The role of decision-making in influencing outcomes in long-term care

1. The role of decision-making in influencing outcomes in long-term care Findings from the Care Pathways and Outcomes Study

2. What will be presented? • Introduction to the CPO study • Summary of the findings • Implications for decision-making and practice

3. The Care Pathways and Outcomes Study • Research team: Dominic McSherry, Montserrat FargasMalet, KerryleeWeatherall and Greg Kelly • Longitudinal study following a population of children (n=374) under 5 and in care in NI on 31/03/2000. • 3 completed phases. All children’s placements profiled in 2000, 2002, 2004 and 2007. • Phase 3: The Children’s Perspective (interviews with subgroups of 9-14 year old children and their parents/carers – quantitative & qualitative data)

4. Placement profile 2000-2007

5. Regional variations

6. Placement stability

7. Children’s attachment to their parents/carers

8. Children’s behaviour

9. Children’s health and behaviour • Which children had serious health problems according to parents/carers: • A range of conditions • Child’s behaviour stayed the same or improved • Highlighted the strengths of children and positive behaviours

10. Children’s education • Poor scores in the BPVS • Receiving additional supports at school: majority of children adopted by carers; nearly half of those in foster care; BUT only a few with birth parents. • Children coping very well/ “alright” at school (considering limitations); a few - with problems (e.g. bullying and behavioural problems). • A few doing very well at school and passed the Eleven Plus test – BUT low expectations from teachers and social services.

11. Parent / carer stress

12. Contact with birth families • Majority had some sort of contact • Regular face-to-face contact with parents/siblings common for foster, kinship and RO children but adopted children – post-box contact. • Contact arrangements changed over time, reducing or stopping altogether • Many children, especially in foster or kinship care, used to have negative reactions to contact in the past, but for the majority, the situation had improved. • Some children were happy with the level of contact, others longed for more contact with birth family or even wished to live with them. • The majority of parents/carers whose children had face-to-face contact had no issues, but where tensions existed - in kinship care.

13. Family communication • sharing info about birth family/past in care: (1) sharing all the info; (2) concealing certain facts deemed potentially distressful (adoptive); & (3) simplified or romanticised version of the past/birth family (adoptive & kinship). • (1) some children were asking questions / talking about birth family though not often; (2) some were not doing that now but did in the past; and (3) some never did, because already knew everything, had forgotten, or were not interested. • A few children were curious about their birth family but their parents/carers appeared unaware of this.

14. Social services’ involvement • Birth parents most critical of support provided by social services (marginalised, undermined and distrusted). • Some adoptive parents advocated for a continued role of social services; others and some RO carers felt a sense of ‘abandonment’ by ss post-adoption/post-residence order. • A few kinship carers experienced a sense of disregard and lack of support, and felt less valued/supported by ss precisely because they were relatives. • Some RO carers happy that ss were no longer there, leading ‘normal’ family lives; others advocated a continued role for ss, in terms of the provision of financial support.

15. Social support • The most important source of support provided for the parents and carers was their family. • Birth parents had the least extensive network of support, in relation to both family and friends. • Foster carers and residence order carers had access to the most extensive family support networks. Their extended family were closely involved in the lives of their children. • Support from extended family also provided on an extensive basis for the majority of adoptive parents who also fostered the child.

16. Implications for decision-making • Imp of finding stable placements – early decision-making • Post-code lottery • Need to acknowledge high level of health needs for children in adoption, living with birth parents & in foster care + high level of parent/carer stress – Post-adoption support plans; support packages for birth families?? • Informing residence order carers • Getting the child’s perspective

17. Thank You For more info: McSherry, D., FargasMalet, M., Weatherall, K. (2013). Comparing long-term placements for young children in care. The Care Pathways and Outcomes Study – Northern Ireland. London: BAAF Montserrat FargasMalet m.fargas@qub.ac.uk

18. I had to fight with social services to get him to do the Eleven Plus… They weren’t going to let him do it… and I felt he should do it … The Education Board wasn’t going to let him do it. … At the end, they allowed him to do it but he had to sit in a room on his own… in case he would disrupt the class… he got a B1. I was all delighted. (Martin’s foster mum)

19. [In the future] I might go and live with my birth parents … Because I’ve never seen them before and I don’t know anything about them. (Bridget – adopted by carers) But things seem to be going well this last year or so, better than it had been, so I mean the kids come back and I don’t have any problems now. Whereas at the beginning there were lots of problems with behaviour and different things, but that has all settled down now and things have been going well this past year because they have been doing more family orientated things. Whereas before they were in a Family Centre and the kids would be bored … (Pol’s foster mum)

20. We would have done (talk about birth family) right up until after the court there last year, whenever his mother took us back to court over access… Now we wouldn’t really talk about her because he just doesn’t want to… he just doesn’t want to know anything about her. (Ryan’s residence order carer) Just she didn’t grow up in mummy’s tummy, she grew in somebody else’s tummy and then we picked her specially. So that is really as far as she understands. So far. You say that to her and she will repeat it, you know, that is it. (Ciara’s adoptive mother)

21. I don’t know what to say there [at the LAC reviews]… I think they’re a bit sore on me at times… They put it down as neglect… Does she look like somebody who’s neglected? I’m sitting crying usually. (Alexandra’s birth mum) We sort of felt that once we took over the role nobody else wanted to know … It just seemed to me you could bluff your way through the whole thing … There have been no checks whatsoever since, a small concern of mine. (Ciara’s adoptive mother) No other option. The children were dumped on us… and the social worker says you have to take them, didn’t ask will you take them… just take them. (Nathan’s grandmother – kinship carer)

22. As for my brothers and sisters, as I said, I never see them so they weren’t suportive at all… so we were doing it by ourselves… (Bronagh’s birth parents) Especially my son and daughter-in-law are very, very supportive … would babysit at the drop of a hat… and even my older daughter… it’s very good (Ryan’s residence order carer)