Blog post: Born into Care - One thousand mothers in care proceedings in Wales

A blog from Professor Karen Broadhurst (Lancaster University) & Dr. Lucy Griffiths (Swansea University)

This blog is focused on two main findings from our recently published report “1000 Mothers in Care Proceedings in Wales” (available here). First, we focus on what we have learned about the timing of women’s engagement with antenatal services. Second, we discuss the scale of women’s mental and health vulnerabilities uncovered by the research. We also draw readers’ attention to a new practice initiative in Newport in Gwent: “Baby and Me” delivered by Barnardo’s. This new project is achieving some promising results from a very different way of working with parents in pregnancy.

We write on behalf of colleagues in our Family Justice Data Partnership, which is a collaboration between Lancaster University and Swansea University, funded by the Nuffield Family Justice Observatory (see here for more details).

  

1. Concealed pregnancy – fact or fiction?

There is growing recognition that effective help must be provided to parents pre-birth – if we are to reduce the numbers of infants coming before the family courts in care proceedings. In Wales, more and more infants are appearing in care proceedings at birth, or early in the first year of life, and many of these babies will not return to parents. These were key findings from earlier reports in the “Born into Care” series (available here).

However, help can only be provided to women and their partners in pregnancy if health and social care services know that women are pregnant at a timely point. Concern has been expressed by professionals that some mothers may avoid engaging with antenatal services, or may in fact conceal their pregnancies. Indeed, many local authorities publish guidance on the topic of pregnancy concealment. Parents can be fearful of children’s services involvement, particularly if a child has been removed previously, from their care.

Findings from our new report, provide for the first time, an evidence based picture of the timing of women’s engagement with antenatal services. We were able to pinpoint the timing of women’s first antenatal assessment, by looking back at maternity records for over 1000 women in Wales, whose babies were the subjects of care proceedings between 2015 and 2018. This is the first time that population-level family court and maternity records have been linked.

Our new findings firmly challenge assumptions that avoidance of antenatal services or pregnancy concealment is common for this particular population of mothers. The researchers found that opposite was the case. 63% of the mothers were known to antenatal services within the first 12 weeks of pregnancy – only a small proportion were not known until the late stages of pregnancy (approximately 5%). Although overall, the total population of our mothers tended to book their pregnancies later than the general population – the findings are good news and point to a pivotal role for midwives in helping mothers access the help they need at the earliest possible point in pregnancy. The majority of mothers, at least when they ‘book’ their pregnancies with midwives, appear to be receptive to professional help. Of course, mothers who do book very late are concerning – and the research team are currently engaged in further work to understand this small group of mothers.

  

2. Uncovering the scale of mental and physical health needs

Turning to our second major finding, our work has also uncovered the scale of mental and physical health vulnerabilities among women involved in care proceedings. Through record linkage we have been able to produce a far more holistic picture of women’s health needs. Findings about mental health need are particularly stark – more than 50% of women self-reported mental health difficulties at their initial maternity assessment (or ‘booking’) and from analysis of GP and hospital records, over three-quarters of women had recorded mental health difficulties. Alongside mental health vulnerabilities, women also recorded high rates of smoking and substance misuse. Given these findings, we cannot afford to miss the opportunity that pregnancy provides to improve the health and wellbeing of mothers and their unborn children. Mental health and physical health vulnerabilities are all amenable to treatment, but achieving durable change takes time.

Once the local authority issues care proceedings for a baby after birth, there is very little time for parents to make the changes they need, such that they can convince the courts that their babies should be returned to their care. The family courts in Wales, as in England, must (save for exceptional cases) conclude care proceedings within 26 weeks. In addition, once care proceedings are issued, professional time will be consumed by the requirements of the court - again reducing the resource available to support parents to improve their ability to provide safe care for their babies.

Placing maternal mental health and wellbeing far more central in pre-birth assessment is a robust finding that follows directly from our analysis of all (usable) records for mothers appearing in care proceedings between 2015 and 2018. Improving the health of mothers will in turn impact on the health of the unborn child. Policy and practice needs to be underpinned by reliable evidence, which is best derived from large and representative samples – or in this case - full service populations.

 

3. “Baby and Me” – a different approach to working with parents in pregnancy

We know from a growing body of literature that new and innovative approaches to practice can succeed with vulnerable and ‘high risk’ parents – where the local authority standard casework model has struggled to turn lives around. The new “Baby and Me” service in Newport is one example of a different kind of intensive service offered to mothers and their partners in pregnancy, which is having very promising results. This is a service resulting from collaboration between the local authority and the third sector, working together to design services that meet the needs of parents in pregnancy requiring higher levels of support. Through involvement with the “Baby and Me” service in pregnancy, a number of parents who may otherwise have lost their children to public care or adoption, have managed to keep their babies. For parents who have not been able to make sufficient change – “Baby and Me” has still been a positive experience, enabling parents to accept and understand the reasons why children were removed. Although it is early days for this service, it is surely a clear example of how services might be offered to benefit vulnerable mothers and their partners during pregnancy.

Professionals delivering the “Baby and Me” service understand that parents involved with them will often have significant difficulties in engaging with the structure and formal appointment systems of mainstream services – and this applies to mainstream mental health services. Parents who find themselves in care proceedings may, for a range of reasons, find it difficult to attend appointments. “Baby and Me” practitioners understand that, in many cases, a lack of confidence, self-worth or hope results in parents believing they have little to be gain by working with local authority children’s services. Within this innovative service, “Baby and Me” professionals spend considerable time working with parents to explore feelings that stand in the way of engaging with services. This is an outreach service that explicitly conveys care, wanting parents to feel that if others are hopeful for them - then they can feel hopeful too.

So, what has all this got to do with mental health and wellbeing? Firstly, social workers and family support workers who are able to work intensively with parents, and see their own relationships with families as the vehicle for change, can have a direct impact on reducing common mental health difficulties of depression and anxiety. In addition, professionals working in services such as “Baby and Me” can serve as a bridge to more specialist mental health treatment where this is needed. Without such bridging relationships, the gulf between the lives of vulnerable parents and formal service provision can simply be too great. Moreover, without “someone to turn to” in our everyday worlds – the value of more formal mental health treatment, is likely to be limited.

A note on the SAIL Databank:

The research was enabled by the Secure Anonymised Information Linkage (SAIL) Databank at Swansea University, a safe haven for billions of person-based records. It can be used to shed new light on important areas of public health and public service. The SAIL Databank holds linkable datasets, and all data that can be accessed for research is anonymous – meaning that the identities of the individuals represented are not known. This is particularly important when working with vulnerable and young people. Information is also available for the entire population of Wales, so it can be used to understand more about people who may not be easily reached through surveys or other research methods. https://saildatabank.com/