AIMS CONTRIBUTION TO THE GOVERMENTS NICE LEGISLATION

Name:

Jean Robinson

Organisation:

Association for Improvements in the Maternity Services

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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

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