Judge recommends family group conferencing in non-accidental injury case

A judge has recommended the use of family group conferencing to enable two children to stay with their parents, after one child sustained a suspected non-accidental head injury.

The judge in the case, Mr Justice Hayden, did not endorse the local authority’s care plan which recommended placing the children in the care of their maternal grandparents under a special guardianship order.

Creative and comprehensive assessment

He said the inquiry into the potential for them to live with their parents had been unsatisfactory and called for a “detailed, rigorous, creative and fully comprehensive assessment” to explore the “potential that this couple appear to offer to their children”.

The family first came to the attention of the local authority in January 2015 after their oldest child, then nine months old, was taken to hospital. Her mother claimed she had fallen backwards off a cushion and hit the back of her head.

‘Shaking’ concerns

Although she was fully conscious, she presented as alternately floppy and rigid and had an episode of vomiting. Later scans revealed various symptoms that suggested the possibility of a non-accidental head injury, including a retinal haemorrhage where there is bleeding in the back wall of the eye.

The lack of any injury to her scalp gave rise to concern she had been shaken by a “frustrated” carer, the judge said.

Expert witness Professor David Taylor, a professor of paediatric ophthalmology at University College London, said: “One would not normally expect short falls, rolling backwards or other minor head trauma with retinal haemorrhages but they are not out of the bounds of possibility.”

Paediatric neurosurgeon Peter Richards said the fact most of the population would not have brain imaging after a lower level fall meant it was possible these injuries happened but went undetected more often than the medical profession was aware.

‘Ships in the night’

The mother cared for her daughter, referred to as LM, at night while her husband worked. He got into bed when she got up and Mr Justice Hayden described the pair as being like “ships in the night”.

The mother held herself to very high standards and wanted to appear to be coping, and so, when her daughter had difficulty establishing a sleep pattern, she became anxious to ensure she got her back into her own bed in time for the father’s return.

Under strain

The judge said: “I do not doubt that the adults were happy and that LM was a very wanted baby, but the strains placed on the mother were obvious. The opportunities for the mother to share her concerns with her partner were inevitably limited.

“The mother plainly considered that LM responded better to her father as far as sleeping routines were concerned and…the mother told me that she felt LM was often deliberately playing up for her at bedtime,” he added.

He said it was clear the mother had little sleep on these occasions but, despite having family living nearby, she did not take advantage of them as a support network.

Mr Justice Hayden said the mother was unprepared to acknowledge any stress, fatigue or frustration of any kind.

“What is most concerning is the mother’s refusal or inability to recognise them.”

The judge concluded that, based on medical and other evidence, the injury was most likely to be non-accidental and inflicted by shaking, probably due to a “momentary loss of control on the part of a frustrated carer”.

Lack of assessment

He added that it was unfortunate and regrettable that the issues of home life had not been addressed in social work assessments.

“It strikes me that these essentially social work issues are better explored in the relative calm of an assessment room, speaking to familiar social workers, rather than by cross examination in a witness box.”

However, the judgment does not make clear why this assessment did not take place. Mr Justice Hayden said the judgment should be shared with the wider family and they should be involved in any assessment through family group conferencing.

This judgment comes after former education secretary Alan Johnson called for family group conferencing to be made statutory.

Speaking in support of kinship care, Johnson said family group conferences should take place as soon as there is any suggestion a child might be taken into care, in an effort to keep them in their biological families.