Parent and Child Fostering: the UK Experience

My presentation today is in four basic parts. In the first part I will talk about the UK fostering system in general terms, as without this understanding, much of what I will say subsequently may not make good sense. The second part of the presentation will look briefly at the history of parent and child fostering in the UK, and will summarise the limited research evidence. The third part will get into the discussion about the actual practice of parent and child fostering, how different models have emerged, and will look at the different roles assigned to professionals. I will also talk about assessing, training and supporting foster carers for this specific task. The fourth part of the presentation will look at planning individual placements to maximise the chances of success, and will offer a case study showing the different roles of the various people involved.

Introduction

I am very pleased to have been invited to talk to you today, and would like to thank Jenny Chambers of Community to Children, and the Moscow University of Psychology and Pedagogy for all their efforts in making this happen.

My name is Paul Adams and I currently work for the British Association of Fostering and Adoption (BAAF) as a Fostering Development Consultant.  BAAF is a membership charity that works on behalf of children in care; with an emphasis on providing advice and support to those involved in fostering and adoption.   As Fostering Development Consultant my role includes working with government to influence policy and practice, supporting practitioners through advice, training and guidance, and contributing to publications and other resources, as well as working collaboratively with other agencies on various committees and groups. 

My background is primarily as a social worker and manager in UK local government children’s services.   I have also been a foster carer in the USA and UK, and am currently in the process of adopting two older children.  I like to think this helps me see things from the perspective of both social worker, and foster carer.

My interest in parent and child fostering began when I became involved in research where, with a colleague, we looked at the experience of some parent and child foster carers, and published the first UK article focussing on this type of fostering. In 2011 I went on to co-author a good practice guide on the same subject.

In preparing for the presentation today I have been very mindful of the specific requests around what I should cover.  These were to look at parent and child fostering in terms of the following questions:

• What is the function of parent and child fostering?
• Which agencies are responsible for the placements and in what ways?
• How are parents referred and how is funding arranged?
• How are placements legislated for, monitored, and who is responsible for the welfare of the child?
• How are suitable families identified and what criteria are used?
• How are the foster families trained, supervised and supported?
• How is effectiveness measured?
• How is length of stay determined, and how is the mother helped to move on?
• What are the implications of research into the effectiveness of parent and child fostering?

I was also asked to try and offer practical advice, illustrate the roles of different professionals, and provide a case study.

In an effort to try and address all of this, my presentation today is in four basic parts.  In the first part I will talk about the UK fostering system in general terms, as without this understanding, much of what I will say subsequently may not make good sense.  The second part of the presentation will look briefly at the history of parent and child fostering in the UK, and will summarise the limited research evidence.   The third part will get into the discussion about the actual practice of parent and child fostering, how different models have emerged, and will look at the different roles assigned to professionals.  I will also talk about assessing, training and supporting foster carers for this specific task.  The fourth part of the presentation will look at planning individual placements to maximise the chances of success, and will offer a case study showing the different roles of the various people involved. 

However, before I go any further, it is probably helpful if I explain what is meant by parent and child fostering.   Parent and child fostering refers to a situation where a parent or parents, who can be male or female are living in an approved and regulated fostering household.  This can happen under a variety of legal contexts, and the parent might be a teenager (technically a child themselves) or an adult (even in their thirties or forties).  

Historically we tended to talk about ‘mother and baby’ placements, and in practice the majority of parents are mothers rather than fathers, and most of the children are babies or toddlers.  However, we have very consciously decided to talk about ‘parent and child’ rather than ‘mother and baby’ and this is for two main reasons.  The reason for this is that those of us involved in this work don’t think that these arrangements should only be offered to women, and are very mindful of how sexist societies stereotype women as child carers, often excluding men in the process.  We don’t wish to perpetuate such thinking and prefer to emphasise that fathers as well as mothers can care for children.  Furthermore there are examples of where fathers have been placed in foster homes with their children, either as the primary carer, or as part of a couple, and this needs to be recognised and encouraged where appropriate.  I will come back to this issue later when talking about assessing parents in relation to their suitability for parent and child fostering.

Part 1: the UK fostering system

So, in the first part of this presentation I am going to talk about fostering in the UK generally, as unless you understand some of the basic facts about how the UK system works, then discussion about the very specialist area of parent and child fostering will not make sense.

Child care law in the UK is made by the national governments of England, Scotland, Wales and Northern Ireland (although for the most part my presentation today will focus on practice in England and to a lesser extent Wales).   Implementation of the law is the responsibility of local government in each of the four countries, also known as local authorities, and the UK is divided into 232 local authorities and each of them with a Director of Children’s Services who has statutory responsibility for work with children who at risk of harm, or who are unable to live with their birth parents[1]. 

In England, at the end of March 2012 there were 67,000 children in the care of the local authority, of which 50,000 were living with foster carers.   That is about ¾ of all placements, with the other children and young people living in children’s homes or other settings. 

Each of these children in care will have a social worker from the local authority, who is responsible for making all placements of children with foster carers.  The social worker is a key individual who is responsible for the care planning for the child, and is the personification of the local authority that is looking after the child.  They will need to see the child regularly and have a good and meaningful relationship with them.  It is the child’s social worker who has prime legal responsibility for the child’s safety and well-being, but this in no way lessens the responsibility for all the other professionals involved in their care, directly or indirectly.

If a teenager becomes pregnant then they still have a social worker who is responsible for them and for ensuring they have an appropriate care plan. They are after all, still a child and entitled to the same services that other children receive, including access to education and the like.  Once the baby is born it is usual that the baby will be allocated a different social worker, so that each individual can focus on the individual needs of the child that they are responsible for.  It goes without saying that these social workers will need to work closely together.

Successful outcomes will only result from people working cooperatively, and there are other key roles that are crucial to understanding the UK fostering system.  These can be described in the context of developing a ‘team around the child’ where the child is at the centre, surrounded by their social worker, foster carer, birth parents, teacher, and others. 

The foster carer or carers will usually know the child better than anyone else; spending everyday with them, and probably having the strongest relationship with them.  The foster carer is supervised and supported by the Supervising Social Worker, and this person will have regular meetings with the foster carer to talk through how they are caring for the child, to look at what training or support they might need to do this effectively, and to see how fostering might be impacting on the whole fostering household.  They also play a role as an interface with the child’s social worker, and must never forget that although they are linked to the foster carers, it is the child who is the most important person.  The Independent Reviewing Officer brings further scrutiny of the child’s situation.

In England there are about 43,000 approved foster families, fostering for either one of the 150 local authority fostering services or for one of the nearly 300 independent fostering services.  The independent sector consists of voluntary, not for profit, and profit-making organisations; many of which are quite small.  In practice the majority of children (especially younger children) will be looked after by local authority foster carers, with some of the more specialist placements being offered in the independent sector.

In terms of funding, it is local authorities who are responsible for the costs of caring for children who are unable to live with their birth families.  Local authority finance comes from central government grants as well as locally raised taxes, and is administered by locally elected politicians.  In practice, the child’s social worker has the option to place the child with a local authority foster carer, if there is one available, or with a foster carer who is approved by an Independent Fostering Provider.  In the first scenario there will need to be a referral to the local authority fostering team, but no financial exchange in that the infrastructure and specific foster placement costs are all held within the same local authority that has financial responsibility for the child.  If however, the child’s social worker wants to place the child with an Independent Fostering Provider, then they will need to commission that service with regular payments to cover both the cost of the foster carer, and the associated infrastructure including training costs and the costs of the Supervising Social Worker.  Since the child’s social worker is acting on behalf of the local authority, the funding for foster care comes from that organisation.

Fostering in the UK is a highly regulated activity, and the requirements of foster carers and their fostering services are almost identical whether they are local authority services or independent providers.   The relevant statutory and regulatory framework is primarily set out in the Children Act 1989; The Fostering Services Regulations 2011 (amended 2013); The Children Act Guidance: Fostering Services 2011; and the Fostering Services National Minimum Standards 2011.  I don’t have the time to share with you the full contents of this legislation, exciting though that would be, but think it important to highlight some key areas, as the positive elements of parent and child fostering in the UK context have only been possible with this extensive framework in place.

However, before looking at some of the specific regulations it is important to note that all the UK legislation is in line with the United Nations Convention on the Rights of the Child, with an emphasis on the child’s best interest being paramount.  It recognises that wherever possible it is best to keep children within birth families (or in contact with birth families), and that taking account of children’s wishes and feelings is crucial.  The law also states that “full attention [should be] paid to the individual child’s gender, faith, ethnic origin, cultural and linguistic background, sexual orientation and any disability they may have”. 

The UK is an increasingly multi-cultural society, with a large influx of immigrants since the Second World War in particular.  We have large numbers of people of African-Caribbean, Asian, and increasingly East European descent living in cities across the UK.  Social work has long recognised the need for anti-discriminatory practices that will effectively meet the needs of children from these backgrounds, and this is embedded in legislation and practice.  It is recognised that in order to meet the needs of all the children in society it is essential that foster carers and adopters are recruited from all parts of society, and efforts have been made over the years to target Black and Asian foster carers.  This has been very successful, so that children can be matched with foster carers who are best able to meet their needs. 

Furthermore, when children are placed trans-racially, then it is expected that foster cares and adopters have a good understanding of the needs that will arise from this; including practicalities like hair and skin care, understanding developing identity, and dealing with racism in society.  Issues about culture and identity are addressed within the UNCRC, and this applies to all children.  One group that are of particular interest to me, are Gypsy, Roma and Traveller children, and I have recently co-authored a book looking at the need for culturally appropriate social work and fostering with this group of children.   This value base underpins all work with foster carers and children in their care in the UK, and is particularly important to consider this when looking at learning across geographical and cultural divides. 

In thinking about parent and child fostering as a specialist area, it is necessary to understand some of the wider requirements set out in legislation and guidance, and I will start with consideration of assessment. 

Assessment of foster carers is a long and robust process in the UK, and notwithstanding concerns from some quarters that this can put people off, it is generally accepted to be a good thing.  Children in care are both vulnerable and challenging, and fostering is not an easy task.  It is crucial to know that any approved foster carers (including parent and child carers) are both safe and competent to do the role well.  Following a particularly harrowing case where an adopter killed a child in his care, the subsequent inquiry (which applies at least as much to fostering as adoption) concluded:

This is a really important element of the UK system.  While we know that most foster carers have good and genuine motives, we also know that people who want to sexually abuse children will find ways to do this; and what could be better for them than having a vulnerable child in their own home.   There are a handful of cases in the UK where foster carers have subsequently been imprisoned for child sexual abuse, and without the careful screening and assessment it is likely there would have been many more.  I would contend that trying to short-cut the assessment process is ultimately not in the best interest of children.

So, if an individual or couple is interested in becoming a foster carer they will approach a fostering service (local authority or independent) that will provide information about what fostering entails, and then usually arrange for an initial visit to see whether to progress the application.  There is broad recognition that there is no one ‘type’ of person who is more suitable to foster than another, and interest is encouraged from people irrespective of race, ethnicity, sexuality, age, couple relationship, income, religion or other such matters.  We know that good foster carers can come from very different places in society, and the focus must be on what they can offer to children in the care system.

After a successful initial visit, the potential foster carer or carers will be allocated an assessing social worker whose role is to undertake an assessment of their suitability to foster.  This will include a number of checks with police, local authorities, and health services (including a medical check with their doctor), as well as requiring references from friends and family members. 

All household members including children will be interviewed, and if children are of school age then checks will be made with their schools.  There will be a health and safety check of the home, and if the prospective foster carers have dogs or other pets then there will be an assessment to look into whether they might pose a risk to children in placement.

Alongside this there will be a ‘home study’ where the assessing social worker will arrange a series of meetings with the prospective foster carers (probably between 8-12 in total) to discuss a range of matters.  This is an in-depth process that will often start with finding out about their childhoods, and their experience of being parented.  It will look at their attachments as children, and will look at what sense they have made of their childhood, including how they may have dealt with adversity and poor experiences then, and subsequently.  Further assessment will cover attitudes and experiences in relation to education, employment, health and leisure, with a focus on how that will be relevant in a fostering capacity.  Discussions will also cover adult relationships including any current partner relationship and look at how secure that is, recognising that fostering can put a stress on even the most solid couple relationship. 

Then there will be the obvious consideration of parenting experience and capacity, and discussions about lifestyle and how a child might fit into that.  There will need to be discussion about managing the range of behaviours presented by traumatised children, and about keeping everyone in the household safe.  Potential carers will need to understand how fostering differs from parenting birth children, including the issues around promoting contact with birth families, and will need to be assessed in relation to their ability to keep appropriate records and work with the various professionals involved.  There are other areas too, but this is enough to illustrate the depth and detail of assessment - that will likely take about 7-8 months from start to finish - and it is generally recognised that when assessing parent and child foster carers all this is needed, and more.

After assessment, the UK legal framework requires the assessment report to be presented to a fostering panel consisting of various ‘experts’ and lay people, often including social workers, foster carers, health professionals and local politicians.  This panel is chaired by a person independent of that fostering service, and it will make a recommendation about the suitability of the person or persons to be approved as foster carers, and where appropriate, detail terms of approval in relation to maximum numbers of children, their ages and gender. 

In normal circumstances a foster carer is not approved for more than three children, and quite often less, when either their accommodation or their capacity suggests that a lower number is more appropriate.  This independent aspect in the form of a fostering panel is an important quality assurance measure, and should be a factor in ensuring that only people who are suitable are approved as foster carers.  Parent and child foster carers are also subject to this same assessment process.

In understanding the UK system it is also important to understand the level of support and training that is available to foster carers, and is expected to be achieved under the various regulations and standards.  Even before approval prospective carers will attend six half-day sessions called ‘skills to foster’ that will start to prepare them for what fostering entails. 

After approval they will be expected to complete a series of training ‘standards’ within their first year of fostering, with a very clear recognition that fostering is a skilled professional role; not just like looking after your own children.  The sort of training courses that will be made available to foster carers by a good fostering service will include: child development, keeping children safe, direct work with children, child abuse, understanding attachment, safer caring, managing allegations against carers, promoting good health, supporting education, managing behaviour, supporting contact with birth families, equality and diversity, record keeping, and safety in a digital age.  This sort of training will also be available to parent and child foster carers, with some additional specific courses that we will talk about later.

In addition to training, approved foster carers are all required by law to be allocated a qualified social worker with the responsibility for their supervision and support, and this is not the same social worker who is responsible for the child.  When done properly this system will entail regular visits, maybe two-weekly or monthly, but more at difficult times, to discuss how things are going with any children in their care, to look at how they are managing, how they might do things differently or better, the quality of their record keeping, and how they are developing their skills as foster carers.  These social workers will also often have a role in communicating information back to the child’s social worker.  Research shows that foster carers in the UK very much value the support they receive from their Supervising Social Worker.

Fostering regulations also require that foster carers are formally reviewed on an annual basis to check that they continue to be suitable as foster carers.  The review process requires reports from the foster carer’s social worker, the foster carers themselves, any children in placement (according to their age and understanding), social workers of these children, any birth children in the family, and potentially others according to the specific situation.  Good fostering services will employ an independent person to chair a meeting with the foster carer and their social worker to consider the reports, and in some circumstances the reports including the minutes of the review meeting, will need to go the fostering panel for consideration.  This process will apply equally to parent and child foster carers, and in the set of forms that BAAF have devised for undertaking foster carer reviews, there is also a specific form for parents to complete when they are living in parent and child arrangements.

There is much more that is regulated in the UK, but I have picked out here what I consider some of the most important features to show what our fostering system looks like. 

So, in summary, the UK fostering context is one characterised by strict regulation.  Every child in the system will have an allocated social worker who is responsible for planning their care, and where appropriate they will find that child a foster home, either with a local authority foster carer, or with a foster carer from an Independent Fostering Provider.  In either of those cases, the foster carer will have been subject to an in-depth assessment, provided with pre-approval and post approval training, and allocated a Supervising Social Worker who is independent of the child’s social worker.  

You need to be aware that these elements will apply equally to parent and child fostering, and any discussion about what is specific to parent and child fostering will need to be seen as being contained within, or additional to these fundamental elements that I have described.  With this in mind, let me move on now to talk specifically about parent and child fostering, starting with some history and research evidence.

Part 2: History of parent and child fostering and research evidence

Parent and child fostering has developed enormously in the UK over recent years, but it is not an entirely new phenomenon, and there are plenty of historical examples, usually foster carers with teenagers who subsequently became pregnant.  These tended to be fairly ad hoc arrangements, but that doesn’t mean that they did not offer positive outcomes for the parents and children involved.

What is new in the UK however, is that parent and child fostering has become more formalised, more structured, and more common-place.  In addition to providing support to young mothers, parent and child fostering now also involves assessments of older adult parents, often as part of a court process. 

Historically, these parenting assessments were undertaken in residential settings rather than in foster homes, but as funding arrangements changed, and the costs for such assessments fell on local authorities, efforts were made to identify alternative ways of assessing parent’s abilities.  The most obvious answer was to try and use foster placements, and as it became clear that the parent and child fostering alternative could work well, the demand for such placements grew.  In response to this demand from commissioning social workers, and from the courts, fostering services in local authorities and the independent sector responded by developing their services accordingly.

Before looking at these developments in more detail however, it is worth looking first at what we know from the research about parent and child fostering, and the short answer is, very little. There are no longitudinal studies about outcomes, no comparisons with alternative provision, and certainly no randomised control trials to tell us what works and what doesn’t. In short, there are no in-depth, valid and reliable studies.

However, there is some interesting data, even if much of this does not meet the strict academic standards usually applied to research evidence.  This consists of two serious case reviews, two primarily quantitative studies undertaken within local authorities, and three small scale qualitative studies.  All of these were published between 2006 and 2011, and to my knowledge there has been nothing relevant since.

Even though this collection of data is undoubtedly limited, it is interesting that the various texts do arrive at some common themes, but before I present them, I propose to give you a bit of detail about each study.

In the UK a Serious Case Review is undertaken in circumstances such as when a child who is known to the local authority dies or is seriously injured as the result of abuse or neglect.  The aim is to find out what happened and to identify learning across the professional network.  There are a couple of serious case reviews that are very relevant when looking at parent and child fostering.

The first took place in December 2008 and concerned the London Borough of Bromley.  Child B was a baby who had been living with his mother in an IFP foster home when his mother took him from that foster home to stay with her mother, the child’s grandmother.  Child B sadly died of natural causes - Sudden Unexpected Death in Infancy - after sleeping on the sofa with his mother.  The background to this case was that B’s mother had experienced an unstable adolescence characterised by homelessness, family conflict, alcohol misuse and domestic violence, and the father had longstanding problems with drug misuse, criminality and domestic violence.   The mother’s two older children had already been removed and their future was being considered as part of legal proceedings. 

The other serious case review took place in August 2009 and concerned the London Borough of Brent.  In this case child D moved with his mother into a parent and child fostering arrangement, where there was already another young mother with her baby, Child F.  Child D was subsequently admitted to hospital, critically ill due to suspected salt poisoning, and it was later concluded during legal proceedings that the overwhelming likelihood was that the mother of child F was responsible for contaminating his feed.  The background of both of the mothers was complex, with them both having experienced abuse by adults resulting in low self-esteem, self-harming and challenging behaviours.

We will come back to the findings from these serious case reviews when we look at the six emerging themes.

Then there are two primarily quantitative studies that were undertaken within specific local authorities in the south of England, and consisting primarily of analysis of their own experiences with parent and child fostering in those local authorities.

The first, by Tim Martin and Susan Davies (2007) in West Sussex looked at outcomes for 39 parent and child arrangements between January 2005 and August 2006.  Data was collected from the existing local authority data bases and there were additional interviews with children’s social workers.  Three-quarters of the arrangements were with Independent Fostering Providers; the rest were in local authority fostering or in residential settings.  All the parents were mothers aged 14-35; most were white British, and 40% were, or had been, in care themselves.   The children were mostly babies under two months, but some were toddlers.

The second study by Sharon Donnelly and Vanessa Wright (2009) at Brighton and Hove was very similar, looking at 61 parent and child arrangements between 2004 and 2008.  This study also used data from existing local authority data bases alongside interviews with carers, parents, social workers and health staff (although these are not fully set out in the report).  54 of the 61 arrangements were fostering, and about half of these were with Independent Fostering Providers carers, and half local authority carers.   The parents were mostly mothers, a few were fathers, and they were mixed in age, some were under eighteen; others were in their 30’s and 40’s.

And finally, there are three small scale qualitative studies, all using semi-structured interviews with either foster carers, birth parents or both.

Firstly, Knight, Chase, and Aggleton (2006), mention parent and child fostering in the context of a much wider study into pregnancy and sexual health amongst children in care.  It includes interviews with six young mothers who had been in parent and child foster homes, and with two of those foster carers.

Secondly, Natalie Greenaway (2010) undertook a study for her MSc Social Work dissertation at Bristol University, interviewing 5 parent and child foster carers and one birth parent all within a local authority specialist parent and child fostering scheme.

And finally, with Sarah Bevan (2011), I was involved in a study where we interviewed eight parent and child foster carers from three local authority fostering services in North West London.  These foster carers had fostered 16 parents and children between them, but not as part of any particular scheme.   All the parents were in fact mothers, aged between 13 and 30, although the majority were under eighteen and were still in care themselves.  

With such limited material it is in some ways surprising that it has been possible to identify any findings or trends, but there are some quite clear themes that emerge from these studies and serious case reviews.  It is significant that in relation to the quantitative and qualitative studies, the authors were often not aware of each other’s work, and so the consistency in findings carries more weight.  So, what are these emerging themes?

Maybe the most important one is a consensus that parent and child fostering works, and can offer a very effective way of assessing parenting, and supporting parents to care for their children.  Although there are no studies with comparison groups or long term outcome data, there is much positive anecdotal or case study evidence to this effect. 

In the Adams and Bevan study (2011) we did not specifically ask about placement outcomes, but in over half of the cases, the foster carers were aware that mothers had continued to parent their babies after leaving the foster home, and talked very positively about this as making their own efforts worthwhile.  They said:

The Brent serious case review (2009) also highlighted the benefits of a good parent and child foster home:

 “It was apparent that the foster placement had the ability to provide much needed security and support to either of these young people, and eventually their babies... And it was no doubt the level of professional support offered which contributed to both of these young mothers being able to demonstrate some good parenting skills when their babies were born.”

This idea that parent and child fostering can work well is also indicated by the local authority studies.   In Brighton and Hove (2009) over half the children returned to the community with their parents.   In West Sussex (2007) the study specifically assessed parenting skills before and after each placement and in 30% of cases there was an identified “significant improvement” at the end.

This does however raise the question about how we measure success, and we also need to recognise that where children did not remain with parents but moved to another permanent family elsewhere, such as adoption, that if the parent and child arrangement had allowed for a fair, timely, and effective assessment of that situation, then this too could be deemed a positive outcome.

In acknowledging the potential for positive benefits from parent and child fostering, it must however also be recognised that the work brings significant challenges for both the carers and the parents.  This brings us to another theme that emerges very clearly from the data; the importance of clarity around roles and responsibilities, including the need for good pre-arrangement planning.  This becomes clear where things have gone well, but also where they have gone wrong.

Knight et al (2006) whose study was undertaken in a period where parent and child fostering was set up in a rather ad hoc manner, identifies the problem using the words of a fostering manager:

This lack of clarity around roles was mentioned in a number of the studies, and foster carers themselves highlight the importance of clear written agreements in all areas, but especially in regards to contact with the birth parent’s partner or family.  The Adams and Bevan (2011) study heard from carers were things had worked well.  One foster carer said:

And:

“I could say to her ‘You go and look at your contract’... [It covered] what her role was and what mine was and when the father could visit... [and] when I’d look after the baby for her.”

In that same study we also heard from other foster carers where lack of clarity proved to be a problem:

The importance of clarity was also identified as an issue in both of the serious case reviews.  The Bromley serious case review (2008) highlighted the need for: specific policies and procedures for parent and child arrangements; better sharing of information to inform arrangement planning; and a checklist for use at the planning meeting.  The Brent serious case review (2009) reached similar conclusions and not surprisingly asked questions about the appropriateness of planning for two parent and child arrangements together in the same foster home.

In a few of the studies foster carers also stressed the importance of being clear about requirements for record keeping, about finances, and about any respite arrangements that might be available to the foster carers.

The third theme links to something that is fundamental to all fostering work, and that is the importance of the relationship; in this instance between the foster carer and the parent.   In some ways this is an obvious point, but one that emerges very clearly from qualitative studies.

Knight et al’s (2006) study describes this from the perspective of the young people in placement, and for one young person:

“The foster carers gave me space to think about things and also gave advice.  They treated me like one of their own children.  My foster mum came with me to the scans and was at the birth – like a mother.  They offered to let me stay with them when I had the baby but I wanted my independence.”

Natalie Greenaway (2010) writes about the importance of trust and good communication:

“Whether the relationship between the carer and parent progressed in a positive or negative way during the placement depended largely on trust and communication. Where the carer had a good relationship with the parent and was able to communicate honestly and openly about any concerns, the relationship strengthened and often the carer’s confidence in the parent grew.  Where communication and trust between the parent and carer was limited, the relationship was often strained and this lead to a difficult and stressful experience for the carer.”  (p.24-25)

Both the Greenaway (2010) study, and Adams and Bevan (2011) article, suggest that there is something about the ‘chemistry’ or the ‘fit’ between parent and carer that is important - crucial maybe - but hard to measure.  Greenaway (2010) quotes foster carers to show where the relationship really helped the arrangement to work, and where the absence of a good relationship made it difficult.  For one carer:

“She’s got a very lively and dry sense of humour and we’ve enjoyed each other’s company a lot, so it’s been really good.  I’ve enjoyed it.”

But for another:

The Adams and Bevan study (2011) provided similar examples.

Linked to the idea of relationship is the importance of the carers’ wider family, and this has emerged in a few of the studies.  Greenaway (2010) discusses this as follows:

“What was apparent from the findings was that it was not only the parent’s relationship with the carer/s that was important, but also how the parent got along with other family members and in particular other children in the home. Carers felt appreciative of parents’ efforts to get on with other family members, and were reassured when it became evident that the presence of the parent and child in the home was not impacting negatively on their children or other foster children in the home.” (p.24)

Donnelly and Wright (2009) make the point that for some of the birth parents, the parent and child arrangement is the first time they have received nurturing and warmth in a family setting, and in the Adams and Bevan study (2011) a few of the carers also talked about the importance of their extended family, although this was not something specifically asked about in the semi-structured interview.  For one carer:

“We became very close.  She did say that it was the first time she felt part of a big family... My mum would make a big fuss of her.  We took her as a member of the family and I think sometimes she didn’t kick off because of the respect she had for us.”

And for another:

“It was very nice having a baby around; she was totally spoilt and my mother was visiting and the baby was like another grandchild.  They became a part of this family”.

Another theme that emerged within discussions about relationships was the benefits from the mother and carer knowing each other prior to the baby’s birth, and ideally living in the foster home during that time.  This came out in three of the data sources, and one of the foster carers in the Adams and Bevan study (2011) said:

“What worked well for me was the fact that the mother came when she was pregnant, so I got to know her before she actually had the baby, and it worked well when I had to advise her, as we had got to know each other.  When the second mother came her baby was already born and she was at risk of losing her baby, but it was more difficult to give advice when you don’t know the mum”. 

When we are focussing on systems and structure and roles, it is sometimes easy to forget about relationships.  However, the importance of human relationships – something that is not easy to measure – arises time and time again in different aspects of fostering work, and is central to foster carers being successful with foster children, and in parent and child fostering. 

I am reminded that former US President Bill Clinton famously had a notice over his desk to remind him that what mattered most in the minds of the electorate.  This notice read ‘it’s the economy stupid’, and I sometimes think that social workers and foster carers might usefully have a similar notice reading; ‘it’s the relationship stupid’.

The fourth emerging theme is also quite predictable, and a number of the studies emphasise the importance of providing good support to parent and child foster carers, both from the supervising social worker and child’s social worker.  More often it was issues about the child’s social worker that were highlighted as problematic and the Brent serious case review (2009) is clear in this regard:

“The foster carer had an inconsistent level of support from children’s social care and at times was left too much to her own devices... Although the foster carer was experienced, she should have been given more formal assistance in addressing the needs of the two young mothers and babies”.

The report also recommended the need for additional training and guidance for both foster carers and social workers around parent and child fostering.  This reflects arguments made in other studies (Donnelly and Wright, 2009; Greenaway, 2010; and Adams and Bevan, 2011) about the central role of the child’s social worker, the importance of good communication with them, and the need for consistency wherever possible.  The Adams and Bevan study (2011) revealed examples of good and bad practice.   One carer said:

“The baby’s social worker was quite good and was firm with her [the mother].  Some social workers just want to give, give, give... But he would say ‘I can’t allow you to do that’... He told her in a calm way.  I got a lot of support from him.”

More problematic, and disappointingly one foster carer reported:

“It’s not good – the baby and mother have had five social workers in five months.  They can’t build a relationship.  She speaks more to my supervising social worker.”

The research consistently identified the need for effective training in parent and child fostering, and we will come back to some of these issues later in the presentation.

Another theme that comes out of the various studies and reports, and it seems out of almost every serious case review in the UK, is the challenge of inter-agency and inter-disciplinary working. 

As this theme is arguably much wider than just parent and child fostering I’m not going to go into this in detail, but it is important to at least flag it up as an issue.  We need to remember that in some ways parent and child placements entail more obvious risk than most other fostering arrangements; and effective work across the immediate team, but also more widely, is essential to manage that risk.

The Brighton and Hove study (2009) in particular discussed the importance of close working relationships between children’s social care and health professionals, and it is worth noting that both the Bromley and Brent serious case reviews suggested that there should be joint parent and child training for social workers and health professionals who are involved with the children in these foster homes.

The other thing to specifically mention under the heading of inter-agency working is the importance of transitional arrangements; or the need to make robust plans for moving on from parent and child foster homes.  Central to this is the issue of housing, but equally important is the need to ensure that appropriate social care support is available to parents and children once they have moved into their own accommodation.

The final emerging theme is about the importance of assessment, both in terms of assessment of risk and the management of risk; but also in terms of the assessment of parent and child foster carers.   The serious case reviews both talk extensively about the assessment of parenting and associated risk.  From the Bromley serious case review (2008):

It was also noted that the foster carer needed a more structured environment in which to contribute to the assessment of parenting ability including training in child protection and a pro-forma for assessing parenting.

The Brent serious case review (2009) notes that:

They recommended routine pre-birth assessments for pregnant looked after children, that the fostering service needed to have a risk assessment template, and that guidance and training was needed for social workers in assessment, safeguarding and recording.

In relation to the assessment of foster carers it was really only the Adams and Bevan (2011) study that explored this issue.  What emerged was that most carers had not been approved specifically for the parent and child task, and the fostering services involved did not have appropriate policies or procedures in this regard.  For the most part arrangements had just developed in that a child already placed became pregnant, or a respite arrangement got extended.  In most cases the carers suggested they had been approached for pragmatic reasons linked to the fact that they had a vacancy, rather than them having been assessed specifically for the parent and child fostering role. 

This suggests that practice was not as good as it should have been, and we will come back to the issue of assessing foster carers in more detail later.

Part 3: Parent and child fostering in practice

So, that is what we know from the research.  It is limited but nevertheless useful in raising important questions for fostering services developing parent and child arrangements:

• Are we clear about the different roles and responsibilities of the various people involved?
• Do we have policies and procedures specific to parent and child fostering?
• How are we going to promote good relationships between the carer and parent, and help parents feel part of a family?
• Have we got the right support in place for parent and child foster carers?
• Are systems in place for effective inter-agency working, and have we included health, legal and other relevant services?
• Are we being sufficiently mindful about assessing risk and managing risk?
• And are we clear about what constitutes a good assessment in relation to parent and child foster carers?

Research cannot be seen in isolation from practice however, and is only helpful if we see how the two inter-relate.  Let’s move on now to look at what we know from the practice experience of those offering parent and child fostering arrangements; how they have responded to the challenges identified in the research, and what sort of solutions they have come up with.  Much of the material in this section comes from two focus groups that I conducted with social workers and managers in 2010.

A key question at the outset must be about what is the purpose of parent and child fostering; what are we trying to be achieve.   In looking at what fostering services in the UK are doing we identified three basic parent and child fostering types, each with a distinct purpose.  We describe these models as assessment, support or holding arrangements.

The most common type of parent and child fostering, and the one that has grown most in recent years is the assessment model, that provides for a time defined and clearly structured assessment of parenting capacity, usually in the context of court proceedings.  Assessment models have been used by local authorities and Independent Fostering Providers and typically might last for a period of 12 weeks with regular reviews of progress, and interim and final reports.  It is likely that the parent or parents in this context will be adults of various ages, sometimes having had previous children removed, and where the risk to the child is perceived as being too high to allow the parent or parents to live with the child in their own home.  These arrangements have tended to be used where historically a residential parenting assessment might have been provided.

With a support arrangement the emphasis is on supporting and helping the parent, rather than assessing them.  Although there will be elements of assessment throughout the arrangement, this will not be structured and time limited as in an assessment arrangement.  Support parent and child fostering will be most suitable in situations where the risk is identified as being relatively low, outside of court proceedings, and where it is anticipated that the parent will continue to care for the child in the future.  Such arrangements might be most appropriate for young mothers including those who are looked after themselves, who are broadly cooperative, and can potentially benefit from foster carers in a nurturing and teaching role.  In a support model it is likely that the fostering arrangement will be much longer than in an assessment model, often determined by the individual needs of the parent, and usually for at least a year or more.

Holding arrangements are the third type of parent and child arrangement we identified, and are less common, but might be used when a parent and child need to live together in a safe and supervised environment, often while other plans are being made.  Usually these will be time limited arrangements, while awaiting a court date, or to allow a parent to address short term medical issues, or while waiting for another suitable placement, or accommodation, to become available.

In thinking about parent and child fostering in relation to individual cases, it is important to be clear about the purpose at the outset; is it primarily about assessment, or is it about support.  It is important to recognise the difference, as it will impact on who is suitable and might benefit from such an arrangement, and will also have implications in relation to the suitability of particular foster carers, and what is expected of them.

Consideration also needs to be given to how best to deliver a parent and child fostering service.  Historically in the UK, parent and child foster carers emerged in ad hoc ways; often through their role as traditional foster carers for children, moving to offer individual parent and child placements alongside other types of fostering.  In many cases they were not approved specifically for the parent and child fostering role, and the fostering service would not have policies and procedures to support this type of work.  For the most part, these arrangements would have reflected the support model within parent and child fostering.  Some individuals did develop a level of experience and expertise as parent and child foster carers, taking a series of such placements, but any specialism will inevitably have been limited by the absence of a more structured approach to parent and child fostering.

As noted earlier, the recent growth in parent and child fostering in the UK has been primarily in relation to the assessment model, and as a response to increased demand both local authority and Independent Fostering services have begun developing specialist teams or schemes to offer parent and child arrangements.   These specialist services are all constructed in slightly different ways, but they have all developed specific policies, procedures and practices to maximise the chance of success.  This includes structures providing specific assessment, supervision and training in relation to parent and child fostering, and usually with established processes for undertaking assessments of parenting where that is part of their remit.

Although the demand has been primarily for assessment arrangements, these developing services have also offered support models and holding models where appropriate, and it is increasingly being recognised that specialist parent and child schemes can develop expertise in a way that is not possible where the service is primarily concerned with the traditional fostering of children without their parents.

This leads us start thinking in more detail about the various elements in the fostering process, and how they might need to be adjusted to apply to parent and child fostering.  The first question is about assessment and approval, and what qualities are specifically required for parent and child foster carers.  It is generally accepted that they need to have the same basic skills and understanding that all foster carers need, but that overlaying that there are some additional and specific areas to consider.

One crucial element is that parent and child foster carers will need to be able to exercise good judgement in relation to keeping children safe in their homes, as the risks associated with parent and child fostering are potentially much greater than with traditional fostering of children.  Parents rather than foster carers will be the main carers, and they will need to be allowed a certain amount of freedom to do things their own way, to make mistakes, and to develop their confidence as they go along.  Foster carers will need to allow this, but will also need to know when to intervene in order to keep children safe.  This will not be an easy task and at times will require them to be assertive in managing parental responses that might pose a risk to the child.  To get this balance right foster carers will probably need to be reflective and be able to make good use of professional advice and guidance.

Another aspect that will need specific assessment relates to working with birth parents.  All foster carers are expected to do this in terms of promoting contact with birth families, but for most of them this is not in the context of the parents living in their homes.  We have already heard the research in relation to how good relationships are crucial to successful arrangements, and foster carers will need to maintain a balance where maintaining professional boundaries run alongside being warm and supportive.  This means that an assessment will need to identify strong communication and relationship-building skills, with an ability to teach patiently, criticise constructively and sensitively, to offer praise without patronising, and to model good parenting.  All of this will require a sensitive, calm and nurturing personality, combined with good judgement and emotional robustness.

Assessors in the UK context also need to look closely at the ability of potential parent and child carers to keep high quality written records.  Again, this is true of all foster carers, but in a parent and child context these records are very likely to be used to inform assessment reports, and also in court settings.  This demands an ability to observe carefully, record accurately, and distinguish between fact and opinion.  It will also require the confidence to be able to share records with the parents if they are being assessed, so that they can understand what aspects of parenting they are doing well, and what they might need to improve or change.

The assessment of parent and child carers will also need to take into account practical considerations such as the space available in the home, and how this will allow sufficient independence for parents, while still providing high levels of observation and supervision.  The assessment will need to consider the availability of the foster carer, and assess this against the expectations of the fostering service.  For example, is it expected that the foster carer is always present in the home, or can the parent be allowed to take out the child on his or her own. 

A final area for assessment will be about whether the foster carer has the ability to accept what in the UK we call ‘good enough’ parenting.  This relates to parenting that is not perfect, not even good, but might be described as ‘adequate’.  Parent and child foster care is different to other fostering in that the main responsibility for the child (usually a baby) lies primarily with the parent and not with the foster carer.  Foster carers, particularly foster carers for babies, often have high standards but parents who require parent and child fostering, by definition, will often be struggling to provide even ‘good enough’ care.  The challenge for foster carers in this context is to allow the parent to struggle, supporting and encouraging them, but being able to accept parenting that is ‘good enough’ rather than ‘good’. 

This is really important, and is linked to the assessment of the foster carers general attitude to a struggling to parent.  Are they critical and judgemental, or do they understand that the parent may not have had the right opportunities or environment to flourish as parents.   It goes without saying that suitable parent and child foster carers must not be thinking that this role might provide access to a child for themselves if the parent fails; and the system must ensure that this cannot happen. 

But more than that, the foster carer needs to fully understand that the parent must be allowed to parent in their own style, so long as this does not compromise the safety of the child.  There is a famous UK television comedy where the father consistently says to his son and daughter-in-law ‘you don’t want to do it like that; do it like this’, but any psychologist will tell you, that is the worst way to try and influence behaviour!  The fostering assessment needs to explore these issues carefully, for example asking potential foster carers to role play how they might offer advice, and providing training to develop these skills where necessary.

In discussions about assessing suitability for parent and child fostering, a couple of common dilemmas arise.  Firstly, do parent and child foster carers always need other fostering experience prior to undertaking this role?  On one hand there is the argument that all fostering is very challenging, and it is very hard to know how this will feel unless you have done it.  This leads to a view that there are advantages for people gaining experience in traditional fostering before moving into this specialist area.  While for many people that might be the right approach, there may be others with particular skills and experience, such as backgrounds in social work, residential work, or paediatrics, who may be fully aware of the fostering role and have significant transferable skills.  So, on balance I would argue that previous fostering experience is probably helpful in most cases, but a rigid requirement for this will potentially exclude foster carers with the requisite skills and aptitude.

Secondly, should parent and child foster carers be considered unsuitable if they have other children in their household?  Some fostering services have taken the view that the very specific needs of parent and child fostering mean that it is not compatible with fostering other children, for reasons of both safety and time.  Additionally, it is felt that where children have already experienced trauma in their own birth families, they should not witness barely ‘good enough’ parenting as this has the potential to re-traumatise them.  On the other hand, with careful planning and matching, there is evidence that these very different types of placements have worked well alongside each other.  Having other children living in the house allows the parent to observe the foster carer modelling high quality care, and contributes to an environment that feels like a family rather than an assessment centre.  Similar arguments can be advanced in relation to whether foster carers with birth children might be suitable or not for the parent and child role.  Again, on balance, I would argue against rigid positions, and in favour of each case being considered on its merits.

The issue of foster care recruitment is a much wider issue than I can address here, but where fostering services have developed parent and child fostering, they have used a combination of recruiting from their existing approved foster carers, and advertising to the general population.

Once approved and fostering, we know that parent and child arrangements involve complex and challenging issues for foster carers, and they need to receive a high level of support.  For some fostering services this means that visits from the Supervising Social Worker are undertaken on a weekly basis, but as important as frequency, is the quality of the supervision provided. 

It is important that supervision has a clear purpose, is recorded, and is reviewed regularly to check that it is serving its purpose.  Supervisory visits need to include discussion about the care being offered by the parent, provide an opportunity for carers to share concerns or thoughts, and to help them reflect on their practice.  It also needs to consider the impact of parent and child fostering on the carer and on other members of their household.  This supervisory relationship is crucial to making parent and child fostering work well.

Other support might be available through foster carer support groups, and these will be of particular benefit where they are specifically set up for parent and child carers rather than for all foster carers.  For newly approved parent and child foster carers there may be benefits from ‘buddy’ schemes linking them with more experienced carers who are already engaged in this type of fostering.  Valuable support can also come from making links with other professionals, and a number of fostering providers have established good links with health visitors, nurses, psychologists and others.  Finally, since parent and child arrangements are by their nature likely to create particular stresses and crises, it is important that 24 hour support is available from practitioners with a good understanding of parent and child fostering.

The importance of training has already been mentioned, as something necessary for all foster carers, but parent and child foster carers have particular training needs over and above that of mainstream carers.  Those providers with an expertise in this area have developed various pre and post approval training ranging from two-day to seven day courses, and often involving practitioners from other disciplines. 

There are a number of potential subject areas, but the most commonly cited areas include understanding parent and child fostering, child development, paediatric first aid, building positive relationships with parents, promoting good attachments, recognising signs of abuse, understanding the child protection system and managing risk, minimising the likelihood of allegations about the foster carer, contributing to assessments of parenting, and recording, report writing and court skills.  Fostering services obviously need to think about how to effectively deliver training in these subject areas, and how to support carers to attend.

Part 4: Planning in individual cases

Having identified issues in relation to the foster carers themselves, let’s move on to look at care planning for individual arrangements in relation to parents and children.  We have heard the research about advanced planning, and I would suggest that the benefits of this cannot be over-emphasised.  In starting to consider an arrangement, the first question must be about whether a particular parent and child are suitable to live together in a fostering environment.  This will largely be determined by their willingness to participate in assessment or accept support, and whether or not the risks to any child can be safely managed in the context of a foster home. 

It is also essential to undertake a risk assessment in relation to the parent or parents; and this is essential to ensure that they will be able to live in a foster home without jeopardising the health and safety of any other household members.  This will be particularly important for adults who are not used to living with foster carers, and the fostering service will need to consider criminal history, including any history of child abuse or animal cruelty, violence including domestic abuse, arson or damage to property.  The risk assessment will also need to look at any inappropriate sexualised behaviour, alcohol or substance misuse, self-harming, absconding, medical risks, and any behaviour arising from mental health conditions. 

Some of these issues will be manageable in some foster homes, but it is important to recognise that parent and child fostering is not appropriate for all situations.  The safety and well-being of the fostering household must remain the priority for the fostering service.

As with all fostering, it will be necessary for the child’s social worker to make a referral to the fostering service with full information about the parent and child requiring the placement, including their basic details, their current situation, longer term plans including any court dates pending, information about education or employment, their views and wishes, details of other key people such as family members, contact plans, and any other relevant information.  Where fostering services accept referrals with insufficient or inadequate information, the chances of achieving a successful outcome will be much reduced.

The child’s social worker will also need to be clear about the proposed purpose of the arrangement; is it about assessment or support, and what does that imply in terms of how long fostering is required for, and the content of what will happen during this time.  

Once a parent and child have been assessed as suitable for a parent and child fostering arrangement, it will be necessary to prepare them as much as possible.  Best practice involves the preparation of detailed written materials usually in the form of information leaflets, but this needs to be alongside in-depth face to face discussions involving all the relevant parties.  It is difficult for me to talk in any detail about the content of these materials as they will need to be specific to the individual scheme, but need to set out things in relation to how long people stay, what happens while they are there, who will be responsible for what, any general rules, and how decisions will be made about the future.  Parents also need to be aware of how to address matters that may be unhappy about.

Prior to any fostering arrangement being established, it is crucial that everyone involved knows what is expected of them and each other.  The research data highlights this as an important element when things work well.  The exact role of individuals will depend very much on the specific nature of the scheme, the purpose of the fostering arrangement, and the individual issues in the particular case, but there are some fundamental responsibilities for those involved.

The child’s social worker is responsible for ensuring that there is a clear plan in place for the child and their parent, that will meet the child’s needs for safety and well-being in the short term and subsequently.  They will need to make a referral for a parent and child foster arrangement, and make sure that any such arrangement meets the identified needs of the child, including the need for any assessment.  They will be expected to visit the placement frequently, and work closely with the parent, foster carer, child (depending on age and ability), and other professional network, coordinating reviews, and making plans for the future. 

If there is an assessment being undertaken then everyone needs to be clear about who is responsible for coordinating this.  Where services have parent and child fostering as part of wider fostering responsibilities, rather than offering a specialist scheme, it was often the child’s social worker who completed the assessment, although in practice this had a number of shortcomings. 

With the development of more specialist schemes it has come to be accepted that a dedicated assessing social worker (or psychologist) based within that parent and child scheme is a better arrangement.  Under this model, the commissioner of the service (child’s social worker) will then purchase or access a package that includes the parent and child foster home, and the associated work involved in the parenting assessment.  This model allows considerable expertise to develop, creating a coherent and structured assessment process, and familiarity with particular ways of working.

The foster carer has a number of basic responsibilities to provide an appropriate foster home, but the detail of their role will depend largely on whether the arrangement is about assessment or support.  In a support arrangement the carer will need to work closely with the parent to advise and encourage, and work closely with other professionals to ensure they are aware of how things were progressing.  They would also need to be mindful of any risk, and take responsibility for the child’s safety in line with any agreed plans.

Within an assessment model their role is slightly different, and foster carers have a crucial role in the assessment - being described as the ‘eyes and ears’ of the assessing worker – observing, recording and feeding-back, while at the same time encouraging and teaching appropriate parenting skills.  It is likely that the requirements of the foster carer are more structured in an assessment placement, with pro-formas setting out the content of record keeping, and with requirements for formal feedback to all parties.

We have already discussed the role of the Supervising Social worker in relation to supporting the foster carer, and other professionals such as health visitors, mental health workers, psychologists, counsellors, substance misuse workers and the like may have particular roles according to the individual circumstances of the case.

In addition to making broad plans, it is also essential to consider the detailed issues that if not addressed, can create problems and ultimately lead to arrangements breaking down.  This needs to be considered once a particular foster home is identified, and is probably best done at a placement planning meeting which should involve all relevant parties who have an involvement in the arrangement.  Fostering services in the UK have learned from experience, and have identified a number of areas that benefit from early discussion.

Responsibility for child care is one; what is the foster carer expected to monitor, when and how, and if the parent is in employment or education what are the child care arrangements.  And what about baby-sitting; how often, for how long, and if the parent is expected to resume care on coming home after a night out what does this mean in relation to alcohol consumption, for example.  All of these things need to be considered and agreed before a problem emerges.

Sharing living space is inevitably going to be stressful, so agreeing house rules is essential to try and make this work.  Smoking in particular can be a contentious issue, influenced by strong personal opinions, clear medical advice about harm, and statutory requirements in relation to fostering households.  Arrangements for smoking might need careful consideration, and will need to be agree on a case by case basis, taking into account what might be reasonable for a parent who smokes, the child’s needs, and what the foster carer is willing to accept in his or her home. For example, if it is agreed that smoking will take place outside, then who will be looking after the child during these times.

The issue of contact and visitors is also complex and requires careful consideration, balancing the need for the parent to not be distracted from their parenting role, but also reflecting the fact that they will leave the foster home at some point, and will likely re-engage with partners, relatives and friends.  The plans need to be clear about what is acceptable, and carefully consider what role if any the foster carer might have in managing contact. Finance and equipment is another aspect where everyone needs to know where they stand; what expenses should be covered by the fostering allowance and what is the parent expected to budget for.

And finally, placement planning needs to consider the potential ending of placements or ‘exit plans’.  What will happen in certain circumstances?  Is the placement conditional on certain behaviour, for example not disclosing the address to an abusive partner with a history of violence?   If the parent refuses to cooperate with the assessment or leaves, what will this mean for everyone involved?  Who will look after the child?  Can the parent take them, or will they go to relatives, or will they stay with the foster carer or another foster carer?  These are not issues best considered in the midst of an arrangement breaking down, and are better considered calmly and clearly in the planning stage.  If things end more positively then accommodation and support will need to be in place, and these too need to be considered at the outset and throughout, not when the placement is nearing completion.

Case Study: baby William

In the final part of this presentation I am going to describe one real case that I heard about recently, with names changes to preserve confidentiality.

Debbie is a 22 year old white British woman, who is diagnosed with a mild learning disability.  She spent a period during her childhood living in care, primarily because of arguments with her mother during her teenage years.  She is currently living in her own accommodation, but visits her aunt Theresa most days.  She has a boyfriend, also with a mild learning disability called Thomas and Debbie is now 8 months pregnant with Thomas’s child.  The health visitor has referred her case to the local authority social worker because of concerns that Debbie had engaged very late with pre-natal care, and appears unrealistic about what parenting entails.  Peter is the social worker who takes responsibility for this case.

Peter undertakes an initial assessment and understands why the health visitor was concerned.  Debbie does appear to lack understanding about parenting, and in conversation is unable to describe what babies need, or how being a parent might impact on her own life.  At the same time, he recognises that Debbie is living independently, and with the support of her aunt runs her own home successfully.  She has good budgeting skills (being on state benefits); her self-care skills seem appropriate; and she has never come to the attention of social services as an adult.  Peter finds out that Thomas wants to support Debbie but also wants to continue to live with his own parents.

Peter does not think it is safe for Debbie to be allowed to take her baby home, and talks with her about the reasons for this.  He thinks that a parent and child foster placement might be appropriate, with the purpose of assessing her parenting capacity.  In undertaking a risk assessment he notes that Debbie does not have any significant criminal or other history that might make her unsuitable for a foster placement; and Debbie is in agreement to the proposal that Peter makes.  She recognises, at least in part, that she could benefit from some help in learning to be a good parent, and thinks it will be nice to live with someone else so she doesn’t get lonely.  With Debbie’s agreement Peter also visits her aunt who is very supportive of the plan and agrees that if things go well in the foster placement, then maybe Debbie could move in with her.

Peter makes a referral to an Independent Fostering Provider specialist parent and child fostering scheme, and they agree that the proposed plan could work well for Debbie.  They have an experienced single female foster carer called Doreen who has been assessed and approved for parent and child arrangements, and who has completed the range of relevant training.  She lives with her adult daughter who works in a day care centre with young children.  The fostering service provide written information about their parent and child fostering scheme, including the format for assessment, and it is suggested that Peter and Debbie attend a care planning meeting to discuss things further.

At the care planning meeting Ingrid, the assessing social worker at the fostering service describes how she will undertake the assessment, with twice weekly visits to observe and talk with Debbie about all aspects of parenting a baby and toddler.  She explains that Doreen the foster carer will keep a daily record that she will share with Debbie at the end of each day, and that Doreen will also attend a weekly meeting with Ingrid and Debbie to review how things have been going.  Peter will be invited to these review meetings at week 5 and week 10, and there will be an interim and final report presented at these meetings.   Debbie is shown the workbook that is used to help parents in relation to a number of parenting dimensions.

Ingrid also explains that they have access to a psychologist who will be able to advise the team about how best to work with Debbie given her learning disability.  Peter explains that he is thinking that if things go well then maybe Debbie might want to move in with her aunt Theresa immediately after the foster placement.  He further explains that if for any reason the arrangement ends, he will need to take legal advice with a view to the baby moving to another foster placement without her.

After that there is a placement planning meeting at the foster home to consider day to day arrangements, attended by all of those who are involved in this situation.   Debbie doesn’t smoke so there is nothing to discuss in relation to that matter, but Doreen does explain the house-rules in relation to sharing the living space and bathrooms etc.  It is agreed that Debbie will be the carer for her baby at all times, she will not take out her baby without Doreen or her daughter going with her, and it is agreed that Thomas and Theresa will each visit once a week on different evenings during the week, but will leave before 10pm.  Plans are also put in place for regular visits from Ingrid, Peter, and Doreen’s supervising social worker, and dates are set for the review meetings.  

Debbie moves in three days later, and after a further week she has a baby boy who she calls William.  Initially things are difficult.  Debbie needs a lot of assistance with basic parenting tasks like feeding and winding and changing the baby.  She seems unfocussed, reluctant to take advice, and gives the impression that she does not need any help.  Debbie is also angry that Thomas cannot visit more often and is verbally aggressive to Doreen.  Peter speaks with her about this and reminds her that there is a clear plan in place and that she is expected to adhere to this.

The team around the child communicate closely and are reassured that although things are not going well, William remains safe because of the monitoring role that Doreen and her daughter can offer.  Doreen is also provided with advice from the psychologist about how to help Debbie learn more effectively by using pictures and visual prompts, and this leads to a significant improvement in her child care skills.  It also becomes clear that Doreen’s daughter is having a strong positive influence on Debbie and as she becomes more settled in the foster home, and more confident, she is able to demonstrate better parenting of William.

At the five week review the professional network are feeling positive about the progress being made, and begin to make provisional plans for Debbie to move to her aunt Theresa.   Arrangements for Thomas to visit are relaxed, and he begins to visit more regularly and he also asks for help and advice around looking after his son.  At ten weeks the assessment is completed and concludes that Debbie’s parenting is satisfactory in relation to all of the parenting dimensions under consideration, and there is evidence of this contained within her workbook.  The plans are firmed up for moving on, and two weeks later Debbie and William move out of the foster home.  Peter continues to work with Debbie and her son, to monitor and support her, but the early indications are that things are going well.

It seems appropriate to end on that positive note.  Parent and child fostering is complex and difficult work, and in this presentation I have tried to give a flavour of some of the issues and dilemmas that it poses.  However I think it is worth reminding ourselves about the most significant finding from research and practice: that notwithstanding the challenges, parent and child fostering can, and does, work very well.  It allows parents to demonstrate their ability to look after their children without having to have been separated from them, and provides structures whereby foster carers can offer effective support, training and encouragement to avoid the need for children to be separated from their parents.   To conclude we should give the last word to one of the foster carers in the Adams and Bevan (2011) study, who is talking about a mother that she fostered:

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[1] Northern Ireland has slightly different arrangements.