Intervening with pregnant women at risk of repeat care proceedings: a realist and quasi-experimental evaluation of the Startwell service in North East England
Download the final evaluation report, below.
Background
For the past two decades there has been a year-on-year increase in the number of children being taken into care, resulting in a ‘care crisis’ (Family Rights Group 2018). There is particular concern regarding the 24% of mothers who experience child removal and return as a respondent in successive care proceedings (Broadhurst, Alrouh et al. 2015) and the rising number of babies ‘born into care’ (Bilson and Bywaters 2020). There is an urgent need to understand how to interrupt the cycles of trauma and child removal experienced by mothers who are subject to repeat care proceedings.
Aim of the work
This study aimed to evaluate the Startwell intervention provided by Barnardo’s for pregnant mothers who have had one or more previous child(ren) removed from their care.
The objectives of the evaluation were to:
- Estimate the effectiveness of the Startwell intervention at reducing the number of infants in care.
- Conduct a cost consequence analysis to assess return on investment based on the financial implications of the project offset by the reduction of children entering the care system.
- Derive explanatory evidence to describe what works in supporting mothers at risk of repeat care proceedings.
Method
The study employed a realist approach to service evaluation, using quasi-experimental and qualitative methods.
Findings
Infants whose mothers received the Startwell intervention were more than twice as likely to be born into care than mothers in the comparison group who did not receive the Startwell intervention.
However, infants whose mother received Startwell were less likely to be in care at 12 months than infants of mothers who were in the comparison group.
Infants who were born into care were 10 times more likely to be in care at 12 months.
However, the outcomes of infants who were born into care and received the Startwell intervention were better than those infants that were born into care and did not receive the Startwell intervention.
Within the challenging context of child protection, the Startwell practitioner provides a safe and trusting relationship, focusing upon the needs and experiences of mothers at risk of repeat care proceedings. This supports the challenging of behaviours and beliefs that are a risk to the infant. Where a decision is taken to remove the infant, that Startwell practitioner supports the mother to grieve her loss, enhancing her mental health and wellbeing.
Conclusion
The Startwell intervention provides non-adversarial relational-based support which is effective at increasing the reunification of infants who are born into care with their mothers.
This evaluation was supported by researchers funded by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC).
You can download the full report, below.