A new approach to substance misusing mothers and children in care proceedings: findings from the FDAC Evaluation Project

1. A new approach to substance misusing mothers and children in care proceedings: findings from the FDAC Evaluation Project Professor Judith Harwin Women and Addiction The 2012 Manchester Women and Addiction Conference November 2012

2. AIMS • What is a family drug and alcohol court (FDAC)? • What is the potential of FDAC to deliver better child and parent outcomes than ordinary care proceedings and services? • Findings from the FDAC Evaluation Project • Prospects for FDAC • opportunities and challenges

3. What is FDAC? • A specialist court within care proceedings • For parents whose substance misuse is a key factor in the decision to initiate care proceedings • It offers parents treatment for their substance misuse and other problems • Voluntary- parent can opt for ordinary care proceedings • If parental progress is poor, case reverts to ordinary proceedings

4. How is FDAC different? • Based on the principles of ‘therapeutic jurisprudence’ • Judicial continuity • Multi-disciplinary team attached to court • Rapid expert assessment and intervention • Regular non-lawyer review hearings • Parent mentors

5. General Manager FDAC Team Structure as at November 2010 Consultant Child & Adolescent Psychiatrist & Clinical Lead Service Manager (FT) Honorary Consultant Adult Psychiatrist Team Administrator (FT) Senior Practitioner (FT) Clinical Nurse Specialist (FT) Volunteer Parent Mentor Coordinator (PT 3 days) Parental Substance Misuse Specialist (PT 4.5 days) Social Worker (FT) Parental Substance Misuse Specialist (PT 3 days) Social Worker (FT) Volunteer Parent Mentors

6. Why was FDAC set up? To respond to 3 main issues: • Frequency of parental drug or alcohol misuse in care proceedings • Concerns in relation to practice • Concerns in relation to court processes And: US evidence on specialist family courts for substance misuse was promising

7. FDAC Evaluation Project: Stage 1 (Funded by the Nuffield Foundation and Home Office: 2007-2011) • 3 inner London pilot LAS & 2 inner London comparison LAS • Inclusion criteria:- • care proceedings in which parental substance misuse is a key factor in the application (mothers and fathers with primary care responsibility) • All FDAC and non-FDAC cases entering Inner London Family Proceedings Court consecutively (Jan 08-June 2009) • Exclusion criteria – psychosis; discretion for ongoing DV • 86 families (55 FDAC & 31 non-FDAC) tracked for 6 months from 1st hearing • 41 FDAC & 19 comparison families tracked to final order • Method: file reviews; cost analysis; interviews; focus groups * Funded by the Nuffield Foundation and Home Office

8. FDAC Evaluation Project: Stage 2 (Funded by the Nuffield Foundation: 2011-2013) • Stage 2 evaluation • up to 200 cases [including Stage 1 cases] tracked to final order • Reunification cases followed for 1 year post-order to explore sustainability of parent and child outcomes after FDAC ends – a new element in the study • 3 original FDAC authorities and 3 comparison LAS • Same methodology as in Stage 1 + file studies and interviews with FDAC parents (reunification cases only)

9. Stage 1 FDAC and comparison case profiles • All proceedings triggered by maternal substance misuse (care proceedings typically involve mothers) • 55 FDAC & 31 comparison mothers • 30/37 FDAC & 13/21 comparison fathers misused • Hard cases with similar profiles in both samples • More than ½ the maternal sample misused illegal drugs and alcohol together; lengthy substance misuse histories and treatment • Mental health, DV and convictions widespread in both samples and lengthy previous involvement with children’s services • In both samples children under 5 predominated

10. Stage 1 FDAC- results were better • More FDAC parents stopped misusing by final order • More FDAC mothers reunited with their children • Children placed more swiftly in permanent alternative homes when reunification was not possible • Fewer contested proceedings • Cost savings

11. Maternal Substance Misuse Outcomes at Final Order

12. Permanency rates and length of proceedings (per case analysis)

13. What might explain the results? • Single biggest difference between the two samples was the receipt of FDAC • In first 6 months FDAC mothers:- • accessed substance misuse services more quickly and more successful at staying in treatment • more received help with housing, benefits and domestic violence services • No difference in the number and type of services received by the children • Profiles of the sample were similar

14. The offer of FDAC and reasons for entering the programme • All but two parents accepted the offer of FDAC • A range of motivators (37 parent interviews) • The chance to keep the child was the most frequent • Other reasons • change own behaviour and sort out problems • receive family treatment and/or access wider range of services • get help in dealing with local authorities • Drifted in with low/ no expectations

15. Parents’ views on the intervention Based on interviews with 37 parents still in FDAC • All but two would recommend FDAC to parents in a similar situation • Judges- perceived as fair, knowledgeable about the case, important in problem-solving; valued his praise • FDAC team: support (emotional and practical); ‘strict’; available; valued ‘being talked to as normal’ • Mentors • Influence on aspirations

16. Parents liked FDAC “FDAC has helped me be the sort of person I want to be. It’s helped me remain focused and motivated and instilled in me a real sense of achievement and confidence.” “They take time to listen. They don’t judge you straightaway.” “Instead of fibbing we’re encouraged to be honest ...They were being honest with us and making it easier for us to be honest with them” “I like it because they are strict and they try to help and support you” “Its always nice to be given a chance. If you then mess up you can never say you weren’t helped and given that chance. Normally if you are on drugs, you are seen as all bad” (father)”.

17. Professionals liked FDAC • It is effective. It is how care proceedings ought to be (lawyer) • The consistency of judges is a great benefit. They remember the cases. (LA Lawyer) • In normal proceedings it is very much ‘us and them’. It is very good for parents to see the lack of antagonism between professionals in these cases (LA Lawyer) • There is something about using the authority of the court to do social work that has been really helpful (guardian) • There are no delays in the process – it starts straight away (social worker)

18. Was FDAC more expensive? • Average cost of FDAC team per family over life of case is £8,740 (2010 prices) • Savings through shorter care placements, shorter hearings, fewer hearings with legal representatives present and fewer contested cases • Work equivalent to that done by experts is less expensive • Bottom-up method for costing provides a solid basis for further exploration of costs

19. Prospects for FDAC Opportunities • Family Justice Review recommended limited roll-out to expand the evidence base • Some FDAC features central to FJR • Judicial continuity; active case management; fewer assessments • Good fit with the Munro Child Protection Review • pro multi-disciplinary teams, to be involved earlier, and for more clients • Safeguarding review: FDAC is a serious trial for change • Better coordination of adult and child services

20. Prospects for FDAC: Challenges • Findings from the evaluation • Hard and chronic cases • More parents continued to misuse than stopped • Could cases have come to court earlier? • Capacity issues • Post reunification support • The new landscape • FJR 26 week timeframe in all but exceptional circumstances and impact on a therapeutic approach • Calls for more children to come into care • Costs

21. More information • Full first stage report, executive summary and highlights are available on www.brunel.ac.uk/fdacresearch • Report on the feasibility of establishing a family drug and alcohol court at Wells Street Family Proceedings Court (2006) Ryan M , Harwin J and Chamberlain C. Available www.brunel.ac.uk/fdacresearch