Children’s Needs – Parenting Capacity Child abuse: Parental mental illness, learning disability, substance misuse, and domestic violence Hedy Cleaver Ira Unell 2nd edition Jane Aldgate C HILDREN’ S N EEDS – PARENTING C APACITY Child abuse: Parental mental illness, learning disability, substance misuse and domestic violence 2nd edition HEDY CLEAVER, IRA UNELL AND JANE ALDGATE LONDON: TSO 1VCMJTIFECZ540 5IF4UBUJPOFSZ0GGJDF BOEBWBJMBCMFGSPN 0OMJOF XXXUTPTIPQDPVL .BJM 5FMFQIPOF 'BY&NBJM 540 10#PY /PSXJDI /3(/ 5FMFQIPOFPSEFST(FOFSBMFORVJSJFT 'BYPSEFST &NBJMDVTUPNFSTFSWJDFT!UTPDPVL 5FYUQIPOF 540!#MBDLXFMMBOEPUIFS"DDSFEJUFE"HFOUT Published for the Department for Education under licence from the Controller of Her Majesty’s Stationery Office. All rights reserved. © Crown Copyright 2011 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence/ or e-mail: [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is also available for download at www.official-documents.gov.uk ISBN: 9780117063655 Printed in the UK by The Stationery Office Limited J2441707 C2.5 09/11 11130 Contents List of figures and tables vi Preface vii Acknowledgements viii Introduction 1 Research context 1 Legal and policy context 8 Limitations of the research drawn on in this publication 16 Structure of the book 18 PART I: GENERAL ISSUES AFFECTING PARENTING CAPACITY 21 1 Is concern justified? Problems of definition and prevalence 23 Problems with terminology 23 Prevalence 27 Prevalence of parental mental illness: general population studies 28 Prevalence of parental learning disability: general population studies 33 Prevalence of parents with problem drinking or drug misuse: general population studies 36 Prevalence of domestic violence: general population studies 43 Summary of the evidence for a link between parental disorders and child abuse 47 To sum up 48 2 How mental illness, learning disability, substance misuse and domestic violence affect parenting capacity 49 Physical and psychological impact on parents’ health and well-being 50 iv Children’s Needs – Parenting Capacity Impact on parenting 61 Social consequences 74 To sum up 80 3 Which children are most at risk of suffering significant harm? 85 What constitutes significant harm? 85 Vulnerable children 86 Protective factors 90 To sum up 93 Moving on to explore the impact on children at different stages of development 95 PART II: ISSUES AFFECTING CHILDREN OF DIFFERENT AGES 97 4 Child development and parents’ responses – children under 5 years 99 Pre-birth to 12 months 99 Pre-birth to 12 months – the unborn child 99 To sum up 108 Pre-birth to 12 months – from birth to 12 months 108 To sum up 115 Children aged 1–2 years 116 To sum up 124 Children aged 3–4 years 125 To sum up 134 Identified developmental needs in children under 5 years 135 5 Child development and parents’ responses – middle childhood 137 Children aged 5–10 years 137 To sum up 155 Identified unmet developmental needs in middle childhood 157 Contents v 6 Child development and parents’ responses – adolescence 159 Children aged 11–15 years 159 To sum up 179 Children aged 16 years and over 180 To sum up 193 Identified unmet developmental needs in adolescence 195 PART III: CONCLUSIONS AND IMPLICATIONS FOR POLICY AND PRACTICE 197 7 Conclusions 199 8 Implications for policy and practice 201 Early identification and assessment 201 Joint working 204 Flexible time frames 205 Information for children and families 206 Training and educational requirements 207 To sum up 208 Bibliography 211 Index 253 List of figures and tables Figures Figure 1.1 The Assessment Framework Tables Table 1.1 Prevalence of mental illness among adults in the general population Table 1.2 Prevalence of mental illness among parents in the general population Table 1.3 Relationship between the rate of recorded parental problems and the level of social work intervention Table 4.1 Proportion of children with identified unmet needs – children under 5 years Table 5.1 Proportion of children with identified unmet needs – middle childhood Table 6.1 Proportion of adolescents with identified unmet needs Preface It is probably true to say that, for most people, childhood is a mixed experience where periods of sadness and loss are balanced with moments of happiness and achievement. Such complexity, however, is rarely represented in the literature of childhood. Indeed, much of the written word in the nineteenth and twentieth centuries depicts childhood in one of two contrasting ways. For example, A.A. Milne’s poem ‘In the Dark’, first published in 1927, (Milne 1971) shows childhood as a golden era where children are loved and nurtured by caring parents. It is a time characterised by innocence, unqualified parental love, irresponsibility, peer friendships and a thirst for adventure and knowledge. I’ve had my supper, And had my supper, And HAD my supper and all; I’ve heard the story Of Cinderella, And how she went to the ball; I’ve cleaned my teeth, And I’ve said my prayers, And I’ve cleaned and said them right; And they’ve all of them been And kissed me lots, They’ve all of them said ‘Good-night.’ But never far away is the alternative experience, typified by parental desertion, illness, isolation and poverty. James Whitcomb Riley (1920), who penned uplifting poems of perhaps questionable quality for children during the 1890s, paints a much bleaker picture in his poem ‘The Happy Little Cripple’. I’m thist a little cripple boy, an’ never goin’ to grow An’ get a great big man at all! – ‘cause Aunty told me so. When I was thist a baby onc’t, I falled out of the bed An’ got “The Curv’ture of the Spine” – ‘at’s what the Doctor said. I never had no Mother nen – fer my Pa runned away An’ dassn’t come back here no more – ‘cause he was drunk one day An’ stobbed a man in thish-ere town, an’ couldn’t pay his fine! An’ nen my Ma she died – an’ I got “Curv’ture of the Spine!” Acknowledgements We acknowledge with sincere thanks the many people who gave generously of their time to help us with this work. We particularly appreciate the expertise and advice offered by Arnon Bentovim, Richard Velleman, Lorna Templeton, Carolyn Davies and Sheena Prentice. The work has been funded by the Department for Education and we thank staff in the department, particularly Jenny Gray who supported us throughout the work with her interest and valuable comments. The work was assisted by an advisory group whose membership was: Isabella Craig and Jenny Gray (Department for Education); Christine Humphrey (Department of Health) and Sian Rees (NICE); Arnon Bentovim (consultant child and adolescent psychiatrist at the Great Ormond Street Hospital for Children and the Tavistock Clinic); Marian Brandon (reader in social work, University of East Anglia); Carolyn Davies (research advisor, Institute of Education, University of London); Jo Fox (social work consultant, Child-Centred Practice); David Jones (consultant child and family psychiatrist, Department of Psychiatry; University of Oxford); Sue McGaw (specialist in learning disabilities, Cornwall Partnership Trust); Sheena Prentice (specialist midwife in substance misuse, Nottingham City PCT); Wendy Rose (The Open University); Lorna Templeton (manager of the Alcohol, Drugs and the Family Research Programme, University of Bath); and Richard Velleman (University of Bath and director of development and research, Avon and Wiltshire Mental Health Partnership NHS Trust). Introduction This second edition of Children’s Needs – Parenting Capacity provides an update on the impact of parental problems, such as substance misuse, domestic violence, learning disability and mental illness, on children’s welfare. Research, and in particular the biennial overview reports of serious case reviews (Brandon et al 2008; 2009; 2010), have continued to emphasise the importance of understanding and acting on concerns about children’s safety and welfare when living in households where these types of parental problems are present. Almost three quarters of the children in both this and the 2003-05 study had been living with past or current domestic violence and or parental mental ill health and or substance misuse – often in combination. (Brandon et al 2010, p.112) These concerns were very similar to those that prompted the first edition of this book, which was commissioned following the emergence of these themes from the Department of Health’s programme of child protection research studies (Department of Health 1995a). These studies had demonstrated that a high level of parental mental illness, problem alcohol and drug abuse and domestic violence were present in families of children who become involved in the child protection system. Research context The 2010 Government statistics for England demonstrate that, as in the 1990s, only a very small proportion of children referred to children’s social care become the subject of a child protection plan (Department for Education 2010b). However, the types of parental problems outlined above are not confined to families where a child is the subject of a child protection plan (Brandon et al. 2008, 2009, 2010; Rose and Barnes 2008). In many families children’s health and development are being affected by the difficulties their parents are experiencing. The findings from research, however, suggest that services are not always forthcoming. Practically a quarter of referrals to children’s social care resulted in no action being taken (Cleaver and Walker with Meadows 2004). Lord Laming’s progress report (2009) also expressed concerns that referrals to children’s services from other professionals did not always lead to an initial assessment and that ‘much more needs to be done to ensure that the services are as effective as possible at working together to achieve positive outcomes for children’ (Lord Laming 2009, p.9, paragraph 1.1).