Mike Shaw Tavistock Clinic

Role of the C&A Psychiatry Expert  Comment on ‘Significant Harm’  Whether there is “…an impairment of (mental) health or development”  “…attributable to the care given…” etc  Identify the child’s needs and timeframe  Comment on whether the parent is likely to meet those needs in that timeframe

Role continued  Recommend placement and contact  Recommend a ‘care plan’ that will achieve the best possible (Every Child Matters) outcomes, through:  Monitoring  Support  Education  Treatment

Conventional Assessment  See the child at home (could be foster care)  Interview the parents  Interview foster carers/ teachers etc  Observe contact  Read the papers  Write up and answer the questions

Family Drug & Alcohol Court (FDAC)  FDAC is a novel collaboration between the Family Court and other agencies (including experts) to improve outcomes for children of substance misusing parents  The model comes from the US where it has been running for about 12 years and large non-randomised controlled trails suggest  more parents recover  more children returned to their parents

Major child health problem  3% of young people “ live with a parent who is dependent on or abused illicit drugs ”,  while 10.3% “ live with a parent who is dependent on or abused alcohol” (National Survey on Drug Use and Health 2009)  Parental substance misuse responsible for 62% of care proceedings ( Forrester and Harwin 2006)

Better outcomes for children  The best outcome for any child is to be safely and successfully raised by his or her parents  For the children of substance misusing parents the best achievable outcome might be an alternative placement with the minimum delay

Child’s Timeframe  Nearly all the FDAC parents want to overcome their drug and alcohol problems and be united as a family  However these ambitions are only achievable if they can be realised in the child’s timeframe

Attachment  Most of the children we work with are new born babies  The sensitive period for healthy attachment is between 6 & 18 months  We try to ensure that children are permanently placed by their 1 st birthday  For children to return home their parents need to be ready by the time the baby is 9 months

Other TimeFrames  With older toddlers the critical consideration will be leaving time for adoption if parents fail  Timeframes are more flexible with school aged children who still stand to gain even if the parents need a couple of years to recover and the outcome is improved contact (although the proceeding will have ended with a care order of special guardianship order long before then)

Chart a course  If we knowing where we are starting from and where we want to be in 9 months, it is possible to chart a course  and calculate way points that will tell us if we are travelling in the right direction and whether we are likely to arrive on time

Collaboration

Multi-agency Collaboration The families The court (Wells Street, judges, guardians, lawyers) Social services (Camden, Islington & Westminster) The intervention team (‘parent mentors’, children’s social workers, substance misuse health workers, psychiatrists) Treatment and support services (local authority, NHS & independent sector) Housing, probation etc

Timetable MondayTuesdayWednesdayThursdayFriday Week 1Meet family in court on first day of proceedings Read papers Contact network Full day assessment Week 2Formulation & Intervention Planning Meeting Week 3Agree plan in court with lawyers Sign an undertaking with the judge

the court  Lends its authority to the intervention plan  Reviews the family’s progress at fortnightly meetings between the parents and the judge  Is a hybrid that can switch between collaborative and adversarial as necessary

Accumulating the Evidence

Trial: definitions 1. Examination of evidence and applicable law by a competent tribunal to determine the issue of specified charges or claims 2.The act or process of testing, trying, or putting to the proof

Case example: Heracles

Trials of Heracles 1.Slay the Nemean lion 2.Slay the 9-headed Lernaean Hydra 3.Capture the Golden Hind of Artemis 4.Capture the Erymanthian Boar 5.Clean the Augean stables in a single day. 6.Slay the Stymphalian Birds 7.Capture the Cretan Bull 8.Steal the Mares of Diomedes 9.Obtain the Girdle of the Amazon Queen 10.Obtain the Cattle of the Monster Geryon 11.Steal the Apples of the Hesperides 12.Capture and bring back C erberus

12 Capturing Cerberus

3 Trials for FDAC Parents 1. Abstinence (at least 9 months) 2.Therapy 1.Personal (3 or more months) 2.Parent child (3 months) 3. Lifestyle change (gradual change from drug & alcohol centered to child- centered lifestyle)

Abstinence

Intensive treatment PersonalParent-child

Lifestyle

Outcomes  1/3 of parents complete the ‘trials’ and have their children returned  1/3 can’t even achieve abstinence and their children are permanently placed with the minimum delay  1/3 complete some but not all of the trials and their outcome is variable