childrens needs parenting capacity

Children’s Needs – Parenting Capacity

Child abuse: Parental mental illness, learning disability,

substance misuse, and domestic violence

Hedy Cleaver

Ira Unell

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H I L D R E N

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E E D S

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A R E N T I N G

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A P A C I T Y

C h i l d a b u s e : P a r e n t a l m e n t a l i l l n e s s , l e a r n i n g d i s a b i l i t y,

s u b s t a n c e m i s u s e a n d d o m e s t i c v i o l e n c e

2 n d e d i t i o n

H E DY C L E AV E R , I R A U N E L L A N D J A N E A L D G AT E

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ＵＴＰＡＣｍｂｄｌｘｆｍｍ！ｂｏｅ！ｐｕｉｆｓ！Ｂｄｄｓｆｅｊｕｆｅ！Ｂｈｆｏｕｔ

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Contents

List of figures and tables vi

Preface vii

Acknowledgements viii

Introduction 1

Researchcontext 1

Legalandpolicycontext 8

Limitationsoftheresearchdrawnoninthispublication 16

Structureofthebook 18

PART I: GENERAL ISSUES AFFECTING PARENTING CAPACITY 21

1 Is concern justified? Problems of definition and prevalence 23

Problemswithterminology 23

Prevalenceofparentswithproblemdrinkingordrugmisuse:general

Summaryoftheevidenceforalinkbetweenparentaldisordersand

Prevalence 27

Prevalenceofparentalmentalillness:generalpopulationstudies 28 Prevalenceofparentallearningdisability:generalpopulationstudies 33

populationstudies 36

Prevalenceofdomesticviolence:generalpopulationstudies 43

childabuse 47

Tosumup 48

2 How mental illness, learning disability, substance misuse and domestic

violence affect parenting capacity 49

iv Children’sNeeds–ParentingCapacity

Impactonparenting 61

Socialconsequences 74

Tosumup 80

3 Which children are most at risk of suffering significant harm? 85

Whatconstitutessignificantharm? 85

Vulnerablechildren 86

Protectivefactors 90

Tosumup 93

Movingontoexploretheimpactonchildrenatdifferentstagesof

development95

PART II: ISSUES AFFECTING CHILDREN OF DIFFERENT AGES 97

4 Child development and parents’ responses – children under 5 years 99

Pre­birthto12months 99

Pre­birthto12months–theunbornchild 99

Tosumup 108

Pre­birthto12months–frombirthto12months 108

Tosumup 115

Childrenaged1–2years 116

Tosumup 124

Childrenaged3–4years 125

Tosumup 134

Identifieddevelopmentalneedsinchildrenunder5years 135

5 Child development and parents’ responses – middle childhood 137

Childrenaged5–10years 137

Tosumup 155

v Contents

6 Child development and parents’ responses – adolescence 159

Childrenaged11–15years 159

Tosumup 179

Childrenaged16yearsandover 180

Tosumup 193

Identifiedunmetdevelopmentalneedsinadolescence 195

PART III: CONCLUSIONS AND IMPLICATIONS FOR POLICY AND

PRACTICE 197

7 Conclusions 199

8 Implications for policy and practice 201

Earlyidentificationandassessment 201

Jointworking 204

Flexibletimeframes 205

Informationforchildrenandfamilies 206

Trainingandeducationalrequirements 207

Tosumup 208

Bibliography 211

List of figures and tables

Figures

Figure1.1 TheAssessmentFramework

Tables

Table1.1 Prevalenceofmentalillnessamongadultsinthegeneralpopulation Table1.2 Prevalenceofmentalillnessamongparentsinthegeneralpopulation Table1.3 Relationshipbetweentherateofrecordedparentalproblemsandthe

levelofsocialworkintervention

Table4.1 Proportionofchildrenwithidentifiedunmetneeds–childrenunder 5years

Table5.1 Proportionofchildrenwithidentifiedunmetneeds–middle childhood

Preface

Itisprobablytruetosaythat,formostpeople,childhoodisamixedexperience whereperiodsofsadnessandlossarebalancedwithmomentsofhappinessand achievement.Suchcomplexity,however,israrelyrepresentedintheliteratureof childhood.Indeed,muchofthewrittenwordinthenineteenthandtwentieth centuriesdepictschildhoodinoneoftwocontrastingways.Forexample,A.A. Milne’spoem‘IntheDark’,firstpublishedin1927,(Milne1971)showschildhood asagoldenerawherechildrenarelovedandnurturedbycaringparents.Itisa timecharacterisedbyinnocence,unqualifiedparentallove,irresponsibility,peer friendshipsandathirstforadventureandknowledge.

I’vehadmysupper, Andhadmysupper,

AndHADmysupperandall; I’veheardthestory

OfCinderella,

Andhowshewenttotheball; I’vecleanedmyteeth,

AndI’vesaidmyprayers,

AndI’vecleanedandsaidthemright; Andthey’veallofthembeen

Andkissedmelots,

They’veallofthemsaid‘Good­night.’

Butneverfarawayisthealternativeexperience,typifiedbyparentaldesertion, illness,isolationandpoverty.JamesWhitcombRiley(1920),whopenneduplifting poemsofperhapsquestionablequalityforchildrenduringthe1890s,paintsamuch bleakerpictureinhispoem‘TheHappyLittleCripple’.

I’mthistalittlecrippleboy,an’nevergoin’togrow An’getagreatbigmanatall!–‘causeAuntytoldmeso. WhenIwasthistababyonc’t,Ifalledoutofthebed

An’got“TheCurv’tureoftheSpine”–‘at’swhattheDoctorsaid. IneverhadnoMothernen–fermyParunnedaway

An’dassn’tcomebackherenomore–‘causehewasdrunkoneday An’stobbedamaninthish­eretown,an’couldn’tpayhisfine! An’nenmyMashedied–an’Igot“Curv’tureoftheSpine!”

Acknowledgements

Weacknowledgewithsincerethanksthemanypeoplewhogavegenerouslyoftheir timetohelpuswiththiswork.Weparticularlyappreciatetheexpertiseandadvice offeredbyArnonBentovim,RichardVelleman,LornaTempleton,CarolynDavies andSheenaPrentice.TheworkhasbeenfundedbytheDepartmentforEducation andwethankstaffinthedepartment,particularlyJennyGraywhosupportedus throughouttheworkwithherinterestandvaluablecomments.

Theworkwasassistedbyanadvisorygroupwhosemembershipwas:

IsabellaCraigandJennyGray(DepartmentforEducation);ChristineHumphrey (DepartmentofHealth)andSianRees(NICE);ArnonBentovim(consultantchild andadolescentpsychiatristattheGreatOrmondStreetHospitalforChildrenand theTavistockClinic);MarianBrandon(readerinsocialwork,UniversityofEast Anglia);CarolynDavies(researchadvisor,InstituteofEducation,Universityof London);JoFox(socialworkconsultant,Child­CentredPractice);DavidJones (consultantchildandfamilypsychiatrist,DepartmentofPsychiatry;Universityof Oxford);SueMcGaw(specialistinlearningdisabilities,CornwallPartnershipTrust); SheenaPrentice(specialistmidwifeinsubstancemisuse,NottinghamCityPCT); WendyRose(TheOpenUniversity);LornaTempleton(manageroftheAlcohol, DrugsandtheFamilyResearchProgramme,UniversityofBath);andRichard Velleman(UniversityofBathanddirectorofdevelopmentandresearch,Avonand WiltshireMentalHealthPartnershipNHSTrust).

Introduction

ThissecondeditionofChildren’sNeeds–ParentingCapacityprovidesanupdate ontheimpactofparentalproblems,suchassubstancemisuse,domesticviolence, learningdisabilityandmentalillness,onchildren’swelfare.Research,andin particularthebiennialoverviewreportsofseriouscasereviews(Brandonetal2008; 2009;2010),havecontinuedtoemphasisetheimportanceofunderstandingand actingonconcernsaboutchildren’ssafetyandwelfarewhenlivinginhouseholds wherethesetypesofparentalproblemsarepresent.

Almostthreequartersofthechildreninboththisandthe2003­05studyhadbeen livingwithpastorcurrentdomesticviolenceandorparentalmentalillhealth andorsubstancemisuse–oftenincombination.

(Brandonetal2010,p.112)

Theseconcernswereverysimilartothosethatpromptedthefirsteditionofthis book,whichwascommissionedfollowingtheemergenceofthesethemesfromthe DepartmentofHealth’sprogrammeofchildprotectionresearchstudies(Department ofHealth1995a).Thesestudieshaddemonstratedthatahighlevelofparental mentalillness,problemalcoholanddrugabuseanddomesticviolencewerepresent infamiliesofchildrenwhobecomeinvolvedinthechildprotectionsystem.

Research context

The2010GovernmentstatisticsforEnglanddemonstratethat,asinthe1990s, onlyaverysmallproportionofchildrenreferredtochildren’ssocialcarebecomethe subjectofachildprotectionplan(DepartmentforEducation2010b).However,the typesofparentalproblemsoutlinedabovearenotconfinedtofamilieswhereachild isthesubjectofachildprotectionplan(Brandonetal.2008,2009,2010;Rose andBarnes2008).Inmanyfamilieschildren’shealthanddevelopmentarebeing affectedbythedifficultiestheirparentsareexperiencing.Thefindingsfromresearch, however,suggestthatservicesarenotalwaysforthcoming.Practicallyaquarterof referralstochildren’ssocialcareresultedinnoactionbeingtaken(Cleaverand WalkerwithMeadows2004).LordLaming’sprogressreport(2009)alsoexpressed concernsthatreferralstochildren’sservicesfromotherprofessionalsdidnotalways leadtoaninitialassessmentandthat‘muchmoreneedstobedonetoensurethatthe servicesareaseffectiveaspossibleatworkingtogethertoachievepositiveoutcomesfor children’(LordLaming2009,p.9,paragraph1.1).Practitioners’fearoffailingto identifyachildinneedofprotectionisalsoafactordrivingupthenumbersof referralstochildren’ssocialcareserviceswhichresultinnoprovisionofhelp.‘This iscreatingaskewedsystemthatispayingsomuchattentiontoidentifyingcasesofabuse

2 Children’sNeeds–ParentingCapacity

andneglectthatitisdrainingtimeandresourceawayfromfamilies’(Munro2010,p.6). Munro’sInterimReport(2011)drawsattentiononceagaintothehighlytraumatic experienceforchildrenandfamilieswhoaredrawnintotheChildProtectionsystem wheremaltreatmentisnotfound,whichleavesthemwithafearofaskingforhelp inthefuture.Afindingwhichwasidentifiedbyearlierresearchonchildprotection (CleaverandFreeman1995).

Evidencefromthe1995childprotectionresearch(DepartmentofHealth1995a) indicatedthatwhenparentshaveproblemsoftheirown,thesemayadverselyaffect theircapacitytorespondtotheneedsoftheirchildren.Forexample,Cleaverand Freeman(1995)foundintheirstudyofsuspectedchildabusethatinmorethan halfofthecases,familieswereexperiencinganumberofproblemsincludingmental illnessorlearningdisability,problemdrinkinganddruguse,ordomesticviolence.A similarpictureofthedifficultiesfacingfamilieswhohavebeenreferredtochildren’s socialcareservicesemergesfrommorerecentresearch(CleaverandWalkerwith Meadows2004).Itisestimatedthatthereare120,000familiesexperiencing multipleproblems,includingpoormentalhealth,alcoholanddrugmisuse,and domesticviolence.‘Overathirdofthesefamilieshavechildrensubjecttochildprotection procedures’(Munro2011,p.30,paragraph2.30).

Children’sserviceshavethetaskofidentifyingchildrenwhomayneedadditional servicesinordertoimprovetheirwell­beingasrelatingtotheir:

(a) physicalandmentalhealthandemotionalwell­being; (b) protectionfromharmandneglect;

(c) education,trainingandrecreation;

(d) thecontributionmadebythemtosociety;and (e) socialandeconomicwell­being.

(Section10(2)oftheChildrenAct2004)

TheCommonAssessmentFramework(Children’sWorkforceDevelopment Council2010)andtheAssessmentFramework(DepartmentofHealthetal.2000) enablefrontlineprofessionalsworkingwithchildrentogainanholisticpictureof thechild’sworldandidentifymoreeasilythedifficultieschildrenandfamiliesmay beexperiencing.Althoughresearchsuggeststhatsocialworkers(Cleaveretal.2007) andhealthprofessionalsareequippedtorecogniseandrespondtoindicationsthata childisbeing,orislikelytobe,abusedorneglected,thereislessevidenceinrelation toteachersandthepolice(Danieletal.2009).

Theidentificationofchildren’sneedsmayhaveimproved,butunderstanding howparentalmentalillness,learningdisabilities,substancemisuseanddomestic violenceaffectchildrenandfamiliesstillrequiresmoreattention.Forexample,a smallin­depthstudyfoundlessthanhalf(46%)ofthemanagersinchildren’ssocial care,healthandthepoliceratedas‘good’theirunderstandingoftheimpacton childrenofparentalsubstancemisuse,althoughthisroseto61%inrelationtothe impactofdomesticviolence(Cleaveretal.2007).Theneedformoretrainingon assessingthelikelihoodofharmtochildrenofparentaldrugandalcoholmisuse

3 Introduction

wasalsohighlightedbyasurveyof248newlyqualifiedsocialworkers(Galvaniand Forrester2009).Acallformorehigh­qualitytrainingonchildprotectionacross socialcare,healthandpolicewasalsomadebyLordLaming(2009).Munro’s reviewofchildprotectioninexploring‘whypreviouswell­intentionedreformshave notresultedintheexpectedlevelofimprovements’(p.3)highlightedthe‘unintended consequencesofrestrictiverulesandguidance’,whichhaveleftsocialworkersfeeling that‘theirprofessionaljudgementisnotseenasasignificantaspectofthesocialwork task;itisnolongeranactivitywhichisvalued,developedorrewarded’(Munro2010, p.30,paragraph2.16).

Theexperienceofprofessionalsprovidingspecialistservicesforadultscan supportassessmentsofchildreninneedlivingwithparentalmentalillness,learning disability,substancemisuseordomesticviolence.Research,however,showsthatin suchcasescollaborationbetweenadults’andchildren’sservicesattheassessment stagerarelyhappens(Cleaveretal.2007;CleaverandNicholson2007)andalack ofrelevantinformationmaynegativelyaffectthequalityofdecisionmaking(Bell 2001).Anagreedconsensusofoneanother’srolesandresponsibilitiesisessential foragenciestoworkcollaboratively.TheevidenceprovidedtotheMunroreview (2011)found‘mixedexperiencesandabsenceofconsensusabouthowwellprofessionals areunderstandingoneanother’srolesandworkingtogether’andarguesfor‘thoughtfully designedlocalagreementsbetweenprofessionalsabouthowbesttocommunicatewith eachotherabouttheirworkwithafamily...’(Munro2011,p.28,paragraph2.23). Althoughresearchshowsthatthedevelopmentofjointprotocolsandinformation­ sharingproceduressupportcollaborativeworkingbetweenchildren’sandadults’ services(Cleaveretal.2007),asurveyof50Englishlocalauthoritiesfoundonly 12%hadclearfamily­focusedpoliciesorjointprotocols(CommunityCare2009).

Themulti­agencyapproach

Inmanyofthecasesthatarereferredtochildren’ssocialcare,nosingleagencywill beabletoprovideallthehelprequiredtosafeguardandpromotethewelfareof thechildandmeettheneedsoftheirparents.Socialworkers,inpartnershipwith familiesandotheragencies,mustjudgewhatservices,fromwhichagencies,are calledfor.Aresearch­basedtypologyoffamilieshasbeendevelopedtohelpsocial workersidentifytherange,typeanddurationofservicesrequiredtomeettheneeds ofthechildandsupportthefamily(CleaverandFreeman1995).Threecategories inthetypologyareparticularlyrelevant:

ｴ！

Families experiencing multiple problems: thesefamiliesarewellknownto children’sservicesandwelfareagencieslinkedtotheCriminalJusticeSystem. Theyexperiencearangeofproblems,manyofwhicharechronic.Difficulties mayincludeparentallearningdisability,poormentalandphysicalhealth, domesticviolence,severealcoholproblems,drugabuse,poorhousing,long­ termunemploymentandfinancialandsocialincompetence.

4 Children’sNeeds–ParentingCapacity

ｴ！

Families experiencing a specific problem: thesefamiliesarerarelyknownto statutoryagenciesandcometotheirattentionbecauseofaspecificissue,for exampleacuteparentalmentalillnessoraparentaldrugoverdose.Families arenotconfinedtoanysocialclassand,onthesurfacetheirlivesmayappear quiteordered.

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Acutely distressed families: thesefamiliesnormallycope,butanaccumulation ofdifficultieshasoverwhelmedthem.Familiestendtobecomposedofsingle orpoorlysupportedandimmatureparents,orparentswhoarephysicallyill ordisabled.

Theabovetypologymakesacleardistinctionbetweenfamilieswhonormallycope wellbuthavebeenrecentlyoverwhelmedbyproblemsandthosewhohavemany chronicproblemswhichrequirelong­termmulti­serviceinput.Toensurechildren’s safetyandwelfare,manyofthesefamilieswillrequiresupportfrombothchildren’s andadults’services.Acollaborativeapproachwouldensurethatnotonlyareparents recognisedashavingneedsintheirownright,buttheimpactofthoseneedson theirchildrenbecomespartofamulti­agencyresponse.Researchsuggeststhatthe valueofsuchinter­agencycollaborationiswidelyacceptedbyprofessionals(Cleaver etal.2007).AreviewoftheliteratureonneglectbyDanielandcolleagues(2009) highlightedtheimportanceofdevelopingmoreeffectiveintegratedapproaches tochildrenwhereallprofessionsregardthemselvesaspartofthechildwell­being system.However,ensuringthatpracticereflectstheseprinciplesisnotalwayseasy, despitethesupportofnationalpolicyandguidance.

Despiteconsiderableprogressininteragencyworking,oftendrivenbyLocal SafeguardingChildrenBoardsandmulti­agencyteamswhostrivetohelpchildren andyoungpeople,thereremainsignificantproblemsintheday­to­dayrealityof workingacrossorganisationalboundariesandcultures,sharinginformationto protectchildrenandalackoffeedbackwhenprofessionalsraiseconcernsabouta child.

(LordLaming2009,p.10,paragraph1.6)

Theimportanceofanintegratedprofessionalgroupbeingaccountableforlocal childprotectionratherthanconfiningtheresponsibilitytochildren’ssocialcarewas stressedinMunro’sfirsttworeportsonthechildprotectionsystem(2010,2011).

Reluctancetoadmitproblems

Inadditiontoidentifyingandrespondingtotheissuesthatcanaffectparenting capacity,theoriginalchildprotectionresearchalsorevealedthatparentalproblems themselvescouldinfluencetheprocessofenquiriesundersection47oftheChildren Act1989,whichareundertakenwhenthereareconcernsthatachildmaybesuffering significantharm(DepartmentofHealth1995a).Anumberofkeyfactorswere identified,manyofwhichremainpertinent.Thefirstofthesewasparents’anxiety aboutlosingtheirchildren.CleaverandFreeman(1995)notedthatintheearly stagesofachildprotectionenquiry,familieswerereluctanttoadmittoahistoryof

5 Introduction

problemdrinkingordruguseormentalillnessbecausetheyassumeditwouldresult insocialworkerstakingpunitiveaction.Subsequentresearchreinforcesthisfinding (see,forexample,BoothandBooth1996;Cleaveretal.2007;Gorin2004).

Forsimilarreasons,familieswereeagertoconcealdomesticviolence.Farmer andOwen’s(1995)researchsuggests,firstly,thathiddendomesticviolencemay accountformanymothers’seeminglyuncooperativebehaviourand,secondly, thatconfrontingfamilieswithallegationsofabusecouldcompoundthemother’s vulnerableposition.Indeed,childprotectionconferenceswereoftenignorantof whetherornotchildrenlivedinviolentfamiliesbecauseinthe‘faceofallegations ofmistreatmentcouplesoftenformedadefensiveallianceagainsttheoutsideagencies’ (FarmerandOwen1995,p.79).Infact,theauthorsfoundthatthelevelofdomestic violence(52%)discoveredduringtheresearchinterviewswastwicethatdisclosed attheinitialchildprotectionconference.‘Problemswhichparentsthoughtwouldbe discreditingwerenotairedintheearlystages–especiallythosewhichincludeddomestic violenceandalcoholanddrugabuse’(FarmerandOwen1995,p.190).

Thefearthatchildrenwillbetakenintocareandfamiliesbrokenupifparental problemscometolightmaybefeltmoreacutelywhenthemotherisfroma minorityethnicgroup.Difficultiesincommunicationandworriesovercultural normsbeingmisinterpretedincreasewomen’sfears,andofficialagenciesmaybe seenasparticularlythreateningifthemotherisofrefugeestatus(Stevenson2007). Parentsvalueprofessionalswhoarenon­judgementalintheirapproach,who communicatesensitivelyandwhoinvolvetheparentsandkeeptheminformed duringallstagesofthechildprotectionprocess(CleaverandWalkerwithMeadows 2004;KomulainenandHaines2009).Evidencesuggeststhatparentsareableto discusstheirownconcernsabouttheirparentingwhenprofessionalsapproachthem openlyanddirectly(Danieletal.2009).Unfortunately,manyparentsfeeltheyare treatedlesscourteouslybymedicalstaffonceconcernsofnon­accidentalinjuryare raised(KomulainenandHaines2009).

Workinginpartnershipwithchildrenandkeyfamily

members

Statutoryguidance,producedforprofessionalsinvolvedinassessmentsofchildren inneedundertheChildrenAct1989,acknowledgestheimportanceofinvolving childrenandfamiliesandseekstoensurethatallphasesoftheassessmentprocessare carriedoutinpartnershipwithkeyfamilymembers.

Thequalityoftheearlyorinitialcontactwillaffectlaterworkingrelationships andtheabilityofprofessionalstosecureanagreedunderstandingofwhatis happeningandtoprovidehelp.

(DepartmentofHealthetal.2000,p.13,paragraph1.47)

TheimplementationoftheAssessmentFrameworkhasaffectedpractice.Parents’ andchildren’sunderstandingoftheassessmentprocesshasimprovedashastheir

6 Children’sNeeds–ParentingCapacity

involvementinassessments,plansandreviews.Researchshowsthatmanysocial workersgotoconsiderablelengthstoexplainthingstoparents(particularlythose withlearningdisabilities)andchildren,andtoinvolvethemasmuchaspossiblein allstagesofthechildprotectionprocess(CleaverandWalkerwithMeadows2004). Asecondfindingisthatprofessionalstendtoevadefrighteningconfrontations;a featurewhichcontinuestobeidentifiedinseriouscasereviews(Brandonetal.2009, 2010;DepartmentforEducation2010c;LordLaming2009).Researchsuggests thatwhenprofessionalsfeelunsupportedormustvisitalone,visitingandchild protectionenquiriesmightnotalwaysbeasthoroughastheycouldbe(James1994; Denny2005;Farmer2006).

Gender

Fewofthe1995childprotectionstudiesexploredparentalproblemsintermsof genderandwhetherthegenderoftheparentwiththeprobleminfluencedsocial workintervention.Irrespectiveofwhichparentalfigurewaspresentingtheproblem, professionalsfocusedtheirattentiononworkingwithmothers.Insomecases, despiteprolongeddomesticviolencedirectedfromafatherfiguretothemother andsuspicionsthatthemanwasalsophysicallyabusivetothechildren,fatherswere rarelyinvolvedinthechildprotectionwork.‘Theshiftoffocusfrommentowomen allowedmen’sviolencetotheirwivesorpartnerstodisappearfromsight’(Farmer2006, p.126).However,forsomefamiliesthepossibilityofsocialworkersengagingwith thefatherfigurewasdifficultbecauseherefusedtodiscussthechildwiththeworker, wasalwaysoutduringsocialworkvisitsornolongerlivedinthehousehold(Farmer 2006).

Interpretingbehaviour

Afinalfactoridentifiedbytheoriginalchildprotectionstudies,andstillpertinent today,isthatsocialworkersmaymisinterpretparents’behaviour(Departmentfor Education2010c;HMGovernment2010a;C4EO2010).Forexample,research hasshownthatsocialworkerswerelikelytoassumethatguiltyorevasivebehaviour ofparentswasrelatedtochildabuse.Butsuchbehaviourwas,onoccasions,found tobetheresultofparentswantingtokeepsecretahistoryofmentalillness,learning disability,illicitdruguseorotherfamilyproblems(CleaverandFreeman1995).

Incontrast,theapparentco­operationofsomeparentsmayresultinpractitioners applyingthe‘ruleofoptimism’(Dingwelletal.1983).Thisstemsfromanumberof assumptions–thestrongestbeingthatparentslovetheirchildrenandwantthebest forthem,andthatchildren’slivesarebetteriftheystayathome,evenifthathome isverydysfunctional.Theapplicationoftheruleofoptimismmayresultinoverly positiveinterpretationsofwhatparentssayandofthebehaviourandcircumstances observed.Researchsuggeststhat‘over­confidencein“knowing”theparentorcarer, mightleadtomisjudgement,over­identificationwithparentsorGPsnotseeingconcerns aboutchildren’(Tompsettetal.2009,p.3).Inthesecircumstancespractitioners maytooreadilyacceptparents’explanationsofeventsandbereluctanttochallenge

7 Introduction

them(CleaverandNicholson2007;Brandonetal2010;DepartmentforEducation 2010c).Professionals’sympathyforparentscanleadtoexpectationsforchildren beingsettoolow.LordLamingstresses,‘Itisnotacceptabletodonothingwhenachild maybeinneedofhelp.Itisimportantthatthesocialworkrelationship,inparticular,isnot misunderstoodasbeingarelationshipforthebenefitoftheparents,orfortherelationship itself,ratherthanafocusedinterventiontoprotectthechildandpromotetheirwelfare’ (LordLaming2009,p.24,paragraph3.2).Practitionersupportwhichbenefits theparentsbutdoesnotpromotethewelfareofthechildrenwasalsoaconcern highlightedinMunro’sfirstreportofthechildprotectionsystem.Sheidentified‘a reluctanceamongmanypractitionerstomakenegativeprofessionaljudgmentsabouta parent....Incaseswhereadult­focusedworkersperceivedtheirprimaryroleasworking withintheirownsector,failuretotakeaccountofchildreninthehouseholdcouldfollow’ (Munro2010,p.17,paragraph1.27).Akeyfindingfromareviewofevidenceon whatworksinprotectingchildrenlivingwithhighlyresistantfamilieswastheneed forauthoritativechildprotectionpractice.

Families’lackofengagementorhostilityhamperedpractitioners’decision­making capabilitiesandfollow­throughwithassessmentsandplans...practitioners becameoverlyoptimistic,focusingtoomuchonsmallimprovementsmadeby familiesratherthankeepingfamilies’fullhistoriesinmind.

(C4EO2010,p.2)

Alackofknowledgeaboutdifferentcultureswithinminoritycommunities canalsobeabarriertounderstandingwhatishappeningtothechildren.Inquiry reportsandresearchhavehighlightedthatstereotypingoffamiliesfromdifferent backgrounds,linkedwithdifficultiesinattributingthecorrectmeaningtowhat parentssay,mayhaveanegativeimpactonsocialworkassessmentsandjudgements (DuttandPhillips2000).Forexample,inthecaseofVictoriaClimbié,achildwho cametoEnglandfromtheIvoryCoastofAfrica,professionalsassumedtheunusual, exceptionallyrespectfulandfrequentlyfrozenresponsetoher‘mother’wasnormal inthefamily’sculture,wheninfactitwasasignthatVictoriawasafraidofher abusivecarer(Cm57302003;ArmitageandWalker2009).Communicationand understandingcanbeeasedwhenparentshavetheopportunitytousethelanguage oftheirchoice(GardnerandCleaver2009).Thefollowingconclusion,drawnfrom analysingchilddeathsandseriousinjury,isrelevanttoallthoseprofessionalswho haveconcernsaboutthewelfareandsafetyofachild.

Inordertohaveabetterchanceofunderstandinghowdifficultiesinteract, practitionersmustbeencouragedtobecurious,andtothinkcriticallyand systematically.

8 Children’sNeeds–ParentingCapacity

Legal and policy context

Safeguardingandpromotingchildren’swelfare

TheChildrenAct1989placesadutyonlocalauthoritiestoprovidearangeof appropriateservicesforchildrentoensurethatthose‘inneed’aresafeguardedand theirwelfareispromoted.Childrenaredefinedas‘inneed’whentheyareunlikely toreachormaintainasatisfactorylevelofhealthordevelopment,ortheirhealth anddevelopmentwillbesignificantlyimpairedwithouttheprovisionofservices (s17(10)oftheChildrenAct1989).

Althoughmanyfamiliescopeadequatelywiththedifficultiestheyface,others needtheassistanceofservicesandsupportfromoutsidethefamilyto‘safeguardand promotethewelfareofthechildren’,whichisdefinedas:

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protectingchildrenfrommaltreatment;

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preventingimpairmentofchildren’shealthordevelopment;

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ensuringthatchildrenaregrowingupincircumstancesconsistentwiththe provisionofsafeandeffectivecare;

andundertakingthatrolesoastoenablethosechildrentohaveoptimumlife chancesandtoenteradulthoodsuccessfully.

(HMGovernment2010a,p.34,paragraph1.20)

TheDepartmentofHealth‘regardssafeguardingvulnerablechildrenasahigh priorityandissupportingtheNHStoimprovesafeguardingarrangements’(Department ofHealth2010a,p.6).Providingsupporttoparentsinordertoimproveoutcomesfor childrenispartoftheGovernment’sstrategytoimprovepublichealth.IntheWhite PaperHealthyLives,HealthyPeople(Cm79852010)theGovernmentseekstogive ‘everychildineverycommunitythebeststartinlife’throughreducingchildpoverty, increasingthenumbersoffamiliesreachedthroughtheFamilyNursePartnership programmeandthenumberofSureStarthealthvisitors(p.7,paragraph11(c)).The strategyacknowledgesthatimprovingthehealthandwellbeingofwomenbefore, duringandafterpregnancyisa‘criticalfactoringivingchildrenahealthystartinlife andlayingthegroundworkforgoodhealthandwellbeinginlaterlife’(p.17,paragraph 1.17).Thereisalsoacommitmenttoinvestinearlyyearssupportinordertoimprove children’sdevelopment;akeyfactorintheirfuturehealthandwellbeing.Thevalue ofsupportinggoodparent­childrelationshipsinordertobuildthechild’sselfesteem andconfidenceandreducetheriskofchildrenadoptingunhealthylifestylesisalso recognised.Forfamilieswithcomplexneedsthestrategysetsoutacommitmentto locallyco­ordinatedsupporttopreventproblemsfromescalating.

9 Introduction

TheGovernment­commissionedreportonearlyinterventionprovidesmuch evidence‘tosuggestthatthefirstthreeyearsoflifecreatethefoundationinlearninghow toexpressemotionandtounderstandandrespondtotheemotionsofothers’(Allen2011, p.5,paragraph15).Thereisanemphasisonearlyinterventionpackageswhich haveaproventrackrecord,andarecommendationthatanew,EarlyIntervention Foundationiscreated.

Pastgovernmentshavealsosoughttorespondtotheneedsofvulnerablefamilies withtheaimofimprovingthewellbeingofchildren.TheChildrenAct1989 recognisedthattopromotechildren’swelfare,servicesmayneedtoaddressthe difficultiesthatparentsexperience.

Parentsareindividualswithneedsoftheirown.Eventhoughservicesmaybe offeredprimarilyonbehalfoftheirchildren,parentsareentitledtohelpand considerationintheirownright...Theirparentingcapacitymaybelimited temporarilyorpermanentlybypoverty,racism,poorhousingorunemploymentor bypersonalormaritalproblems,sensoryorphysicaldisability,mentalillnessor pastlifeexperiences...

(DepartmentofHealth1991,p.8)

UndertheChildrenAct2004‘achildren’sservicesauthorityinEnglandmusthave regardtotheimportanceofparentsandotherpersonscaringforchildreninimproving thewell­beingofchildren’(Section10(3)oftheChildrenAct2004).

TheNationalFrameworkforChildren,YoungPeopleandMaternityServices stressedtheimportanceofprovidingsupporttoparentsandtheneedforcollaboration betweenadults’andchildren’sservices.

Inadditiontomeetingthegeneralneedsofparentsfromdisadvantaged backgrounds,itisimportanttoconsiderthemorespecialisedformsofsupport requiredbyfamiliesinspecificcircumstances,suchassupportforparentswith mentalhealthdifficultiesordisabilities,orwithsubstancemisuseproblems.Good collaborativearrangementsarerequiredbetweenservicesforadults,wherethe adultisaparent,andchildren’sservices,inparticular,wherechildrenmaybe especiallyvulnerable.

(DepartmentofHealthandDepartmentforEducationandSkills2004, p.69,paragraph3.4).

TheneedsofvulnerablechildrenwereaddressedintheDepartmentofHealth’s revisedcodeofpracticewhichprovidesguidancetodoctors,relevanthospitalstaff andmentalhealthprofessionalsonhowtheyshouldproceedwhenundertaking theirdutiesundertheMentalHealthAct1983.Thecodeofpracticenotesthat practitionersshouldensurethat:

ｴ！

childrenandyoungpeopleareprovidedwithinformationabouttheir parents’illness;

10 Children’sNeeds–ParentingCapacity

ｴ！

appropriatearrangementsareinplacefortheimmediatecareofdependent children;

ｴ！

thebestinterestsandsafetyofchildrenarealwaysconsideredin arrangementsforchildrentovisitpatientsinhospital;and

ｴ！

thesafetyandwelfareofdependentchildrenaretakenintoaccountwhen cliniciansconsidergrantingleaveofabsenceforparentswithamental disorder.

(DepartmentofHealth2008)

Improvingchildprotectionandreformingfrontlinesocialworkpracticeis apriorityfortheGovernment.Althoughpastgovernmentswerecommittedto protectingchildren,statisticalreturnsonthenumbersofchildrensubjecttoachild protectionplancontinuetoincreasesuggestingmoreneedstobedone(Department forEducation2009and2010a).AtMarch201039,100childrenweresubjecttoa childprotectionplan,anincreaseof5,000(15%)fromthe2008­09figures(Munro 2011,p.25).Threeprinciplesunderpinnedtherecentreviewofchildprotection whichtheGovernmentaskedProfessorMunrotoundertake:‘earlyintervention; trustingprofessionalsandremovingbureaucracysotheycanspendmoreoftheirtimeon thefrontline;andgreatertransparencyandaccountability’(Munro2010,p.44).

TheChildrenAct2004placedstatutorydutiesonlocalagenciestomake arrangementstosafeguardandpromotethewelfareofchildreninthecourseof dischargingtheirnormalfunctions.Ensuringeffectiveinter­agencyworkingisa keyresponsibilityofLocalSafeguardingChildrenBoards(LSCBs).LSCBsshould ensurethatagenciesdemonstrategoodcollaborationandco­ordinationincases whichrequireinputfrombothchildren’sandadults’services.Servicesforadults includeGPsandhospitals,learningdisabilityandmentalhealthteams,drugaction teamsanddomesticviolenceforums.

Asurveyoftheorganisationsresponsibleforsafeguardingandpromotingthe welfareofchildrenundersection11oftheChildrenAct2004suggestedthat althoughsignificantprogresshasbeenmade,two­thirdsoforganisationsdidnotyet haveallthekeyarrangementsinplace(MORI2009).TheGovernment’sstatutory guidanceWorkingTogethertoSafeguardChildrenmakesclearthatsafeguardingand promotingthewelfareofchildren‘dependsoneffectivejointworkingbetweenagencies andprofessionalsthathavedifferentrolesandexpertise’(HMGovernment2010a, p.31,paragraph1.12).

Adultmentalhealthservices–includingthoseprovidinggeneraladultand community,forensic,psychotherapy,alcoholandsubstancemisuseandlearning disabilityservices–havearesponsibilityinsafeguardingchildrenwhenthey becomeawareof,oridentify,achildatriskofharm.

11 Introduction

Parentalmentalillness

TheGovernmentiscommittedto

‘protectingthepopulationfromserioushealththreats;helpingpeoplelivelonger, healthierandmorefulfillinglives;andimprovingthehealthofthepoorest,fastest; andliftingfamiliesoutofpoverty.’

(Cm79852010,p.4(1))

Poormentalhealthisakeycomponentoftheoverallburdenoflongstanding illnesswithinthegeneralpopulationandisresponsibleforthegreatestproportionof workingdayslost(HealthandSafetyExecutive2010).Initsstrategyforimproving publichealthinEngland,theGovernmenthasidentifiedtheneedtotargetarange ofissuesincludingmentalillness,heavydrinkinganddrugmisuse(Cm79852010). Itrecognisesthatnosingleagencycandothisalone.‘Responsibilityneedstobeshared rightacrosssociety–betweenindividual,families,communities,localgovernment, business,theNHS,voluntaryandcommunityorganisations,thewiderpublicsectorand centralgovernment’(Cm79852010,p.24,paragraph2.5).TheCross­Government mentalhealthoutcomesstrategysetsoutplanstoensurementalhealthawareness andtreatment(forchildrenaswellasadults)aregiventhesameprominenceas physicalhealth.Sixobjectivesarehighlighted:

(i) Morepeoplewillhavegoodmentalhealth

(ii) Morepeoplewithmentalhealthproblemswillrecover

(iii) Morepeoplewithmentalhealthproblemswillhavegoodphysicalheath (iv) Morepeoplewillhaveapositiveexperienceofcareandsupport

(v) Fewerpeoplewillsufferavoidableharm

(vi) Fewerpeoplewillexperiencestigmaanddiscrimination (HMGovernment2011,p.6,paragraph1.5)

Childrenareattheheartofthisstrategy.Itacknowledgesthatsomeparents‘will requireadditionalsupporttomanageanxietyanddepressionduringpregnancyandthe child’searlyyears...’(HMGovernment2011,p.39,paragraph5.5).Theaimisto interveneearlywith‘vulnerablechildrenandyoungpeopleinordertoimprovelifetime healthandwellbeing,preventmentalillnessandreducecostsincurredbyillhealth, unemploymentandcrime’(p.9,paragraph1.15).Itisanticipatedearlyintervention willbringbenefitsnotonlytotheindividualduringchildhoodandintoadulthood, butalsoimprovehisorhercapacitytoparent.

Adultsmayexperienceasingleoracombinationofissues,suchaspoormentalhealth andlearningdisability,substancemisuseanddomesticviolence,andrequirearangeof servicesinordertoremainindependent.AVisionforAdultSocialCareacknowledgesthat somepeoplewillneedsocialcaresupportbecauseoftheeffectsoflongtermconditions.

12 Children’sNeeds–ParentingCapacity

‘Goodpartnershipworkingbetweenhealthandsocialcareisvitalforhelpingthemtomanage theirconditionandliveindependently’(DepartmentofHealth2010b,p.13,paragraph 3.13).

Parentswithalearningdisability

TheEqualityAct2010prohibitsserviceprovidersdiscriminatingonanumberof criteriaincludingdisability.Disabilityisdefinedinthefollowingway.

(1)Aperson(P)hasadisabilityif—

(a)Phasaphysicalormentalimpairment,and

(b)theimpairmenthasasubstantialandlong­termadverseeffectonP’s abilitytocarryoutnormalday­to­dayactivities.

(Section6(1)oftheEqualityAct2010)

Section47(1)oftheNationalHealthServicesandCommunityCareAct1990 placesadutyonlocalauthoritiestoconsidertheneedsofdisabledpersons,including thosewithlearningdisabilities.Thisissupportedbypracticeguidance.

Ingeneral,councilsmayprovidecommunitycareservicestoindividualadults withneedsarisingfromphysical,sensory,learningorcognitivedisabilities,or frommentalhealthneeds.

(DepartmentofHealth2010b,p.18,paragraph43)

Supportingdisabledadultsintheirroleasparentsishighlightedinthispractice guidance.Forexample,indeterminingeligibility,allfourlevelsincludethesituation inwhich‘familyandothersocialrolesandresponsibilitiescannotorwillnotbe undertaken’(DepartmentofHealth2010b,p.20,paragraph54).Localauthorities areenjoinedtoconsidertheadditionalhelpthoseadultswith,forexample, mentalhealthdifficultiesorlearningdisabilitiesmayneediftheyhaveparenting responsibilities.Thisincludesidentifyingwhetherachildoryoungpersonisacting inacaringroleandtheeffectthisishavingonthemandexploringwhetherthereis aneedtosafeguardandpromotethewelfareofthechild.

Parentalsubstancemisuse

IntheGovernment’sdrugstrategy,theimpactofdrugsandalcoholmisuseonsociety isrecognised.

Fromthecrimeinlocalneighbourhoods,throughfamiliesforcedapartby dependency,tothecorruptingeffectofinternationalorganisedcrime,drugshave aprofoundandnegativeeffectoncommunities,familiesandindividuals. (HMGovernment2010b,p.3)

Preventionandsupportingrecoveryisattheheartofthisstrategy.A‘whole­life’ approachisproposedinordertobreakthe‘inter­generationalpathstodependency

13 Introduction

bysupportingvulnerablefamilies’,providinggoodqualityeducationandadvice, interveningearlyandsupportingpeopletorecover.Relevantagenciesareexpectedto worktogethertoaddresstheneedsofthewholeperson.Topreventsubstancemisuse amongstchildrenandyoungpeople(someofwhomwillhaveparentswhomisuse drugsandalcohol)thestrategyadvocatestheuseoffamily­focusedinterventions (HMGovernment2010b,p.11).

Ithasbeenestimatedthattherearebetween250,000and350,000childrenof problemdrugusersintheUK(AdvisoryCouncilontheMisuseofDrugs2003) andathirdofadultsintreatmenthavechildcareresponsibilities(HMGovernment 2010b).TheGovernment’sdrugstrategyplacesaparticularfocusonthechildrenof parentswithdrugandalcoholproblems.Theneedtobeawareoftheharm,abuse andneglect,aswellastheinappropriatecaringroles,somechildrenmayexperience isstressed.Thestrategyisclearthat‘wherethereareconcernsaboutthesafetyand welfareofchildren,professionalsfrombothadultandchildren’sservices,alongside thevoluntarysector,shouldworktogethertoprotectchildren,inaccordancewiththe statutoryguidanceWorkingTogethertoSafeguardChildren(2010)’(HMGovernment 2010b,p.21).

Arangeofrelevantpracticeguidanceisavailabletolocalauthorities.Forexample, theDepartmentofHealthhasproducedguidancewhichfocusesonpeoplewith severementalhealthproblemsandproblematicsubstancemisuse.

Substancemisuseisusualratherthanexceptionalamongstpeoplewithsevere mentalhealthproblemsandtherelationshipbetweenthetwoiscomplex. (DepartmentofHealth2002,p.4)

Theguidancesupportedjointworkingandimprovedco­ordinatedcarebetween mentalhealthservicesandspecialistsubstancemisuseservices(Departmentof Health2002).

ModelsofCareforAlcoholMisusers(DepartmentofHealthandNational TreatmentAgencyforSubstanceMisuse2006)providedpracticeguidancefor localhealthorganisationsandtheirpartnersinthecommissioningandprovisionof assessments,interventionsandtreatmentofadultswhomisusealcohol.Theguidance acknowledgedtheimpactofparentalalcoholmisuseonchildren.Thisisclearly statedintheforewordbythethenchiefmedicalofficer,SirLiamDonaldson:

Thereisnodoubtthatalcoholmisuseisassociatedwithawiderangeofproblems, includingphysicalhealthproblemssuchascancerandheartdisease;offending behaviours,notleastdomesticviolence;suicideanddeliberateself­harm;child abuseandchildneglect;mentalhealthproblemswhichco­existwithalcohol misuse;andsocialproblemssuchashomelessness.

(DepartmentofHealthandNationalTreatmentAgencyforSubstanceMisuse 2006,p.5)

14 Children’sNeeds–ParentingCapacity

However,therecommendationsrelatingtoscreeningandearlyassessmentsdid notincludethechildrenofparentswhomisusealcohol,althoughtheguidancedid recommendthatcomprehensiveriskassessmentsshouldbetargetedat,amongothers, userswithcomplexneedsincludingwomenwhoarepregnantorhavechildren‘at risk’.TheDepartmentofHealthhasrecentlytrialledarangeofalcoholscreening andbriefinterventionapproachestoevaluatetheirdelivery,effectivenessandcost­ effectiveness(ScreeningandInterventionProgrammeforSensibleDrinking(SIPS) seewww.hubcap.org.uk/F25W.)

Domesticviolence

TheGovernmentisalsoconcernedaboutviolenceagainstwomenandchildren andiscommittedtoimprovingthestandardsofcareandsupport.

Aswellasthegovernment’scommitmenttosupportexistingrapecrisiscentre provisiononastablebasisandtoestablishnewcentres,theHomeOfficehas allocatedaflatcashsettlementofover£28moverthenextfouryearsforworkto tackleviolenceagainstwomenandgirls.

(HMGovernment2010c,p.15,paragraph2.1)

TheDepartmentofHealth’sactionplanImprovingservicesforwomenandchild victimsofviolence(HMGovernment2010c,p.15,paragraph2.1)ispartofthe cross­Governmentapproachtotacklingsuchviolence.Theplanacknowledgesthat ‘violenceandabusecanalsobeariskfactorinfamilieswithmultipleproblems....the SpendingReviewmakesacommitmentforanationalcampaigntosupportandhelpturn aroundthelivesoffamilieswithmultipleproblems,improvingoutcomesandreducing coststowelfareandpublicservices’(p.10).

Withtheaimofimprovingtheresponsetothevictimsofviolence,theGovernment’s actionplanproposesto:

ｴ！

raiseawareness:amongsthealthprofessionaloftheirroleinaddressingthe issues,andthroughprovidingpatientswithinformationthathelpsthem accessrelevantservicesquicklyandsafely;

ｴ！

improvethecompetencyandskillsofNHSstaffthroughdevelopinga

trainingmatrix;

ｴ！

improvethequalityofservicestovictimsofviolence;and

ｴ！

improvethedatacollectiononviolenceandsupporthealthprofessionalsto appropriatelyshareinformation.

15 Introduction

TheDomesticViolence,CrimeandVictimsAct2004amendedpart4ofthe FamilyLawAct1996andtheProtectionfromHarassmentAct1997.The2004 Actextendedthepowersofthecourtinprotectingthepartnersinarelationship. Furthermore,itcreatedanewcriminaloffenceof‘causingorallowingthedeathofa childorvulnerableadult’(Section4oftheDomesticViolence,CrimeandVictims Act2004).

Section24oftheCrimeandSecurityAct2010alsoseekstoprotectwomen andchildrenwhoarethevictimsofdomesticviolence.Seniorpoliceofficershave beengiventhepowertoissuedomesticviolenceprotectionnotices(DVPN).Such anoticecanbeusedtobanviolentmenfromthefamilyhome,initiallyfor24 hours,topreventwomenfromfutureviolenceorthethreatofviolence.Thesafety ofthechildmustalsobetakenintoconsideration.BeforeissuingaDVPNthe officermustconsider‘thewelfareofanypersonundertheageof18whoseintereststhe officerconsidersrelevanttotheissuingoftheDVPN(whetherornotthatpersonisan associatedperson)’(Section24(3)oftheCrimeandSecurityAct2010).Theissuing ofaDVPNtriggerstheapplicationtothemagistratescourtforadomesticviolence protectionorder.Thisisanorder,lastingbetween14and18days,whichprohibits theperpetratorfrommolestinghisvictim.

Thereisalsostatutoryandpracticeguidanceavailabletosupportprofessionalsin safeguardingwomenandchildrenfromdomesticviolence.Forexample,Working TogethertoSafeguardChildrenreinforcedtheroleofthepoliceinidentifyingand safeguardingchildrenlivingwithdomesticviolence;‘patrolofficersattendingdomestic violenceincidents,forexample,shouldbeawareoftheeffectofsuchviolenceonany childrennormallyresidentwithinthehousehold’(HMGovernment2010a,p.71, paragraph2.126).Toensurepoliceofficersworkinginchildprotectionatalllevels haveaccesstospecialisttrainingondomesticviolence,anupdatedtrainingmodule hasbeenmadeavailabletopoliceforcessinceDecember2009(Cm7589).

The2009HomeOfficeguidanceandpracticeadviceandWorkingTogetherto SafeguardChildren(HMGovernment2010a)bothadvocatetheuseofmulti­ agencyriskassessmentconferences(MARAC)asaprocessfor‘helpingtoaddress anissueofdomesticviolence;formanagingPPOs,includingthosewhoareproblematic drugusers;orforidentifyingchildrenatrisk’(HomeOffice2009a,p.14­15,paragraph 2.3.3).(PPOsrefertoProlificandotherPriorityOffenders).MARACmeetingsare expectedtoinvolverepresentativesofkeystatutoryandvoluntaryagencies,who mightbeinvolvedinsupportingavictimofdomesticabuse.

Anotherexampleofmulti­agencyworkingincasesofdomesticviolenceisthe SpecialistDomesticViolenceCourt(SDVC)programme.Thesespecialcourts, withintheCriminalJusticeSystem,bringtogetherasimilarrangeofbodiesto MARAC.

Agenciesworktogethertoidentify,trackandriskassessdomesticviolencecases, supportvictimsofdomesticviolenceandshareinformationbettersothatmore offendersarebroughttojustice.

16 Children’sNeeds–ParentingCapacity

Limitations of the research drawn on in this

publication

Differentlawsandcultures

Muchoftheresearchonmentalillness,learningdisability,domesticviolenceand substancemisusecomesfromtheUS,whichhasdifferentlaws,traditions,andsocial institutionsfromtheUnitedKingdom.Forexample,amajordifferencewhich existsinrelationtosubstancemisuseisthecommitmenttoharmminimisation intheUnitedKingdom.ThisapproachisnotuniversallysharedintheUS,which hasfollowedanabstinence­onlypolicyforthelast30years.Asaresultthereare uniqueservicesintheUnitedKingdom,suchasconsistentlyavailablemethadone treatmentandneedleandsyringeexchangeschemesforproblemdrugusers,and controlled­drinkingprogrammesforproblemalcoholusers.IntheUS,abstinence­ basedprogrammes,especiallyinalcoholservices,aremoreavailablethancontrolled drinking,andmethadonemaintenanceprogrammesaremorerestrictiveintheUS comparedtotheUnitedKingdom.Thishasimplicationsforservicesforwomenin theUS,wheremanytreatmentprogrammesforpregnantdrugandalcoholusers requirewomentobeabstinentinordertotakepartintheprogramme.Inmany Americanstates,pregnantmotherswhousedrugsoralcoholriskprisonsentences whilepregnantonthegroundsofphysicalchildabuse.

Focusingonaspecificissue

Mostresearchiscentredonaspecificissuesuchasdomesticviolence,depression, learningdisabilityorheroinuse.However,inpractice,manyproblemdruguserswill useavarietyofdrugsandalcohol(polydruguse).Similarly,manyofthoseexperiencing domesticviolencealsosufferdepressionandmayusealcoholordrugsasawayof coping;orthosewhoareperpetratingtheviolencemaybeundertheinfluenceof alcoholordrugs.Moreover,alearningdisabilitydoesnotinureanindividualto drugmisuse,domesticviolenceormentalillness.Inthispublication,althougheach issueistakenindividuallywhendescribingthepsychologicalandphysicalsymptoms, whendiscussingthefindingsfromresearchinrelationtotheimpactonparenting capacityamorepragmaticandinclusiveapproachhasbeentaken.

Time­limitedresearch

Researchontheseissuesusuallylooksattheinfluenceonparentingcapacityover arelativelyshortperiod.Thisapproachdoesnottakeintoaccountthediffering needsofthechildatvarioustimesintheirlifeorthefluctuatingnatureofdrugand alcoholuse,learningdisability,mentalillnessordomesticviolenceontheparents themselves.Longitudinalstudieswouldhelpminimisethislimitation,buttheyare fewandfarbetween.

17 Introduction

Samplingbias

Thesamplesusedinmanyresearchstudiesaretakenfromspecificgroupssuch asparentalcocaineoralcoholusersintreatment,mentallyillparentsinhospital, parentsinreceiptofservicesforlearningdisability,ormothersinrefuges.Farlessis knownaboutparentsinthegeneralpopulationwhoexperiencetheseproblemsbut donotseekhelp;itwouldbedangeroustoassumethatthepopulationsstudiedare representative.

Researchontheimpactofparentalproblemsonchildrentendstobebiased towardswomenascarers.Therearemorestudiesonmaternalparentingcapacity thanpaternalcapacity,andoftentheinfluenceofotherfamilyfactors,suchas theroleofgrandparentsorsiblings,ortheimpactofdivorceorseparation,isnot considered.

Manyofthestudiesfocusonspecificproblems,suchaschildren’sdrugandalcohol use,violence,mentalhealth,education,offendingandbehaviouralproblems,rather thanamoreholisticapproachortheidentificationofsignsofresilienceorcoping strategies.

Itisoftennotpossibletoaccuratelymeasurethequantitiesofdrugsandalcohol beingusedbyparents,thedegreeofviolenceexperienced,ortheextentofmental illnessorlearningdisability.Forexample,someparentsmayfeelthreatenedby serviceswhichcantakeactiononthecareoftheirchildrenandunderestimate theirdifficulties.Inothersituationsparentsmayoverestimatetheirproblems.For example,drugusemaybeexaggeratedandpresentedasmitigatingcircumstancesin criminalcourtcasesorinanattempttomaximiseamethadoneprescription.

Afurtherlimitationoftheresearchisthedependenceonclientrecall.Drugs andalcohol,domesticviolence,mentalillnessandlearningdisabilitiesalladversely affectthecapacitytoremember,andmanystudiesrelynotonlyonrecentmemory butmemoryovermanymonthsoryears.Itisquestionablehowaccuratethese measurementsare.Finally,itisessentialtorememberthatthemajorityofparents whoexperiencetheseissues,especiallythosewhopresentforservices,areusually alsosufferingfrommultipleformsofdeprivationandsocialexclusion.Thesefactors shouldnotbeunderestimatedintheirneteffectonparentingcapacity.

Withalloftheabovelimitationsinmind,thereisagreatdealofconsistencyin theresultsofresearchonsomeaspectsofparentingcapacityandtheinfluenceof theseparentalproblemsonchildren,whileotheraspectsarelessconsistent.One ofourobjectivesistohelpplacetheresearchincontext,takingaccountofthe limitations.

CHILD’S DE VEL

OPMENT AL NEEDS

PARENTING CAP

A_CIT Y CHILD

Safeguarding & promoting

welfare

Health BasicCare

EnsuringSafety

EmotionalWarmth Stimulation Education

BehaviouralDevelopment

FAMILY & ENVIRONMENTAL FACTORS

Emotional&

Identity

Family&Social _Guidance&

Relationships _Boundaries

SocialPresentation

Stability SelfcareSkills

18

Community R

esour ces

Family ’sS

ocial Integration Income

E_mplo yment

H

ousing W_iderF amily

FamilyH

istor y &F

unctioning

Children’sNeeds–ParentingCapacity

Structure of the book

Inconsideringhowparentalmentalillness,learningdisability,problemdrinking, drugmisuseordomesticviolencemayaffectthechild,aholisticanddevelopmental modelisapplied.Researchfindingsaredisaggregatedthroughapplyingthe conceptualframeworkdesignedtoassessandmeasureoutcomesforchildreninneed (DepartmentofHealthetal2000).Thethreedomainsofthechild’sdevelopmental needs,parentingcapacityandfamilyandenvironmentalfactorsconstitutethe framework.Thethreeinter­relateddomainsincorporateanumberofimportant dimensions(seeFigure1.1).

Figure1.1�eAssessmentFramework

19 Introduction

Theevidenceisexploredinrelationtothesedomainsanddimensions,with particularemphasisonhowparentalmentalillness,learningdisabilities,substance misuseanddomesticviolencehaveanimpactonchildren’shealthanddevelopment, andwhetherthereisevidencethatchildrenaresuffering,orlikelytosuffer,significant harm.Becausetheimpactonthechildwilldependonavarietyoffactorsincluding ageanddevelopmentalstage,theagebandsfirstusedintheIntegratedChildren’s System(DepartmentforChildren,SchoolsandFamilies2010)havebeenapplied. Forexample,withregardtotheeducationaldevelopmentofchildrenaged3–4years, itisimportanttoidentifywhenparents’problemssubstantiallyrestrictthechild’s accesstostimulatingtoysandbooks,orpreventparentsspendingsufficienttime talking,readingorplayingwiththeirchildren.Alternatively,assessingtheimpactof thesesameparentalissuesontheeducationofadolescentsaged11–15yearsneeds tofocusondifferentthemes–forexample,schoolattendanceandinvolvementin otherlearningactivitiessuchassport,musicorhobbies.

Withineachdimensionandforeachagegroup,evidenceisusedtohighlight boththeadverseimpactonchildrenandthefactorswhichactasprotectors,suchas thestrategieschildrenusetocopewithstressfulfamilysituationsandthesupport andinfluenceofthewiderfamilyandcommunity.

Thebookisdividedintothreeparts,PartsI,IIandIII.

Part IincludesChapters1–3andexploresthefollowinggeneralissues:

Chapter 1:questionswhetherconcernisjustified,andexplorestheproblemsof definitionandprevalence.

Chapter 2:exploresthewaysinwhichmentalillness,learningdisability,problem druguse(includingalcohol)anddomesticviolenceaffectparentingcapacity.

Chapter 3:identifieswhichchildrenaremostvulnerable.

Part IIincludesChapters4–6,withaspecificfocusonchildrenofdifferentages andstagesofdevelopment:

Chapter 4:discussestheimpactofparentalproblemsforchildrenunder5 years.

Chapter 5:focusesontheissuesforchildrenaged5to10years.

Chapter 6:focusesonyoungpeopleaged11yearsandover.

Part IIIincludesChapters7and8whichdrawtogetherthefindingsand

implicationforpolicyandpractice:

Chapter 7:discussestheconclusionsfromthestudy.

PART I: GENERAL ISSUES

AFFECTING PARENTING

CAPACITY

1

Is concern justified? Problems of

definition and prevalence

Tounderstandwhetherthepresentconcernsoverparentalmentalillness,learning disability,problemalcoholanddruguseordomesticviolencearejustified,this chapterexaminestheproblemswithterminologyandtheprevalenceoftheseissues. Generalpopulationstudiesprovideevidenceoftheirprevalenceandtherelevance ofgender,cultureandclass.Findingsfromchildprotectionresearchareusedto identifyassociationsbetweentheseparentalproblemsandchildren’shealthand development,includingtheextenttowhichtheymayposeariskofsignificant harmtothechild.

Problems with terminology

Understandingthedegreeoftheseparentalproblemsisdifficultbecausedifferent researchstudiesusedifferenttermsandtherearefewdefinitionsprovided. Forexample,intheDepartmentofHealth’s1995studiesonchildprotection (DepartmentofHealth1995a)itisunclearwhetherSharlandetal.’s(1996)parents whohave‘relationshipproblems’areasimilargrouptoThoburnetal.’s(1995) parentswhoarein‘maritalconflict’,orFarmerandOwen’s(1995)familieswhoare experiencing‘domesticviolence’.Difficultiesalsoarisebecause,forexample,different countriesusedifferentwaysofmeasuringdrugandalcoholuse.Forinstance,the ‘unitofalcohol’intheUnitedKingdomhaslittlemeaningintheUSwheredifferent measuresofalcoholareusedinpeer­reviewedjournalsandresearch.Inaddition,the purityofdrugsusedindifferentcountriesmaydiffer.Forexample,agramofheroin inNewYorkmaybemoreorlesspurethanagramofheroininLondon.

Indiscussingtheimpactoftheseissuesonfamilies,theterm‘parent’isgenerally usedinagenericwaytorefertoanyadultresponsibleforparentingthechild.Thus thementallyill‘mother’couldbethebirthmother,stepmother,fostermother, father’sfemalecohabiteeorfemalerelativewhoisbringingupthechild.Theprecise relationshipofthecarertothechildhasbeennotedwhenthefindingsfromresearch suggestthisisrelevant.Identifyingtherelationshipbetweenthechildandparent figurecanbeimportantbecauseitcanaffectchildren’sperspectivesonevents.For example,inexaminingwhysomechildrenwhohadwitnesseddomesticviolence weremoreresilientthanothers,Sullivanetal.(2000)foundchildren’sadjustment wasaffectedbytheirrelationshiptotheabuser;stepfathersandfatherfigureswere moreemotionallyabusiveandinstilledmorefearinthechildrenthanbirthfathers ornon­fatherfigures.

24 Children’sNeeds–ParentingCapacity Whenscrutinisingtheliteratureonmentalillness,learningdisability,problem alcoholanddruguse,anddomesticviolencetheauthorshavebeenguidedintheuse oftermsbythefollowingpolicyandpracticedocuments.

Mentalillness

ClinicalstudiesofadultsgenerallydefinementalillnesseitherbyusingtheEuropean system:TheICD­10ClassificationofMentalIllnessandBehaviouralDisorders(World HealthOrganisation1992)ortheUSclassification:DiagnosticandStatistical ManualofMentalDisorders(AmericanPsychiatricAssociation2000).Unfortunately, thequalityofinformationfromcommunity­basedrecordsmayprecludesuch aprecisediagnosis.Inaddition,therecontinuestobeconsiderabledisputeover whether‘personalitydisorder’isapsychiatricillnessassuchormerelyadescription ofextremesofnormalvariation(seeKendell2002foradiscussionofthisissue). Moreover,because‘personalitydysfunctionhasbeenrepeatedlydescribedinanecdotal casereports,clinicalstudiesandsurveysoftheparentsofmaltreatedchildren’(Falkov 1997,p.42)itwasthoughtthattoomititinastudyoftheimpactonchildrenof parentalproblemswouldberemiss.Insomeways,therecentamendmentstothe MentalHealthAct2007simplifytheissueinclinicaltermswiththeuseofanew expression–‘mentaldisorder’–whichisdefinedas‘anydisorderordisabilityof themind’butexcludesbothalcoholanddrugdependenceand‘learningdisabilities unlesswithabnormallyaggressiveorseriouslyirresponsiblebehaviour’.

Learningdisability

TheDepartmentofHealth’sdefinitionoflearningdisabilityencompassespeople withabroadrangeofdisabilities.Learningdisabilityincludesthepresenceof:

ｴ！

asignificantlyreducedabilitytounderstandneworcomplexinformation,to learnnewskills(impairedintelligence);with

ｴ！

areducedabilitytocopeindependently(impairedsocialfunctioning);

ｴ！

whichstartedbeforeadulthood,withalastingeffectondevelopment. (HMGovernment2010a,p.279,paragraph9.56)

Mencapalsoprovidesacleardescriptionoflearningdisability.

Alearningdisabilityiscausedbythewaythebraindevelops.Therearemany differenttypesandmostdevelopbeforeababyisborn,duringbirthorbecauseof aseriousillnessinearlychildhood.Alearningdisabilitycanbemild,moderate, severeorprofound,butallarelifelong.Manypeoplewithalearningdisability, however,liveindependentlives.

25 Isconcernjustified?Problemsofdefinitionandprevalence

Thecauseoflearningdisabilitiesincludesgeneticfactors,infectionbefore birth,braininjuryatbirth,braininfectionsorbraindamageafterbirth.Examples includeDown’ssyndrome,FragileXsyndromeandcerebralpalsy(RoyalCollegeof Psychiatrists2004a).

Problemdrinking

TheNationalInstituteforHealthandClinicalExcellence(2010)intheirpublic healthguidanceonalcohol­usedisordersprovidesthefollowingdefinitions:

Hazardous drinking ­Apatternofalcoholconsumptionthatincreasessomeone’s riskofharm.

Harmful drinking ­Apatternofalcoholconsumptionthatiscausingmentalor physicaldamage.

Higher-risk drinking ­Regularlyconsumingover50alcoholunitsperweek(adult men)orover35unitsperweek(adultwomen).

IntheUnitedKingdomoneunitisequivalenttohalfapintofordinary­strength lagerorbeeroroneshot(25ml)ofspirits,whileasmall(125ml)glassofwineis equalto1.5units.Theunitmeasurehaslostsomeofitsvalueandsimplicitybecause fewpubsorrestaurantsserve125mlglassesofwine(theyarenoweither175ml or250ml).Also,whentheunitwasdevisedwinewascalculatedashavingon average9%alcohol,whilemostwinesthesedaysare12–15%.Similarly,thealcohol contentofmanybeersandlagersisnowmorethanitwaswhentheunitsystem wasestablished.Previously,thealcoholcontentofbeerandlagerwasestimatedat 3.5–4.0%.Nowmostbeersarestronger,3.5–9.0%,withmanypopularbeersat5%. Thepub‘measure’ofspiritshas,insomepubs,beenreplacedbya35mlmeasure. Recently,thenumberofunitsofalcoholinabottleofwinehasbeenprintedonthe label.

TheGovernmentstrategyforpublichealth(Cm79852010)acknowledgesthe deleteriousimpactofheavydrinkingonhealthandthenegativeeffectonothers. ‘Drunkennessisassociatedwithalmosthalfofassaultandmorethanaquarterofdomestic violenceincidents’(p.20,paragraph1.31).

Problemdruguse

Researchintoproblemdruguseemploysabewilderingrangeoftermsinits descriptionsincludingdruguse,drugmisuse,drugdependence,addiction,drug abuseandproblemdruguse.Thesetermsarenotalwaysdefined,whichmakesit difficulttocomparethefindingsfromonestudywithanother.Forinstance,someone canbeaproblemdruguser(havingproblemsasaresultofdruguse)butnotsuffer fromaddiction(suggestingphysicalandpsychologicaldependence).

Withregardtoproblemdruguse,thispublicationfollowstheleadtakenbythe AdvisoryCouncilontheMisuseofDrugs(2003).

26 Children’sNeeds–ParentingCapacity

Byproblemdrugusewemeandrugusewithseriousnegativeconsequencesof aphysical,psychological,socialandinterpersonal,financialorlegalnaturefor usersandthosearoundthem.Suchdrugusewillusuallybeheavy,withfeatures ofdependence.

(AdvisoryCouncilontheMisuseofDrugs2003,p.7)

Domesticviolence

Whenconsideringdomesticviolence,the2009definitionusedbytheHomeOffice wasfoundtobehelpful.

Domesticviolenceis‘Anyincidentofthreateningbehaviour,violenceorabuse (psychological,physical,sexual,financialoremotional)betweenadultswhoareor havebeenintimatepartnersorfamilymembers,regardlessofgenderorsexuality.’ Thisincludesissuesofconcerntoblackandminorityethnic(BME)communities suchassocalled‘honourbasedviolence’,femalegenitalmutilation(FGM)and forcedmarriage.

(HomeOffice2009b)

Thisdefinitionofdomesticviolencedoesnotconfineitselftophysicalorsexual assaultsbutincludesarangeofabusivebehaviourswhicharenotinthemselves inherentlyviolent.Asaconsequence,someauthorsprefertousetheterm‘domestic abuse’.Itshouldalsobenotedthatdomesticviolencerecognisesfewsocial boundaries.Forexample,researchonfemalevictimsofdomesticviolencereports that‘violenceagainstwomenisthemostdemocraticofallcrimes,itcrossesallreligious, classandracebarriers’(Women’sAid1995).

Childabuseandneglect

Childabuseandneglectareformsofchildmaltreatmentandresultfromanyone (butmorecommonlyaparentorcarer)inflictingharmorfailingtoacttoprevent harm.Statutoryguidanceprovidesthefollowingdescriptionsofabuseandneglect.

Physicalabusemayinvolvehitting,shaking,throwing,poisoning,burningor

scalding,drowning,suffocating,orotherwisecausingphysicalharmtoachild. Physicalharmmayalsobecausedwhenaparentorcarerfabricatesthesymptoms of,ordeliberatelyinduces,illnessinachild.

Emotionalabuseisthepersistentemotionalmaltreatmentofachildsuchasto

causesevereandpersistentadverseeffectsonthechild’semotionaldevelopment.It mayinvolveconveyingtochildrenthattheyareworthlessorunloved,inadequate, orvaluedonlyinsofarastheymeettheneedsofanotherperson.Itmayincludenot givingthechildopportunitiestoexpresstheirviews,deliberatelysilencingthem or‘makingfun’ofwhattheysayorhowtheycommunicate.Itmayfeatureageor developmentallyinappropriateexpectationsbeingimposedonchildren.Thesemay

27 Isconcernjustified?Problemsofdefinitionandprevalence

includeinteractionsthatarebeyondthechild’sdevelopmentalcapability,aswellas overprotectionandlimitationofexplorationandlearning,orpreventingthechild participatinginnormalsocialinteraction.Itmayinvolveseeingorhearingtheill treatmentofanother.Itmayinvolveseriousbullying(includingcyberbullying), causingchildrenfrequentlytofeelfrightenedorindanger,ortheexploitationor corruptionofchildren.Somelevelofemotionalabuseisinvolvedinalltypesof maltreatmentofachild,thoughitmayoccuralone.

Sexualabuseinvolvesforcingorenticingachildoryoungpersontotakepart

insexualactivities,notnecessarilyinvolvingahighlevelofviolence,whetheror notthechildisawareofwhatishappening.Theactivitiesmayinvolvephysical contact,includingassaultbypenetration(forexample,rapeororalsex)ornon­ penetrativeactssuchasmasturbation,kissing,rubbingandtouchingoutsideof clothing.Theymayalsoincludenon­contactactivities,suchasinvolvingchildren inlookingat,orintheproductionof,sexualimages,watchingsexualactivities, encouragingchildrentobehaveinsexuallyinappropriateways,orgroominga childinpreparationforabuse(includingviatheinternet).Sexualabuseisnot solelyperpetratedbyadultmales.Womencanalsocommitactsofsexualabuse,as canotherchildren.

Neglectisthepersistentfailuretomeetachild’sbasicphysicaland/orpsychological

needs,likelytoresultintheseriousimpairmentofthechild’shealthordevelopment. Neglectmayoccurduringpregnancyasaresultofmaternalsubstanceabuse.Once achildisborn,neglectmayinvolveaparentorcarerfailingto:

ｴ！

Provideadequatefood,clothingandshelter(includingexclusionfromhome orabandonment);

ｴ！

Protectachildfromphysicalandemotionalharmordanger;

ｴ！

Ensureadequatesupervision(includingtheuseofinadequatecare­givers); or

ｴ！

Ensureaccesstoappropriatemedicalcareortreatment.

ｴ！

Itmayalsoincludeneglectof,orunresponsivenessto,achild’sbasicemotional needs.

(HMGovernment2010a,p.38­39,paragraphs1.33­1.36)

Prevalence

Oneofthefirstquestionstoaddressishowprevalentisparentalmentalillness, learningdisability,drugoralcoholmisuseanddomesticviolenceinfamilieswith dependentchildren.Manyadultshavetimeswhentheysufferfromanxietyor depression,developunstablerelationshipswithpartnersordrinkalcohol,and increasingnumbershaveuseddrugs,bothlicitandillicit,butthisdoesnotmean theyarepoorparents.Moreover,researchhasconsistentlyfailedtoshowanyclear

28 Children’sNeeds–ParentingCapacity relationshipbetweenintelligence–untilitfallsbelowacertainlevel,usuallytaken tobeanIQof60orless–andparenting(BoothandBooth2004;Tymchuck1992). Itistheextremityorcombinationofthesesituations,particularlytheassociation withviolence,whichmayimpairparents’capacitytomeettheirchildren’sneeds and,insomesituations,resultinchildabuseandneglect.

Unfortunately,theabilitytoaccuratelygaugetheextentofparentalmentalillness, learningdisability,problemalcoholordruguse,anddomesticviolenceishampered notonlybyproblemsofterminologybutalsobecauseprevalencedependsupon thepopulationgroupbeingstudied.Forexample,community­basedsamplessuch asthehouseholdsurveycarriedoutbytheOfficeforNationalStatisticswillbe morerepresentativethanresearchwhichfocusesonspecificgroups,suchashospital patients,womenandchildreninrefuges,orthosewhoattendclinicsorcourts. Moreover,theseverityoftheconditionunderstudyislikelytobemuchgreaterin specificsamplegroupsasisthecoexistenceofavarietyofadditionalproblems.But regardlessofthetypeofsamplegroupunderconsideration,anygeneralisationsto samplesbeyondthatbeingstudiedshouldbemadewithconsiderablecaution.

Thefollowingsectionsexplore,inturn,theexistingevidenceontheprevalence of:

ｴ！

parentalmentalillness

ｴ！

learningdisability

ｴ！

problemdrinkinganddruguse

ｴ！

domesticviolence.

Twosourcesareexaminedforeachcategory:

ｴ！

generalpopulationstudies

ｴ！

childprotectionresearch.

Prevalence of parental mental illness: general

population studies

Thereiswidevariationinthemorbidityofdifferenttypesofmentalillness.For example,theGeneralHouseholdSurvey(OfficeforNationalStatistics2003)shows thatoneinsixadultsinGreatBritainhadaneuroticdisorderduringtheweek surveyedin2000.Incontrast,theprevalenceofapsychoticdisorderwasmuch lower–duringthesametimeframeonly1in200hadadisordersuchaspsychosis andschizophrenia(Singletonetal.2001).Table1.1comparestherateofdifferent typesofmentalillnesswithinthegeneralpopulationderivedfromcommunity­ basedstudies.

29 Isconcernjustified?Problemsofdefinitionandprevalence

Table 1.1: Prevalenceofmentalillnessamongadultsinthegeneralpopulation

Type of mental illness Rate Source of data Mixed anxiety and

depressive disorder

8.8% Singleton et al. 2001 (based on data from the General Household Survey)

Generalised anxiety disorder

4.4% Singleton et al. 2001

Depression 2.5–6.6% Singleton et al. 2001; Kandal et al. 2000; Kessler et al. 2003

Phobia 3.5% Singleton et al. 2001 Obsessive compulsive

disorder

3.3% Singleton et al. 2001; Hollander 1997 Panic disorder 0.7% Singleton et al. 2001

Schizophrenia 0.5–1.0% Office for National Statistics 2006a; Singleton et al. 2001

Personality disorder 4.4–13.4% Singleton et al. 2001; Torgersen et al. 2001; Coid and Yang 2006

Postnatal depression 9–27% O’Hara 1999; Royal College of Psychiatrists 2010; Netmums 2005

Itisencouragingtonotethattheproportionofpeoplereceivingtreatmentfor mentalhealthdifficultieshasincreasedfrom14%in1993to24%in2000.In themainthiswastheresultofadoublingintheproportionofthosereceiving medication,whereasaccesstopsychologicaltreatmenthasremainedconstant(Office forNationalStatistics2005).

Thepictureiscomplicatedbecausementalillnessfrequentlyexistsalongsideother disorders.Forexample,USresearchindicatesthathalfofthosewithadiagnosis ofschizophrenia(Swoffordetal.2000)andnearlyathirdofthosewithamood disorderalsomisusedorweredependentuponalcoholordrugs(Regieretal.1990). TheworkofRosenthalandWestreich(1999)intheUSalsosuggeststhathalfof individualswhoexperiencealcoholordrugproblemsormentalhealthdisorders willhavetwoormoreofthesedisordersovertheirlifetime.WorkintheUnited Kingdomwhichfocusedonthoseattendingmentalhealthservicesfound44%of patientsself­reportedproblemuseofdrugsand/orwereassessedtohaveusedalcohol athazardousorharmfullevelsinthepreviousyear(Weaveretal.2002).

Researchwouldsuggestthat30%ofadultswithamentaldisorderhavedependent childrenand7%liveinlone­parenthouseholds(Falkov1998;Melzer2003).There areanestimated50,000to200,000childrenandyoungpeopleintheUKcaringfor aparentwithaseverementalillness(MentalHealthFoundation2010).TheOPCS survey(OfficeofPopulationandCensusesandSurveys1996),whichbrokedown

30 Children’sNeeds–ParentingCapacity

thedatabythetypeoffamilyunit,showedpsychiatricmorbiditytobeassociated withfamilycharacteristics.Coupleslivingwithchildrenhaveagreatermorbidity forbothneuroticdisorder(155perthousand)andfunctionalpsychoses(4per thousand)thancoupleswithoutchildren(134perthousandforneuroticdisorder andtwoperthousandforfunctionalpsychoses).Thedataalsoshowahigherrateof mentalillnessforloneparentsthanforadultslivingasacouplewithchildren(see Table1.2).Thesefindingssuggestthatchildrenmaybemorevulnerabletoharm andneglectwhenlivingwithaloneparentwhosuffersfrommentalillness,because whentheparentisexperiencingthedisorderthereislikelytobenoothercaring adultlivinginthehometotakeontheparentingrole.

Table 1.2: Prevalenceofmentalillnessamongparentsinthegeneralpopulation

Type of mental illness Couple and child(ren) Lone parent and child(ren) Neurotic disorders 15.5% 28%

Functional psychoses 0.4% 1.1%

Parentalmentalillness:issuesofgender,

cultureandclass

Researchonfathersormalecarerswithmentalhealthproblemsissparse.What isclearisthatmenwholiveeitherasacouplewithchildrenorinalone­parent situationhavealowerrateofneuroticdisorderandfunctionalpsychosesthando womeninsimilarsituations(Singletonetal.2001;CoidandYang2006).

Incontrast,thereisaconsiderablebodyofworkwhichrecordstherateofmental illnessinmothers.Somewhatsurprisingisthattheprevalenceofmaternalmental illnessappearstovaryfromcountrytocountry.Forexample,anAmericanstudy suggestsasmanyas25–39%ofwomensufferdepressionfollowingchildbirth (CentreforDiseaseControlandPrevention2004),whereasBritishstudieshave traditionallyplacedthefigureataround10%(O’HaraandSwain1996).However, amorerecentonlinesurveysuggestsdepressionfollowingchildbirthhasincreased significantlyoverthepast50yearsinBritain,upfrom8%inthe1950sto27% today(Netmums2005).Onemightquestionwhetherthevarianceinreported ratesofmentalillnessisduetorealdifferencesinprevalence,inhowmentalillness manifestsitself,orinthemethodsofassessmentandrecording.Forexample,the USstudy(CentreforDiseaseControlandPrevention2004)of453,186women recordeddepressionintermsofitsseverityandfound7.1%ofmothersreported experiencingseveredepression,andjustmorethanhalfreportedexperiencinglow tomoderatedepressionfollowingchildbirth.

Researchintotheimpactofrace,classandculturesuggestsafurthercomplicating factoringaugingprevalence.Mentalillnessislinkedtosocialclassandpoverty.Data fromtheGeneralHouseholdSurvey(Singletonetal.2001)showedthatthosewith

31 Isconcernjustified?Problemsofdefinitionandprevalence

amentalillnessweremorelikelythanthosewithouttohavenoformaleducational qualificationsandtocomefromsocialclassV(unskilled,manualoccupations)and beeconomicallyinactive.Adultswithmentalhealthproblemshavethehighest unemploymentratesforanyofthemaingroupsofdisabledpeople;only21%are employed(OfficeforNationalStatistics2006b).Theimpactofclassandpovertyare exacerbatedwhenadultsareparentscaringforchildren.‘...amongthosewithchildren athome,working­classwomenwerefourtimesmorelikelytosufferfromadefinite psychiatricdisorder’thancomparablemiddle­classwomen(BrownandHarris1978, p.278).

Vulnerabilitytomentaldisordersmaybetheresultofadverselifeeventssuchas poverty,poorenvironment,sexismorracismandotherformsofsocialdisadvantage (CentreforDiseaseControlandPrevention2004;GhateandHazel2002;Propper etal.2004).Forexample,researchbasedin15electoralwardsinLondonfoundthe incidenceofschizophreniainnon­whiteminoritieswasrelatedtotheproportion oftheethnicminoritylivinginthearea;thesmallertheminoritygroupthegreater theincidenceofschizophrenia(Boydelletal.2001).Ofsignificanceareindividual experiences,particularlythoseinvolvinglong­termthreat(BrownandHarris1978; Sheppard1993).

Thepictureisfurthercloudedbecausementalillnessisperceiveddifferently bydifferentculturalgroups(NSPCC1997a;Anglinetal2006).Forexample, theliteratureseemstosuggestthatinsomesouthAsianculturesmentalillnessis expressedintermsofphysiologicalailments.Asaresult,symptomsmaybereported asproblemsrequiringmedicalratherthanpsychiatricservices.Likewise,insome culturesoutsidetheWesternworldschizophreniaisinterpretedasapossessionof thesuffererbymalevolentspirits,andtheservicesofpriestsratherthandoctorsare sought(LittlewoodandLipsedge1997).

Thiscumulativebodyofevidence,althoughillustratingsomeofthedifficulties inassessingprevalence,suggeststhataconsiderablenumberofchildrenarelivingin familieswhereatleastoneparentissufferingfromamentalillness.

Prevalenceofparentalmentalillness:

childprotectionstudies

Themajorityofparentswhoexperiencementalillnessdonotneglectorharmtheir childrensimplyasaconsequenceofthedisorder(Tunnard2004).Childrenbecome morevulnerabletoabuseandneglectwhenparentalmentalillnesscoexistswith otherproblemssuchassubstancemisuse,domesticviolenceorchildhoodabuse (Cleaveretal.2007).

Studiesinthefieldofchildprotectionsuggestthattheprevalenceofidentified mentalillness,whichinmanycasesexistsalongsideotherparentaldifficulties, increaseswiththelevelofenquiry.Atthereferralstageprevalenceislow.Cleaverand

32 Children’sNeeds–ParentingCapacity

WalkerwithMeadows’(2004)studyof2,248referralstochildren’ssocialcarefound, onre­analysingtheirdata,thatparentalmentalillnesswasrecordedin10.4%of referrals,afindingsimilartothe13%identifiedbyGibbonsetal.(1995).However, prevalenceincreaseswithgreaterknowledgeofthefamilycircumstances.Following aninitialassessment,socialworkersrecordedparentalmentalillnessin16.9%of cases(CleaverandWalkerwithMeadows2004).Whencasescomeundergreater scrutinyandachildprotectionconferenceisheld,prevalenceincreasesonceagain. Parentalmentalillnesswasidentifiedinaquarterofcasescomingtoconference (FarmerandOwen1995).Thereisafurtherriseinprevalenceforchildreninvolved incareproceedings.Parentalmentalillnesshadbeennotedinsome43%ofcases wherechildrenarethesubjectofcareproceedings(42%inHuntetal.1999;and 43%inBrophyetal.2003).

Earlyresearchonchildmurderrecordedparticularlyhighratesofmaternalmental illness.Resnich’s(1969)reviewof131casesofparentalchildmurderidentified71% ofmothersasbeingdepressedandGibson’s(1975)studyofmaternalfilicidenoted 90%ofthemothershadapsychiatricdisorder.Morerecentresearchintoextreme casesofchildabusetempersthesefindings,althoughthereremainsconsiderable variation.Falkov’s(1996)studyoffatalchildabusefound32%ofparentshada psychiatricdisorder,afindingsimilartotherate(28%)identifiedinfamiliessubject toseriouscasereviewsduring2007–8(Ofstedetal.2008).However,thisislikelyto beanunderestimate.Theanalysisofanintensivesampleof40seriouscasereviews foundalmosttwo­thirds(63%)ofchildrenlivedinahouseholdwithaparentor carerwithcurrentorpastmentalillness(Brandonetal.2009and2010),afigure ratherhigherthanthe43%foundinRederandDuncan’s1999studyoffatalchild abuse.

Thefocusonmothers,commoninmuchofthechildprotectionresearch,might suggestthattheyaremorepronetokillingtheirchildren.However,filicideisnot theprerogativeofmothers.Exceptforneonates,fathersandfatherfiguresaremore likelytomurderachildintheircarethanaremothers(MarksandKumar1996; Stroud1997;Cavanaghetal.2007).

Fatheradmittedshakingthebaby...Bothparentshaveahistoryofmentalillness. Littleknownaboutfamily,buttheyhavehadfrequenthousemovesandchanges ofname.

(Brandonetal.2008,p.46)

Parentalmentalillnessandtypeofchildabuse

Thereisafurtherimportantissuetobeconsidered;thepossibleassociationbetween parentalmentalillnessandtypeofchildabuse.Asearchoftheliteraturefailedto identifyanyworkwhichspecificallyexploresthislink.However,studiesfocusing onspecifictypesofchildabusesuggestparentalmentalillnessisassociatedwith

33 Isconcernjustified?Problemsofdefinitionandprevalence

emotionalabuse.Forexample,whenchildrenareregisteredasemotionallyabused, parentalmentalillnesswasrecordedin31%ofcases(GlaserandPrior1997).

Researchonchildsexualabusealsosuggestsagreaterassociationwithparental mentalillness.Sharlandandcolleagues’(1996)studyofchildsexualabusefound 71%offamilies,wherethereweresuspicionsofabuse,wereina‘poorpsychological state’usingtheGeneralHealthQuestionnaire(GoldbergandWilliams1988)and therewasafurtherincreasewhensuspicionswereconfirmed.Thesefindingsarein linewithMoncketal.’s(1995)studyoffamiliesattendingaspecialisedtreatmentand assessmentdayclinicforchildsexualabuse.Theyfound86%ofmothers(assessed usingtheGeneralHealthQuestionnaire)showedsymptomsofdepressionoranxiety and,foraconsiderableproportion,thesymptomshadbeenoflongduration.

Caution,however,mustbeexercisedinrelationtothesefindingsbecausestudies ofphysicalabuseandneglecthavetendednottousestandardisedmeasuresofmental healthanditisnotpossibletocomparelikewithlike.

Prevalence of parental learning disability:

general population studies

Theprevalenceoflearningdisabilityamongthegeneralpopulationisdifficultto establishbecausenoinformationiskeptnationally.EmersonandHatton(2008), usingdatafrom24localauthoritiesestimatedthattherewere985,000peoplein Englandwithalearningdisability,equivalenttoanoverallprevalencerateof2%of theadultpopulation.

However,McGawandNewman(2005)raiseanoteofcaution,pointingout howdifferencesinclassificationresultinconfusionandinconsistency.Traditionally, scoresonstandardisedintelligencetestshavebeenusedtodefinelearningdisability; approximatelytwo­thirdsofpeople(69%)fallwithinthenormalrangeof85to115 (averageIQbeing100).Individualswhoseresultsaretwostandarddeviationsbelow themean,i.e.anIQof70orbelow,areclassifiedas‘learningdisabled’(Dowdney andSkuse1993).Onedifficultyinestablishingtheprevalenceoflearningdisability relatestohowthosewithborderlineIQs(70to85)areclassified.Inaddition, individualsmayexhibitdifferentabilitylevelsacrossthecomponentsofIQand othertestsused.‘...inrealitythereisnocleardemarcationbetweenparentswhohave learningdisabilitiesandthosewhodonot’(McGawandNewman2005,p.8).

Similarproblemsareencounteredwhentryingtoestablishthenumberofadults withlearningdisabilitieswhoareparents.EstimatesintheUnitedKingdomvary widelyfrom23,000to250,000(BoothandBooth2004;DepartmentofHealth andDepartmentforEducationandSkills2007).Furtherinformationcomesfrom asurveyinEnglandduring2003–2004of2,898adultswithlearningdisabilities, whichfoundthat1in15(7%)wasaparent(Emersonetal.2005).Theinconsistency intheestimatesofparentswithalearningdisabilityprobablyreflectsthedifficulties inclassification.‘Whatisclear,however,isthatthereareincreasingnumbersof

withdrawalsymptoms 53,56,57,58 seealsomultipleproblems

problemdruguse,terminology 25–6 problemdrugusebychildren 138,162,190 problemdrugusebyparents 55–8

anxietyand 53,56,57,58

attachmentrelationships 72,73–4,112,113,115,121,123 childabuse 5,42–3,50,78

childneglect 13,42–3,65,70–1,104,117 childrenand 91–2,199–200,201

children’scognitiveandlanguagedevelopment 111,119,127–8 children’seducationandcognitiveability 141,142,164–5,184

children’semotionalandbehaviouraldevelopment 112,113,121,129,143–5, 186

children’sfamilyandsocialrelationships 114–15,123–4,132–4,150–3,173, 174,190

children’shealth 1–2years117–18 3–4years126 5–10years139

11–15years 161,162 16yearsandover 181–2,183 birthto12months 109–10 pre­birth 39,99,103–5

children’sidentity 122,131,147–9,171,172,187 children’sself­careskills 178

children’ssocialpresentation 122,131,153–4,177,192 children’sunmetdevelopmentneeds 135–6,157–8,196 clientrecalleffects 17

depression 52,53,56,57 domesticviolence 43,44,56 emotionalabuse42

geneticfactors87 healthhazards104–5

learningdisability 65–6,79,87–8 legalandpolicycontext 12–14 loneparents39

men 38,39,44

mentalillnessand 56,57,65–6 prevalence 29,38,199 multipleproblems 38,65

parentalmentalillnessand 13,65–6

personalitydisorders54 polydruguse16

prevalence 13,29,38–43,47,199 relationshipsand 64–5,77–9,173,174 socialclass39–41

socialconsequences74–9

supportservices 2–3,5,12–14,16,204–5,206 trainingandeducationalneeds 2–3,207–8 withdrawalsymptoms 53,56,57,58 seealsocannabis;heroin;multipleproblems psychiatricdisordersseementalillness

relationshipsseeattachmentrelationships;familyandsocialrelationships; separation

resilience90–3 ‘ruleofoptimism’ 6–7 runaways175–6,190 samplingbias 17 schizophrenia50–1

effectsonchildren5–10years 140,142 ethnicminorities31

geneticfactors 87,101 learningdisabilityand 34 parentingcapacity69

prevalence 28,29,31 smokingand102

socialconsequences74

ScreeningandInterventionProgrammeforSensibleDrinking(SIPS) 14 sedatives57,58

self­careskills

children 120–1,128–30,131,154–5,178,192–3 schizophrenics50

seealsohygiene self­harm

adolescents 166,168,185,186 seealsosuicide

separation

childrenfromcommunityandfriends 78,141–2,152,165–6,189,200 childrenfromparents 73–4,199

birthto12months 112 1–2years121

3–4years133

5–10years 142,149,152–3 11–15years 175,176 ofparents 77,88,133

sexualabuse,domesticviolence 44,59,72,107,138,150–1,168–9 sexualabuseofchildren

3–4years133–4 5–10years138 anxietyand33

byotherchildren/adolescents 27,168–9 consequencesinadulthood 86

definition27 depression33

domesticviolence 46–7,138

parentallearningdisability 34,36,169,173 parentalmentalillness 33

personalitydisorders54 problemdrinking42

problemdruguse 42,78 women27,33

sexualactivity,teenagers 160,180–1,182–3,188 sexualdisinhibition,personalitydisorders 54 significantharm 85–6

singleparents 29,30,37,39 smoking

bychildren 138,160,162,181,182 children’shealth 100,101,102 mentalillnessand 102

pregnancy100,102 women 40,100,103,162 socialclass

domesticviolence44–5 drugusebyteenagers 180 parentallearningdisability 34 parentalmentalillness 30–1 problemdrinking/druguse 39–41 socialconsequences 74–9,110,199

seealsolivingstandards;poverty socialphobia 53

socialpresentation 121–2,130–1,153–4,157,176–8,191–2 solvents57,160–1

SpecialistDomesticViolenceCourt(SDVC)programme 15 specificphobias 53

stepfathersseemen stepmothersseewomen stimulants57

seealsococaine

substanceabuseseeproblemdrinking;problemdruguse suicide 52,54,59,185,186

supportservices 2–15,17,200–8 SureStart 8,203

teenagersseeadolescents terminologyproblems 23–7

training,supportservicespersonnel 2–3,15,203,207–8 tranquillisers57,58

unipolaraffectivedisorderseedepression

unmetdevelopmentneeds 135–6,157–8,195–6 violenceseedomesticviolence;physicalabuseofchildren ‘whole­life’approach 12–13

withdrawalsymptoms 53,56,57,58,112 women

anxiety 33,52,60,100–1 borderlinepersonalitydisorder 70 childabuse 33,42,46,86

childmurders32 childneglect 42,65

depressionseematernaldepression;postnataldepression domesticviolenceperpetrators 44–5,46,59

domesticviolencevictims 5,14–15,26,43,44,46,58–61,199 attachmentrelationshipsand 72,113

childrenand88–9

children’semotionalandbehaviouraldevelopment 113 children’sfamilyandsocialrelationships 114,115,133,150 children’shealth 107,126

children’sidentityandsocialpresentation 131 maternaldepression 60,107

relationshipsand 77,78 ethnicminorities 5,61 generalisedanxietydisorder 52 health8

parentalmentalillness 30,31,32,69–70 childsexualabuse 33

effectsonchildren 99,100–1,102,111,140,147,167 seealsomaternaldepression;postnataldepression

parentingcapacity 17,69–70 post­traumaticstressdisorder 60 problemdrinking

attachmentrelationships112 childabuse 42,86

childneglect 42,65

effectsonchildren 99,103,105–6,111,112,114,138 identificationandassessment 14

pregnancy 14,16,103,104,105–6 prevalence 36,39–40,199

supportservices16 problemdruguse 39,40

attachmentrelationships 72,112 cannabis 38,40,162

cocaine104,111

effectsonchildren 99,103–4,111,112,142,162 effectsonrelationships 78

heroin 39,103,104

inpregnancy 16,39,40,64–5,103–5,111 supportservices16

sexualabuseofchildren 27,33 smoking 40,100,103,162 seealsogirls;pregnancy youngcarers 90

collaborationofsupportagencies 193 educationandcognitiveability 165,184

emotionalandbehaviouraldevelopment 168,169–70 familyandsocialrelationships 176,189

identificationandassessment 170,176,202,203 identity172

informationprovision207 self­careskills 155,178,192–3 socialpresentation153 youthmentors 201

children’s development?

Do children always suffer as a result?

These are the questions which this second edition of

Children’s Needs – Parenting Capacity

seeks to answer.

The original exploration of the research literature has been

updated in the light of legal and policy changes in England

and findings from more recent national and international

research. The edition has also been expanded to cover

parental learning disabilities and how it may impact on

parenting and children’s health and development. The findings

show that these parenting issues affect children differently

depending on their age and individual circumstances. While

some children grow up apparently unscathed, others exhibit

emotional and behavioural disorders. This knowledge can

inform practitioners undertaking assessments of the needs of

children and their families and effective service responses.

The book is essential reading for practitioners, managers and

policy makers concerned with improving the outcomes for

children and families who are experiencing such problems.

ISBN 978-0-11-706365-5 £25

9 780117 063655 www.tso.co.uk