Recurrent Care Resource: Section 1

Setting up a service: Messages from research, understanding local need and getting going

 This section covers:

  • Key messages from the Vulnerable Birth Mothers and Recurrent Care Proceedings study
  • Understanding local need and existing local provision
  • What a local recurrent care service might look like
  • Identifying key local partners
  • Getting going – progressing the development of a service. 

Background reading
The background reading for this section is the Vulnerable Birth Mothers and Recurrent Care Proceedings study (Broadhurst et al, 2017) from Lancaster University. You can find the full report at: http://wp.lancs.ac.uk/recurrent-care/publications/

Exercise 1: Setting the scene: A journey through current provision, using a case study

In order to understand your local requirements, it is helpful to think about current likely pathways through services for parents experiencing recurrent care proceedings. This exercise uses two case studies to encourage reflection about the local services and sources of support that women are likely to encounter.

Time: Allow 35 minutes for the exercise, plus 15 minutes for discussion.

What you’ll need: Flipchart paper and marker pens or Post-it Notes.

What to do: Work in small groups or in pairs, before coming back together for a whole-group discussion. If yours is a multi-disciplinary and/or multi-agency group, then it’s helpful to ensure a mix of professionals/agencies within the discussion groups.

Here is a link to two case studies based on the biographies of women who took part in the Vulnerable Birth Mothers and Recurrent Care Proceedings research. Choose one (or use both if you prefer). Case Study One, Case Study Two.

Read the case study and imagine that this young woman lived in your area. Starting with her childhood, use a flipchart (and marker pens or Post-its) to create a visual ‘map’ of her journey through services in your area as her story progresses. Include on the map:

  • Any services she is likely to have been in contact with.
  • Detail about what those services would have provided or offered. Make sure you include services provided by partner agencies.
  • Any services currently available in your area that may have been able to provide support, but which she might not have accessed.

When creating your map, think about the different points at which services and support might have been most helpful, and identify what those services or support might be.

After 35 minutes, come back together for feedback and reflection. Keep the maps developed from this exercise.

Film and slide presentations: Introduction to the research findings from Lancaster Animated PowerPoint presentations and film

These presentations and film provide an introduction to the Vulnerable Birth Mothers and Recurrent Care Proceedings study (Broadhurst et al, 2017) from Lancaster University. Allow around 45 minutes for the animated PowerPoint presentations, 10 minutes for the documentary film, and a further 15 minutes for reflection and discussion.

Animated PowerPoint presentations – ‘Birth Mothers and Recurrent Care Proceedings’. Speaker: Claire Mason, Senior Research Associate, Centre for Child and Family Justice Research, Lancaster University.

Part One: Claire introduces the key messages from the research (24 minutes and 36 seconds)

Part Two: How can we better intervene to prevent recurrent care proceedings? (17 minutes and 6 seconds)

 

  • Film 1: ‘Turning Points: Birth mothers and journeys to change’. Speakers: Six birth mothers involved in the study each tell their own story. They talk about the impact of having a child removed and their subsequent journeys to change. Go to: http://wp.lancs.ac.uk/recurrent-care/turning-points-documentary/ (9 minutes and 14 seconds)

Having listened to the research findings and watched the film, allow some time for feedback and reflections. Think about the issues you need to bear in mind for developing your own service and record them on a flipchart (or electronically).

Key points from the Vulnerable Birth Mothers and Recurrent Care Proceedings study 

  • The research confirms what has been known anecdotally for some time (ie, that some mothers experience repeat care proceedings), but shows that the incidence of mothers coming back into proceedings is greater than previously suspected. One in four women will come back into care proceedings within seven years.
  • Mothers experiencing recurrent proceedings have significant and multiple adverse experiences in their own childhoods. There needs to be greater understanding about how these contribute to the persistence of their difficulties in adult life.
  • Women experiencing recurrent proceedings are not a homogenous group. They experience different combinations of difficulties and different pathways though Children’s Services and the family justice system.
  • 40 per cent of the mothers in the study had themselves been in care as children. Most had entered care aged ten or older and had experienced multiple placement moves. There needs to be greater understanding of how a parent’s experiences of being in care impact on their interaction with the family justice system.
  • Mothers are often young at the start of their experiences with care proceedings, and their pregnancies are often unplanned.
  • The removal of a child is in itself a traumatic event, which exacerbates a mother’s existing difficulties.
  • Women identify positive ‘turning points’ that are linked to change – change in relationships with partners, with relatives or friends, with professionals – and to a desire to do better for their children. (Broadhurst et al, 2017)

Identifying local need 

Carrying out a needs assessment is always helpful. It will help you to identify the likely demand for a service and gain a picture of presenting issues so you can shape your service to local need.

A detailed needs assessment that captures the challenges experienced by the intended recipients of your service, and the circumstances in which they are living, will also provide you with some of the baseline data you will need to capture and collect in order to begin the process of measuring outcomes once your service is up and running.

Exercise 2 will help you identify what you know in relation to the population of women in your area who are caught up in recurrent care proceedings and what sources of information you can use to fill the gaps in your knowledge. For example, do you know what the prevalence of recurrent care cases are in your area? Do you know what the needs of these parents are? What are the similarities and differences in their needs and backgrounds?

Exercise 2: Identifying local need

Having reflected on the research messages from the Vulnerable Birth Mothers and Recurrent Care Proceedings study, this exercise is an opportunity to think about what is known about the prevalence of parents experiencing recurrent care in your local area.

Time: Allow 30 minutes for this exercise plus 15 minutes for discussion afterwards

What you’ll need: Flipchart paper or whiteboard, and marker pens or Post-its

What to do: Write the following questions as four headings on flipchart paper or a whiteboard. Then, working in pairs or small groups, answer each of the questions:

  • What do you know already?
  • What do you suspect?
  • What do you need to find out?
  • How can you find out?

Come together as a group and review your answers. You may want to use the Tips from Practice (see below) to prompt the whole-group discussion. Pull the information together, grouped under these headings, and keep as a note to inform future activity.

Tips from Practice: Collecting evidence of local need

Here are some tips from the Change Project’s practice experts on their experience of collecting evidence of local need in relation to recurrent care cases, and the circumstances and needs of the parents involved:

  • Collecting evidence is not straightforward and can take a lot of time.
  • The most reliable data will usually be found by conducting a manual trawl through files. (Children’s Services data systems are designed primarily as management systems for recording information about individual children and often lack basic information about parents. They rarely include easily accessible information about whether a child’s parent has been involved in previous proceedings, for example. This means the collection of more detailed data will usually require a manual trawl through files to collect information.)
  • In some areas, practice leads have worked with their legal departments to look back at care proceedings issued over a period of years and identify cases where parents had previous experience of proceedings. In one local area, the legal department also provided information on the cost of legal representation and expert evidence in recurrent cases.
  • In other areas, court staff have been able to identify cases over the period of a year where a mother was coming back into proceedings with a different child.
  • Other potential sources of information are post adoption services or parenting assessment services.
  • You might decide to check through all cases going into care proceedings over a period of 12 or 24 months, or the cases of all children who are looked after at a particular point in time, or all children who became looked after during a specific period. An alternative approach would be to select a percentage of these cases for a more in-depth look to build up a picture of need.
  • You could start tracking all current cases in pre-proceedings to see whether the parents have been involved in proceedings before. Another approach would be to look at all care leavers over a defined period of time and identify those cases where they lost a child through proceedings, either while still in care or shortly after leaving care.
  • Make use of focus groups with mothers (or fathers) who have lost a child through care proceedings to talk about their experiences.
  • You could commission an outside body to assist with a needs assessment. For example, Pause will carry out a needs assessment and prepare a business case for areas wishing to set up a Pause Practice. (There is a charge for this service.) Pause may also be able to carry out assessments for areas that decide to develop a response to recurrent care that is not a Pause Practice.
  • Large data sets, such as the Cafcass data, can be analysed by local authority area to give an indication of the proportion of women in care proceedings in each year who are mothers experiencing recurrent proceedings. Accessing, and then analysing, this data is not straightforward, however; it is unlikely to be something a local area will do without support from an academic institution.

Tips from Practice: Collecting baseline data

When carrying out a needs assessment, it is helpful to start identifying the baseline data that you will be able to use to measure progress of your service later on and which will help you develop a business case.

Some relevant baseline characteristics include:

  • In relation to the mother/father, the number of children who have been removed from their care in the past
  • The reasons why the children were removed
  • The ages of the parents in the sample
  • The age of the mother at first pregnancy
  • Whether the mother/father had themselves been in care
  • The presence of mental health problems in either parent
  • Evidence of existing or past domestic abuse
  • Parental drug or alcohol problems
  • Whether the parents have a learning disability
  • Relevant childhood experiences of the parents.

Exercise 3: Mapping of services

Time: Allow 30 minutes for the first part of the exercise, plus 15 minutes for discussion.

What you’ll need: The two case studies from Exercise 1 and the visual maps of Amy and/or Chantelle’s progress through local services (these were created during Exercise 1). You will also need the ‘Sustain, Start, Stop’ template.

What to do: Having had an opportunity to hear and reflect on the research findings (in the earlier film and slide presentations), revisit the case studies and the map of the journey through services that you created in Exercise 1. Then, working in pairs or small groups, identify: 

  • The services or processes (eg, referral pathways or protocols, links between agencies/services, thresholds for support) that are working well in your area for parents who experience recurrent care proceedings. (Record these under ‘Sustain’ on the template provided.)
  • The gaps in provision or processes, and ways those gaps could be addressed. (Record these under ‘Start’ on the template.)
  • Services, processes or polices that are hampering your ability to respond well to parents experiencing recurrent care proceedings. Record these under ‘Stop’ on the template. Then come back together as a whole group for 15 minutes or so to discuss your conclusions. Collect up or take photos/copies of the templates, and/or record the whole-group discussion at the end, and use this information to inform your planning.


What might a local service look like?

You may know already that there are gaps in service provision – for example, in relation to post-proceedings support for parents, or the processes around pre-birth assessment and support. Or parents may face barriers in accessing services because of overly rigid processes and procedures – for example, difficulties in accessing specialist services for domestic abuse, mental health or substance misuse.

Exercise 4: Developing your service

Time: Allow 50 minutes for this exercise (30 minutes working in pairs or small groups and 20 minutes for a whole-group discussion).

What you’ll need:The two slides that show the different need groups from the research and the different points of possible intervention. Copies of the ‘Designing Your Service’ template.

What to do: Think about the different types of need and the different points of intervention identified in the Vulnerable Birth Mothers and Recurrent Care Proceedingsstudy (Broadhurst et al, 2017). Bearing in mind the work you have done in relation to identifying local need and mapping local services (Exercises 2 and 3), divide into pairs or small groups and consider: 

  • Where might you focus your efforts (given what you know about need)?
  • What are the key details of the service you plan to provide?
  • Who do you need to engage?

Each pair or group should fill in a template as they develop their answers to these questions. They can use the Tips from Practice (set out below) to prompt their discussions.

At the end of the exercise, collect together and/or keep copies of the templates, or pull the information together onto one template. Use this information to inform your planning. This initial service outline will be developed further in subsequent sections of this resource.

Tips from Practice: Developing your service 

You can use the Tips from Practice below to help your thinking and discussions when doing Exercise 4. All these pointers are drawn from the experiences of Change Project participants.

Where might you focus your efforts?

  • Care leavers: Given the proportion of mothers caught up in recurrent care proceedings who were themselves in care, some Change Project participants decided to focus their activity on young care leavers who have lost one child through care proceedings.
  • Pre-birth assessment and support for women who are pregnant and who have had one or more children removed.
  • Post-proceedings support for women in the immediate aftermath of a child’s removal or shortly afterwards.
  • Some participants were interested in working with mothers both pre and post proceedings and some worked with both parents pre, during and post proceedings.
  • Some projects are working with fathers as well as mothers.

What are the key details of your service?

Other factors to consider when developing a service will be:

  • What will be the model of delivery – key work, group work, outreach, or a mixture of all of these?
  • Will there be therapeutic input and if so, how and what?
  • What skill-set and experience do you need within the team?
  • How many mothers or fathers or both will you offer a service to? For how long?
  • What will be the eligibility criteria for the service?
  • If you’re not planning to work with women who are pregnant, what will you do if they become pregnant? What links or pathways are in place for pre-birth assessment and support?
  • What will the referral system be? Will you use referral forms? Can parents self-refer?
  • What sort of caseloads are you considering?
  • Will your service be independent of Children’s Services, located within it, or jointly commissioned with adult services or health?
  • Will the service be part of early help and targeted provision, family support, or an intensive family intervention project?    

Identifying local partners – who do you need to engage?

It is crucial to engage a wide range of local partners in your service development discussions and to obtain their support for the proposal, ideally with a commitment also to provide funding, staff or other support. Change Project participants identified a range of potential key partners:

  • Health services (midwifery, perinatal mental services)
  • Public health (health visitors, sexual health, substance misuse services)
  • Domestic abuse services
  • Learning disabled services
  • Family support and early help
  • Third sector organisations
  • Housing.

Participants also identified practical ways to engage relevant partners. These include:

  • Improving the pre-birth assessment and support offer to mothers who have had a previous child removed, through earlier intervention and closer working between family support and midwifery.
  • Developing a multi-agency protocol for pre-birth assessment.
  • Developing a multi-agency protocol for working with parents who are learning disabled.
  • Being informed about the strategic and policy priorities of partner agencies that you might link the development of a service to.

Tips from Practice: Getting going – taking the next steps

A clear message from the Change Project was the importance of getting going, even if that means starting without all the necessary information on needs, or the answers to all the questions set out above.

Here are some tips about how to get going with the development of your service. They can be used to inform your discussions and help you think about your next steps. All these tips are drawn from discussions within the Change Project group and what the participants learnt from setting up new projects:

  • Don’t be daunted by difficulties in accessing data – if necessary, think small.
  • Identify local champions among managers of key services.
  • Set up a Steering Group and make sure it includes senior management representatives from key partners.
  • Set up an Operational Group – this should include members drawn from a similar range of key partners, but make sure you include operational staff who can help problem solve along the way.
  • Start a project plan with a timeline.
  • Consider finding funding (via contributions from all services or a funding application) for a project manager (possibly part-time) to manage the process of needs assessment, engaging partners, developing a service specification, finding a venue or location, supporting recruitment or secondments, publicising the service.
  • Visit similar projects in other areas (see some of the examples in Section 5).
  • Communication and publicity locally is important – with children’s social care, with health services, with adult treatment services, adult social care, adult mental health services, with third sector organisations working with families, with the police, and with domestic abuse services. This is not just to raise interest locally and develop support, but also to ensure that once your service is up and running, referrals come from a wide range of agencies.
  • Take account of the local geography and how it might impact your service. For example, in a large rural county area there are likely to be transport issues (for both parents and staff), so would it be better to start with a small pilot in one area of your county only?
  • Is a regional approach being considered – for example, in a large area like Greater Manchester or West Yorkshire, or in an area with a mix of unitary and a county local authority? If so, what are the likely obstacles to progress? Will there be difficulties accessing each other’s services? How could these be overcome?
  • Start thinking about IT systems, data protection and data sharing from the start. Once again, this is because the focus of your work will be with adults rather than children.
  • Start thinking about how you will incorporate parents’ experiences to inform the development of your service.

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