Note that any names of residents in our case studies have been changed to protect their privacy. Their stories, however, are real.
Rachel and Peter and their daughter Ivy
Family Background and Concerns
Rachel and Peter arrived at Majestic Family Services Residential Family Centre, with their newborn daughter, Ivy. Ivy was the first child born to both parents. Prior to the placement, the Local Authority had significant concerns regarding the parents’ capacity to safely and consistently meet Ivy’s needs independently.
Both parents presented with additional needs and vulnerabilities. Peter had diagnoses of Autism Spectrum Disorder, ADHD and learning difficulties. He also had a complex childhood background himself, having been adopted at the age of one following reported prenatal alcohol exposure and neglect. Peter had remained within his adoptive family throughout childhood. Throughout his time at Majestic he described relationships within his adoptive family as strained, albeit ongoing.
Rachel had a diagnosis of Autism Spectrum Disorder and Dyspraxia. She also had a significant history of mental health difficulties, including self-harm and suicide attempts during adolescence and early adulthood. Rachel experienced significant social anxiety which impacted her confidence in public settings. Rachel had limited familial support, though she was close with her mother and she reported a difficult childhood, characterised by frequent bullying from her peers as she grew up experiencing difficulty making or maintaining friendships. Rachel presented as the parent more involved in Ivy’s care throughout the placement, though her emotional wellbeing and stability depended frequently on Peter’s presence, and she often attributed improvements in her mental health and stability on the presence of Peter in her life and a stable five year marriage at the time of the birth of Ivy.
There were concerns in respect of both parents’ capacity to meet their own needs. For example, they spent significant amounts of their money on almost daily take out foods and gaming purchases. Further, there had been an incident outlined in referral that Rachel had not sought support from health services when she was unwell during her pregnancy.
There were concerns regarding Peter’s cannabis misuse. Peter engaged openly with substance misuse services throughout the placement and reported abstinence from cannabis use from the latter stages of Rachel’s pregnancy with Ivy, onwards; which was supported by hair strand testing requested by the Local Authority. Peter remained open to substance misuse prevention services throughout placement and engaged consistently in weekly support calls.
Ivy was a healthy newborn baby at the time of admission. Throughout the placement there were no concerns regarding her physical health or developmental progress. Ivy presented as a smiley, interactive and responsive baby who developed well throughout her time at Majestic.
Assessment and Support Provided
A 12-week residential CUBAS parenting assessment was completed. Throughout the assessment period, Majestic provided intensive support, teaching and observation to assess the parents’ ability to meet Ivy’s needs safely and consistently. Given both parents’ additional needs, interventions were tailored to support their learning styles and ability to retain and implement information, guided by their cognitive and psychological assessments which were provided to Majestic by the Local Authority. Support included:
- One-to-one CUBAS assessment sessions
- Tailored key work sessions
- Role modelling and guidance in the moment, including in respect of play and development
- Pictorial cards and visual resources
- Independence skills work around routines and daily living tasks including cooking sessions
- Video-based mentalisation work
- Emotional literacy sessions
- Healthy relationship sessions
- Referrals made to adult social services for both parents with their consent gained
- Independent parenting sessions to promote both parents’ strengths and support areas of focus
Progress During Placement
During the initial four weeks of placement, Rachel increasingly demonstrated strengths in relation to Ivy’s basic care, hygiene, emotional warmth and play. Peter demonstrated strengths in practical tasks such as sterilising feeding equipment and supporting with top and tail washes. Despite these strengths, concerns remained regarding the parents’ ability to independently maintain routines, understand Ivy’s changing developmental needs and consistently implement their learning into practice. Rachel completed the majority of Ivy’s care at this stage, whilst Peter required frequent prompting, reassurance and direct support to prioritise and respond consistently to Ivy’s needs. Peter also often struggled with taking on board feedback, and the change of the expectations in placement versus when he lived independently at home. In response to this, independent and one-to-one parenting sessions and opportunities were gradually increased to strengthen both parents’ individual confidence in their parenting skills and styles.
As supervision levels reduced during the placement, Rachel at times became overwhelmed whilst managing the majority of caregiving and household responsibilities. Staff observed that parental conflict, emotional dysregulation and inconsistent responses to Ivy had the potential to impact upon Ivy’s emotional wellbeing if changes were not made.
At the conclusion of the initial 12-week assessment, concerns remained regarding Peter’s ability to consistently prioritise Ivy’s needs independently and the sustainability of the parents’ progress without intensive support. However, meaningful progress was observed during weeks 11 and 12 of the placement, particularly in relation to the parents working more collaboratively together and implementing safer and more consistent standards of care.
Given the progress demonstrated towards the latter stages of the assessment, an extension to the placement was recommended for 6-8 weeks and agreed to allow further assessment and support within Ivy’s timescales.
Re-Assessment Period
During the reassessment period, Rachel demonstrated significant progress in her parenting capacity. She had developed improved insight into the impact of parental conflict and emotional inconsistency upon Ivy, and demonstrated an increased understanding of Ivy’s developmental needs. She was increasingly able to adapt to Ivy’s changing care needs, maintain routines, provide consistent emotional warmth and sustain a satisfactory standard of daily care with reduced supervision. Rachel also demonstrated improved independent living skills, maintained emotional stability throughout placement and sustained abstinence from cannabis use. Rachel was child focused, and she demonstrated her capacity to frequently prioritise, intervene and advocate for Ivy’s safety needs in respect of gaps in Peter’s care without staff prompts.
Peter had also demonstrated areas of progress throughout the reassessment period meaning Rachel had less gap to monitor and intervene. He developed some improved understanding of child development and sustained abstinence from cannabis use throughout placement. However, concerns remained regarding his ability to consistently implement learning into Ivy’s daily care without support. Peter continued to require prompting around prioritising Ivy’s needs and struggled to consistently regulate his emotions and communication within the placement.
The Outcome
Following the reassessment period, it was recommended that Rachel and Peter could care for Ivy together within the community with ongoing professional support and oversight, with Rachel identified as the primary protective factor. It was recommended that Rachel act as Ivy’s primary caregiver for this arrangement to be successful, alongside ongoing support for both parents to maintain and sustain progress within the community such as local authority visits and engagement with planned baby groups and a local children centre.
At the time of departure, concerns remained regarding Peter’s ability to independently care for Ivy consistently without support. Therefore, a plan was agreed with the Local Authority for Peter to continue receiving ongoing support and learning in respect of Ivy’s basic care and development and progressing towards increased independent care.
Rachel had demonstrated an increased and consistent ability to prioritise and protect Ivy’s needs throughout the reassessment period, which supported the recommendation for the family to return home together despite the identified concerns regarding Peter independently caring for Ivy at that stage.
Following discharge, the family maintained positive contact with Majestic and professionals reported that Rachel and Peter continued to make progress in their independent care of Ivy within the community until services were appropriately stepped down and closed.
