AIMS CONTRIBUTION TO THE GOVERMENTS NICE LEGISLATION

[Alison J Stevens]

Name:		Jean Robinson
Organisation:		Association for Improvements in the Maternity Services
Section number Indicate section number or ‘general’ if your comment relates to the whole document.	Page Number	Comments Please insert each new comment in a new row.
3.4.	11	HELPING CHILDREN AND YOUNG PEOPLE TO....MAINTAIN CONTACT WITH BIRTH PARENTS. We are disappointed that this guideline gives inadequate attention to this, as it clearly appears as important surveys of looked after children by the Children's Rights Officer Firstly, the blockages in the system have to be recognized and dealt with. Social workers seem to see reduction of contact as a weaning process, however much children want it, from parents whom they have labelled as unsatisfactory, but whom we, as experienced community workers, having seen all the court documents, and having spent extended time in the family, see as more than "good enough." and on observing contacts have seen children as strongly attached. Children in care are still denied mobile telephones and access to computers long after their peers have them - because of fear that they will contact their parents or family , in cases where there has been no suggestion of serious or sexual abuse of any kind. We have seen numerous cases where reduction or loss of contact happens not because children need or wish it - quite the reverse. We see it used over and over again as a disciplinary measure against parents who have displeased social workers in any way (eg particularly when they report the fact that their children have shown them injuries, reported unhappiness, mistreatment, etc. in care) Thus children learn they must not tell, and parents know they must not make a fuss. Children's problems in placements social workers have chosen are a no-go area if they are to continue to see parents. Thus a vital aspect of their protection is lost and children are herded towards concealment and silence. It is this loss of their emotional and intellectual integrity, as well as risks to their safety, which deeply concern us. Contact was also reduced when an older sibling who remained at home, despite his mother's previous warnings blurted out some details of why social workers had decided to take the child into care. Often contacts are supervised (and in some uncongenial centres) despite no real risk, in order to prevent information of this kind being shared. The rules are unspoken, but parents know what they are. Another problem is that rare, precious and brief contact meetings may include the whole family - including siblings who remain at home - and parents feel have to allow the children to have that time, and deliberately hold back time and time again. They may then find themselves accused of not doing enough - they feel they can't win. There needs to be parent time as well as family time. A further problem is cost. When siblings are split and looked after children are far away, local authorities can be surprisingly parsimonious about fare and travelling expenses, and late with payments, when parents have very limited resources. Contacts are watched, and reported on, by staff at contact centres whose training and education is totally unadequate for such a task. We have seen reports which are risible, and amount to tick-boxes of how much time mother spent with child A compared with child B (children of different needs, and different ages), whether mother smiled etc. while changing a child's nappy - when the child was a wriggly toddler impatient to get up and resume play. One mother filmed an entire contact - which shows a very different picture from that recorded in the worker's notes. When only supervised contact is allowed, this is vulnerable to frequent cancellation, sometimes at short notice causing great upset to children, because workers or social workers are not available, or because of bank holidays etc. If children are reported as "disturbed" after these contacts it could well be the result of their distress at separation, exacerbated by the artificial conditions and behaviour of staff (again recorded on film) , which put their parents and children on edge. We agree with the comments in your Report C.3 7..5.7.6 p.23 concerning the value of contact at the foster carer's home in more informal surroundings where this is possible, and so that relationships can be established between parents and carers. Sometimes constructive relationships we have seen developing with foster carers (eg through an exchanged record book, or at review meetings) have been actively discouraged or stopped by social workers, when they seemed to operate well in the interests of the child. Above all, there is totally inadequate frequency of contact with babies and young children, and especially for breast-feeding mothers. In our view babies should only be removed in the most extreme circumstances - and in the many cases we have seen they have never existed. Social workers seem unaware of the long-term value of breast milk to the baby and decisions in the European Court of Human Rights, or the problems of mixing breast and bottle, and do not cooperate in seeing the baby obtains expressed breast milk. MAINTENANCE OF, AND SUPPORT FOR, BREAST FEEDING SHOULD BE A REQUIREMENT IN THE GUIDELINE. In our experience many temporarily removed babies are returned, but with loss of breast feeding. (as also mentioned by Nursing Matters in their Stakeholder comments) We have even seen a case where a breast fed baby (an only child) , too young to be immunised, contracted whooping cough in a foster home with older children where it was bottle fed. It was later returned to the mother, who would have increased its immunity with her breast milk. Even if the baby is not breast-fed, precious bonding time is lost, at a time when the mother's oxytocin levels are at their highest. Many of these babies who spend time in care are subsequently returned, and it seems there were no adequate grounds for removal in the first place. Sometimes babies are taken into care because of mothers' post-partum mental illness, with no other serious parenting problem. Often mothers have received inadequate mental health care which does not meet NICE guidelines. Since removal of the child, or threat to do so, can trigger suicide (1),(2) and suicide of a parent carries a long shadow for the child - whether returned to the family or not, care of the parent also matters to children.. Social workers should be arranging places in mother-and-baby units which give the best outcome; instead they have fought us right up to the steps of the court for a baby they saw as an adoption target. Not mentioned in your list of reasons for removal of babies, but surprisingly common in our experience, is supposed "risk factors" in parents where there is no evidence of actual harm or uncaring behaviour, and who have had no opportunity to demonstrate the parenting they could provide. (1)Gwyneth Lewis (2005) Why Mothers Die 2000-2002. Chapter 11A. RCOG Press, London (2)Gwyneth Lewis (2007) Saving Mothers' Lives 2003-5. Chapter 12. CEMACH, London
3.10	13-14	STABILITY OF FOSTER PLACEMENT Stability for the child, rather than the statistics, depends on what happens within the foster home. We were shocked by the experience of one adopted child who had been in the same home with foster parents who cared only for babies, since birth. The 2 year old child arrived with serious behavioural problems. It transpired that the foster parents took frequent holidays abroad without the foster children, leaving them with a series of different families who were not even supervised. The child had severe attachment problems. In another case foster carers would take holidays with their own children, without the older foster child - who would move for a few weeks elsewhere. This difference in treatment was felt keenly by the child. In another case two very young siblings in an apparently good placement where they seemed to be doing well suddenly became disturbed and lost weight. The mother found that additional foster children had arrived in the home as an emergency placement. An agency foster carer caused concern to social workers and to the mother by her severe disciplinary methods. When the issue was raised, she simply changed agencies - and nothing more was heard of the matter. The child remained in that home.
3.14	15	SOCIAL PEDAGOGY The recognition that good results can be obtained by having an (expensive) team of highly trained and qualified people for residential care instead of a team of low paid semi, or untrained staff, seems to have come as a surprise! These professionals incidentally also seem able to develop and encourage good relationships with parents, who are happy with their care, so support and contact with them is likely to continue after the child leaves care. As an investment for the future of many troubled young people, it is a bargain for them and for society - but in the present economic climate unlikely to be affordable on the scale needed, unless our scale of values as a society changes. What is essential is the recognition that assessments of children and parenting are often carried out at present by workers with totally inadequate training and levels of skill, which results in poor judgements being made both in taking, and failing to take, children into care. It is not just that we lack the super workers at the top; far more children and families are affected by the inadequate standards in the main service. We were shocked to find social workers do not have specific training in talking to and questioning children, and reports from some children caused us great concern. One enterprising older child decided to record an interview; we found this shocking - it consisted largely of leading questions to try to persuade the child to criticise a parent - something which was blatantly obvious to the child. Unfortunately the child does not dare to take this up with anyone in authority, for fear of repercussions.
3.18	17	"CONTACT WITH THE BIRTH FAMILY.....WHILE LEGAL PROCEEDINGS ARE UNDERWAY CAN OFTEN BE DAMAGING FOR CHILDREN" Where is the evidence for this? We object to its inclusion. Legal proceedings can be lengthy, lasting months or years - and a week is an interminable time to a two-year old.
3.23, 3.24	18	"SEPARATIONS WITHIN THE FIRST 6 MONTHS ARE LIKELY TO BE LESS DAMAGING" This is a subject which is inadequately understood and researchers differ in their conclusions. The emphasis here is on the need to establish stability of placement and attachment within that context. Yet the importance of not disturbing the original attachment to the parent unless really necessary and the long term damage which is done by the original removal at sensitive ages when appropriate support and assistance could have prevented it, is ignored. We have see the long term adverse effects on children and families when there was a temporary removal at e.g. 18 months, 2 years, etc. It is therefore essential when separation is necessary, to reduce its length to a minimum, and to increase contacts to a maximum. As community workers we are acutely aware of body language in young children, when they are too young to talk properly, or at all (or when they can talk but body and voice tell different stories) Body language in parents too is important, especially when we are working with depressed mothers and flummoxed fathers. We have also observed contacts with parents and siblings when children are in care. The body language of children throughout this time often speaks too obviously to be misunderstood, but is not recorded or reported by social workers, guardians or contact centre workers. Only what they see as adverse indications may be mentioned, e.g. as the period of separation increased, a 3 year old did not run to the mother as before, but hung back. The mother realised how unsure the child felt and the reasons for it, and did not rush to the child. She spread out the toys she had brought, until the child approached her, and all went well. The mother's sensitivity to the child was interpreted as lack of enthusiasm for meeting the child. Similarly, she would make a game or putting on the child's outdoor clothes at the end of the session to reduce trauma at parting. She managed this so well that the child's cooperation again was seen as indifference to the mother. The emphasis in this work seems to be on securing attachment within the State-as-Parent system, not on preventing the break which causes the original damage, or maintaining adequate contact with the birth family to maintain existing attachments since it is apparently feared that that would damage other future attachments rather than helping future emotional stability.
3.27	19	BLACK AND MULTIPLE HERITAGE CHILDREN As we pointed out in our written and oral evidence to the Select Committee,(1) children's needs in this respect can be crudely interpreted in damaging ways, and prioritising similar ethnicity in carers may not meet the needs of the child - or the parents. A child brought up in an English speaking home by parents born in the UK may not do well in a foster home where the religion and country of origin may be those of its grandparents, but the language spoken by the family is Urdu. One parent told us that a high standard of nutrition was more important to her than Halal meat, as her toddler lost weight and sparkle and if a white family could do it better, that was OK. We also find that light skinned children of mixed parentage may be viewed differently from darker skinned siblings with whom they identify, and more suitable for "white" adoptions or placements. This simply shows, unsurprisingly, that a simplistic approach does not best serve children, and that cultural training in many social workers is inadequate. Crude ethnic matching ticks all the right the boxes, but may not suit the child. And it is sending a message to the child "your ethnicity is the most important thing about you in our eyes " when the child and family may see things very differently. (1)http://www.aims.org.uk/Submissions/lookedAfterChildren.htm
3.30	20	HEALTH INFORMATION - ACCURATE AND UP TO DATE. From AIMS' 50 years work with maternity care, and researchers, we know that health records may sometimes contain inaccuracies, or different patients' records may be confused. Although some birth parents "may not recall or be reluctant to share this information" we find it surprisingly common in child protection cases that health and social histories of birth parents, siblings, pregnancy, and the birth, are inaccurately reported and recorded on official documents. . Rules allow a substantial delay before parents can obtain health, social, and other records - and social service departments are notorious for failing to comply, so that parents can make corrections. By that time records have spread far and wide - and despite indisputable written evidence, social workers will continue to believe and act on original assumptions. Babies can be, and are, recorded as bottle fed from birth when there is ample evidence in records that they were breast fed. A separate concern for us is that when children are cared for outside their own local authority (sometimes with supervision orders, in kinship care) social services in the area where they now reside do not have information about them, and reasonable parental concerns about their health are not properly monitored or linked up. Even when parents still have parental responsibility for children in the care of the local authority, they are still wrongly denied access to health and school attendance records they should be able to see
Recommendation 32	62	ENSURE PARENT-HELD RED BOOK FOLLOWS THE CHILD In some cases the Red Book is an essential record for the parent to respond to allegations which have been made. eg I accompanied a mother to a review meeting after a health visitor had produced a chart apparently showing her formerly breast fed baby had gained (instead of losing) weight in foster care, as the mother alleged. The mother produced her own evidence from the book showing that the Health Visitor had entered the baby's weight readings in the wrong order to produce a misleading chart. The Red Book is also a record for the parent of the care that they gave before the child entered care and may be needed by them in future. If necessary the PARENT should be given the option of photocopying the information for the social worker, and not handing over an original document which may well be mislaid or not returned when the child comes home. In our experience valuable documents go missing far more often in the system than in the hands of parents. In any case, the current version of the Red Book provides for carbon copies of entries to go to the health visitor and the child health trust, so there is no need to deprive the parent of a record of what happened when they were legally responsible for their child which is already duplicated elsewhere. Parents are also encouraged to put photos and events in this book, which are important memories for them. The relationship should not be airbrushed out.
Recommendation 7	37	WHEN DECIDING ON REHABILITATION WITH BIRTH PARENTS GIVE PARTICULAR ATTENTION TO REASONS WHY SIBLINGS HAVE BEEN PLACED FOR ADOPTION AND WILLINGNESS AND ABILITY OF PARENTS TO CHANGE Research from Sure Start shows that the only aspect which was proved to improve parenting was an approach which empowered parents and respected their contribution as partners (1) (2) This is the reverse of the controlling, disempowering approach we have seen when social workers lay down conditions parents must follow to have a small child or baby returned or retained. Indeed, many of the recommendations run directly counter to the main body of knowledge on rearing babies, breastfeeding, encouraging nurturing relationships and so on. Unfortunately the training of social workers in this area is so poor, that parents understandably resist (or feign compliance) when all their commonsense and experience tells them what they are being told is nonsense. It also makes no allowance for the needs of individual children - who may have had a difficult birth, or special needs, or the experience of parents. Fear that parents may "fail to cooperate with professionals" is commonly cited as a reason for separation or continuation of it, yet the quality and style of that advice is too seldom examined or questioned. Some of us are old enough to have refused to follow the universal advice at that time to put our babies face down to sleep because our instincts told us otherwise. Recent advice to safeguard children from experiencing risk is already changing. In addition we have seen many cases where previous children were taken for adoption at a time when it was an OFSTED target to increase numbers. Given better advice and legal representation for parents, the older siblings of these babies would still be at home. (1) Research Report NESS/207/fr/024(2007) Understanding variations in effectiveness among Sure Start Local Programmes. HMSO (2) Fiona Williams & Harriet Churchill (2006) Empowering parents in Sure Start local programmes. HMSO
Recommendation 18	50	ALLOW CONTACT TO DIMINISH WHEN TO DIMINISH IT IS CLEARLY NOT IN THE BEST INTERESTS OF THE CHILD AND CONTRARY TO THEIR WISHES A balanced approach would equally suggest that frequency and duration of contact should increase when that is in the interests of the child and is what they wish for. Unfortunately children soon learn not to ask for something which they sense will not meet with approval.
GENERAL		KINSHIP CARE Although we, and parents, welcome this in most cases, and surveys of children show they prefer it when possible, we see problems which do not seem to be mentioned. Where there are half brothers and sisters, grandparents, aunts, etc. understandably welcome their own kin, but may not encourage, or may actively discourage, contact with other children in the family who see each other as normal brothers and sisters. We have seen this lead to great hurt and distress, and subsequent behavioural problems. Willingness to respect and support half-sibling relationships should be included in the criteria for selection Mention of "siblings" in the guideline does not take into account some of the problems we see from professional misunderstandings of children's and parent's views. Much later problems can arise in families because in their initial investigative approach, social workers concentrate on gathering "bad news" about parents from whom they wish to safeguard children from wider family and former partners. The way in which this is done and used can unnecessarily damage relationships which could be supportive to children in the future, and between family members after children are returned. We have known a number of cases where this has happened. MOST LOOKED AFTER CHILDREN WILL RETURN HOME. THEIR NEEDS WHILST IN THE CARE OF THE STATE CANNOT BE CONSIDERED WITHOUT THOUGHT FOR THE EFFECTS OF PROCESSES ON LONGER TERM WELFARE. IF THE STATE IS TO BE A PARENT, THAT IS WHAT A GOOD PARENT DOES. WE HAVE SEEN FAR TOO MANY CASES WHERE "CARE" HAS DONE FAR MORE HARM THAN THE PARENT WAS EVER THOUGHT CAPABLE OF.
GENERAL		BLEAK OUTCOMES FOR LOOKED AFTER CHILDREN There is endless debate by researchers as to how far these stem from instability in care and how far from parental care. However, what is omitted is the damage inflicted by the process itself, and whether this, in itself, contributed to or initiated some of the damage. The very best quality evidence - from a large scale randomized trial with long term follow up in the USA of two kinds of social work: one similar to that currently used her, and an alternative one supportive to families, seems to demonstrate worrying adverse effects from our current policies. There was a significant increasse in percentage of parents receiving the alternative approach who felt more able to care from their children (42% - 62%), and a decline in the control group from 49% to 42%. In Alternative Approach families fewer children had a serious illness, had trouble learning at school, had a hard time getting on with other students, were difficult to control, or engaged in delinquent behaviour. Although their levels of missing school through illness, truanting or acting depressed remained unchanged, these problems in the control group actually increased.(1) (1)Extended follow-up study of Minnesota's Family Assessment Response Final Report (December 2006). Conducted for the Minnesota Department of Human Services. A report of the Institute of Applied Research, St. Louis, Missouri.
Jean Robinsons contribution