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Literature mapping: Pre-birth assessment, Gaps in the literature,…

- - - - Critchley 2019:The social worker intervention is the risk
    - - Critchley 2019: How can social workers know best, they are not living the experience
    - - Critchley 2018 Families saw this risk as higher, the lack of time to bond
  - - - Hodson 2011: found this too - concluions were based on their own interpretation of the information they had gathered.
    - - Hart 2001: Cooperation and engagementwas seen to be key
      - Hodson 2011: Cooperation was present across the cases but this did not necessay impact on the case outcome MAYBE GOING AGAINST HART, LUHAMA, MARSH AND CRITCHLEY?
      - Luhamaa et al 2021 - There is an emphasis on cooperation of parents with social services agencies. It was mentioned in 83% of cases across the study (across Europe) and 93% of English cases.
      - Lushey et al (2017) Most parents participate, even though there are barriers
      - Critchley 2018 trying to recruit the parents to see the risk in the same way as they did was the only thing social workers could do - this was seen to reduce the risk
        
        When there is resistance to this, the risk is seen as increased Critchley 2018 CAN PARENTS NOT HAVE A DIFFERENT VIEW?
    - - Hodson 2011 - Social workers were not worried about families fleeing, they felt there were ways around this
    - - Critchley 2018 This was the focus of professionals, and it was more around phycial immediate safety, not considering the logner term impact of separation
    - - Critchley 2018
    - - Critchley 2018Women were vulnerable, men were risks
- - - - Critchley 2020: Limited time to form compassionate relationships
        
        Lushey et al (2017) needing to form a relationship in a limited time
        
        Critchley 2018 - found this to be a barrier too
      - Harrison et al 2020 - time to undertake assessments is a barrier
      - Lushey et al (2017) they are seen as less urgent, with issues around timing and viability being mentioned.
        
        Critchley 2018 - Cases not being allocated as you can't change the risk to the unborn. Being seen as less urgent. Social workers had discressioon about what they did and when
      - Critchley 2018 Chairs know that timescales can be unhelpful, having an RCPC so close to or after birth
      - Critchley 2018 Assessments feel rushed because the timescales are so short, limited chance to evidence change
      - Critchley 2018 Social workers need more time to do the assessments, guidelines need to be reviewed
      - MAson et al (2015) late allocation or involvement is a barrier to PPO working properly as it does not allow the time for meaningful enagement and might result in parents having to agree plans because of timescales
    - - Barlow et al: 18 weeks
      - Hart 2001: timing varied, even when other children were open in the family. Some too a wait and see approach
        
        Critchley 2018 - still found this to be the case
      - Hodson 2011: Referral times varied
      - Timeings from guidance weren't always afhered to - 28 weeks in Scotland
      - Critchley 2018 parents would know about the referral at 10 weeks but often no contact was made until 20 weeks
      - Broadhurst et al 2017 The majority of women at interview wanted earlier help in pregnancy, even when a child had been removed from their care previously
    - - Broadhurst et al 2017 We found that 32% of pre-birth child protection conferences were held between 8 and 4 weeks before the birth of the child, 24% between 4 weeks and the birth, and 6% after birth.
  - - - Lushey et al (2017) Practitioners are still seeking advice from colleagues where there is little guidance
    - - Lushey et al (2017) found this continued to be an issue, with people interpteting this in different ways and taking their own angle
    - - Lushey et al (2017) Some LAs use Calder's 2003 guidelines but these have not been widely adopted and need updating
      - Mc Elhinney et al (2019) No studies identified during literature review that explored Calder's framework, even though it is one that is more used
  - - - Lushey et al (2017) built on Hodson's research. 96% of LSCBs made reference to prebirth assessment and offered additional guidance to that within statutory guidance. The guidance differed
    - - Lushey et al (2017) also found this, they would welcome more guidance
  - - - Critchley 2018 found this
      - Critchley 2018 This goes against the law, no order, best interests etc
    - - Hart 2001 "Practitioners operating within the current climate are likely to be held accountable for any harm suffered by children and their priority becomes covering their back through adopting a cautious and protective stance" (p.178)
  - - - Hart 2001: Fathers were often excluded, with social workers sometimes justifying this exclusion even when they had PR
      - Hart 2001:Grandparents were more likley to be involved, but they may have put themselves forward, rather than being asked
      - Hart 2001:Engagement with mothers was seen to be key
      - Hart 2001Parents voices in meetings seemed to be poor, not felt to be participatory
      - Critchley 2018Fathers were not central, there was a focus on mothers
      - Critchley 2018 Family memmbers cast as victims or vilans - not recognising that they are human
    - - Hart 2001:Professional involvement was not consistent and midwives were often not consulted
      - Hart 2001: Other professionals opted out of making a judgement
      - Hodson 2011: involvement with other agencies was consistent across all of the cases explored in depth GOING AGAINST HART 2001- HAS PRACTICE DEVELOPED?
      - Mc Elhinney et al (2019) Collaboration by professionals is key
  - - - Hodson 2011: Social workers were lanacinc high case loads and workload pressures
    - - Critchley 2018: No consideration of previous trauma and the need for additional support during pregnancy and birth was evidenced in assessments
      - Broadhurst et al 2017:Trauma informed practice might help practitioners understand resistance
- - - - Saw a reduction in removal from birth and legal intevention. Also improved safeguarding status
    - - Harnett et al: The importance of setting goals and monitoring change
    - - Harnett et al:Theraputic work by social workers can have a different, rather the referring to other services and having more people involved
      - Mc Elhinney et al (2019) psychosocial support services were seen to be positively received and have an impact
      - Critchley 2018Parents not knowing which appointments are the most important, the CP process is demanding and some families fought against this, whereas some accepted it
      - Hestbaek et al 2020 In Finland there is an infant family work concept (vauvaperhetyö) in child welfare to offer multi-agency support for families with infants at particular risk dont know how well this works
    - - Harrison et al 2020: The state should be responsible tfor ensuring the support is available to families to address their issues.
    - - Luhamma et al 2021: In the UK 2/3 of services focus on addressing parental risk
      - Support or surveilance
        
        Critchley 2018 Sometimes the support we put in place can not feel like support - more surveillance. Governance was often called support, making sure people did things, but is this really support? “Is it possible for the intervention of child protection serv ices to be experienced as supportive?” p.185
    - - Luhamaa et al 2021: Services often focus on parental traits, not how good the services are. There is not enough research to suggest our services are good.
    - - Critchley 2018 The structure of the meetings raisies questions of holding 2 CP confrernces before birth, and the imopact this can have on the parents. The first was often seen to not have a conclusion as the work had often not started - this is oppressive to parents
      - Critchley 2018 Parents not having a voice - due to being upset or silenced. Parents being afraid to say the wrong thing so not saying it
    - - Critchley 2018 Babies end up staying CP for longer than they should
    - - Critchley 2018 Having the time to introduce the families to the foster carers before removal would be helpful, rather than the baby leaving the hospital with a stranger. Those relationships are important
    - - High
        
        Critchley 2018 found that there were high demands on parents and tey experienced high levels of structural inequalities that anyone would suffer with, they they were expected to overcome those
      - Low Expectations
        
        Critchley 2018 Low expectations of men
    - - Mason et al 2015 PPO can be effective as long as this is done in enough time - it is an opportunity to reflect the seriousness, and a step up between CP and court.
  - - - A lack of support
        
        Broadhurst et al 2015: There is a gap in policy around support services post removal and mothers often return with the same issues
        
        Marsh et al (2019) support is needed to address the issues they have faced
        
        Broadhurst et al (2013): Policy is lacking in this area
        
        Broadhurst et al 2013 We need a more proactive response to addressing the issues the women face, to avoid multiple removals. And also to address the impact of state intervention. Mothers need to be considered as welfare subjects in their own right,
        
        The mothers tend to fall between the gaps of services
        
        The cost of subsequent removals is high
        
        They are not arguing for not removing children or adoption, but for support for the women to avoid the pattern of subsequent adoptions
        
        Broadhurst and Mason - There is an expectation that women will just recover naturally - this clearly does not happen. There needs to be a safety net of support after removal
        
        Broadhurst et al 2017 The impact of post proceedings support has not yet been felt in a reduction of repeat care proceedings. As there is no statutory mandate for this support, access to this varies across the country.
      - Emerging initiatives
        
        PAUSE project
        
        Body and Wheeler: The Pause project has supported mothers who have had their children removed to make positive changes in terms of their housing, income, mental health, substance misuse, and be less likely to go on to have another child straight away (admittedly due to forced contraception)
        
        Broadhurst et al (2013): There are emeging initiatives
        
        Cox et al 2017 - Emerging programmes are shown to be effective in reducing subsequent pregnancyes - huge financial saving as well as more positive impact on mothers.
  - - - Marsh et al (2019) One professional suggested this would be a factor in helping them turn their lives around
    - - Marsh et al (2019) Not all people do this, as midwives felt some proessionals usied their power.
- - - - Resistance
        
        Critchley 2019:The need to fight what is going on
      - Defeatism
        
        Critchley 2019: More likely when there had been previous removals
        
        Lushey et al (2017) found when interviewing social workers that people thinking it was a foregone conclusion was a barrier.
      - Engagement as a form of control
        
        Critchley 2019: The only way that the families can evidence change is to be involved This is an issues as women cannot be forced to engage with the process
      - Chambers 2009 They would look at pictures to try and deal with it. Or try not to think about it too much, or too far in advance. Others fantasized about being together again.
    - - Critchley 2019: The involvement interupted the pregnancy and removed the chance for joy
    - - Critchley 2019: The experience is stressful, feeling out of control
      - Critchley 2018 parents would know about the referral at 10 weeks but often no contact was made until 20 weeks - causing anxiety for waiting
      - Critchley 2018 families found it very anxiety provoking not knowing what as happening during the process, or what was likely to happen
      - Critchley 2018 The delays and not knowing what was going on added to anxiety
    - - Harrison et al 2020: The experience is disempowering and traumatising
      - Marsh et al (2019) feelings of guilt and shame. Knowing people will know they were pregnant, but don't have a baby, so not going outside. Trauma, nightmares, high emotions, feeling numb inside
      - Chambers 2009 Painful, abrupt, feeling empty, lonely and frustrated. the removal was the transition from happiness to sadnes
    - - Marsh et al (2019) Not being shown any care
      - Broadhurst and Mason (2020) Profound emotional pain, immediate devestation, thoughts or actions of a suicidal nature
    - - Marsh et al (2019) the mothers experienced disenfranchised grief and were seen as illigitimate morners
      - Body and Wheeler: Reporting concerns and not being taken seriously
      - Body and Wheeler: Mothers being referred to as tummy mummys
    - - Critchley 2018 parents had a lack of voice, Sometimes there narratives were not heard, they were silenced in meetings, unable or afraid to speak due to saying the wrong thing or being too upset to speak
      - Mason et al (2015) Having a lawyer present during the PPO process encouraged parents to speak and left them feeling as if they had a voice
    - - Critchley 2018 feeling ambushed my outcomes that dthey didnt know about
      - Needing better communication across the process
    - - Marsh
      - Cox
      - Broadhurst and mason 2020 Shame (LIKE COX AND MARSH) and the sight of children re-inforcing the loss (LIKE MARSH)
    - - Broadhurst and Mason 2020 Stigma and impact in the community (LIKE MARSH 2019) Professional stigma, feeling as if their cards were marked as being unsitable carers – they felt that it was past risks that dominated current assessments (CRITCHLEY FOUND THIS AND LUSHEY MENTIONED IT AS A BARRIER TO ENGAGEMENT A COURT PAPER ALSO FOUND THAT THIS WAS THE FOCUS – HOW CAN THEY EVIDENCE CHANGE WITH ENDURING PROBLEMS - JUHASZ)
    - - Broadhurst and mason 2020 Emptiness and dispair - no reason to go on - mothering was seen as a positive in lives which had been marked by adversity and the removal of that role left nothing, it had been a buffer to make changes - no reason to get up or be an active member of society. Not surprising that women go on to have subsequent pregnancies
      - Broadhurst and mason 2020Wider impact - loss of tenancy, homelessness - loss of relationships due to being seen as a risk. Breakdown in family relationships when the child is placed in kinship care - the process and obtaining PR could cause a rift and isolate mothers from previously supportive families. Removal results in a loss of welfare entitlements (LINKS TO PAUSE EVALUATION) vulnerability to homelessness because they no longer need the house they have – leading to other harmful behaviours.
      - Broadhurst and Mason 2020Parents with MH or SMU issues - the issues were exacerbated by the removal and got worse - LIMINTING THE CHANCES OF REUNIFICATION
    - - Broadhurst and Mason 20202 This can lead to a lack of trust ISOLATED FROM BOTH PERSONAL AND PROFESSIONAL NETWORDS
  - - - Critchley 2020: Heightened anxiety due to vulnerability
    - - Critchley 2020: The work is highly emotive and a big responsibility (hints towards identity)
      - Marsh et al (2019) lasting traumatic experience. Struggling to switch off their feelings
      - Marsh et al (2019) difficult balance of not becoming harsh but managing emotions
      - Critchley 2018Practitioners were reluctant to discuss the emotional nature of the work
      - Losing sleep and feeling distressed of anxiety
      - Critchley 2018 The speed at which they need to build a relationship results in emotional investment which can be draining
    - - Critchley 2020: Feeling like there is additional scrutiny over plans, being seen as too optimistic
    - - Critchley 2020: Focus on the child - having a narrow focus allowed them to be able to work
      - Marsh et al (2019) focusing on the law and the best interests of the child to get through
      - Marsh et al (2019) debriefing with a colleague is needed
      - Marsh et al (2019) removal is easier to live with if you think a baby will be hurt
      - Critchley 2018 the longer they do it the easier it is
    - - Critchley 2019: Worry that they would continue to get pregnant and nothing has changed role of support after removal which is currently lacking, expcept for the pause project
    - - Marsh et al (2019) AUSTRALIAN DIFFERENT ROLE not wanting to be there and do it, but knowing it is what they do
    - - Critchley 2018 support or assessment? Can ot be both?
    - - Critchley 2018 Social workers are vulnerable as making the wrong decision can result in them losing their jobs
- - - - Wall weiler et al 2018b They were more likely to have a diagnosis of anxiety or depression in their first year, and if the infant was placed in the first week they were more likely to have post-partum depression, or anxiety. They were more likely to use anti-depressants
      - Broadhurst and Mason 2020 Parents with MH or SMU issues - the issues were exacerbated by the removal and got worse - LIMINTING THE CHANCES OF REUNIFICATION
- - - - Bilson and Bywaters: The NFJO work has underestimated the scale of care proceedings for infants. They found half of children enter initially under S20, another 7.5% under PPO or EPO
    - - Alrouch et al: There has been a growth in care proceedings. Similar rates across England and Wales
      - Bilson and Bywaters: A rapid increase of BIC
      - Broadhurst et al 2018: ENGLAND Increase in care proceedings for new borns - they accounted for 42% of care proceedings by 2017. Also an increase in volume over time, more than doubling, and the liklihood of a newborn being subject to care proceedings more than doubling
      - Harrison et al 2020 BIC is growing in Western Australia at a might higher rate than the birth rate
      - Raab et al (2020) Similar increases in scotland as in England
      - Hestbaek et al 2020 There is a slowly increasing trend in infant removals in nordic countries. The ratte is between 3.5 and 7.7 per 1000 babies
- - - - Bilson and Bywaters: Small correlation between the increases and deprivation scores
      - Griffiths et al: WALES - Half the mothers lived in the most deprived quantile, 76% in the two most deprived
    - - Bilson and Bywaters: There appear to be links between increases in BIC and low OFSTED ratings, with the largest increases being found in LAs which 'Require Improvement'
    - - Mental health
        
        Griffiths et al 2020: Much higher rate of mental health issues identified than the general population
        
        Wall Weiler et al 2018b Mothers who had a child taken into care had much higher rates of mental health issues than those not separated from their children, mothers with involvement had higher rates of mental illness than those not involved with CPS.
      - Substance misuse
        
        Griffiths et al 2020 Much higher rates of substance misuse than the general population (6 x higher)
        
        De Bortoli 2014: The link between SMdP and child abuse is not clear - it does not take into account the complexity of other interacting factors
      - Engagement with pre-natal care
        
        Griffiths et al 2020: findings refute the fact that women are less likely to engage with pre-natal care when there are concerns about removal
        
        Marsh et al (2019) The fear of mandatory reporting can reduce engagement in care - disagreeing with Griffiths
      - Hart 2001: Violence was an issue across most of the sample
      - Being in care as a parent
        
        Wall-Weiler et al (2018) this was the biggest predictor of having a first child taken into care - 11 times greater than if she had not been in care
        
        Broadhurst et al 2017 54% experienced out of hoime care. They had unsettled childhoods
      - Broadhurst et al 2017 Women were more likely to have children younger and describe the pregnancies as unplanned
  - - - Hodson 2011: Most referrals were from health or the LA
- - - - Broadhurst et al 2015 - are they more likely to have further issues, or increased issues even?
      - Harrison et al 2014: research into the impact of involvement on the attachment
    - - Griffiths et al: Long term outcomes
      - Harnett et al: Long term outcomes for babies from OxPuP trial