Key message ten: Post-separation support is essential to reduce trauma and avoid recurrent care proceedings

Previous research undertaken by the team at Lancaster University has highlighted the issue of recurrent care proceedings. That is, women who appeared multiple times with different children through the family justice system. What this research showed is that after a preliminary set of care proceedings, a mother has a one in five chance of returning with a subsequent child within a seven year window and that's most likely within the first two years.

This evidence is really important because what we heard from women themselves and experienced recurrent care proceedings was how that loss was so profound, and yet very little support was offered. Following that research and research done by others in the field, there has been a number of services developed nationally and locally in response. However, much of that work is focused on post proceedings, what the born into care qualitative work and interviews with parents has really highlighted is the immediate impact of that separation before proceedings have concluded.

00:01:27:19 - 00:02:00:16
Speaker 1
On leaving the hospital, women went home often alone, to houses full of baby things, their bodies telling them that they were a mother, but with no baby in their arms. That is psychologically an incredibly difficult space to be in. And yet at that time they have a change, a midwife back to a community midwife who they may not know, and the social worker's focus is on the baby, understandably, the baby in placement.

So we kind of drop the women and the fathers and we expect them to try to come to terms with that space and with that loss without support is perhaps not surprising then, that what they return to is all the unhelpful coping strategies that have brought them into the system in the first place. We heard about women's experiences of substance misuse of suicide attempts and in some cases of making themselves homeless because they couldn't bear to be in the house where the baby things were.

So what we do is set them up to fail, and it isn't then surprising that their problems get worse rather than better. So thinking about how do we support men and women in this space immediately following separation is really important and requires a coordinated response from all agencies.

This is a complicated type of grief and loss. That baby hasn't died. You know, that baby is out there being cared for by somebody else. You're likely to see the baby, but perhaps just an hour a time. And in some cases where family time arrangements weren't in place, the parents were left not knowing when they would see their baby.

And so what we need is to help them feel connected, to feel connected to that baby even when they're not in their care. And again, if you look at the resources around the hope boxes, they've been designed as a tool to help the mother stay connected to her baby when they're not together.

So for more information and resources regarding this specific message around Post-separation support, have a look at the links below and hear about some of the practice already happening across the country. You can also visit the Nuffield Family Justice Observatory website where they also have some information directly linking to this key message.

What we've learned from the research is that once that those parents leave the hospital, they are nobody's priority. Um, and that they, that immediate post-separation time is often a time of acute psychological distress.

We've heard of women returning to, to violent partners that they've so desperately tried to, to be away from because they, they just need comfort. We've heard women who just completely withdraw and won't even let a midwife over the threshold to, to give her her routine medical checks. We've heard about self-harm, return to substance misuse. Women not even be able to face going in their own home because it's full of baby things and, and making themselves homeless.

So this period we've done lots of work around recurrent care, but that tends to come at the end of care proceedings. Whose job is it to wrap around the parents at this immediate post-separation stage? How are they getting home? Do they have food? Is there gonna be someone to provide emotional impact? Does the GP know that this is happening? How can we make sure that midwives offer that assertive outreach? If there's continuity that really helps - they're more likely to engage with somebody they already know. How can we think about all those other services that have been working with them before separation to really step up and to be thinking about being a team around these parents?

At this point, it's not surprising that often parents give up at this point because we set them up to fail because we are not providing the support they need at the most difficult time. So it does feel, um, it does feel a bit like a foregone conclusion to parents. 'You've taken my baby, I fall apart, and then you all say, I told you so.' But is it a surprise if that support isn't being offered in this space? How can we improve that? How can we make sure family time arrangements are positive for families that they maximise positive interactions, not just add another level of stress?

So in the guidelines, again, we look at continuity. Um, extended post-natal care being offered beyond the routine ten days, know lots of areas are already doing this. Thinking about what the role of the health visitor might be. For example, obviously the health visitor at the moment follows the baby into foster care, but who's doing that six week check? 

Who's making sure that that post-natal depression check, for example, is done? Often this group of women are missing out on this, and we start to think about priority pathways into adult services as appropriate. When there are acute needs. An assertive outreach around reproductive health, for example. 

Contraceptive offer is really important. We know quick subsequent pregnancies are so common, but that has to be done really sensitively and in a trauma-informed way. 

And on the right here you'll see some quotes from some of the women that we interviewed that just really bring home how difficult this particular period is. 

So included in the guidelines is, is, um, some recommendations around the role of family and friends and how we can include that in family group conferencing. For example, how could we have a review family group conference that thinks about who's the... what the family and friend role might be here? 

How can we improve that information and consideration of family time arrangements? And how do we really gear the whole system up through training, supervision and support to hold the parents in mind?

So some of the practice change we've seen - post-separation planning and that forming either part of birth arrangements, if that's been appropriate, to have the discussions pre-birth or at least it's happening as part of that pre-discharge planning. 

Or, um, while the mother's still in hospital, uh, join up with a local recurrent care service. So an early alert, not waiting, waiting til the end of care proceedings. 

So if you've got a recurrent care service in your area, making sure they're aware that this mother has just, and father, they've just had a baby separated from their care. Assertive outreach around contraception, reproductive health, thinking about the health visit and GP. FGCs [Family Group Conferences]. And again, um, the HOPE boxes, which I'll come onto. 

And finally, the thought about therapeutic family time. How can family time be used in a way that's positive for everybody? It doesn't serve anybody's needs for family time to be, um, really difficult and traumatic. 

Boddy, J. Bowyer, S., Godar, R., Hale, C., Kearney, J., Preston, O., Wheeler, B., & Wilkinson, J. (2020). Evaluation of Pause. Evaluation report. Department for Education. https://assets.publishing.service.gov.uk/media/5fa2d5e2d3bf7f03b3ee4925/Pause_-_Sussex.pdf 

Broadhurst, K., & Mason, C. (2019). Child removal as the gateway to further adversity: Birth mother accounts of the immediate and enduring collateral consequences of child removal. Qualitative Social Work, 19(1), 15–37. https://doi.org/10.1177%2F1473325019893412 

Cox, P., McPherson, S., Mason, C., Ryan, M., & Baxter, V. (2020). Reducing recurrent care proceedings: Building a local evidence base in England. Societies, 10(4), 88. https://doi.org/10.3390/soc10040088 

Mason, C., & Wilkinson, J. (2021). Services for parents who have experienced recurrent care proceedings: Where are we now? Research in Practice. https://www.researchinpractice.org.uk/children/publications/2021/june/services-for-parents-who-have-experienced-recurrent-care-proceedings-where-are-we-now/ 

Morriss L. (2018). Haunted futures: The stigma of being a mother living apart from her child(ren) as a result of state-ordered court removal. The Sociological Review, 66(4), 816–831. https://doi.org/10.1177%2F0038026118777448  

Wall-Wieler, E., Roos, L., Bolton, J., Brownell, M., Nickel, N.C., & Chateau, D. (2017). Maternal health and social outcomes after having a child taken into care: population-based longitudinal cohort study using linkable administrative data. Journal of Epidemiology and Community Health, 71(12). http://dx.doi.org/10.1136/jech-2017-209542 

• Felker, A., Patel, R., Kotnis, R., Kenyon, S., & Knight, M. (2024). Saving lives, improving mothers’ care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020-22. University of Oxford. 
• Mason, C., Broadhurst, K., Ward, H., Barnett, A., & Holmes, L. (2022). Born into Care: Developing best practice guidelines for when the state intervenes at birth. Nuffield Family Justice Observatory.