A night to remember

April 5, 2006 in Child safeguarding, Children, Fostering and adoption

A teenage mother runs away with her baby, who is in need of medical attention. Once traced, out of hours social worker Chris Hadley has to co-ordinate several agencies in the middle of the night to make them safe. Graham Hopkins reports

CASE NOTES
The names of the mother and baby have been changed

PRACTITIONER: Chris Hadley, practitioner-manager, Derby City Care Line.
FIELD: Out of hours emergency social work
LOCATION: Derby, East Midlands.
CLIENT: Neetu David is a mixed Asian British one-year-old on a care order to another authority. Her mother Leah, 17, has mild learning difficulties and had disappeared with Neetu some weeks ago.
CASE HISTORY: A telephone call at 12.30am alerted the emergency duty team to the whereabouts of Neetu and Leah. It was understood that Neetu had a heart defect that needed to be closely monitored. Having absconded with Neetu, this monitoring had not been taking place, hence the high level of concern to find their whereabouts. One of the reasons for the care order had been Leah’s inability to take responsibility for Neetu’s health needs. Police had been monitoring Leah’s withdrawals from cash machines. The most recent had been in Alfreton, Derbyshire. From there the police traced her to an address in Derby where she was with her baby.
DILEMMA: Both the young mother and baby would have needs but the resources are not readily available in the early hours of the morning.
RISK FACTOR: With Neetu taking priority, she had to separated from Leah which would be distressing for them both, but placing Neetu in unfamiliar surroundings with limited knowledge of her health and cultural needs could be problematic.
OUTCOME: Neetu was made safe, and placed for a few hours with approved carers and then transported home to the care of her home authority.

The International Federation of Social Workers defines social work as: “A profession which promotes social change, problem solving in human relationships, and the empowerment and liberation of people to enhance well-being.”

However, problems do not always dutifully clock-in during office hours. Problems that are faced by an emergency duty team (EDT) or out-of-hours team can be more challenging as time, staff and access to other agencies are restricted at night. The aim for duty workers is to make situations safe until daytime services can take over.

Providing a generic service every evening, night, weekend and bank holiday has meant workers have developed an expertise in crisis resolution and risk assessment. And with an average 15 years’ post-qualifying service with all client groups, workers have a deep and rich seam of knowledge, skills and experience to mine. Sometimes all of this can combine in the heart of the night to go beyond making a situation safe. As in the case of one-year-old Asian-British baby Neetu David.

Neetu has a heart condition. Her mother, Leah, 17, has mild learning difficulties. Neetu was on a care order because of her young mother’s inability to look after her child, particularly her health difficulties; Leah had been failing to keep Neetu’s hospital appointments. These concerns were heightened when Leah disappeared with Neetu.

“There was a recovery order issued by the home authority,” says Chris Hadley, practitioner-manager, Derby City Care Line, the council’s out-of-hours service. “This required Neetu’s return. Police had traced them to an address in Derby very late one night. We did quite a lot of liaison with police and home authority on what should happen now that they had been picked up.”

There were concerns for both but Neetu was the priority. “It took a lot of time but at 2.30am we started to arrange a foster placement,” explains Hadley. “In our authority we have to go through one of the daytime managers to access a resource – so we got a manager out of bed. We found approved foster carers who had advanced first aid skills and who lived close enough to the hospital to take Neetu straightaway if any problems developed. The carers got up at 4am and sat and waited for the child to arrive.”

The situation had been made safe. Hadley continues: “We anticipated that it would be several days before the home authority could do anything about it; but the other EDT worker found out that the home authority had a resource set up and waiting for Neetu whenever she was found. We then organised escorts to take them home.”

Because an escort agency was being used rather than the police or social workers, there was a concern that if Leah had travelled back with Neetu there was a good chance that she would abscond with the child again. So, separate escorts were arranged.

“Within a few hours we had sorted out the situation,” says Hadley. “We made the child safe; she was looked at medically, had a safe place to spend the rest of the night and was then transported back home. Rather than ring residential or fostering services for a short stay placement and come up with a blank, and then have to look for a private agency to provide a night sitting with a child in a bed and breakfast, which is sometimes what EDTs are faced with, we managed to get it all sorted within a few hours.”

The case illustrates that out-of-hours work can be liberating from the more bureaucratic-driven approach to social work. As a neighbouring EDT manager notes: “It’s a chance to do some proper social work: you’re not having to go to panels for this or to panels for that – none of the gate keeping exercises you get involved with in daytime services. It’s all about problem-solving: here’s the problem – sort it.”

With Neetu placed safely, Leah, who had remained at the police station, was taken back to the address she had been staying at. “She stayed there for the rest of the night, so she could try and get some rest and then travelled back and see her social worker the following morning,” continues Hadley.

It turned out that the Neetu’s health issues were more complicated than had originally been believed. “She had a chromosomal problem and it needed to be reviewed by medics but that could have been done back in their area. Nonetheless, the children’s emergency department were aware of the situation.”

“It was a good outcome for the child – we knew she was safe and not poorly. Everything fell into place. It doesn’t normally work that way but it was brilliant,” says Hadley.

Arguments for risk

The issue in the early hours of the morning is: what do you do with a one year old? If you are going to separate the child from mum who is going to look after the child? Carers approved to look after a baby was far preferable to a makeshift residential solution or a night sitting service in a bed and breakfast.

The foster carers had advanced first aid skills and lived close to the hospital – where staff had been alerted – to take Neetu if problems developed.

A more long-term issue would have been meeting the cultural needs of the child. Being Asian-British – white mother, Asian father – Hadley admits it would have been difficult to source culturally appropriate foster parents at that time of night. “We have to be very pragmatic in our territory: we have to work within the resources we have. Our priority had to be to make the child safe first and if needed we could later begin to address cultural needs.”

Arguments against risk

It’s clear that Leah’s parenting skills were worrying. She appeared to show little understanding or concern for the seriousness of Neetu’s condition. She wasn’t looking after the health needs of her baby and by fleeing with her she only served to intensify the belief that she was lacking due parental concern. The baby was rightly taken away from Leah but with limited resources available it may have worsened the situation – causing heightened distress for both mother and baby.

If these events had taken place in the daytime there may well have been more hoops to jump through. But there are good reasons why layers of accountability are built into the process and not just to do with financial control.

The demoting of Neetu’s cultural needs in favour of concerns about her health is understandable. Nonetheless, once Neetu’s health needs were met, her cultural needs should have been dealt with immediately, rather than deferred to some later date.

Independent comment
This case is typical of much emergency duty team (EDT) work: a complex, urgent situation demands attention “out of the blue”, writes Martin Smith.

EDT workers are frequently working alone at 12.30am and initially have only themselves to “consult” when formulating a way forward within tight deadlines. A crucial skill is to absorb all the information presented without missing anything of importance or being overwhelmed by it so that an action plan can be formulated.

The partnership networking demonstrated here is impressive as the police, two different local authorities, a manager, foster carers and an escort agency are drawn in to the planning and effectively co-ordinated. It was fortunate that an appropriate resource could be identified so quickly as the lack of suitable placements for children out of hours is an increasing cause for concern for many EDTs.

The way everything came together in such a short time frame shows what synergies are possible from experienced EDT workers who have accumulated unrivalled knowledge and experience.

When EDT workers make creative use of the networks that exist out of hours it is as if the sum of what can be achieved is greater than the total of the constituent parts. Furthermore, through 30 years of working, EDTs have an outstanding safety record.

This case represents EDT work at its resourceful, creative, inspired best. It acts as a timely reminder of why a generic perspective that is mindful of the diverse needs of all people in a system is to be valued highly.

Martin Smith is practitioner-manager, Buckinghamshire EDT