had harboured doubts about the wisdom of return at that time and about their ability to cope, whilst children had been worried about rejection, abuse and exposure to their parents’ problems when they returned.

Preparation for the Returns and Problem Resolution

Specific preparations for the children’s returns were made in a third (36%) of cases whilst only a third of the children (aged 4+) were recorded as having been consulted about the timing and manner of the return, and some told us that they had gone home too quickly without adequate preparation. When adequate preparation for return had been made, reunification was significantly less vulnerable to disruption. In addition, when caregivers (mostly foster carers) had developed an exceptionally supportive relationship with the parents (a fifth of cases), there were significantly fewer return disruptions. In such placements, caregivers worked closely with the parents and/or children to bring about change, remaining available and at times involved after children returned home.

Many (57%) of the returns were supported with a package of services (although in a quarter no services had been provided for the parents or children whilst the child was in care). In the researchers’ view, in only a quarter of the cases (26%) had all the problems for the children and their parents been addressed prior to reunion? Often, issues which had the potential to jeopardise the success of the returns, remained unresolved or hidden (especially drug or alcohol problems or continuing relationships with violent partners).

The Returns

Change and Continuity

Two-thirds of the children (64%) returned to the same parents (or parent figures) they had lived with previously, a quarter (26%) returned to a household which a parent or partner had left or joined while they were away, whilst 10% returned to a different parent. Other siblings had also left or joined these households so that, in total, only half of the children (52%) did not experience any changes in the membership of the household to which they returned. Returning with siblings was related to return stability (as in other kinds of placement).

The likelihood of return stability was significantly higher when children moved to the other parent (who generally had fewer problems than the parent/s from whom the child entered care) or when there was a change in household composition (which could mean that a new more positive partner had joined the family or a former negative partner had left). So, change was often positive.

The Children’s Experiences

Although most children returned to the same school, some saw a change of school as an opportunity for a fresh start. Just under half of the children interviewed had not been able to maintain contact with all their friends whilst they were in placement and the same proportion lacked strong friendship networks during the returns. A third confided in no-one once they had returned home, whilst a few felt like outsiders in their own families.

Returning to Parental Difficulties

Three-quarters of the children (77%) were returned to parents who had previously abused or neglected them. Four fifths (82%) went to parents with a history of domestic violence, drug or alcohol misuse or exposure to inappropriate sexual activity2 and three-fifths (60%) to a parent with mental health problems. Ten percent of the mothers (10%) and five percent (5%) of the fathers had learning difficulties.

Parental ambivalence (relevant to 42% of the children) and previous failed returns (which had occurred for 38%) were significantly related to return disruption. This highlights the need for proactive intervention to tackle children’s and parents’ difficulties before any renewed attempt at return.

Children’s Services Support for the Returns

Support was provided by Children’s Services to the majority of the children’s families (84%) during the return. This included financial or material support (41% of the families), assistance from Family Support Workers (41%), respite care (24%) and attendance at play-schemes or other activity groups (12%), albeit that such help was sometimes short-term. Over half of the children under school age received assistance to attend childminders or day nursery. Social workers also provided direct work to one in five of the children and parents.

Other Agency Services

Nearly half of the parents (46%) and of the children (aged 4 +) (43%) were also provided with specialist support by other agencies, such as mental health or youth offending teams, local family centres or health professionals.

The Impact of Services

Families with children subject to Care or Supervision Orders received the best support with over three-quarters (77%) rated by the researchers as good or very good compared with under half (45%) of the support provided when children had been accommodated. Returns were significantly more stable when additional services such as day care or specialist help for the parent or child were provided during the return. The social work task in arranging reunification was often “huge” and depended on team manager support, particularly when cases required intensive services. However, in practice reunification was sometimes viewed as an area where resource savings could be made. Highly competent social work (that is consistent and purposeful work and monitoring of the child and parent/s) was significantly related to return stability. These findings emphasise that appropriate specialist services and highly skilled relationship-based social work can and do make a difference to return outcomes.

Gaps in Services

There were many gaps in the services to support return, most notably insufficient assistance with behaviour management (especially in dealing with behaviourally difficult adolescents) and the lack of help for parents with substance misuse problems. Whilst almost half (46%) of the mothers and a fifth (17%) of the fathers to whom the children returned had known drug or alcohol problems, only 5% were provided with treatment to help them address their substance misuse. Another gap was evident where the policy of providers (particularly CAMHS) was not to offer a service until the child was settled (which in some cases never happened).

In all, almost a fifth of the parents (17%) and two-fifths of the children (40%) did not receive any support at all during the return—either from Children’s Services or a specialist agency—and as a result, some parents were caring for very disruptive or emotionally troubled children without any assistance. The full extent of many difficulties did not become apparent until some time into the return or after it had disrupted.

Support from Schools

The local education authority provided educational assistance to over half of the school-age children. Some schools provided considerable support to children (and sometimes parents) and the interviews suggested that this could be important to the success of the returns. During return 42% of the children attended school poorly whilst 20% were excluded from school and both of these issues were significantly related to return disruption.

Informal Support

Informal support during the returns could be critical and was provided to over half of the children’s families by friends, family or local organisations. Good informal support for parents and/or adolescents was significantly related to return stability, whereas social isolation was highly associated with return disruption. When parents or young people lack adequate support from their own networks, attempts to initiate a network of informal support may be needed or more professional help and support in compensation.

Monitoring and Regulation during Returns

Other agency professionals (eg health visitors or nursery staff) provided supervision of the child in three fifths (61%) of cases and such monitoring was associated with return stability. Setting conditions before or during return was also related to return stability but was rarely undertaken with the parents of adolescents. Returns were less likely to break down when the return took place during care proceedings, was subject to multi-agency supervision, the children were on the Child Protection Register or had been looked after from birth. These were the returns which were closely monitored and resourced to try to ensure that the home situation improved.

Nonetheless, parents often disliked being monitored or assessed, feeling that professionals, especially social workers, were “digging the dirt” on them and sometimes that control was provided without any accompanying encouragement. Indeed, a small number of the children were rarely or never seen during the return, partly because of parental/child resistance. A number of the parents were extremely difficult to help, with some attempting to conceal their substance misuse problems or violent partners from social workers. Forming constructive working relationships with parents in such situations was far from easy but when this was achieved parents were appreciative. Firmness about parenting standards needed to be combined with empathy.

Case Closure

Almost half (48%) of the cases had been closed before the end of the two-year follow-up period—a fifth within six months. Many (47%) had been closed despite ongoing concerns and these returns had an increased chance of breaking down. Almost half of the closed cases had to be re-opened, whilst for a few families a social worker was never allocated or never visited during the return.

The Children’s Progress at Home

Recurrence of Parental Difficulties, especially Substance Misuse

Once the children went home, there was considerable improvement in some areas. Domestic violence, which had featured in two-thirds (67%) of families before the children entered care, was reported in under a fifth (16%) during the two-year follow-up period, probably because mothers had separated from violent partners whilst substance misuse, which had been an issue in 59% of the families, was now evident in just under a third.

However, the difficulty faced by professionals in bringing about change in parental behaviours is shown by the recurrence rates of these issues. Whilst domestic violence re-appeared in only a fifth of cases, alcohol misuse recurred in more than half the cases (51%) and drugs misuse in 42%. Other issues which recurred frequently were social isolation (74%), financial problems (59%), poor parenting skills (57%), multiple parental partners or house moves (53%), parental anti-social behaviour (43%) and poor home conditions (42%), despite a drop in the overall prevalence rates of these behaviours.

In addition, all of these issues were significantly more likely to occur where a parent was misusing drugs or alcohol. In addition, children of substance misusing parents (78%) were much more likely be abused or neglected than children of parents without substance misuse problems (29%).

Abuse and Neglect

Almost half of the children (46%) were abused or neglected during the return—exactly half the number who were thought to have been maltreated prior to entering care (91%). Neglect (33%), emotional abuse (25%) and physical abuse (21%) were particularly likely to recur, unlike sexual abuse (9%), where the perpetrator had often left the household. New occurrences of maltreatment were relatively rare, except in relation to physical abuse. Statistical analysis revealed that poor parenting skills was the greatest predictor of child maltreatment during the return, followed by drug or alcohol misuse.

After concerns about maltreatment had been raised, 17% of the children were immediately taken back into care. However, 41% of them remained at home without adequate safeguards, whilst 16% of the children stayed at home despite ongoing maltreatment. When babies or children under five were at risk or had been physically abused, great care was usually taken to assess the parents and monitor returns and swift action was taken if necessary to remove the children. However, practice was much less consistent as children became even a little older. Delays in returning children to care sometimes occurred because there was thought to be insufficient evidence to initiate care proceedings.

Only a quarter (28%) of the children’s names were on the Child Protection Register during the return (including less than a third of those who had suffered abuse). The children who were least likely to be monitored adequately were those where there had been no assessment or who were not on the Register.

Most forms of difficult behaviour were more likely to recur during the return than be resolved. For example, almost half of the children exhibited conduct problems, under-achievement or non-attendance at school or nursery during the return. Many parents struggled to cope with these behaviours and concerns about the parents’ care of 69% of the children were reported to Children’s Services, mainly by professionals but also by relatives and neighbours.

Nonetheless, most children (57%) appeared to be close to a parent, although a tenth (11%) were close to only one parent/figure and not the other, and worryingly a third (32%) were close to neither. A considerable number of the young people said in interview that they found things difficult at home (12/16), felt sad, confused or angry or missed their former placement. Seven young people were depressed or felt lonely and abandoned and two wanted to be in care.

The Outcomes of the Returns

By the end of the two-year follow-up period almost half (47%) of the returns had broken down.

Although most (59%) of the continuing returns were rated as of good quality (or “successful”) for the child, a quarter (24%) were borderline (where it was finely balanced as to whether or not the child would have been better off in care) and 12% were of poor quality (or “unsuccessful”). Given this situation, there is a need for closer monitoring of return decisions and return progress within local authorities.

After the Returns Ended

A third of the disrupted returns failed within three months, a further third after 4–9 months, and the final third before the end of the two-year follow-up. The 84 disrupted returns had lasted an average of seven and a half months. The parents themselves initiated the end of almost half of the returns (43%), whilst Children’s Services (28%) or the court (5%) intervened to protect the children a third of the time. Few children (17%) were able to return to the placement they had been in before the return. Almost two thirds (62%) of the children with disrupted returns were reunified again, once or more during the remainder of the follow-up period and half of these returns also failed.

Issues

Legal Status and Age

Children who returned home on a Supervision or Care Order (or who were on the Child Protection Register) were significantly less likely to experience return breakdown as compared with those who had been voluntarily accommodated. Part of the explanation is that children on orders were younger,3 received more (and better) support, were more often set conditions and were subject to closer monitoring. However, age was only part of the picture, since for both the younger and the older children, return to their parents on court orders was significantly associated with lower levels of return disruption, compared to when no order was in place.

Being over the age of 10 was strongly associated with return disruption, as in other kinds of placement and in previous research on reunification. A range of adolescent behaviours prior to the return were significantly linked to disruption (substance misuse, offending, truancy, school exclusion, conflict with parents). The proportion of young people who showed improved behaviour or lessening of their difficulties as a result of their stay in care was low.

The interviews revealed the difficulties of bringing about change in such young people. Nonetheless, there were promising examples of good practice, where the placements in care had included interventions for the young people aimed at helping them to change their behaviour, (and assistance for parents with behaviour management) and where adolescents and their parents were able to access a strong network of support after return, which could include respite care and support for the young people from a mentor, teacher or a parent’s partner. After-care services from the placement also helped to maintain some of these returns.

Parents’ Views of the Help they Need

When we asked parents what help they had needed they prioritised: treatment for substance misuse combined with clarity about the consequences of their taking no action about their addiction; help with behaviour management and earlier recognition of their difficulties with their children; help to build up their self-confidence as parents; to be listened to and respected; monitoring of their progress that is combined with emotional warmth; direct help for children (such as mental health assistance, anger management and mentoring), respite care and the opportunity to talk to other parents in the same situation.

Factors that Related to Return Outcomes

Prior Parenting, Abuse and Hyperactivity

A number of the factors that significantly related to return outcomes have already been mentioned. In addition, previous physical abuse of the child and evidence that parenting skills were poor prior to the return were both significantly associated with return disruption. Prior sexual abuse of the child was related to poor quality returns (probably because of the link between sexual abuse and poor parenting and with later emotional and behavioural difficulties). For children under the age of 10, previous hyperactive behaviour was also strongly associated with return breakdown.

The combination of factors which best predicted return stability

When we analysed the factors by age, we found that in order of influence for younger children the most influential variables in relation to return stability were: parental ability to cope after return, the child having entered care with siblings, receiving financial and practical support, being on a court order and change of home. But for adolescents the most influential variables were in order of influence: a change of home, good informal support and the local authority the child lived in (see next section).

Different Local Authority Policies and Practice

There was considerable variation in the priority and resources given to reunification by the different authorities in the study and the return disruption rates in our local authorities varied widely4 from a high of 75% of returns to a low of 32%; similarly, success (or quality) rates varied from a high of 64% to a low of 10%. It appears then that different practices in different authorities lead to different outcomes. Local authority variations in practice were particularly apparent in relation to the outcomes for the older children, where practice appears to be especially variable across authorities. There is therefore a need for authorities to develop clearer policies and procedures to guide reunification practice for all children, whether they are accommodated or on Care Orders.

Highly Unsatisfactory Returns

We considered that 20 of the returns of the children who remained at home at follow-up were borderline (where it was finely balanced whether the child was better off at home despite the serious limitations there or should have been in care), whilst 10 (6%) were of very poor quality. In the latter group, children were living with parents with serious mental health problems or substance misuse difficulties (sometimes combined with domestic violence) who were often also physically or emotionally abusing their children, such that it appeared to be damaging to their welfare.

Oscillation

Two thirds (64%) of the children in the study had experienced one or more failed returns over the time we followed their histories, including a third (35%) with two or more. This latter third of children we termed “oscillators”. One such child had endured 13 return breakdowns by the age of 16. The social workers and children in the interviews commented on the severe negative impact on children of oscillating between home and care. More needed to be done in some cases to prevent a continuing pattern of oscillation between home and care eg through ensuring that reviews pick up patterns of oscillation so that more decisive intervention can be planned.

Implications for Policy

Returns subject to scrutiny by the courts had high levels of assessment, monitoring and service and were more likely to succeed. A more structured approach to returns for accommodated children, combined with parenting support and behaviour management is needed.

There is a need for more targeted work with young people with behavioural and emotional problems during their placements and also more consistency in arranging tailored support packages for young people and their parents to help to make these returns work. The use of respite care and marshalling informal support for parents and young people might play an important part in maintaining some of these placements.

It might be useful if individual local authorities reviewed their reunification practice, given the variation in success rates across our authorities, especially with accommodated children. The value of skilled and purposeful social work reunification practice requires recognition within authorities.

Assessment and case planning need to specify from the outset what needs to change, over what timescales (having regard to children’s developmental needs) before return is possible and how this is to be supported and monitored. Using written contracts which agree clear goals with parents and which are regularly reviewed can be useful, alongside the provision of tailored services addressing parents’ and children’s difficulties.

More focus is needed on preparation for return. There are likely to be benefits if foster carers and residential workers could be more involved in preparing children and in providing follow-up support to them and to their parents after reunification. This is an area of practice that might usefully be further developed.

Reunification practice in cases where parents misuse alcohol or drugs needs to be reviewed, to introduce clear expectations that parents will be required to address their substance misuse before children are returned to them and that their use of substances will be closely monitored and reviewed before and during return. In addition, more access to treatment for parental substance misuse problems is required alongside more training for practitioners in how to work with substance misusing parents—substance misuse was related to higher levels of abuse and neglect, poor parenting and domestic violence during return.

Standards during the return need to be agreed and regularly reviewed with action being taken when children’s quality of life at home becomes unsatisfactory or when they oscillate between home and care. Not taking such action involves considerable ‘costs’ to the well-being and future prospects of the children concerned.

Reference

Elaine Farmer, Wendy Sturgess, Teresa O’Neill and Dinithi Wijedasa (2011) ‘Achieving Successful Returns from Care: What makes reunification work?’ London, BAAF (British Association for Adoption and Fostering).