Overcoming Adversity and Capacity to Change

Report
Overcoming Adversity and Capacity
to Change
Harriet Ward and
Georgia Hyde Dryden ,
CCFR,
1
Safeguarding Babies and Very Young
Children from Abuse and Neglect:
(Ward, Brown and Westlake 2012; Ward, Brown and Maskell Graham, 2012)
 Prospective longitudinal study of 57 babies identified
as suffering or likely to suffer significant harm
 All identified before first birthdays
 43 followed until age three; 37 until age five.
Continuing now until ages 7- 8
 Data from case papers; annual interviews with birth
parents/carers; Strengths and Difficulties
Questionnaires; interviews with children aged 7+
 Very high risk sample
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Children
 Majority from families already known to children’s
social care through involvement with older siblings
 65% identified before birth; almost all before they
were six months old
 63% were boys
 69% White British; 31% from BME groups: 69% of
these were of mixed heritage. High proportion of BME
infants found in other studies (see Selwyn et al.
2010)
 14% were identified as having disabilities or special
health care needs. Children with disabilities are 3.4
times more likely to experience abuse and neglect
(Sullivan and Knutson, 2000)
3
Parents’ difficulties
 Primary risk factors: violence (at home and in
community), substance misuse issues, mental
ill health, learning disabilities, experiences of
abuse in childhood
 Secondary risk factors: housing problems
including homelessness, financial problems
including bankruptcy
 Isolation, poor relationships with extended
family
 Twenty mothers and an unknown number of
fathers had already been permanently
separated from at least one older child
4
Factors associated with future harm
 Abuse: eg Neglect, previous maltreatment
 Child factors : eg Very young, developmental delay
 Parent factors: eg Substance misuse, Personality
disorder, learning disabilities plus mental illness,
experience of abuse in childhood, denial
 Parenting and parent-child interaction: disordered
attachment
 Family: Inter-parental conflict; power problems
 Professional: eg lack of resources
 Social setting: isolation, violent neighbourhood
5
Classifying families by risk of harm
 Based on systematic review of evidence
concerning risk and protective factors and the
likelihood of maltreatment or its recurrence
(Hindley, Ramchandani and Jones, 2006)
 Each child classified according to the level of
risk of maltreatment or its recurrence
 Classification used data at identification by
children’s social care (Time One) at age three
(Time Two) and at age five (Time Three)
 Particular weight given to evidence of parents’
capacity for change
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The children at entry
 Severe risk (12:28%): Risk factors, no protective
factors and no capacity for change
 High risk (7:16%): Risk factors, protective
factors and no capacity for change
 Medium risk (21:49%): Risk factors, protective
factors, capacity for change
 Low risk (3:7%): No risk factors (or previous risk
factors addressed, protective factors and
capacity for change. Includes two outliers
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At age three
 35% (15) Permanently separated
 28% (12) Medium –severe risk: inadequately safeguarded
with birth parents who had not shown capacity to change
 53% (23) had experienced abuse or neglect
 37% (16) maltreated in utero
 37% (16) maltreated while open cases
 57% displayed emotional problems or substantial
behavioural difficulties
 No evidence that 20 (47%) children experienced
maltreatment by the time they were three
 37% (16) Low risk: adequately safeguarded, living with
birth parents who had sustained positive changes
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Which parents can change?
Parents who successfully changed were:
 Less likely to have experienced abuse in
childhood and substantially less likely to have
experienced childhood sexual abuse
 Able to come to terms with the removal of older
children
 Able to acknowledge the risks posed by their
destructive behaviour patterns
 Able not simply to engage with services but also
to make positive use of the support they offered
 Able to develop supportive informal networks
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The birth of a child as a catalyst for change
 No parent overcame substance misuse if they
continued to use drugs after the child had been
born
 All but one set of parents who made and
sustained sufficient changes, had addressed all
known risk factors by the time the child was six
months old
 A number of parents, including four of those who
overcame substance misuse, spoke of a ‘wakeup call’ that acted as a catalyst for change. No
parents in the insufficient change group spoke of
such an epiphany
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Simon’s mother: what made her change?
“My son being born, my son being born, definitely.
And I think the scare what social services gave me
was a kick up the arse and the scare that I
needed…They were going to put [Simon] into foster
care…And I thought to myself, I just cannot, you know,
you know what, I felt like a movie, I felt like, oh my
god, my baby, not my baby. And he was so tiny, I felt
like, oh no my baby, I felt like, and I thought you’re
having a laugh, I couldn’t believe, you know…A big
shock, a big shock, it was a big wake-up call and it
was just a terrible feeling, I couldn’t believe it.”
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Assessing capacity to change
 Cross cutting assessment of parenting capacity
 Cross-cutting assessment of children’s needs
 Case conceptualisation (analysis of gap between
parenting capacity and child’s needs)
 Agreed targets for change and goals set
 Additional support to achieve targets
 Objective measurement of changes
(Harnett, 2007)
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Facilitating engagement with services
 Supporting the decisional balance (Prochaska et al.
1994)
 Helping parents to engage – understanding the
practitioner’s role
 Effective practice in engaging families - Motivational
Interviewing/ Family Group Conferences; Family
Partnership Models
 Understanding engagement: internal and external
determinants of engagement; behavioural and
interactional indicators of engagement (Platt, 2012)
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Supporting parents who changed
 Parents who changed were able to ask for help
 Received some effective interventions, but these were
often short term, and ended abruptly
 No evidence of intensive evidence based interventions
designed to address their needs (eg PUP; MST CAN)
 Sometimes asked for more support, including extension
of child protection plan
 Support for parents in violent relationships could have
unintended consequences (six parents no longer
adequately safeguarding by age 5)
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Assessing parental capacity to change
Ward, Brown and Hyde Dryden (2014)
 Assessment needs to start early and be part of a
process of setting goals, identifying appropriate services
and monitoring change
 Denial, motivation, engagement, action and relapse
 Change is:





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Necessary to ensure that children are safeguarded
Difficult for parents to achieve
Cannot be imposed,
Complex,
Takes time
References
Hindley, N., Ramchandani, P.G. and Jones, D.P.H. (2006) ‘Risk factors for recurrence of
maltreatment: A systematic review.’ Archives of Disease in Childhood 91, 9, 744-752.
Jones, D., Hindley, N. and Ramchandani, P. (2006) ‘Making plans: assessment,
intervention and evaluating outcomes’ in Aldgate, J., Jones, D. And Jeffery, C.
(eds) The Developing World of the Child, London: Jessica Kingsley Publishers.
Platt, D. (2012) ‘Understanding parental engagement with child welfare services: an
integrated model.’ Child & Family Social Work 17, 2, 138-148
Prochaska, J., Velicer, W., Rossi, J., Goldstein, M., Marcus, B., Rakowski, W., Fiore, C.,
HJarlow, L., Redding, C., Rosenbloom, D. and Rossi, S. (1994) ‘Stages of change and
decisional balance for 12 problem behaviours.’ Health Psychology 13, 39-46.
.
Selwyn, J. , Quinton, D., Harris, P. , Wijedasa, D., Nawaz, S. and Wood, M.(2010)
Pathways to Permanence for Black, Asian and Mixed Etrhnicity Children, London: BAAF
Sullivan, P. and Knutson, J. (2000) ‘Maltreatment and disabilities: A population
based epidemiological study.’ Child Abuse & Neglect 24, 10, 1257-1273.
Ward, H., Brown, R. and Westlake, D. (2012) Safeguarding Babies and Very Young
Children from Abuse and Neglect. London: Jessica Kingsley Publishers.
Ward, H., Brown, R. and Maskell-Graham, D. (2012) Young Children Suffering, or Likely
to Suffer, Significant Harm: Experiences on Entering Education. DFE RR209, London:
Department for Education
Ward, H., Brown, R. and Hyde-Dryden, G.(2014) Assessing Parental Capacity to Change
when Children are on the Edge of Care – an Overview of Current Research Evidence,
London: Department for Education
.
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