Care Makes Things Worse? 

When I left the management of the Prison and Probation Services to join Barnardo’s in 2005 I was seized with a conviction that being taken into care was damaging to children. In my defence, I had met so many prisoners who had spent time in care that I might have been forgiven for concluding – however erroneously – that their care experience is what had propelled them to prison.  Nevertheless, saying, as I did in August 2006, that the state, as a parent, fails [children in care] terribly was both wrong and unfair. But I was hardly out of step with general opinion. That view had been long established and it has changed relatively little since. As recently as April of 2009, Barry Sheerman, then Chair of the Select Committee on Children Schools and Families talked of:

the perception that entering the care system is catastrophic for a child’s future prospects.

Certainly when I added my voice to those making this simplistic and fundamentally misconceived assertion, it brought only praise and an invitation from Alan Johnson, then Secretary of State at Education to lead an independent working group to examine the scope for reducing the numbers of those in care. I was delighted to do so and confident that the significant drop in the numbers in care, which started in the eighties, could be given extra impetus.

 A brief history of the numbers in careThe fall in the numbers of children in care in the eighties was not the first fall in recent decades. After the Second World War the number of children in care fell steadily, dropping to a little over 50,000 in the mid fifties and stayed at a relatively low figure into the sixties. But, in the seventies, the numbers began to climb steadily as the reality of child neglect and abuse began to take hold in the UK. By 1981 there were 92,000 children in care in England an increase of almost 50% or 30,000 children on the figure just twenty-five years previously. Of this 92,000, almost two thirds, about 58,000, lived in residential homes.

So there were almost as many children in children’s homes in 1981 as there are in all forms of care now (that needs to be remembered when it is argued that the current care population is too large). Inevitably, the costs of almost 60,000 children in residential care were seen as unsustainable and in any case, a number of high-profile abuse scandals brought the residential sector into disrepute. The large institutions began to close as the voluntary sector rapidly abandoned its orphanages.

In the working group I led for Alan Johnson I was keen to help further drive down the numbers in care seeing that reduction, incontrovertibly, as a good thing. No one suggested otherwise, at least not publicly. But, sometimes, in the margins of consultation

events or at conferences, front line social workers would sidle up to me to whisper their anxiety that the direction of travel was not as clear as I thought. The whispers grew, I became nervous about my initial certainty, and eventually my working group concluded, almost certainly to Ministerial disappointment, that we should not have targets for further reducing the numbers in care.

At about this time I started to see a little more of Barnardo’s own work in this area. I recall a particularly fascinating day in one of our services talking to parents – or more specifically mothers – who were seeking the return of their children from care. Our job was to assess their readiness to re-assume their parenting responsibilities. What I saw made me uneasy.

My practice whenever I visited a Barnardo’s service was to reflect for a day or two on what I had seen and then to share my thoughts with senior colleagues and Trustees. After this visit I wrote:

[I was worried that staff] seemed to be working in a context which required them not to do what was unequivocally the best for the child, but instead one which tasked them, whenever possible, with keeping children with their mothers. One family was described to me as being guilty of the most abject neglect of their children who were filthy, suffered exceptionally serious dental decay and were not attending school. Now fostered, the children, 10 and 14, were doing reasonably well and were both at school. Meanwhile we seemed to see success in this case as eventually returning the children to a mother who, I was told, had very limited awareness of the inadequacy of her care for her children. I wondered why on earth we would contemplate taking such a risk and the answer that “blood was thicker than water” certainly did not convince me.

 

I went on to observe:

Part of the problem is, I fear, that these seem such illiberal things to think, much less write. But I left this visit seriously perturbed that staff were working in a context, overly influenced by considerations of what a Court might opine, in which the interests of the child were not the overwhelming consideration they should be.

 As I began – tentatively at first – to utter publicly the view that we might have to think about taking more, not fewer children into care, my motives were attacked. Some correspondents said I was drumming up trade for Barnardo’s Children’s Homes (ignoring the fact that the last one had been shut two decades earlier). John Hemming MP dismissed my view without debate blogging, simply, ‘Martin Narey is wrong’ and there was a great deal of offensive comment on the internet.  Meanwhile, at successive presentations to staff from Children’s Services Departments in two northern

counties, each host Director referred to my views, respectively as unorthodox and challenging. But amongst the abuse, letters I received convinced me that this was a debate worth having.Meg, a Social Worker with decades of experience wrote to say: I am 57 and started my career as a child care social worker but I found myself unable to tolerate the incredibly low standards that were tolerable within the childcare services...Thank Goodness someone is speaking up for all those children whose lives are witnessed and about whom nothing is done.

 I did not know it at the time but there was no shortage of very sound research to back up my anxieties about the children we leave in neglectful and abusive homes. The reality is that care can be much improved and the current Children’s Minister is right to be impatient about achieving such improvements. But, even as it is, care is much to be preferred to leaving a child in neglect. As Professor Mike Stein from the University of York has said: 

The simplistic view of care as failing 60,000 young people should be confined to the dustbin.

 

Extensive research, much of it commissioned by the Department for Education confirm the Stein view. Very recently, in 2010, DEMOS were commissioned by Barnardo’s to take a comprehensive look at the evidence. DEMOS confirmed that:

Stigmatisation of the care system, combined with concern about the upfront costs to the state, means that some children who might benefit from the care system do not do so.

When the care system is used effectively in this way it can be a powerful tool for improving the lives of vulnerable children and young people.

The mistaken belief that care consigns all looked-after children to a lifetime of underachievement and poor outcomes, creates a culture of uncertainty, increasing delay and leading to instability later on.

There is now a substantial body of academic evidence that provides a longer-term and more nuanced perspective on looked- after children’s lives, taking into account the nature of their pre- care

experiences and comparing them with more appropriate control groups. This evidence shows that care can be a positive intervention for many groups of children.

Some groups of children whose entry to care is delayed by indecision or drift are at risk of experiencing a longer exposure to pre-care adversity; higher emotional and behavioural problems; placement disruption and instability More recently, and more vividly, Becky Hope’s All In A Day’s Work, published in April of this year offers a frequently moving record of the experiences of a social worker who has spent twenty years working in child protection. Her preface could not be more stark when she says:

Children whose basic needs for responsive loving care are not met, and who are left to flounder, have been found to suffer clear detrimental effects to their brain development long before they reach anywhere near their first birthday. It has also been found that children who have experienced severe neglect as tiny babies, but are placed in long term adoptive homes before the age of six months are able to make far greater progress overall than a child placed after that age. [But} at present this research is not infiltrating social work practice in a way that best supports the children who depend on us. To allow these research findings to change our practice will require a change in the mind-set of all involved in the process of child protection.

 

She captures the sad reality that too often we wait too long before removing a child from parental neglect, sometimes because of an unjustified optimism about the capacity of parents to improve. As Jonathan Ewen the Director who leads for adoption for Barnardo’s told me:

Speeding up the decision making after a child first comes to the attention of the authorities is key; research shows that most parents who are going to significantly improve their ability to look after their child do so in the first six months of the child’s life.  If that doesn’t happen, then we need to be bolder – and quicker - in making the decision to remove that child permanently.

It needs to be stressed here that I am not talking about cases where there is room for doubt over whether or not a child has been neglected or the capacity of the mother to become an adequate parent. This is not to deny that mistakes are not sometimes made and that, however occasionally, decent and loving parents suffer the horror of having their children taken from them without justification.

But front line practitioners know that those cases, however regrettable, are overshadowed by a much larger number of cases where we leave children too long and until neglect turns into abuse. I believe that most lay people, most parents, would be deeply shocked both at the conditions in which we routinely leave children and at our continued consideration of returning a neglected child to the circumstances which led to his or her abuse.

In All In A Day’s Work, Hope describes her experience with a typical case where a child had been physically abused, was in care, but seeing her mother regularly (known as contact) with the possibility of a future reunion. The child is Sarah and the mother, Julia:

Over the weeks since Sarah had been taken into care, Julia was often very late for contact meetings and a couple of times she forgot to come altogether. Sometimes it was suspected that she was high on something, at other times there was a suspicious smell of alcohol about her person. It was a frequent event for it to be reported that she had spent her time reading a women’s magazine at contact and often had very little time for Sarah at all, just making the very barest attempts to interact. Sarah said little after these contact sessions but reacted silently with the inevitable wet beds, disturbed sleep and very difficult behaviour at school.Before her birthday Sarah was getting very excited about the prospect of a party and presents and, during contact the week before, her mother had made repeated promises in terms of presents, building up Sarah’s hopes. Sadly, when the pre-birthday meeting with the mother took place, nothing appeared, her mother arrived both an hour late and empty-handed. The long promised bike, the puzzle and the skipping rope – all evaporated in vague excuses. Not even a card. Sarah’s behaviour at the remainder of this contact session was of hesitation and confused silence, but later her hurt came out in tremendously angry outbursts and terrifying nightmares, plus some fights at school. This was the culmination of months of disappointment with her mother’s disinterested behavior.

 Why do we allow children to be damaged in this way? Sometimes it is because sustained changes in parenting capacity can be and are achieved.  But the current system is gripped by an unrealistic optimism about the capacity of deeply inadequate parents to change. Making the birth family successful should be our first option, and I am not arguing that mothers should not be given a second or even a third chance, just not a fourth, fifth and sixth. 

This unjustified optimism in the capacity of deeply inadequate and sometimes uncaring parents to change condemns children to a childhood of neglect and sometimes abuse and damages their chances of leading a successful life in adulthood. We should and do

help parents to change and when that is successful that is a great achievement. But we have to tackle the naïve optimism that paralyses the system. And we have to stop letting children down by returning them to parents only for them to be neglected once again. This is not simply my view. Research supports it.  In Case management and outcomes for neglected children returned to their parents: a five year follow-up study (2010), Professor Elaine Farmer followed the fortunes of 138 children who had been taken into care and then returned to their parents. She discovered that:

[There was] a tendency over time for abuse and neglect to be minimised so that referrals about harm to children [did] not lead to sufficient action to protect them.

Plans made during care proceedings did not work out in three fifths of cases, often when children were returned to parents because of an over-optimistic view of the possibility of parental change by guardians and expert assessors, in the face of long histories suggesting the contrary. 

And, most troublingly, she found that two years after those children had been returned to their parents three in every five (59%) had been abused or neglected once again. We cannot let children down in this way.

 

Findings from a University of York study (Jim Wade, Nina Biehal, Nicola Farrelly and Ian Sinclair) also published last year echo Professor Farmer’s findings. This study compared the progress and outcomes of a sample of maltreated children some of whom were returned home from care with those who remained in care. It was found that outcomes for the children who remained looked after were better than for those who went home with respect both to stability and well-being.

 

Judicial opinion

 

We shall not see many more adoptions, and significantly we shall not see more of the most successful adoptions, until we begin, as a society, including social work professionals, the courts, the media and politicians, to accept that, however well intentioned, we leave some children, too long in neglect. As I have argued here, a frequent reason for this is this strongly held but misconceived belief that however bad things are at home, care will make things worse. It is vital that Judges appreciate that this is not so. But in two presentations to Family Court Judges last year there was

bemusement at my suggestion that care made things better, not worse, for neglected children. This is hardly surprising when shortly after his appointment as President of The Family Division, the most senior Family Law Judge, the much respected Lord Justice Wall said:

What social workers do not appear to understand is that the public perception of their role in care proceedings is not a happy one. They are perceived by many as arrogant and enthusiastic removers of children from their parents into an unsatisfactory care system

Social workers may sometimes get it wrong. I accept entirely that there may be cases where intervention is inappropriate and unnecessary (although sometimes, those who are concerned about such cases jump to the conclusion that such errors mean all interventions are unnecessary). But it is very clear that generally children are not removed from their parental home unless there is the clearest evidence of their abuse and neglect. Even in the wake of Baby Peter when applications for care increased significantly and there was some speculation about social worker over reaction, research from CAFCASS found that none of the additional interventions were premature.

The reality of care is best captured in an article published in the Journal of Social Policy in 2009. Forrester, Goodman, Cocker, Binnie and Jensch reviewed all British research since 1991. Their conclusion was that:

The studies consistently found that children entering care tended to have serious problems but that in general their welfare improved over time. This finding is consistent with international literature. It has important policy implications. Most significantly it suggests that attempts to reduce the use of public care are misguided and may place more children at risk of serious harm.

Judges must understand the truth of those simple sentences.