The names of the child and family have been changed

CASE NOTES

Practitioner: Gill Fox, social worker.

Field: Children and families.

Location: Stockport, Cheshire.

Client: Baby Keeley Saunders was placed with her maternal grandparents along with her three half-siblings, who are on a  residence order.

Case History:  Keeley's mum, Sarah Saunders, 29, has a history of drug and alcohol misuse and has been in prison three times. It was during her most recent spell inside that it emerged that Sarah was pregnant with Keeley, her fourth child. Her chaotic lifestyle had resulted in her first three children being placed on the child protection register and then with Sarah's parents. Sarah also had a history of being dependent on her partners who had physically abused her. Keeley's  father had left Sarah long before their daughter was born. Having lost her partner, Sarah was also concerned that Keeley would be taken away. Foster care was considered initially as it was felt that Sarah's parents could not cope with three children and a baby.

Dilemma: If Keeley were placed with grandparents while an assessment was carried out on Sarah, she would not be able to stay if things failed with Sarah - and would be placed in care.

Risk factor: Sarah's history, if repeated, would put Keeley at risk.

Outcome: Keeley moved in with Sarah last June and mother and baby are doing well. Weekly monitoring visits have reduced to monthly and there are no longer concerns.

Working in partnership with parents and carers, non-oppressive practice and empowerment are everyday theoretical values and ways social workers do their jobs. But how often are these values enforced in the face of difficult cases?

If a mother has a record that includes her first three children being taken into care, imprisonment and a chaotic lifestyle dependent on drugs, alcohol and abusive partners, what hope is there for the fourth child on the way?

In the case of baby Keeley and her mother, Sarah Saunders, social worker Gill Fox believed there was a chance that things could be different.

"Research tells us that the best indicator of the future is the past," says Fox. "But this case made me question my own values because, if we based it on past assessments, we'd say: 'No way. Why am I continuing with this - she's lost three children?' But the big issue for us was partnership - not only with mum, but with the grandparents as well."

Indeed, the grandparents were crucial to any potential success. Fox says: "They had been honest with us about the other three children and had prioritised their needs before Sarah's, which sometimes put them in a difficult situation. Their history of honesty with us was key: because if they didn't tell us what was really going on, we wouldn't know."

Sarah agreed to have supervised contact with Keeley at the grandparents' house. Throughout the assessment period Sarah would arrive at 7am and stay until 9pm. Contact was a big issue, says Fox. "If the baby was placed in foster care, Sarah would never have these levels of contact, which would have meant mother and baby attachment would not have been as strong. Nor would Keeley's siblings or grandparents have been able to have any relationship with her."

Another worry centred on Sarah's past drug use. "We never had any evidence that she had taken drugs in prison while she was pregnant. Sarah said she hadn't," says Fox.

Medical records did not suggest that Keeley had any withdrawal symptoms after she was born. "So Sarah could be telling the truth," Fox says. "However, we know that people who take drugs don't always do so.

Equally, if she was using there was little chance she would be able to stick to her caring routine each day."

The only way to be certain was to have Sarah tested. Fox says: "Whereas urine samples indicate usage over a week, a hair sample can provide evidence over three months. Her first test was clear - and our only question was whether she could maintain this. The answer was a resounding "yes". Two further tests would prove her to have been drug-free for nine months.

A psychological assessment mirrored concerns identified in Sarah's core assessment: for example, her low self-esteem and reliance on a dominant and abusive partner. But being devoted to her maternal role left little time to meet new partners.

"We felt her daily routine was a defence mechanism," says Fox. "There was a risk that if we ended supervised contact she'd be off. So, we needed to test the water. We started a couple of hours a day of unsupervised contact and built it up until there was no supervision at all. But she continued with the same pattern of arriving early in the morning and leaving late."  She continues: "We got Sarah involved in a local women's centre and a domestic violence group, through which she made a new friend. She also started to attend a parent and tots group."

The psychologist felt that Sarah needed a 26-week programme, but the children's guardian and Fox felt this would be excessive and expensive. Fox says: "We went to the women's centre, which provides a 12-week 'freedom programme' with psychotherapy and counselling. I also felt that the women's centre was more relaxed, less clinical, and the course could be taken at her pace and would not be time-limited.

"I felt she was more likely to commit to this and thus make it succeed than if we had made her do something."
The local authority applied for a supervision order rather than care order because, as Fox says, "we had no reason to doubt that Sarah would continue to work with us - which she has". She adds: "Sarah felt that we had given her a voice. I look back on the case now and I think I did take some risks but they have paid off: this little girl is now back with her mum."

Arguments for risk

• The relationship built up between Fox and Sarah made for a positive partnership. Fox says: "She was included in all decision-making and she felt I was giving her a fair shot. I told her 'I'm going to give you every chance. If Keeley can be with you that is where she should be'."
• The relationship with the grandparents was crucial. They were honest about what was going on in the family and their information could be trusted. Fox agreed a contract with Sarah and visited weekly. Monthly meetings, which included the health visitor, and statutory reviews were held. "But the linchpin to it all was the partnership working with Sarah and her parents."
• Initially, the partnership avoided the need for court orders. Fox says: "The mother was working with us, so we didn't apply for one. Nor was Keeley on the child protection register, so we didn't have any official power."

Arguments against risk

• The past is indeed a strong indicator of the future. At least Fox realised that she was taking risks in choosing to assess this case differently.
• In Sarah's case there is alcohol, drugs, crime and violent relationships. Psychological assessments all concluded that she couldn't live alone, and would need to become dependent on a partner. It may be a matter of time before Sarah becomes bored or overwhelmed with her maternal duties and slips back into her known lifestyle.
• Much is made, rightly, of the importance of trust and relationship building. And yet Sarah tried to conceal her pregnancy. Although it could be argued that she would obviously do so given the circumstances around her first three children, it is an open act of dishonesty.
• Disagreeing with the final psychological assessment was another big risk and, although Fox found an ally in the children's guardian, it is a professional decision that might have backfired.

Independent Comment

Those working to  safeguard children do so under media scrutiny, waiting to pounce upon their smallest slip, writes Patrick Ayre.

How much more comfortable it is then to choose an approach with which no one could find fault, even though in our heart of hearts we believe we could and should do more.

Gill Fox and her managers are clearly made of sterner stuff. To propose a rehabilitation plan in the face of the Sarah's record seems at first glance to risk being laughed out of court.

However, if we take the time for a second glance, we may conclude that our question should not really be "Why  bother even trying?" but rather "Why not?". Despite the grim historical background, the immediate risks were low and the only obvious serious  potential downside to Fox's plan is the delay in placing Keeley.

Nonetheless, the viability of this experiment depended crucially on several  factors which are not always present. It was essential that the grandparents could be trusted completely and also that Sarah genuinely believed she was being given a chance. 

Equally important for Keeley's long-term well-being was Fox's understanding that the key challenges in this case might not be found during the short months of the rehabilitation period but during the long years thereafter.

Without access to local services able to address effectively the psychological issues identified in Sarah's assessments, returning Keeley to her care might well have been a risk too far.

Patrick Ayre is senior lecturer at the University of Luton and an independent child welfare consultant.