Born into care in Scotland: circumstances, recurrence and pathways

11. Discussion

This report has uncovered valuable information about the numbers, experiences and outcomes for the youngest children looked after away from home via the Children's Hearings System in Scotland, providing a number of new insights. Administrative data held by the Scottish Children's Reporter Administration was used to establish incidence rates for newborns and infants, and to consider trends over time and by local authority. This also allowed important comparisons with the trends in the rates of newborn babies in care proceedings in England and Wales established in previous research. Analysis of a sample of infant case files has provided a rich understanding of the circumstances of infant removal, including family backgrounds and parental difficulties, and of the pathways and outcomes for children placed on a Compulsory Supervision Order away from home in the first year of life. In this final chapter, we summarise the main findings, considering the policy and practice implications.

Infants and newborns looked after away from home

The decision to remove a baby from his or her parents at or close to birth is an extremely difficult one. Losing a child into care is extremely traumatic for mothers, fathers and wider family networks, eliciting feelings of shame and stigma, and having profound immediate and longer-term impacts, including on mental and physical health, welfare and housing entitlement (Broadhurst and Mason, 2017, 2020; Morriss, 2018). It is also emotionally distressing and ethically challenging for health, social work, and other professionals involved (Critchley-Morris, 2022; Critchley, 2020; Marsh et al., 2019; Taylor et al., 2008). When intervention starts at birth, the whole of children's childhoods stretch ahead. Understanding and monitoring current patterns of practice is an essential first step, given that decisions and interventions made for these children early in their life may either resolve safeguarding concerns and enable reunification, deliver permanence away from home, or lead to very lengthy involvement in public services.

This study established that infants less than a year old constitute a significant proportion of children who become looked after away from home via the Children's Hearings System in Scotland – a fifth of all children between 1 April 2013 and 31 March 2020. Around a third (31%) of these infants entered the CHS as newborns (less than seven days old). In 2013/14, for every 10,000 births in Scotland 23 babies entered the CHS within seven days of birth, with rates fairly stable between 2013/14 and 2019/20.

Comparisons with England and Wales

Whilst the legal framework in Scotland differs from that in England and in Wales, it is still useful to draw comparisons between the incidence rates and trends in the compulsory removal of infants into care. This report uncovered several important findings, including differences in the rate of removal between Scotland and England and Wales. Compared with England and Wales (Alrouh et al., 2019; Broadhurst et al., 2018), a smaller proportion of infants became looked after away from home on a compulsory basis (via the CHS) in Scotland before they were a year old. In Scotland, this was 20% compared to 27% in England and 30% in Wales. Between 2013/14 and 2019/20, the proportion of infants in Scotland who became looked after away from home as newborns (less than seven days old) was fairly stable at around a third. By comparison, in England and Wales the proportion of infants who were less than two weeks old when they entered care proceedings was higher, and showed an upward trend across the period – from 43% to 51% in England, and from 40% to 51% in Wales.

These findings raise questions as to differences in policy and practice in the three countries in relation to compulsory removal of infants at or close to birth. Notwithstanding the difference in how 'newborn' is defined, the trends suggest that Scotland may be less pre-emptive, but there is a need to investigate differences and trends over time in the use of 'voluntary' care for young children. It is also important to consider how and whether pre-birth referral, assessment and planning vary, and the availability of preventative services.

Local authority variation and the link with deprivation

This study found that where children live may affect the chance that they become looked after away from home via the CHS before they are a year old. The rate of infants becoming looked after varied from 14 per 10,000 population (less than a year old) to 174 per 10,000, with a national average of 75 per 10,000.

There is significant evidence from previous research (Bywaters et al., 2015, 2019; Doebler et al., 2021; Hooper et al., 2017) that variation in the rates of children becoming looked after away from home may be partly explained by variation in area-level deprivation, and our study clearly supports this. We found a clear relationship between the level of deprivation in a local authority and the rate of infants becoming looked after away from home via the CHS. Rates increase in line with increasing levels of local deprivation, although the relationship is complex, and may also reflect differences in thresholds for admission to care, the availability of preventative services, and approaches of local authorities, children's hearings and the courts. Further research would be helpful to explore and understand the reasons, including levels of deprivation, for variations in the rates of infants becoming looked after away from home.

Family circumstances and vulnerabilities

As Treanor (2020) identifies, living in poverty has profound consequences for children and their parents, including social exclusion and isolation. It has an impact on all aspects of family life, and makes the task of parenting much more of a struggle. Existing research across the UK, including in Scotland, has consistently shown that there is a demonstrable link between poverty and state intervention to remove children (Bywaters et al., 2018; Cusworth et al., 2019; McGhee and Waterhouse, 2007). Consequently, it was not a surprise that the SCRA data showed that economic disadvantage figured heavily in the lives of the infants in our sample. The Promise asserts that "at its most basic, the existence of poverty, material disadvantage and economic inequality in Scotland is evidence of an economic system that does not provide enough for children and adults" (Independent Care Review, 2020, p18). It is clear from this research that a majority of the families of infants who enter care when they are less than a year experienced poverty and housing difficulties.

Woods et al., (2018), referred to the increasing complexity and inter-relationship of problems faced by parents whose child was placed on a CSO before they were three years old. We similarly found that the families in our cohort experienced a complex and inter-connected range of vulnerabilities, including domestic abuse, substance misuse, mental health difficulties and offending. Within the ambitious framework of family support set out in The Promise and subsequent Plan 21-24, the challenge for policy makers and practitioners is how to enable and provide a multi-agency, holistic and nurturing response to families' multiple needs.

A quarter of the mothers in our cohort were described as having a learning disability or difficulties, half had a history of offending, and more than a third had been in care themselves, with fathers often experiencing the same issues, although this was less well recorded in the case files. Intensive and specialist, trauma-informed, non-stigmatising services, including independent advocacy, to support the specific needs of young or care experienced parents, and those with learning difficulties or a history of offending are essential, to address and reduce the underlying need for children to be taken into care.

The (in)visibility of fathers

In general, less information was found recorded in the case files about fathers than mothers, including details about their backgrounds, vulnerabilities and other children. No details at all were available on 12 fathers. This strongly resonates with a significant body of evidence, which has consistently highlighted issues with under-representation of men in child care and protection processes (for example, Brandon et al., 2009, 2019; Brown et al., 2009; Philip et al., 2019). One recent article (Critchley, 2021), which reported findings from an ethnographic study of pre-birth child protection in Scotland, found that fathers often expressed feelings of familial tenderness, whilst social workers often focussed on the risks that father posed, which led to them being ignored or excluded in significant ways.

Our research found that fathers of 60% of the infants, whilst not always directly responsible for their care, were 'present' in their lives prior to them becoming looked after away from home, and that seven infants were reunified with their father two years later, either living with both parents (5) or with just their father (2). It is important that practitioners actively include fathers, or those in a fathering role, both pre- and post-birth and do not make assumptions about their involvement, and importance, in children's lives.

Early intervention

Pregnancy presents a vital opportunity for support and early intervention for disadvantaged families, and for parents whose infants may be at risk of becoming looked after away from home near birth. Timely and sensitive intervention can improve maternal and fetal health, but also potentially avert the need for removal into care. There was no evidence that mothers in this study, including first-time mothers, concealed their pregnancies or avoided contact with services. All but three of the families were known to children's services prior to the birth, and many were involved with specialist support services, although we don't know what level of support was offered and the extent to which families engaged with services. Around a quarter of the infants were recorded as having experienced substance withdrawal at birth, suggesting that this vulnerable group of mothers needs further support to address addiction during pregnancy, to reduce the impact on their unborn baby.

The national guidance on child protection in Scotland has made reference to unborn babies since 2010, with later editions setting out the timescales for pre-birth assessment and planning. A core principle of GIRFEC is that planning and intervention should take place at the earliest appropriate time. Whilst not always within the suggested timescale, a child protection case conference was known to have been held pre-birth for a majority (84%) of the infants in the study, with 71% placed on the Child Protection Register before birth. Over a quarter (29%) of the infants in the sample were known to have been born prematurely and/or had low birth weight, and it is important that pre-birth planning takes into account the possibility that babies will be born early.

That families were often known to services at a timely point and pre-birth assessment and planning took place for a majority of infants suggests that the supports available are not sufficient to meet the needs of these vulnerable families, and raises questions whether opportunities were missed to enable them to stay together after the child had been born. The Promise (2020) stated that "Scotland must do all it can to keep children with their families" (p52) through the provision of intensive family support where needed, and it is important that this includes the period prior to the birth of a child.

Repeat removals

As seen in previous studies (Alrouh et al., 2020; Bedston et al., 2019; Broadhurst et al., 2015), a significant majority of parents experienced repeat removals of children from their care. Nine out of ten of the mothers known to have older children had at least one child previously removed, with one in five having had three or more children taken into care. Half of these mothers had at least one infant (less than a year old) previously removed. Twelve mothers (17%) went on to have another baby within two years of the study infant becoming looked after away from home, and seven of these infants were also removed from their mother's care. Less information was available for fathers, but over half (56%) of those known to have older children had at least one child taken into care.

The substantial research evidence of the long-lasting conseqences of infant removal is reviewed by Critchley-Morris (2022), with Broadhurst and Mason (2017) discussing the notion of 'collateral consequences' of losing a child to care or adoption. These impacts include feelings of stigma, shame and grief; negative health and mental health outcomes; increased risk of suicide attempts and death by suicide; and implications for financial circumstances and housing, future pregnancies and parenting (Broadhurst and Mason, 2017, 2020; Morriss, 2018; Wall-Wieler et al., 2017, 2018). The need for sensitive, non-judgemental, trauma-informed support, which takes in to account the complexity of the loss has been identified (Mason et al., 2020; Morgan et al., 2019).

Where children are adopted, Section 1 (3) (d) of the Adoption and Children (Scotland) Act 2007 sets out the responsibilities of local authorities to provide a service to parents who have lost a child through adoption. Grant and Critchley (2019) mapped adoption services across Scotland, and while most local authorities who responded provided some service to birth parents, it was clear that 'the majority of services were focused on the needs of adopted children/young people and adoptive parents. With some notable exceptions, far less provision was reported for birth parents, either in-house or via referral to external agencies' (2019, p17). Support for parents who are at risk of losing the care of their child, or have previously lost care of a child may include (but not be limited to) specialist preventative initiatives. The extent of recurrent removals seen for the parents in this study suggests that scaling up investment in specialist preventative initiatives is essential, potentially delivering returns for the family justice system, as well as reducing demand on health and social care services, and bringing support and hope to families.

For parents whose children are no longer living with them, but have not been adopted, support in order to 'promote social welfare' could also be provided under Section 12 (2) of the Social Work Scotland Act 1968, and there is a need to map what supports parents in those circumstances currently receive.

Placement with brothers and sisters

At the time they became looked after away from home, a majority of the infants in our study had at least one brother or sister, and many of these were living with foster carers, kinship carers or adoptive parents. However, despite pre-birth planning and assessment taking place for most families, only 12 infants were initially placed with a sibling, just one in five of those with brothers and/or sisters. Two years later, that had increased to 17 infants living with other brothers and/or sisters, including five who had returned to their parents' care, but still represents less than a third of all those known to have at least one sibling.

Significant work has been undertaken by Stand Up For Siblings^[22] to change policy, practice and the law, and the report of the Independent Care Review asserted that "where living with their family is not possible, children must stay with their brothers and sisters where safe to do so" (Independent Care Review, 2020, p19). Since July 2021, local authorities have had a new legal duty to promote contact between brothers and sisters under Section 13 of the Children (Scotland) Act 2020, with practice guidance published in the Looked After Children (Scotland) Amendment Regulations 2021.

The Promise (2020) reminds that there is already a presumption that children will stay together. However, there are significant challenges to ensuring that this is upheld in practice. We found that infants in the study often had complex combinations of full siblings, maternal and paternal half-siblings, with some also having adult siblings. There are also resourcing issues, around the availability, assessment, and support of carers – foster carers, kinship carers and adoptive parents – both willing and able to care for sibling groups.

Use of Section 25

Infants in the study did not all take the same route to compulsory supervision away from home. Seven out of ten of the infants were accommodated straight from hospital after birth. A majority (63%) were initially looked after on a Child Protection Order (CPO), three-quarters of which were made before the child was seven days old and thus likely to have been planned pre-birth. A CPO triggers a Children's Hearing, and for all but three of these 44 infants, the CPO was continued and further Hearings led to the decision to make a CSO, on average 18 weeks later.

A third of the infants were first accommodated using Section 25 of the Children (Scotland) Act 1995, for between four days and 57 weeks, before entering the CHS, either when a CPO was made by the Sheriff or when a referral was made to the Children's Reporter. Unlike other measures, Section 25 does not involve oversight from the Children's Hearings System or the court, and although often referred to as 'voluntary' measures, requiring consent from parents, in legal terms Section 25 operates on the principle of 'absence of objection'. Research by Anderson and colleagues (2020) in Scotland found variations in the use of Section 25 in different local areas, and raised a number of concerns including the degree to which informed consent is given by parents, and the extent to which accommodation using Section 25 serves the best interests of children and young people. In England, disquiet has also been expressed about the use of the nearest equivalent (Section 20 of the Children Act 1989) including whether parents fully understand their rights and options in relation to voluntary arrangements, are able to give fully informed consent or feel under pressure to agree as an alternative to court-mandated care proceedings (Lynch, 2017; Masson, 2008). Further research on the use of Section 25 would be valuable, including how it is understood and experienced by families. Ensuring that parents, including those with learning difficulties, have the capacity to consent (or decide not to object) remains a challenge for policy and practice.

Permanence outcomes

Over recent years there has been an emphasis that children's needs for stability and permanence should be met in a timely manner. Permanence involves adults providing children with stable, secure nurturing relationships and a home which continues into adulthood. The route to permanence will vary depending on the child's needs but includes remaining with or being reunified to parents, living with family (kinship care), living with long term foster carers, or being adopted. Where it is safe, and possible within a timescale that meets their needs, the presumption is that children should be reunified with parents. Existing studies have shown that safe and sustained return home was influenced by parental motivation to resume care of the child, a reduction in risks and evidence of improvements in the home, and where the return home is carefully planned and well supported by services (Biehal, 2006; Cusworth et al., 2019; Farmer and Wijedasa, 2013; Harwin et al., 2019; Ward et al., 2012). Almost one in five of the infants in our study, who were looked after away from home on a CSO before they were a year old, had been reunified and were living with parent(s) two years later. This may have been due to a reduction in risk associated with parents separating or one parent leaving the home. It is notable that two infants had returned to live with their father only, and this emphasises the importance of engaging with fathers early in the process, given the significant role they may play – including becoming sole carer. The recognition that some families will need ongoing, intensive family support is important, and The Promise suggested that "the scaffolding of the system must shift from managing risks and needs to supporting families to find their own solutions" and set out ten principle of intensive family support (p57-58). It is vital that these are embedded in policy and practice.

Where children cannot be safely reunified with their birth parents, a principle of policy and guidance (Scottish Government, 2011, 2015) is that attention is paid to permanency planning to ensure decision making is timely. The Permanence and Care Excellence Programme (PACE),^[23] designed to reduce drift and delay in permanence planning, was completed by 25 of the 32 Scottish local authorities between 2014 and 2020, which coincided with the timeframe of our cohort. For all the 58 children in our study who had not returned home two years after being looked after away from home on a CSO, a decision for permanence away from home had been made, and over three-quarters (78%) were in their permanent placement.