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Accommodation outcomes for children of drug-misusing women
  1. Jennifer Mitchell1,
  2. Helen Mactier2
  1. 1 Neonatal Unit, Royal Hospital for Children, Glasgow, UK
  2. 2 Neonatology, Princess Royal Maternity, Glasgow, UK
  1. Correspondence to Dr Jennifer Mitchell, Neonatal Unit, Royal Hospital for Children, Glasgow G51 4TF, UK; jennifermitchell4{at}nhs.net

Abstract

Children of drug-misusing women are a vulnerable group. Data describing the pattern of accommodation placements are lacking. We investigated 10- to 12-year accommodation outcomes of children born to drug-misusing mothers at a single maternity hospital. 94% of mothers were prescribed maintenance methadone during pregnancy and at least 87% poly-drug used.

Data were successfully matched for 132 children (29% of the original cohort of 450 babies). These children had a total of 291 placements (median 2 (range 1–6)), only 28.5% of which were with the birth parents. At 10–12 years, 54 (41%) were in the care of their parent(s).

83% (109/132) were discharged from the maternity hospital to their birth parents; 41% of these children (54/132) remained with their parents at 10–12 years. Of the 23 children not discharged from the maternity unit to their parents, 70% remain within the care system or have been adopted at 10–12 years of age.

  • comm child health
  • data collection
  • drug Abuse
  • general paediatrics
  • social work

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What is already known?

  • Children born to drug-misusing mothers are a vulnerable group, some of whom are looked after within the social care system.

  • Looked After and Accommodated children are at higher risk of adverse long-term social outcomes.

  • There are few data to quantify the extent of social work involvement in the care of children of drug-misusing mothers.

What this study adds?

  • Linking of birth to social work records at age 10–12 years has potential to investigate outcomes for children born to drug-misusing mothers.

  • A significant number of these children are not living with their birth parents.

  • Current data underestimated the extent to which children of drug-misusing mothers are accommodated out with the care of their birth parents.

Introduction

Children of drug-misusing women are a vulnerable group whose care impacts significantly on health and social care resources. Neonatal outcomes are well described.1 A proportion of children are discharged from maternity services to care other than that of their birth parent(s), but data describing subsequent living arrangements, including being a Looked After and Accommodated Child (LAAC) within the social care system, are lacking. Children living in care are at higher risk of poor education, poverty, offending, unemployment, drug-misuse and teenage pregnancy.2 Frequent moves between carers are likely to be further detrimental to the child.

Parental substance misuse was the most common reason in Scotland during 2016 for children being placed onto the children protection register (approximately 8.8 per 10 000 children; 39% of all cases conferences).3 In 2003, the UK Government estimated that 64% of substance-misusing mothers and 37% of substance-misusing fathers were living with their children4 and that of the remaining children, only 5% were accommodated within the social care system.

We investigated 10- to 12-year accommodation outcomes of 450 children born to drug-misusing women in a single maternity unit in Glasgow.1

Methods

A database of 450 babies born to drug-misusing women between 1/1/2004 and 31/12/2006 was securely linked with Glasgow City Council Social Work (GCCSW) records for children living within Glasgow until the end of 2015. Anonymised data linkage using the community health indicator (CHI) number was carried out by Safehaven; governance only allowed for records of children residing within GGC to be analysed.

The original data set predated universal use of CHI numbers at birth, requiring CHI matching by Safehaven.

We investigated ‘placements’ since discharge from the maternity unit; placements could be at home with parents; kinship care with relatives (relatives paid by social work); non-kinship care with relatives (no payment associated); foster care provided by the Council or purchased from an external resource; residential school/specialist resource.

Deprivation was defined using the Scottish Index of Multiple Deprivation (SIMD). Quintile 1 corresponds to the 20% most deprived postcodes.

Results

The CHI matching process identified 298 of 450 babies in the original database (figure 1). CHI numbers were unable to be attributed in 152 cases for several reasons, including change of name and address.

Figure 1

Flowchart demonstrating CHI matching process and resultant matched records. CHI, community health indicator.

The 298 CHI numbers were sent to GCCSW, where 151 records were matched to social work records. In all, 19 of these 151 records were excluded by Safehaven as the child had moved out of GGC.

Maternal characteristics

Median age at delivery was 29 years and 70% of women lived in SIMD quintile 1. 94% were prescribed maintenance methadone during pregnancy and 87% had misused other drugs. The majority of babies were formula fed, and 55% received treatment for neonatal abstinence.

Placements

In all, 132 children had a total of 291 placements (median 2 (range 1–6)). In total, 74 (56%) of children had more than one placement. For only 26% of the 58 children who had one placement was that placement with their biological parents.

The percentages of different placements were similar with the exception of residential/specialist resource: foster carer 36%: with relatives (kin or non kinship care) 36%: at home with parents 27.5% and specialist residential resource 0.6%.

Figure 2 demonstrates where the children were living at age 10–12 years. In all, 54 children (41%) were at home with parents, 49 children (37%) were with relatives (kin or non kinship), 16 children (12.5%) were in foster care, 11 children (8%) had been adopted and 2 (1.5%) remained in specialist residential resources. 55% children remained under active social work review.

Figure 2

Piechart demonstrating child’s current placement at 10–12 years of age.

Of the matched cohort, 83% (109) had been discharged from the maternity hospital into parents’ care. In all, 95 of these 109 children were subsequently accommodated, and only 41% remained with their parents at 10–12 years. Of the 23 (17.5%) babies accommodated into foster or kinship care at birth, 70% remained within the care system at 10–12 years of age.

By comparison, 90% of the 317 children for whom follow-up data were not available had been discharged to parents’ care at birth.

75% of children were living within SIMD quintile 1 at age 10–12 years. None of the 7% of children living in quintiles 4 and 5 was accommodated with birth parents, the majority having being adopted.

Discussion

It is common for babies born to drug-misusing mothers to experience one or more episodes of care. Within our cohort, a substantial proportion (87%) of those babies whose birth records could be matched to social work records and who were deemed able to be safely discharged home after birth was subsequently accommodated and 57% are no longer in parents’ care at 10–12 years, demonstrating challenges around assessing the suitability of parental placement at birth. A large majority (70%) of children identified at birth as requiring to be accommodated are still in the care system at 10–12 years of age, suggesting a high threshold for identification at birth of children at risk.

According to figures obtained from GCCSW, foster care provided by Glasgow city council costs close to £500 per child/week; foster care purchased from external providers is twice as expensive, and residential school seven times more costly.

The weakness of this study is the substantial proportion of missing data. The included children were nearly twice as likely to have been accommodated at birth as children whose social care records could not be matched, and their mothers more likely to have been poly-drug misusing during pregnancy. Indeed, we describe a very poor and unstable drug-misusing maternal population, However, even if all 317 children whose data could not be linked have never been accommodated, at least 26% (117 of 450) of babies born to drug-misusing mothers will have been accommodated at least once in childhood, and at least 17% (78 of 450) will remain LAAC or have been adopted at 10–12 years of age.

Our figures are vastly different to previous government estimates,4 and at variance with recent Scottish data3 suggesting that the majority of accommodated children only experience one placement. The data indicate huge resource implications for social work services, in addition to the negative effects for children and their families of accommodation.

These data were obtained from a cohort of children born in an area with a high level of deprivation and their mothers were particularly unstable, with high rates of poly-drug misuse. Both of these factors increase the likelihood that children will be removed from their parents’ care and so our reported outcomes may not be able fully to be extrapolated to other areas.

Conclusion

The consequences for children of drug-misusing mothers in terms of accommodation have been underestimated, and being discharged from the maternity hospital to parental care does not necessarily predict long-term family stability. Anonymised data matching is helpful in exploring outcomes for children and will be facilitated by universal use of the CHI number. More comprehensive long-term data are required to define outcomes for these vulnerable children and to help target resources appropriately.

Acknowledgments

Claire MacDonald and team at NHS GGC Safehaven, Tina Callan and team at Glasgow City Council Social work department, Mums and babies in the study.

References

Footnotes

  • Twitter @HMactier

  • Funding Research grant, Glasgow Children’s Hospital Charity.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Obtained from NHS Greater Glasgow and Clyde (GGC) Safehaven, a research collaboration between NHS and University of Glasgow (Safehaven ID GSH/14/KH/001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.