Overcoming Adversity and Capacity to Change

1. Harriet Ward and Georgia Hyde Dryden , CCFR, Overcoming Adversity and Capacity to Change

2. Safeguarding Babies and Very Young Children from Abuse and Neglect:(Ward, Brown and Westlake 2012; Ward, Brown and Maskell Graham, 2012) Prospective longitudinal study of 57 babies identified as suffering or likely to suffer significant harm All identified before first birthdays 43 followed until age three; 37 until age five. Continuing now until ages 7- 8 Data from case papers; annual interviews with birth parents/carers; Strengths and Difficulties Questionnaires; interviews with children aged 7+ Very high risk sample

3. Children Majority from families already known to children’s social care through involvement with older siblings 65% identified before birth; almost all before they were six months old 63% were boys 69% White British; 31% from BME groups: 69% of these were of mixed heritage. High proportion of BME infants found in other studies (see Selwyn et al. 2010) 14% were identified as having disabilities or special health care needs. Children with disabilities are 3.4 times more likely to experience abuse and neglect (Sullivan and Knutson, 2000)

4. Parents’ difficulties Primary risk factors: violence (at home and in community), substance misuse issues, mental ill health, learning disabilities, experiences of abuse in childhood Secondary risk factors: housing problems including homelessness, financial problems including bankruptcy Isolation, poor relationships with extended family Twenty mothers and an unknown number of fathers had already been permanently separated from at least one older child

5. Factors associated with future harm Abuse: eg Neglect, previous maltreatment Child factors : eg Very young, developmental delay Parent factors: eg Substance misuse, Personality disorder, learning disabilities plus mental illness, experience of abuse in childhood, denial Parenting and parent-child interaction: disordered attachment Family: Inter-parental conflict; power problems Professional: eg lack of resources Social setting: isolation, violent neighbourhood

6. Classifying families by risk of harm Based on systematic review of evidence concerning risk and protective factors and the likelihood of maltreatment or its recurrence (Hindley, Ramchandani and Jones, 2006) Each child classified according to the level of risk of maltreatment or its recurrence Classification used data at identification by children’s social care (Time One) at age three (Time Two) and at age five (Time Three) Particular weight given to evidence of parents’ capacity for change

7. The children at entry Severe risk (12:28%): Risk factors, no protective factors and no capacity for change High risk (7:16%): Risk factors, protective factors and no capacity for change Medium risk (21:49%): Risk factors, protective factors, capacity for change Low risk (3:7%): No risk factors (or previous risk factors addressed, protective factors and capacity for change. Includes two outliers

8. At age three • 35% (15) Permanently separated • 28% (12) Medium –severe risk: inadequately safeguarded with birth parents who had not shown capacity to change • 53% (23) had experienced abuse or neglect • 37% (16) maltreated in utero • 37% (16) maltreated while open cases • 57% displayed emotional problems or substantial behavioural difficulties • No evidence that 20 (47%) children experienced maltreatment by the time they were three • 37% (16) Low risk: adequately safeguarded, living with birth parents who had sustained positive changes

9. Which parents can change? Parents who successfully changed were: • Less likely to have experienced abuse in childhood and substantially less likely to have experienced childhood sexual abuse • Able to come to terms with the removal of older children • Able to acknowledge the risks posed by their destructive behaviour patterns • Able not simply to engage with services but also to make positive use of the support they offered • Able to develop supportive informal networks

10. The birth of a child as a catalyst for change • No parent overcame substance misuse if they continued to use drugs after the child had been born • All but one set of parents who made and sustained sufficient changes, had addressed all known risk factors by the time the child was six months old • A number of parents, including four of those who overcame substance misuse, spoke of a ‘wake-up call’ that acted as a catalyst for change. No parents in the insufficient change group spoke of such an epiphany

11. Simon’s mother: what made her change? “My son being born, my son being born, definitely. And I think the scare what social services gave me was a kick up the arse and the scare that I needed…They were going to put [Simon] into foster care…And I thought to myself, I just cannot, you know, you know what, I felt like a movie, I felt like, oh my god, my baby, not my baby. And he was so tiny, I felt like, oh no my baby, I felt like, and I thought you’re having a laugh, I couldn’t believe, you know…A big shock, a big shock, it was a big wake-up call and it was just a terrible feeling, I couldn’t believe it.”

12. Assessing capacity to change Cross cutting assessment of parenting capacity Cross-cutting assessment of children’s needs Case conceptualisation (analysis of gap between parenting capacity and child’s needs) Agreed targets for change and goals set Additional support to achieve targets Objective measurement of changes (Harnett, 2007)

13. Facilitating engagement with services Supporting the decisional balance (Prochaskaet al.1994) Helping parents to engage – understanding the practitioner’s role Effective practice in engaging families - Motivational Interviewing/ Family Group Conferences; Family Partnership Models Understanding engagement: internal and external determinants of engagement; behavioural and interactional indicators of engagement (Platt, 2012)

14. Supporting parents who changed Parents who changed were able to ask for help Received some effective interventions, but these were often short term, and ended abruptly No evidence of intensive evidence based interventions designed to address their needs (eg PUP; MST CAN) Sometimes asked for more support, including extension of child protection plan Support for parents in violent relationships could have unintended consequences (six parents no longer adequately safeguarding by age 5)

15. Assessing parental capacity to changeWard, Brown and Hyde Dryden (2014) • Assessment needs to start early and be part of a process of setting goals, identifying appropriate services and monitoring change • Denial, motivation, engagement, action and relapse • Change is: • Necessary to ensure that children are safeguarded • Difficult for parents to achieve • Cannot be imposed, • Complex, • Takes time

16. References Hindley, N., Ramchandani, P.G. and Jones, D.P.H. (2006) ‘Risk factors for recurrence of maltreatment: A systematic review.’ Archives of Disease in Childhood 91, 9, 744-752. Jones, D., Hindley, N. and Ramchandani, P. (2006) ‘Making plans: assessment, intervention and evaluating outcomes’ in Aldgate, J., Jones, D. And Jeffery, C. (eds) The Developing World of the Child, London: Jessica Kingsley Publishers. Platt, D. (2012) ‘Understanding parental engagement with child welfare services: an integrated model.’ Child & Family Social Work 17, 2, 138-148 Prochaska, J., Velicer, W., Rossi, J., Goldstein, M., Marcus, B., Rakowski, W., Fiore, C., HJarlow, L., Redding, C., Rosenbloom, D. and Rossi, S. (1994) ‘Stages of change and decisional balance for 12 problem behaviours.’ Health Psychology 13, 39-46. . Selwyn, J. , Quinton, D., Harris, P. , Wijedasa, D., Nawaz, S. and Wood, M.(2010) Pathways to Permanence for Black, Asian and Mixed Etrhnicity Children, London: BAAF Sullivan, P. and Knutson, J. (2000) ‘Maltreatment and disabilities: A population based epidemiological study.’ Child Abuse & Neglect 24, 10, 1257-1273. Ward, H., Brown, R. and Westlake, D. (2012) Safeguarding Babies and Very Young Children from Abuse and Neglect. London: Jessica Kingsley Publishers. Ward, H., Brown, R. and Maskell-Graham, D. (2012) Young Children Suffering, or Likely to Suffer, Significant Harm: Experiences on Entering Education. DFE RR209, London: Department for Education Ward, H., Brown, R. and Hyde-Dryden, G.(2014) Assessing Parental Capacity to Change when Children are on the Edge of Care – an Overview of Current Research Evidence, London: Department for Education .