Can former drug users cope with a new-born baby?

 Independent social worker Ruth Stark: “It was not just about managing for the next two or three nights but their capacity to parent in the longer term”

Can former drug misusing parents, who already have four children, cope with a fifth, or should the newborn daughter be removed from the family?

CASE NOTES

Practitioner: Ruth Stark, independent social worker

Field: Children’s social care

Location: Edinburgh

Clients: Jane*, 36, Tim*, 35, and their newborn daughter, Kirsty*.

Case history: Jane and Tim have a long history of drug misuse. Tim has anger management problems and regularly gets into fights when intoxicated. There is also a history of domestic violence. The couple have been incapable of providing a safe home life for their first four children. As a result, all four were removed and placed with the extended family. However, in the past year Jane and Tim have given up drugs.

Dilemma: Jane has just given birth to their fifth child, Kirsty. A children’s hearing has requested an independent assessment. The couple say they are committed to looking after their baby, but it is uncertain as to whether their change of lifestyle is likely to last.

Risk factor: If the parents revert to drug misuse, Kirsty could be at serious risk of physical harm or neglect.

Outcome: The stress of looking after a baby is too great for the couple. An incident of domestic violence occurs, resulting in the removal of the child.

*Names have been changed.

Independent assessments are crucial when considering parents’ capacity to provide a safe home life for their children. Ruth Stark, a social worker based in Edinburgh, was asked to provide an independent report for a children’s hearing concerning a newborn child living with her parents who were both former drug users.

Jane and Tim’s first four children had been removed and placed with extended family under kinship care arrangements, but they now claimed to be reformed characters.

“The decision was about whether the child should stay with the birth parents or be taken into foster care,” says Stark.

“The mother was now off drugs and she had kept all her appointments with the medical staff for her pregnancy with this child, which was a change from her previous pattern of behaviour. The father, who had previously also had substance misuse problems, was maintaining that he had been alcohol- and drug-free for more than a year.”

Huge amounts of background information were made available to Stark, including all of the couple’s social work and health records. She liaised with the local police, and spoke directly to the couple, the children and extended family involved. She visited the family six times, as well as visiting the kinship carers, holding individual sessions with each of the parents and a joint session with them.

Jane and Tim had a transient lifestyle and moved house frequently. At the point of assessment they were in a new tenancy again, but appeared to be coping well. Stark recognised that the circumstances for this child were very different from those of their older children. However, despite all these improvements, she continued to have concerns, particularly around the history of domestic abuse.

“The couple had managed so far,” says Stark. “But this was during the time when the mother was pregnant and just after the birth of child. In the second part of the assessment I looked at their situation now that the child was a reality and when the baby was screaming in the middle of the night. So, it was not just about managing for the next two or three nights, but their capacity to parent in the longer term. Those were the concerns going through my mind.”

For Stark, the key element in the assessment was to identify the weak points. Although her report to the children’s hearing acknowledged their significant achievements, it also highlighted her concern that the couple would find it a huge challenge coping with the responsibility that comes with looking after a newborn baby.

“My recommendation was that the child should stay with the parents because there was no immediate evidence to suggest that harm was being done,” Stark says. “We eventually agreed on the case being formally reviewed at six months, but that social workers could take their concerns back to the children’s hearing at any time during those six months,” she says.

Stark’s fears were well founded. When Kirsty was just four months there was an incident of domestic violence where Tim struck Jane. The couple were fully aware of the consequences of such an incident because this had been made clear at the children’s hearing. When the abuse occurred, Kirsty’s social worker, who had case responsibility, could act quickly to place the child in foster care. She was later adopted.

Although this was a disappointment, Stark points out there are many parents with similar problems who have been able to sustain their progress and were continuing to look after their children 10 years later.

Reflecting on this case, Stark draws attention to the limited options available for the children in such circumstances.

“My concern is that when we’re looking at that kind of scenario, which is about one child in one situation, we don’t always take into account all the other children,” she says. “That child, who was subsequently adopted, won’t have contact with her siblings when growing up. For me, there is a big issue about how we safeguard the relationship between the siblings. I don’t think we’ve got it right yet.”

WEIGHING UP THE RISKS

Arguments for taking the risk

● Change of lifestyle: Social work is about helping people transform their lives. Jane and Tim have given up drugs and say they have changed their lifestyle. They appear to have a new-found commitment to looking after Kirsty.

● Positive assessment: The independent social worker has done a thorough assessment that has identified the strengths and weaknesses of the couple’s ability to parent. It was established that there was no evidence for removing the child.

● Safeguarding emphasised: All parties were aware of the consequences of any incidents in the home. The couple were told that, if they failed to maintain a safe environment for Kirsty, she could be taken into care.

Arguments against taking the risk

● Are parents true to their word?: There is the risk that that the couple have presented themselves positively solely for the period of assessment.

● History of neglect: Jane and Tim have a long history of drug misuse that has resulted in neglect of previous children. Could they change their behaviour?

● Act sooner rather than later: Nobody in this case would be surprised if the couple reverted to their chaotic lifestyles. If the baby is likely to be taken into care, it might be less damaging to do so sooner, rather than later.

INDEPENDENT COMMENT

Patrick Ayre, senior social work lecturer at the University of Bedfordshire

This case illustrates the dilemmas that are inherent and inevitable in safeguarding work. Tabloid press headlines would have us believe that we should always be able to divine the uniquely correct solution to every problem placed before us, but the reality is that most of the time the best we can do is calculate the risks and hope that the Goddess of Good Fortune favours our endeavours.

In this case, it was right to commission a detailed assessment. The author is inevitably required in the end to produce a “yes or no” recommendation, but in practice the uncertainties are almost always such that the most accurate answer is “it depends”.

However, it was important that those working with the family should concentrate as much upon the content of the risk assessment as upon its outcome. In managing the risks, they needed to focus on three issues.

First, they needed to understand the dangers which had been identified. Second, they needed to decide how best to avoid these dangers becoming a reality. Third, they needed to analyse what further information might be sought to reduce the remaining uncertainty.

➔ Email Mark Drinkwater  to submit your Risk Factor case studies

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This article is published in the 2 June 2011 edition of Community Care under the headline “Can former drug misusers cope with their newborn daughter?”