Transcript Mike Shaw Tavistock Clinic

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
1st 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
Monday
Tuesday
Week 1 Meet family in
court on first day
of proceedings
Week 2
Sign an
undertaking with
Thursday
Read papers
Full day
assessment
Contact
network
Formulation &
Intervention
Planning
Meeting
Week 3 Agree plan in
court with
lawyers
Wednesday
Friday
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
8.
Steal the Mares of Diomedes
2.
Slay the 9-headed Lernaean Hydra 9.
3.
Capture the Golden Hind of
Artemis
4.
Capture the Erymanthian Boar
5.
Clean the Augean stables in a single
day.
12. Capture and bring back Cerberus
6.
Slay the Stymphalian Birds
7.
Capture the Cretan Bull
Obtain the Girdle of the Amazon
Queen
10. Obtain the Cattle of the Monster
Geryon
11. Steal the Apples of the Hesperides
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 childcentered lifestyle)
Abstinence
Intensive treatment
Personal
Parent-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