Submission to the Children, Schools and Families Committee on the
NEW INQUIRY INTO LOOKED AFTER CHILDREN
From The Association for Improvements in the Maternity Services

18 February 2008

SUMMARY As a UK-wide pressure group covering maternity care with nearly 50 years experience, we are particularly interested in the problems of babies and small children in care, and their families. These are the children least able to speak for themselves, and the potential for long-lasting damage is great, not only to the children but to bonding with the parents to whom most of them will return. We draw attention particularly to loss of breast-feeding, damage to bonding and attachment, damage to relationships with siblings and the extended family, inadequacy of arrangements for contact, relationships with siblings. Social workers and courts do not seem to understand the special needs of small children, and unnecessary damage is inflicted. We would also draw attention to the fact that the lack of respect shown to parents within the system means they lose trust in professional services and some avoid accessing care and services in future. Yet high quality research from the USA shows that a more supportive, less authoritarian and punitive approach to parents, yields better results.

ANTENATAL DAMAGE TO CHILDREN
  1. Although the unborn child has no legal status, it is now common for local authorities to convene a pre-birth conference when they know a woman is pregnant. Often this is because she comes into certain risk categories rather than because of information that she individually poses a risk to her child. Having been brought up in care, for example, poses a high risk for the mother of having her child removed, which seems to say "the state as a corporate parent did such a bad job that you yourself are unfit to be a mother" rather than "you may need extra help. Let us talk about what we can provide."
  2. Social workers seem unaware of the fact that there is now a substantial body of research showing that prolonged and severe stress for the mother can do long term harm to the child she is carrying - to its growth, levels of stress hormones, and behaviour. Our experienced team is used to dealing with families in stress - those who have lost babies, had a birth-damaged child, or even a maternal death. However we have been appalled at the prolonged and intense levels of stress in pregnant women faced with the possibility of having a child taken into care at birth - let alone those which are taken from the delivery room. Strong research evidence suggests that the level of damage inflicted on the child before birth by protective services may well exceed any future harm the mother might be capable of.1, 2 Most of these children will be returned to the mother if taken, or if taken into care or adopted, will have greater problems in life than they need have had if only supportive rather than "policing" care had been offered to the mother.
  3. One mother has written movingly to us of the difference in the quality of feeling she has towards her two children, though she loves and cares for both. There is a distance from the older child, whose pregnancy and birth was surrounded by social work "protection" activity. With the second there was no such involvement and her feelings are warmer and much more spontaneous. She thinks of his arrival with nothing but joy.
  4. Sometimes social workers make very strict pre-birth plans about the conditions under which the mother will be allowed to keep her baby. They often show ignorance of how these may impair development of bonding, breastfeeding, or optimal emotional and physical care of a newborn, or affect the mental health of the mother. From time to time we have queries from mothers affected by such future plans. They are women who are willing to cooperate, and take every responsible step to show they can be a good parent, but they realise the conditions are going to be almost impossible to follow and at the same time build a normal relationship with their child. Any deviation then provides an excuse for social services to step in and take the child. In one well-publicised case, a pregnant woman fled abroad to give birth, because she felt the position was hopeless.
  5. Experienced midwives and community support workers see mother and newborn as a dyad, and the initial "babymoon" is a precious and sensitive time, during which the umbilical cord which physically joined the baby to the mother is replaced by an emotional umbilical cord - which will be an important protector of the child even in hard times and poor social circumstances. At this time supporting the father is also important, as the pair adjusts to being a family with their first child: this is a very sensitive time. Intervention may increase the risk of post natal depression, or worsen it, and a number of postnatal suicides of mothers have been connected with social work intervention, and the Confidential Enquiries have expressed concern.3
  6. BREAST FEEDING
  7. In a decision of the European Court of Human Rights concerning a case where a baby was removed from the mother after birth, the UK was criticised for not respecting the baby’s rights to family life or to have the opportunity of breast feeding.4
  8. The baby has a right to its mother’s breast milk if she is willing and able to breast feed. There is now a large body of medical research evidence showing the long-term benefits of breast feeding for the child. In addition, it has health benefits for the mother, prolonged lactation reducing risks of breast and ovarian cancer. We have had a number of cases where breast-fed babies have been removed. In one case it was written on official papers for the court (which, as advocates and supporters we are allowed to see) that the child was bottle fed, although all the medical records clearly showed it was breast fed.
  9. In order to maintain her supply of breast milk and to feed the baby, the mother has to have frequent access, and the best way to establish breast feeding and to nourish the child is to feed on demand. In no case has adequate access been allowed when a child has been removed into care. We have had contact with a number of distressed mothers who have wanted to express milk to continue supplying what they know is best for their baby. There has been no question raised that these mothers were street drug users or addicts. Yet social workers have often refused to take the milk, or if it has been delivered to their office, the mothers discovered it had been thrown away. Who is doing their best to protect the child here - the state or the parent?
  10. In one case a mother's first child was taken into care. The baby was being breast fed. It was placed in a foster home where there were older school children. The baby, too young to be immunised, got whooping cough - presumably caught from the other children. Had it remained at home, as the sole child in the household , the risk of exposure would have been less. The risk of contracting the illness even if exposed would have been less because the mother would have passed on her immunity to this, and other infectious diseases, in her breast milk. Fortunately the baby survived what could have been a fatal illness at that age. The baby was returned to the mother; it seemed that there were inadequate grounds for its precipitate removal in the first place. She was unable to re-establish lactation.
  11. We have had two cases where a mother had to bring her breast-fed child to contact with an older child who was in care. On both occasions a male social worker was supervising the visit and insisted on remaining, although a female social worker was also present. One of the mothers was Asian, and the other was West Indian. Both were deeply upset and asked the male worker to withdraw, but in each case he refused, making remarks which they found offensive.
  12. In many of the cases we have seen, the State could have provided a Norland Nanny for a family with a baby or young child at far less cost than that for social workers, lawyers, medical experts, foster carers, etc, involved in the current process, with better results and with far less damage. A number of new mothers, some of whom knew they might need help, said their ideal situation would be to live for a time with an experienced granny, who would support and advise them, while they gained confidence and experience and enjoyed their new baby. These mothers did not have aunties or mothers of their own nearby who could do the job. Why could such a service not be provided, at least for some mothers?
  13. TODDLERS AND PRE-SCHOOL CHILDREN
  14. Removal of these children happens at a crucial time for attachment, and interruption or loss of the usual continuous carer can, as we know, have long term effects on the child’s personality and mental health for the rest of life. From his own extensive work in Child Guidance Clinics, Dr John Bowlby showed in his classic study of Forty-fourThieves, that the crucial factor which distinguished young offenders from boys brought up in similar unfavourable circumstances, was that they had been separated from their main carer at a crucial period for attachment.5
  15. We find it surprising that his classic volume of work, which is a cornerstone of modern psychiatry, and much more work which followed it, does not seem to have been read, understood, or taken on board by social workers.6 It suggests that unless there are very good grounds babies and toddlers should not be separated from the mother or main carer, and other measures proven to be supportive to the mother and family unit should be used in preference wherever possible.
  16. We find ourselves sharing the concerns of mothers whose young children are removed; they are too young to understand what is happening, or to take in explanations, and their experience of time is very different. Twice weekly contact, to a 2 or 3 year old, is a huge time gap, and weekly or fortnightly incomprehensible. Explanations cannot convey to them when Mummy and Daddy will be seeing them again.
  17. It is well known that continuity of placement with as few foster homes as possible is important, but what has been little remarked on or investigated is how much disruption there is within the foster home, even in longer placements, and how important this may be for very young children
  18. One mother had been telling us for a few weeks that her two very young children seemed to have deteriorated, become disturbed, and lost weight in a foster home where they were previously doing well - and much better than in an earlier placement. Then she discovered that there had been an emergency placement of a family of four children in that home, so her bewildered children were getting little attention. Social workers would not listen to her concerns.
  19. Another cause of disruption within the foster home is when foster carers go away for holidays with their own children, so fostered children are moved to other families. A mother adopted a two year old who had been with the same foster family, who specialised in fostered babies, since birth. She had not expected the degree of persisting attachment difficulties she found: this child would go to anyone. She learned that the foster carers had had frequent holidays abroad, leaving the foster children with a series of different families - and what is more, families who were not monitored
  20. In addition, separations would occur when respite care was arranged for foster carers - often it was respite care which families themselves had been begging for when they had children with serious problems, but which had never been provided. As soon as a child went into foster care, many basic needs which had been denied parents, who had merely become an irritation because they fought so hard for them, were automatically provided.
  21. As with other contacts of older children, planned frequency as decided by the court, is often not borne out in practice. It is disrupted by Bank Holidays, foster carer's arrangements, non-availability of social workers, etc. We have seen a number of cases where contact is suddenly reduced at a whim by social workers, quite contrary to court decisions, and sometimes it seems to be used as a means of disciplining parents or bringing them into line - as it is a most powerful and effective tool. Parents dependent on good will dare not complain about anything in these circumstances, so dissatisfactions are quashed. But contact is for the child not just for the parent, and often it has low priority when there are other demands on resources.
  22. CULTURAL INCOMPETENCE
  23. The levels of cultural competence in social workers and CAFCASS officers can be surprising. They also often assume that needs of a child from one ethnic group can be met by placement with a similar - or vaguely similar - group, ignoring the fact that differences can be as great as differences within any other group. They are unaware, for example, that attitudes and ideas can be very different among families from different parts of the West Indies, or that a well-educated, UK born parent from an Asian family might prefer placement with a white family with similar standards to placement with a family of immigrants.
  24. In one home, the teenage daughter of the foster carer was allowed to use chemical products to straighten the Afro hair of the young foster child. The mother, who supposedly had joint parental responsibility and not been consulted, was appalled. In the first place the products are potentially dangerous and could have injured the child; they are used with great care by professional hairdressers. Secondly, her strongly held belief was that her daughter should be brought up with the confidence that her heritage appearance was beautiful, and did not have to be altered to meet white ideas of acceptability. There seemed to be no concern on either point the social worker or the department; they did not even seem to understand the problems - both families were of West Indian origin so they saw no problem with culture clash. This, alas, is a not untypical example.
  25. A West Indian foster carer was criticised by the agency which employed her for the over-strict discipline which was her cultural norm, but not acceptable in the UK. Social services were also informed of this, and the agency’s concern. The foster carer simply switched agencies, and nothing more was heard about the problem. The child's birth family felt helpless - but like so many others, dare not offend social services by making a complaint to try to protect their child.
  26. The English speaking children of a well-educated English-born mother from a Pakistani family were placed with a Pakistani immigrant family who spoke their own language at home - and a different language from that of their Pakistani grandparents. The children's own language development regressed, and their mother had to watch this with great anxiety, but her comments and concerns were not acknowledged. Although the family provided their customary food, it was not what the English-reared children were used to, and the mother felt that their nutritional standards had greatly deteriorated at a crucial period for growth and development. However social workers felt that ethnic needs had been met, so they could not be criticised, and other standard concerns about child rearing were less important. The mother felt otherwise, but dare not press the matter.
  27. A young black child, born in the UK and only English-speaking, was placed with a white foster family from Europe, who spoke only their own language at home among themselves. She was bewildered, and her own language development regressed.
  28. PARENTS AS CONTINUING PROTECTORS OF SEPARATED CHILDREN
  29. Most children who are looked after by the local authority will be returned to their original home. Unfortunately this will be to a family which may have been damaged by the process and it is a family which will never be the same. Parents have been disempowered, had self esteem lowered, and have lost confidence, as many tell us. Yet there is now excellent research showing that it is empowerment of parents and raising self esteem which is one of the most effective tools in improving parenting; this has been shown in long-term follow up of the randomised trial of home visiting, with long term follow up, by David Olds7,8 and in the final evaluation of Sure Start, which showed that the centres which empowered and trusted parents were the most successful.9 And alternative approaches to social work, involving support and care rather than policing and removal, have been shown in randomised trials in the United States, to improve outcomes without increasing risks for children (eg in Minnesota, Missouri and a number of other States10,11)
  30. We were delighted to see that in the Care Matters: Time for Change white paper the government has acknowledged that more attention will be paid to partnership with parents. This is long overdue. We would like to give some examples of the protective role many parents try to play when they are separated from their children, and the fact these are sadly often discounted and blocked. Parents usually know their children well, and are keen observers of changes in weight, appearance and behaviour. Unfortunately many tell us there concerns are dismissed, and they are seen as a nuisance and a potential source of damaging criticism to them service rather than co-protectors, even when they supposedly have joint responsibility with the local authority.
  31. One mother regularly kept an eye on her children in care at contact visits. She measured a toddler's feet, and found it was wearing shoes which were too small which no-one had noticed. Although she was poor, and no longer received an allowance for the children, she immediately went out and bought new shoes for the child. She also bought and provided sun hats and sun cream when she noticed her very fair skinned children were getting red in the sun. This was typical of her care, but never appeared in reports
  32. A mother noticed frequent unusual bruises, bumps and cuts on one of her children. She pointed them out each time to the supervising worker at the Sure Start contact centre, and for a few weeks they were recorded in a special book kept for the purpose. Then the book disappeared, and was never heard of again, so the record vanished and future episodes were not recorded.
  33. A mother who had been separated from her children by severe post-natal depression was alerted by the relative with whom they had been placed that one was ill. She went to the home and found a very feverish sick child. Immediately she stripped the child and began sponging the child with lukewarm water and told the junior social worker who was present the child must go to hospital. The social worker phoned the office for instructions and was told by her senior that the child must go to the GP. So time was wasted while they went to the surgery, waited for the GP to return, and he then told them to take the child to hospital where it was admitted - admission had been delayed by over 2 hours. A social worker who could not even see the child had given instructions over the telephone which over-rode this experienced mother and put the child at risk.
  34. A mother, accompanied by a social worker, watched her children play outside at a family centre used social services for many families to have contact. Her little daughter ran into a large garage which had open doors. When she did not come out again, the mother looked for her, and found her putting blue pellets from the floor into her mouth. They were rat poison. The mother extracted them and pointed it out to the social worker. If she had been so careless at home, it would have been a source of criticism which appeared in court reports, but here the matter was hushed up.
  35. CONTACT ARRANGEMENTS
  36. Some parents have told us how concerned they are that young children are ferried back and forth to contact visits by a series of strangers, so that they have no fears of getting into cars with strangers - it has become the norm for them.
  37. We hear widely varying reports of centres used for contact, and the behaviour and standards of staff. We feel that an inspection, in which views of parents and children are widely collected, should be done.
  38. Some of these staff carry out assessments of parenting for social services and the courts. We are greatly concerned at the level of training of staff concerned and the poor quality of the reports we see. Some parents also strongly dispute the accuracy of what is written.
  39. Although mostly we deal with parents and young children, their older siblings are often involved, and we have contact with them. When he knew we were making this submission one child whose sibling is in foster care telephoned us to make sure we emphasised how important contact is, and that social workers who arrive late, thereby reducing the short, precious time allowed, seem to regard it as a minor matter, when it is not. A mother also spoke to us pointing out that sometimes a very long journey is made when a child is a long distance away, so a couple of hours contact can involve a whole day trip. Whereas fares are paid by social services, it is a battle to get a quite modest amount to provide food and drink for a family of children on a long trip.
  40. THE VOICES OF CHILDREN
  41. Many of the children whose families we deal with are too young to speak, or to express their wishes clearly. But their body language and vocal sounds are often eloquent, but are unreported, and we see it often. The intense engrossment and mutual prolonged gaze of a mother and baby on a contact visit. The toddler who studiously ignores his father when he arrives to take him for a court-ordered overnight visit which will separate him from his mother, and his piercing screams when he is picked up and taken out to the car.
  42. However we see a worrying number of cases where children's voices which conflict with social workers' decisions are downplayed or ignored. It is assumed - and perhaps wrongly assumed - that these must be brainwashed into them by the parent but some children who have spoken to us are very indignant. Social workers and CAFCASS officers are not invariably accurate, or unbiassed, reporters of the child's views.
  43. Often during contact, communication between parent and child is blocked, and it seems that close supervision is there not because the parent might do anything dangerous to the child, but because of fear that the parent might tell the child a different version of what has happened and why. Children are left bewildered and confused because parents are not allowed to tell them what is going on, and once when a sibling blurted it out, the parent was blamed.
  44. Jean Robinson, Member of the AIMS Committee

    References

    1. O’Connor T.G. et al (2003 Maternal antenatal anxiety and behavioural problems in early childhood. Br. Journ. Psychiatry 180 104-9
    2. Van den Bergh B.R. et a; (2005) antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosc. Biobehav. Rev; 29 (2) 237-58
    3. Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer 2003-5. The seventh report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London 2007. (See pp 39-40 for suicides of mothers after children taken into care)
    4. Case of P., C. and S v. the United Kingdom (Application no. 56547/00) Judgment Strasbourg 16/10/2002
    5. Bowlby, John (1946) Forty-four Juvenile Thieves, their characters and home life. Bailliere Tindall & Cox.
    6. Bowlby, John (1980) Attachment and Loss. Volumes 1-3, 2nd edition. Basic Books
    7. Olds D, Kitzmyer H, Cole R et al (2004) Effects of nurse home visiting on maternal life aims and child development. Age 6 follow up of a randomized clinical trial. Pediatrics 114 1550-9.
    8. Olds D. July 19 2007. Testimony before the Subcommittee on Income Security and Family Support of the House Committee on Ways and Means of U.S. House of Representatives.
    9. Williams, Fiona and Churchill, Harriet (2006) Empowering parents in Sure Start local programmes HMSO
    10. Loman L.A and Siegal G.L. (2004) Minnesota Alternative Response Evaluation Final Report. Executive Summary. A report of the Institute of Applied Research, St. Louis, Missouri.
    11. Extended Follow-up study of Minnesota’s Family Assessment Response.(2006) Final Report Conducted for the Minnesota Department of Human Services. A report of the Institute of Applied Research, St. Louis, Missouri, December 2006.

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