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Rehabilitation – A Postcode Lottery?

There has been recent controversy regarding claims by MP’s and national newspapers that babies are being removed unnecessarily from their parents in order to meet adoption targets. Although the author of this article does not subscribe to such a view the proposition is advanced that there is considerable variation in the approach of different local authorities to possible rehabilitation and the resources that they develop or devote to helping children return safely to their parents.

John Gumbleton, child protection consultant and family therapist in private practice

There has been much recent debate regarding the claim by John Hemming MP that social workers are literally snatching newborn babies and children from good, stable, loving homes to meet adoption targets. Social work journals and the national press have seen a number of angry letters denouncing this assertion and some offering a measure of support. Although a target was set by Government of a 50 per cent increase in the number of children adopted between 2000 and 2006 ministers have denied that a policy to remove children to meet this target exists. Although I am not aware of any evidence of local authorities removing children unnecessarily to meet adoption targets I do believe that there is just cause for concern regarding how different local authorities respond to child protection situations and how they view the possibility of rehabilitation.

As an independent child protection consultant I work across England and Wales and see social work practice from a wide range of local authorities. I am constantly surprised by the differing responses of local authorities to very similar child protection presentations. Many local authorities appear to make every effort to keep children with their parents or in a kinship placement, whilst others seem determined to seek an adoptive placement from early in the child protection process. Such variation has many of the hallmarks of a postcode lottery.

I am frequently asked to provide risk assessments to the Court regarding the viability of rehabilitation where parental denial is a feature. Over the last seven to eight years I have been referred a number of cases where I found it impossible to determine that one carer was more safe / less safe than the other, even when I took into account all the factors from the parents' past and the current context. Typically in these cases a finding has been made that a child has sustained non-accidental injuries whilst in the care of its parents, but there is insufficient evidence to indicate which parent, or both, was responsible.

Such cases come under what has become known as the Lancashire Ruling. The House of Lords in Lancashire County Council v B (2000) 2 AC 147 held that the threshold criteria is established by a finding that a child has suffered harm whilst in the care of its parents without the need to establish precisely who caused those injuries. In these cases neither parent admits to being the perpetrator nor blames the other. They give the Court no assistance, simply saying that they caused the child no harm themselves, and have not witnessed the other doing so.

These cases cause professionals considerable dilemmas as they are left with minimal information upon which to base assessments and decision making regarding the child's future placement. The Court can be presented with two carers who are seemingly good parents and who have had no previous contact with Social Services or the Police. In many of the cases I have worked with there were few, if any, concerns regarding either carer prior to the injuries to the child that led to my involvement. Because of the lack of risk factors and an often significant number of positives the Court can be reluctant to close the door upon the possibility of re-unification, despite the lack of clarity regarding causation and culpability.

Paradoxically, I have found that for many professionals the absence of risk factors causes them to view the concerns as more serious and the prognosis more hopeless. When specific problems are highlighted, professionals can often recommend appropriate services to address the difficulty. For example, if there has been domestic violence the parents can be referred to specialist resources that deal with such issues or to anger management programmes. When no concerns can be identified beyond the child's injuries professionals frequently feel at a loss as to how to respond. This tends to lead to greater anxiety regarding children's safety and a reluctance to consider reunification.

It would appear that for many local authorities the fact that it is unclear who is responsible for the injuries rules out any possibility of children returning home. This can even lead to the ludicrous decision to not even undertake a risk assessment based upon the reasoning that as neither parent is admitting responsibility there is no point. In one case I was involved in recently this position was even supported by the Children's Guardian. As Dr Bentovim states when assessing child protection situations:

" .. the conclusions must take into account all aspects of the family's functioning and not focus exclusively on the presence or absence of denial, which is only one element of a much larger assessment." (1)

When Courts have to make important decisions regarding a child's future I believe it is axiomatic that they should be provided with as much information as possible upon which to make such crucial judgements. The fact that parents are denying responsibility should be taken into account as part of the assessment and not be used as a reason to rule it out. To deliberately refuse to undertake a risk assessment hinders the Court in its deliberations and is also grossly unfair to parents. Natural justice demands that children should only be removed permanently from their parents after thorough and balanced assessment.

One of the main principles of the Children Act 1989 is that children are usually best brought up in their own families wherever possible. With regard to long term placement of children removed because of child protection concerns, the first consideration should always be whether it is safe enough, or might be made safe enough, for them to return home. Only when this has been ruled out should decisions be made to permanently place children elsewhere. In order to determine whether it might be made safe enough for a child to return I believe professionals need to consider a number of factors:

If the answer to most or all of the above is yes I have found that it is often possible to rehabilitate children safely even when the parents remain in denial.

Another wide variation in social work practice concerns attitudes towards possible placement of children with kinship carers, both in the short and long term. Professionals often believe that members of the parents' support network should be able to immediately accept expert medical opinion and any finding of the Court. In my experience this is unrealistic and rarely happens, it usually being more of a process than an event. It is asking a great deal of extended family members to accept that their son, daughter, brother or sister has harmed their own child, especially if they have never witnessed any behaviour that has given them previous cause for concern. A failure to do so, however, often sees them labelled by professionals as "colluding" with the parents and therefore "unsafe" as possible carers for the children. This can deny children a possible placement with adults who they already know and with whom they have a meaningful attachment, thereby minimising the emotional impact of removal from their parents' care.

It is perfectly understandable that extended family members struggle to accept that the parents could have harmed their own child. This should not necessarily disqualify them from offering the child a placement or to be involved in reunification plans to help keep the children safe in the future. Despite a sense of loyalty to the parents I almost invariably find that extended family members' first priority is the safety of the children.

The final difference which is of concern is the variation in resources that local authorities have developed to support any plans for rehabilitation. In considering reunification in serious child protection situations there is a need for both specialist skills and more general support services. As long ago as 1992 Professor Elaine Farmer (2) highlighted the anomaly that Local Authorities often develop specialist teams regarding the fostering and adoption of children who are in the care system but rarely develop specialist resources to help reunify children with their families.

When children return home after suffering significant physical injury there is a need for very close monitoring. I have worked with some local authorities where they were able to provide daily visits by either family support workers or social workers for a significant period following a child's return. In other local authorities they have struggled to visit once per week. If Courts are to be persuaded to consider reunification they need to be assured that children's safety and wellbeing are being taken seriously and closely monitored. Should a local authority not be able to provide adequate services this might influence the Court's decision as to whether children can return home safely. It is not fair on parents that they could lose their children because of a lack of appropriate resources.

Although there will always be some difference in approach between individual practitioners and local authorities, families should not have to fear losing their children because of where they happen to live. The professional system should ensure that every effort is made to allow children to be brought up safely within their own family before pursuing the finality of adoption.

References
(1) Bentovim.A. in Reder and Lucey (eds) "Studies in the Assessment of Parenting", Brunner – Routledge, East Sussex 2003
(2) Farmer, E. (1992) Restoring children on Court Orders to their families: lessons for practice, Adoption & Fostering, Vol 16, No. 1.

John Gumbleton is a child protection consultant and family therapist in private practice. He specialises in assessments where children have been harmed or are deemed at risk, but where parents deny responsibility. He also undertakes therapeutic work to help safely rehabilitate children to their carers. johngumbleton@blueyonder.co.uk