Pause: our work & impact, using a relationship based model

1. Pause: our work & impact, using a relationship based model Ellen Marks, Director of Practice & Learning

2. What is Pause? Our aim to prevent the damaging consequences of thousands of children being taken into care each year. What we do We work with women who have experienced - or are at risk of - repeated pregnancies that result in children needing to be removed from their care. How we do it Through Pause Practices working together with local authorities and other partners

3. Pause evolution Practices open in Derby, Wiltshire, Bristol, NE Lincolnshire, Barking & Dagenham, West Sussex (April – July) Practices open in Slough, Cumbria, St Helens and Blackpool (August – October) Practices open in Hull (April), Newham and Doncaster (June) Practices open in Southwark (September), Greenwich and Islington (October) Tracking of repeat removals in Hackney begins Practice opens in Newcastle (September) Pause pilot begins in Hackney 2015 2005 2012 2013 2016 2017 Hackney funds feasibility study Additional Innovation Fund award Department for Education Innovation Fund award Big Lottery Fund award

4. Where we are now

5. Hackney Prevalence Study 2013 - Presenting social issues of women The social issues identified amongst this cohort of birth mothers should be viewed for most as interchangeable as the likelihood is that women will have experienced at least two or three of these issues over a lifetime. Number of women and type of presenting social issue

6. Key findings from 2017 Broadhurst et el .. Vulnerable Birth Mothers and Recurrent Care Proceedings 2014-17 Reviewed CAFCASS data on 65,000 women involved in care proceedings. “From this confirmed that 1 in 4 birth mothers appearing as respondents in an index set of s.31 care proceedings are expected to re-appear in a subsequent set of proceedings within 7 years. 70% of women who return to court do so in proceedings that concern an infant who is born subsequent to, or during previous proceedings. Repeat care proceedings typically concern children who are younger than those appearing in an index set of proceedings. This indicates that local authorities are issuing proceedings much earlier in a child’s life, if the mother has previously appeared as a respondent in care proceedings.”

7. Broadhurst et el 2017 Profile of Mothers : “Mothers have been exposed to much higher levels of harm and adversity than what would be expected in the general population with 56% of recurrent mothers having an ACE score of 4 or more. Scores of 4 or more are reported as predictive of poor adult outcomes in the international ACE literature.” “From our study, we found that 66% of recurrent mothers had experienced neglect in their childhood, 67% emotional abuse, 52% physical abuse, and 53% sexual abuse. The level of sexual abuse is high and particularly concerning given that sexual abuse has been described as a unique victimisation experience, with particular developmental consequences."

8. Pregnancy triggered memories of women's own often negative or frightening experiences of being cared for as children themselves. • Woman were fearful of the impact that ‘being known’ to services as children would have on social workers’ perceptions of their ability to parent. • Women were fearful for their own children entering the care system because of their own negative experiences.

9. A case study for early intervention

10. https://www.youtube.com/watch?v=V7-sjC_zjIw

12. The Integrated Model Therapeutic Counselling Drug & alcohol support Loss & grief Past trauma Own childhood Practical Housing Benefits Woman Self reflective Taking control Taking responsibility Health needs Sexual health GP & dental Systemic Personal (e.g. partners) Professional contacts Education &employment Literacy & numeracy Ambition Activities Fitness Group work

13. We know it works Independent evaluation commissioned by the Department for Education in England Undertaken by Opcit Research and University of Central Lancashire Remit to assess the impact of programme delivery and processes through which impact was achieved for 125 women through seven Pause Practices

14. The evaluation methodology One-to-one interviews Statistical model 105 women on the Pause programme 34 professionals from partner agencies, including 10 senior Local Authority managers 25 Pause Practitioners 8 Pause Practice Leads 6 Pause Practice Co-ordinators 4 125 women on the Pause programme 134 women in a comparison group 14 In depth case studies Focus groups

15. Impact Who are the women who work with Pause? • As of September 2017 167 women had completed the Pause programme and a further 173 were going through it • Between 1 and 13 children removed (average 3.2) • Age of women: between 21 and 43 (average 31) • 53% of women were under 20 when they had their first child. Cost benefit • Between 21 and 36 pregnancies prevented over 18 months • Cost of supporting a woman on Pause: £20,202 • Cost of taking a child into care: £57,102 • Cost savings over 5 years: £45,000 – £78,500 per woman • Break even point: between 1yr 3 months and 2yrs 5 months

16. What our Practitioners observed Improvements in women’s lives: • 89% of those who identified skills and employment as a goal have made progress towards this goal • 73% of those women with mental health problems have seen an improvement • 88% of those with domestic violence issues have seen an improvement in the situation • 65% of those who had an issue with substance misuse have seen stabilisation or made reductions • 73% of women with housing problems at the start have seen improvements in the stability of their housing situation • 60% of those who had issues around contact with their children have seen improvements in the quality of contact • 67% of all Pause women were accessing support from the appropriate specialist agencies after 18 months/at point of closure

17. How we support Practices

18. Start in the office plan the week, check on the phone with 3 women to see how their weekends have been … MONDAY…... meet Jamie, go for a walk in local park and use this time to talk about contact with her son – due to take place on wed for first time in 15 months … we talk about her worries and I encourage her to think about what her son and his carers might be feeling …. go to see Jane – woman at the early stages, take her a hot drink and sit with her outside Sainsbury's - where she begs, we talk about staying warm. Jane has only been talking to me the past week, so I take thing gently but do mention contraception for the first time, she tells me she has a long term physical health condition Prep work for a session later in the week with Charlie – we are meeting to do some trauma focused work, and safety planning CADAA DASH- call her to make sure plans are in place Speak to Samira – she had English class today, it went well and we can now talk without needing an interpreter

19. Looking for Stacie - new woman, can’t find her … other peole in the square where she often drinks think maybe she has gone to prison? TUESDAY…... Meet Chrissie and go to sexual health clinic – this is the 3rd time we’ve tried to do this – this time she goes in and talks to nurse. Afterwards we meet her sister, turns out she has also had children removed from her care (a possible Pause woman) Meet Emily at her flat and go to GP for CAB appointment – told by receptionist to wait downstairs, check in twice, wait 30 mins - check in again and told we are in wrong place and have missed appointment !! Emily stomps off …. wont talk to me (we need to do some more talking and role playing about when things dont go well) PAPERWORK …... Call Jamie to make sure all is ready for contact tomorrow and agree when I will pick her up, she is nervous but excited and we talk through what she would like to say to her son – and his carer

20. WEDNESDAY…. Collect Jamie – take her to see her son for contact, drive there together and use the time, to talk things through and plan. Contact is taking place in a large shopping centre; the decision of special guardians who care for him. We arrive early and have a coffee …. 20 mins before contact is due to begin a Jamie gets a call to say her son is ill and will not be coming ….. Spend the next 2 hours trying to calm Jamie down as she ‘kicks off‘ .... She will not get back in car with me and leaves on her own ..... Look for Stacie on my way home … cant find her Meet Samaria at local furniture exchange – she is shopping for her new studio flat and we are looking at what she might be able to get for her budget – we talk about possible charity applications as well, I will help her complete Try to call Jamie – she does not pick up, speak to her sons social worker to explain what has happened, he agrees to call Jamie and meet her next week – I offer to join if helpful PAPERWORK …...

21. Group supervision with colleagues, focus on transitions for women approaching 18 months – anxiety from women (and a bit from us practitioners) THURSDAY …. Call Jamie to see how her evening was – she doesn't pick up, text her Accompany Katie to housing appointment – we have been working on plans to manage her outstanding debt’s and be given another chance at holding down a tenancy – we have found a friendly housing officer who is prepared to go the extra mile and argue Katie’s case … there is always one !! Meet Emily, we go for a coffee …. Think about how to cope when things dont go the way you want, we do some work on feelings and behaviour focusing on anger ... Using the ‘what do you think might happen if’ ... And ‘i wonder’ approach Call Jamie x 2 she answers second time - tells me to ‘f*ck off’ it’s not worth it … Stop off to see Jane – see is not outside Sainsbury's … spend the next 2 hours looking for her at the usual ‘haunts’ ... Cant find her PAPERWORK …...

22. Group activity, meet 6 women and another practitioner – we are going to a local artisan bakery who has been working with us … we make pizzas together and then sit to eat, loys of fun and playfullness when needing the dough ... For 2 women this is the first time they been able to stay and eat in front of/with other women and there are no major fall outs betwen women – big progress - next group activity will be cooking on one ring, for those at hostels FRIDAY ….. Look for Jane in local area – find her and suggest we get something to eat for lunch, she agrees and we get a sandwich together – progress as we talk for first time inside, she tells me about her life on the streets PAPERWORK …... Hand deliver a card for Jamie to let her know I’m thinking of her and will talk to her next week speak to women and check in how their weekends will be, make sure plans are in place for next week

23. What the practitioners say are their biggest challenges …… The trauma that the women share can be incredibly challenging. It’s one thing when you have a planned session with a women and another when she decides to tell you something say on a bus, and I’m not prepared All of the women I work with have experienced sexual violence in childhood and or adulthood; there’s been no justice and often I’ve been the first person they have disclosed this information to. When they go missing .... our work is not over; if they are missing for 4 weeks we still communicate, saying, “I’m still here, let’s still do this thing.”

24. What our practitioners say they find most rewarding ….. We’re not just dealing with the behaviours but with their causes and we’re giving women the space to do that. Pause is pioneering and ground breaking. The relationship building I do in very different situations with all of my women. We have great group supervision where we support one another and we have access to other support systems. We work hard to try create a healthy attachment with the women, they become real relationships. Pause has a different way of doing things - women have choices. It’s not the trauma I’m left with at the end of the day. The women are articulate, they are courageous they are trusting. They are just staggering really.

25. Case study Tina is now 23 years old • Family have been known to social care for over 30yrs due to intergenerational physical abuse, neglect and sexual abuse. Records describe a complex family structure comprised of several inter-family relationships and inappropriate boundaries within the family. • Parents separated when Tina was 4 years old - domestic violence. • Allegations of Sexual Abuse made by Tina against her birth father and step-father, not substantiated at the time, no criminal action took place. • Tina and her siblings known to social care most of her life, subject to Child Protection Plans a number of times for neglect and physical and sexual abuse. She was then placed in local authority care from the age of 11 years old. Her mother and wider members of her family had also been in care or were known to CS due to similar issues – family extremely well know to all services in locality. • Run away from family home and placement’s – ‘voted with her feet’ and pretty much went back home from age of 16. • Problematic attendance in school (truanting/poor attendance/poor peer relationships) effectively out of mainstream school from age of 14 – poor level of literacy and numeracy. • History of self-harm and overdose of prescribed medication. • Use of cannabis and cocaine. • Further Sexual assaults as an adult – living with her step father when we met her. • Domestic violence within intimate relationship (children's father).

26. Tina’s children … Tina’s son was born when she was 19 years old, with her on/off partner (who also had a child with her sister). Baby was 10 weeks premature and has a number of physical health problems. Undertook assessments in parents and baby units but ongoing DV and concerns for her ability to meet basic care and emotional stability. Care proceedings initiated when he was 10 months old and he is now on FCO and placed with adopters.

27. When Pause first met Tina - Nov 2015 • She was said to be intentionally homeless – ASB and rent arrears. • Living with abusive step father – SA? • Care leaver – Not engaging with PA or leaving care service. • She was using daily heavy cannabis and alcohol and cocaine weekly. • Emotionally very low, depressed not engaged with MH services. Self-harming weekly overdoses, eating disorder. Diagnosis of mild LD. • Unmet physical health needs – very underweight, dental, opticians, abscesses, never had sexual health advice/check, no effective contraception multiple sexual partners. Non-compliant all meds. • No contact with her sons. • Ongoing family dysfunction/arguments – emotionally abusive and very volatile. • Ongoing victim of DV from partner and step father. • Repeated sanctions from DWP. • Often aggressive with professionals.

28. Working with Pause – what a difference 18 months can make!! • Effective long lasting contraception in place – sexual health check and treatment (STD). • Contact with son – letter box. • Health improved, eating regularly – registered and treatment plan for dental – GP and treating psychiatrist have made comment on her improvement. • GP letter – July 2016 – “it is notable that the A&E attendances have reduced since a more structured care plan has been introduced with the help of your team. I last saw her in July when I noted she was much more confident and more animated”. • Full MH assessment and ongoing treatment plan – Emotional Unstable Personality Disorder – compliant with all medicationand treatment. • Full Housing needs assessment, no longer living with step father. First in temporary and then provided longer term tenancy. • Attended Money Housecourse with practitioner, is managing to budget. • Better expectations of relationship – insight into family functioning, DV partners and improved capacity to regulate her responses and speak to professionals without aggression. • Disclosed level of SA & DV and able to talk about this with her practitioner – first time ever. • Now in receipt of ESA and PiP – supported to attend medicals. • Attended all group sessions. • Talking about the future – work (chef). • She smiles and laughs – internal shift as well as change in practical needs - can of coke! • That’s what will enable her to sustain change.

29. @PauseOrg info@pause.org.uk www.pause.org.uk /PauseOrg