Dare we risk allowing parents time to fail?

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Dare we risk allowing parents time to fail?

Published on 20 Apr 2010

Stephen Naysmith

We give parents a reasonable chance, but if they can’t get it together, we can’t have children paying the consequence of that.

There was a phase in the 1990s when we would try to shore up the biological family and return their kids to them. But for some kids, their parents couldn’t function adequately,” says Professor Charles Zeanah. “The pendulum has now swung in the other direction”.

Prof Zeanah is explaining why the American law on child welfare, which some in Scotland would view as excessively punitive, is one he backs.

Under America’s Adoption and Safe Families Act, introduced by former president Bill Clinton in 1997, any child who has been in care for 15 out of any given 22 months must be found a permanent place to stay, usually by the state filing for adoption.

Prof Zeanah is at the forefront of using the law. The New Orleans Intervention which he pioneeered, aims to take such decisions as early as possible in the lives of young children facing abuse, neglect or maltreatment at home.

Intensive support is put in place for all parents of children under five who have to be fostered. If they make progress, their children are returned to them, but if they don’t the child is fast-tracked for adoption.

He isn’t keen to spell it out, but he clearly thinks the pendulum has yet to swing back in Scotland, where social work departments, children’s panels and the courts tend to err on the side of supporting families on the basis that the best place for a child is usually with their biological family.

The result for a minority of children can be years spent yo-yoing between their original home and a variety of sources of institutional care.

“We have a bit of to-ing and fro-ing to foster care in Louisiana also and for older kids longer term foster care can be an acceptable plan,” Zeanah explains. “But for younger kids it is not in their best interests to languish there because of what we know about the effect of long term foster care on children.

“It is not that we don’t think making efforts to return children to biological families is important – it is. But the question is for how long and how much do you balance the parents’ rights to look after their children against the inreasing evidence and awareness that the longer that is, the less likely you are to be successful?”

In Louisiana, the results have been impressive. Families where children had previously been maltreated were reassessed after they had been through the New Orleans Intervention. In families which did well enough to have their children returned, 68% of those children were not subsequently maltreated. If the mother had further children they were also less likely to be maltreated.

Meanwhile children who had to be adopted tended to suffer fewer long term consequences. This is pretty impressive, Zeanah claims: “If you read the literature there are many serious effects of maltreatment – it is a very powerful risk factor for the child having subsequent problems.”

He is cautious about his findings, which were on a small sample, with no direct control group. “But the kids that had been through our programme looked pretty good. In a follow-up study, there were very few differences between the level of clinical problems shown by children who had been through our programme and kids who had never been maltreated at all.”

It isn’t just Prof Zeanah who feels that the New Orleans model may be better. Now the Intervention is providing the basis for a pilot scheme in Glasgow to test the ‘ticking clock’ principle behind his work.

The City Council and Greater Glasgow and Clyde Health Board are backing it through Glasgow’s West Community and Health Care Partnership, while academics at Glasgow University will research the impact of the scheme robustly.

The intention is that in Glasgow very young children who are placed in foster care will be assessed along with their families – primarily to try to discover whether the parents can change. They will be provided with help and support to do this. Crucially, that help includes input from mental health specialists who will work from the start to attempt to avoid the child being harmed.

However, with no equivalent of the Adoption and Safe Families act in Scotland, the scheme will not have the same powers of compulsion as in Louisiana.

Here, most of the decisions about the welfare of children who are at risk or neglected are taken by children’s hearings, while local authorities apply to special panels if they want children to be freed for adoption.

After six to nine months working with the child’s birth family, the team will be aiming to provide a much more comprehensive, detailed and convincing report on the ability of a child’s parents or carers to change, and at a much earlier stage. Although the best interests of the child are legally defined as paramount in Scotland, children’s hearings sometimes struggle to get mental health assessments carried out when they need them, and decisions can sometimes take too long with families given too many ‘last chances’.

Matt Ford, head of children’s services in West Glasgow said many social workers were enthusiastic about the potential of the pilot. Meanwhile Dr Graham Bryce, Consultant Child and Adolescent Psychiatrist at NHS Greater Glasow and Clyde, said it had great potential. “It appears to offer a reliable and pretty transparent way of inding out whether these children can safely be with their birth families.

“On the one hand everyone wants that to be the case, but on the other, the risks are sometimes just intolerable,” he said.

Helen Minnis, a psychiatrist and lecturer at Glasgow University, said the key was often whether families were willing to accept that they had maltreated their child. “If they can, the evidence is you can work with the most surprising families.

“In total we will have about one year to work with families. After about half it starts to become clear whether it is likely to work or not and if not, you can begin to work with the foster family and the birth family to come to terms with the chance they’ll be adopted.”

Ms Minnis, who researched the New Orleans Intervention as part of a Winston Churchill Memorial Trust grant, said the city was surprisingly similar to Glasgow in demographic terms and suffered similar drug problems. However she rejected the suggestion that the scheme was punitive. “The beauty of their model is if they go to the courts and recommend a child is adopted, they will be doing it having given the family the best chance. At the moment, social workers can’t go to the children’s panel and say that we have given this family nine months of the best assistance.”

She says it is not harsh to put a time limit on asking parents to shape up. “I think there are a lot of people working with children who still don’t understand how absolutely crucial the first weeks and months are. From the moment the child’s born you have to get it right. As far as the child is concerned, that is the time scale they need.”

Professor Zeanah is to speak at the Fred Stone Memorial conference at Glasgow’s Hilton Grosvenor Hotel on Friday May 7. For more information see: http://bit.ly/91EB7P