What Happened Next?

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    Introduction

    What happened next? A study of outcomes for maltreated children following care proceeding

    In 2014 Gerry Mulcahy and colleagues published the results of a study into outcomes for maltreated children who had been through court proceedings where an assessment had been conducted by a multi-disciplinary team. Here we summarise the key findings.

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    Summary

    The family courts make complex decisions about whether children can be safely raised by their birth parents, whether specialist intervention is required, and whether children should be placed with kinship carers or foster or adoptive parents.

    Only a small proportion of cases draw upon assessments and recommendations of a multi-disciplinary team (MDT) that works with the whole family, including the children, as part of the decision-making process. This study investigates whether MDT recommendations for help were accepted, to what extend they were implemented, and their impact following court proceedings.

    The study traced children who had been assessed by an MDT service to explore what happened with respect to their cases and to evaluate their adjustment after court proceedings had ended.

    The sample consisted of 114 children who were referred to an MDT assessment service between 2006 and 2011. The study involved analysing the pre-court assessments made by the MDT and conducting post-court interviews with carers, using measures which assess the children’s social and emotional adaptation and relationships across a range of domains. A global adjustment score was calculated in addition to scores for the individual domains. 68 children took part in the follow up.

  • Discussion

    The study found that the courts followed the MDT placement recommendations in 88% of cases, suggesting that multidisciplinary assessments can play a useful role in decision-making in complex cases.

    It found also that children’s adjustment average showed an overall improvement. However, the scale of improvement remained minor for most children. Global adjustment scores based on the post-court interviews indicated that nearly a quarter of children were still likely to meet the criteria for at least one mental health disorder, and fewer than one in ten showed good psychological adjustment across all of the domains considered. The majority continued to experience serious difficulties post-proceedings – often in relation to dealing with frustration, controlling impulses and coping with stressful events.

    A positive finding from the study is that the overall change in the children did take the average global adjustment score from the clinical to the non-clinical range, but sadly those children whose scores were clinically concerning during assessment showed the least improvement in their global adjustment scores.

    The authors also looked at the breakdown of scores across a range of domains to help understand children’s strengths and difficulties in different areas. The biggest area of improvement was found in the ‘relationship with parents and/or carers’ domain, and the second largest area of improvement was the ‘development of confidence and self-esteem’.

    Less than half of parents and children that the MDT recommended for treatment or additional help were known to have received this. Where maltreated children are not properly assessed, or care plans and services for children in and after proceedings fail to provide appropriate help, this is likely to hinder the potential benefits of decisions made in court.

    Perhaps surprisingly, children whose recommended treatments were not implemented showed significantly greater improvement in their global adjustment scores compared to children who did receive the recommended support. A possible reason for this is that the children receiving extra help tend to be those who are experiencing the greatest difficulties, and therefore are less likely to show evidence of positive adjustment. It may be that some carers are less likely to notice and seek support with children’s difficulties or that children in many of these placements, especially those in kinship care arrangements, have less support from social workers, CAMHS and additional help in school. 

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    Conclusion

    Encouragingly, the study found that there is potential for decisions made in care proceedings to contribute to a reduced likelihood of poor developmental outcomes for maltreated children.

    Both placing children with substitute families and apparent changes in their birth families were associated with improved relationships and adaptation. However, work remains to be done to develop an effective model for resolving the impact of maltreatment and adversity. After care proceedings children remain exceptionally vulnerable, and the resources and attention dedicated to children post-proceedings do not adequately support the investment made around the placement decision.

    That most of the children experienced some continuing difficulty denotes the depth of the challenge for research and also possible opportunities for services to become systematically more therapeutic in practice.

    Click to read the full open-sourced paper, 'What happens next? A study of outcomes for maltreated children following care proceeding' - Gerry Mulcahy, Julia Badger, Hannah Wright, Catherine Erskine