Key message one: Understand and use your data

Whilst there has been growing international and UK based evidence about the importance of the early years in terms of those longer term outcomes for infants, children and adults, and that there has been a policy response to this with an increasing focus on early years, There has been a mismatch in terms of what we understand about infants journeys through the family justice system and the impact of those really important decisions made in the child protection and court arena.

When we first started the Born into Care research, there was no data about newborns in care proceedings, and the first report published in 2018, provided the first insight into the patterns and numbers of newborns in care proceedings in England and Wales.

The first Born into Care report published in 2018 and utilising data from Cafcass the children and Family Court Advisory and Support Service gave us the first insights into newborns in care proceedings. What this data showed us was that there's been more than a doubling of newborns entering care proceeding within the previous decade. It also showed us that there was huge regional variation with numbers much higher in the north of England than in the south.

And this, of course, raised important questions of fairness and equity, as you will hear in the subsequent recording. This data led to further quantitative analysis that provides new and important insights.

However, national data is only useful up to a point. Whilst it has provided really important insights and allowed a focus to be given to newborns, we do not know enough about the local area. Picture. However, this is an opportunity for local areas to really delve into their data to help them answer those really important questions about infants in their own systems, the needs of particular families. And it's this data that will help you and guide you as you build your pre-birth work and response.

To hear more about the details of the research and to hear specifically from some areas of the country already using their data to plan services, please see the links below.

The Born Into Care series began in 2018 with an analysis of all newborns in care proceedings across a 10 year period using cafca data.Up until that point, the DFE releases had looked to under ones as a whole, as you can see from the pie chart on your screen. And perhaps unsurprisingly, those infants less than 1-year-old equate to 27% of all children in care proceedings over that 10 year period. 

The pie chart on the right of your screennow takes those under one year olds and breaks them down to look at what proportion were issued at what point within that first year. And what we can see here is that 36% of them were issued within the first week of birth. 

This next graph considers the age of infants within that 10 year window by the different age bands. And what we can see clearly here isthat whilst there is an increase in the number of infants issued with care proceedings across all the age bands, there's a much steeper increase for those youngest babies IE issued within a week of birth. And actually the numbers have more than doubled in that decade. 

This next graph is specifically looking at what proportion of those infants had older siblings who'd already appeared in care proceedings. We knew from our previous research that recurrent care proceedings were common with one in five women reappearing after an initial set of proceedings. 

What this graph shows us is that this was the case for approximately 40% over this time period with some fluctuation. Of course, what we need to be careful of is that doesn't mean that they were necessarily the first baby in the family. It could be that there were other children but they hadn't appeared in care proceedings but could still have been on child protection plans. 

Of course, this is a national average and rates may vary considerably in different parts of the country, and we encourage you to look at your own data because it might tell you something about how much attention you need to pay to parents who've had one set of care proceedings and then reappear very quickly with a subsequent child. What are you doing between proceedings to ensure you put the parents in the best possible place to avoid further proceedings with other children? 

And of course, we have a lot of learning around what might work in terms of recurrent care proceedings from a number of services across the country.And there are links available on the Research and Practice website. 

Now, as I've said, the first Born Into Care quantitative analysis was published in 2018 and there has been an update since then as you can see on this graph. And this includes figures from England and Wales. And as you can see, the upward trajectory continues, although there has been a slight decrease in Wales on in that latest year returning to the original publication in 2018. 

In this slide, we look at regional variation and there are some really important questions to be asked here about these rates. So as you can see at the beginning of this chart, there was not that much separation between the different regions, although Yorkshire and Humber was already at a higher level than the other regions. 

However, look at how much separation we start to see across this period. And by 2016, we have a lot of difference in the um, in the rates in these different regions with particularly high rates in the Northeast, the Northwest and Yorkshire and Humber. 

So again, this raises some important questions about why are we seeing these big variations? And of course there's lots of different reasons for that and there isn't a simple answer, but we encourage you to really think about what do your figures look like and how do they compare to the national average, to your regional average and also to your statistical neighbours. 

The Born Into Care report released in 2021 focused on the use of urgent care proceedings and the changes that we've seen across England and Wales in the use of short notice hearings. In the majority of cases in both England and Wales, there was only one or two days notice between issuing and the first hearing,and in one in six there was no notice, meaning that they were issued and heard on the same day. 

And there has been some concerns raised about these changes in the use of urgent hearings and how it may affect a parent's Article six writes. So again, we encourage you to have a look at the use of short notice hearings in your own area and to have a think about how you account for any changes that you see. 

Following the release of the 2018 report, which first showed the regional variations in the numbers of newborns in care proceedings across England, we held a series of regional workshops where we spoke directly to practitioners within children's social care and to lawyers and judges about how what they thought about the regional variations and some of the reasons behind it.It's really important to say at this pointthat we do not know what good looks like. We have a national average, but that doesn't tell us the full picture and the detail of those of those individual decisions. So when we spoke in these workshops to practitioners and unsurprisingly, what we found was that there were many reasons that accounted for those regional disparities. Some of this was about changes to family circumstances, and practitioners spoke a lot about cuts as a result of austerity, particularly to preventative and early health services. They talked about increases in problems around housing, increases in poverty in their area. There are also changes to services that they thought were contributing to changes in the numbers of newborns coming into care proceedings. This include changes in the use of pre proceedings, changes in court behaviour, the use of different legal orders. 

What we encourage you to do is look at this list on this slide and think about how this might apply to your area, particularly where you have seen big changes in the numbers of care proceedings relating to newborns. 

The 2022 Born into Care report, 1000 Mothers, which was led by Lucy Griffiths at Swansea University, really demonstrated the importance of understanding some of the multiple disadvantages faced by women in whose infants end up in care proceeding compared to the general population. In this study, there were two data sets linked, which allowed the researchers to compare women whose infants did end up in care proceedings with a proportion of women whose didn't. And we were able to look at both their maternity records and their court data. And what this showed was the much greater levels of socioeconomic health and wellbeing vulnerabilities for women whose infants were in care proceedings compared to those that weren't. And you can see some of the figures on this slide as this slide showed. 

Another important finding from the thousand mothers report related to the timing of antenatal care. And this is important because what this showed was that actually there was only a slight difference there, the timing in which women whose infants did end up in care proceedings booked for antenatal care compared to the comparator group. So although it did tend to be slightly later, still two thirds of mothers whose infants did go on to being involved in care proceedings had booked their initial appointment with a midwife by the end of the 12th week of pregnancy. And this is important because midwives are so pivotal in identifying and initiating support and preventative services for mothers. 

So to summarize some of the key messages from the Born into Care quantitative studies, infants under one make up over a quarter of all children in care proceedings in England, newborns less than seven days old, make up over a third of all infants in care proceedings in England. And there's been an overall upward trend in this figure between 2006 and 2020. 

In both England and Wales, we've also seen marked regional variations in the rates of infants in care proceedings, the mothers of nearly half, so on average, 47% of the newborns in care proceedings have been party to previous care proceedings. Short notice hearings for newborns have increased in England and Wales. There are higher rates of urgent hearings in the north of England and Wales when compared to the south. The majority of women were known to maternity services and early point of pregnancy, and the high levels of mental health need and other socioeconomic disadvantages for this group of women are clear. 

In 2020, we began the qualitative work that led to the publication of the Best Practice guidelines in 2023. This work involved intensive deep dive in eight areas of the country, local authorities and health trusts and the details of the stages of that study and who was involved are on the slide. Now, as part of that work, we carried out intensive interviews with parents in each of the eight areas. 

What we learned from the parents was the many difficulties that they had already experienced in their own childhoods. And so we think understandings of complex trauma are really important when we start to think about how best to work and engage proactively with parents. In this situation, the fathers that we interviewed for the study gave us a sense of how much they felt on the periphery of antenatal care and pre-birth assessment and support On the whole. Their feelings could be generalized into that they either felt that they were seen as a risk and excluded something to be avoided or that they were a protective factor, and that there was a lack of nuance that they could be both. And the Fathers network also felt excluded, not routinely included in support plans, for example, or where there were family group conferences. 

This finding correlates with the broader literature around fathers in child protection work, and we will talk more about this as we move through the resources and draw on the work of other academics and practitioners in this space. There were a number of key challenges identified by practitioners and parents across the study,and they're listed on the slide here, time and delay, late pre-birth assessments, changeover of social workers, and also between teams, all added to the delay experienced by parents, a lack of continuity of professionals, and that was both midwives and social workers. 

The challenges of the assessments processes not being specialized enough, being too long, starting too late, the challenge of the legal process, the timing, the expectations of parents, particularly mothers so close to giving birth problems of system alignment that led to more in built delay and poor communication, the importance of multi-agency working, but the challenges of achieving it and where that wasn't achieved, the frustrations for parents. 

And finally, the access to specialist resources in a timely way to really be able to support parents in the way that was needed. Following the research, the best practice guidelines were published in 2023. They include recommendations relating to the pre-birth period, support in the maternity setting and post-separation support. The recommendations include those that are aimed at organizational and strategic level, as well as those that are more relevant at the individual practice level. On the next two slides, you can see some of those overarching messages, which will also be picked up throughout the rest of this resource. 

So we started with, um,and this was in discussion with, with the local areas. 

Most of them chose to have quite a broad broadcast of the findings and of the, of the, of the, um, guidelines. So they asked us to come and do a, a webinar where they invited sort of key people from across the system. We just did a kind of 45 minute, these are the key findings, this is what we are aiming to do. And that was because they wanted to, well, one, just to spread the word that this work was happening,but also that they wanted to galvanize some passion for change. And really what in a, in some areas what came out of that was that champions appeared. And so they were almost self-selecting, which then meant when they set up their steering group, it was people, it was people who had a, a passion and commitment. So that was the first stage in most areas. 

And then we had, um,much more in depth local area workshop at those workshops. 

Um, we, people had already come to a webinar, so we didn't go back through all the findings,but what we did was pull out those different areas.So we did the first exercise around pre-birth support and intervention, um, and, um,and antenatal care, the second on in the maternity setting.And the third on, on post-discharge support.Um, and we put up the kind of key recommendations from,from the guidelines, gave people a chance to kind of digest that. And then they worked together in multi-agency groups to think about where are we at now and where do we want to get, where do we think we are doing? Okay, where do we think we really need to make change and what are our priorities? So if we had to kind a vote on where we think we should start change, and some places decided to focus on an area where there was already change happening or it fitted with other priorities for that local authority. But what that really allowed them to do was to start to see what, how the priorities mapped across the multi-agency system and start to get some real buy-in change. And outta that came a local area action plan, um,where they were able to say, right, these are the areas that we, we really want to start bringing about change.Um, set up a multi-agency steering group to oversee that local area of action plan, but then set up some task and finish groups underneath that.So once they'd identified, right, okay, here's our,here's our local area action plan. This is our priority. These are the things we need to happen, let's now set up a, a series of tasks and finish groups to make that happen. So I thought, these are the guidelines. The generally the local area action plans were focusing, um, on both organizational structures and practitioner focused activities.'cause that's how the guidelines are separated.But what it did do, being able to give some powerto people on the frontlinewho are doing the day-to-day practice to be able to think about how could we change some of this felt really meaningful for those people that are doing the kind of face-to-face interactions. They were very much involved in, in that work. These are the actions out of the guidelineand they just rated themselves against them. 

They literally just literally did a red, Amber Green against each of each of these action statements from the guideline and then used it as a monitoring process,put it in a shared space, and it just gave a bit of focus to the,to the local steering groups. And then, and then finally,I suppose the other point was really thinking about evaluation from the beginning. So a couple of areas said to us, can you help us just identify what our baseline measures should be? 'cause how are we gonna know that this is working? If we are gonna get, if we want to get continued investment from our senior managers in giving me time to do this or giving us some more resource to do this, we need to be able to show it's having an impact.But we just went, went through the guidelines and thought, how would you,how would you measure this in your system? And we spoke to a few of the quality assurance people, um,within local authorities. And, and really there were three, three bits of learning. One is that actually some of this can be generated, but via your standard reporting, if you, if you've, if you've got the question, some of it can be generated but not a lot. Some of it requires for additional fields to be added to Mosaic or whatever it is that you are, you are using. And then, um, is it worth doing a case file audit? So, um, again, in Blackpool they took a, a, a, a case file audit approach because they wanted to be really sure that any interventions, um, that were offered in that perinatal period matched what they knew were the needs of that particular cohort of parents. So we've got the national findings,but they really wanted to be sure that it stacked up locally and matched the local profiling. So in that case file audit, they've done a, a profile of the parents' characteristics, but, and, and parents', um, particular needs, but also really started to think about what services have we been,have we just been offering too much and it's not coordinated, or are there real gaps? Can we see any difference in that? What can we learn about those that referred early and got support for longer compared to those that didn't? So some of you might decide, and it is, I understand it's, it is really a, a, a big intensive, um, resource requirement to do a case file audit. But if you want to get really good baseline data that's probably, and really help you think about where to focus your resource, that is probably the best thing to do. Um, so the, the, the things on here, um,look at referral assessment as support legal processes. We've put in family group conferences because we've got an emphasis on that in the guidelines. Some of you might have other family decision making models,um, but also what midwifery capture.Um, so this isn't just about children's social care information, but there really simple things. Um, like for example, the, as soon as the baby's date of birth was recorded on the system, the estimated due date just disappeared, which then meant that if you look retrospectively, you couldn't work out what point of gestation they'd been referred in because it, it could have been a premature baby if it was three or four weeks early, then those dates no longer told you anything. So it's just simple things like that that can actually really change the way in which you 

understand your own data and a lot of that stuff around legal processes, um, and is held, I dunno about for you, but in a lot of the areas that we were working in, they had their own system and the two just didn't speak to each other. 

So getting some of the timing around understanding whether you were having an impact on some of the data and timings around first court hearing was really difficult to get hold 

of, um, and didn't marry up with what you could get from your kind of standard, um, children's system. So yeah, that was a challenge for some areas. So they're starting to look at how they can link that data more effectively. 

If you are a practice leader with responsibility for pre-birth assessment practice in your organisation, you can use the Red Amber Green (RAG) tool to help you:  

• Think through which of the key themes it would be most helpful to focus on.
• start to consider how you can develop an action plan to strengthen pre-birth practice in your local area . 

The RAG rating tool emerged from the Born into Care research programme and links with Best Practice Guidelines (Mason et al., 2023).

Listen to this podcast from the Family Justice Data Partnership that explores what lies behind the statistics? Claire Mason speaks with colleagues Pauline, Amelia, and Reuben, from Blackpool Borough Council, highlighting Blackpool's innovative work to reduce high rates of infants entering care.

The following reports published by Born into Care:

• Born into Care: Newborns in care proceedings in England. 
• Born into Care: Newborns and infants in care proceedings in Wales.  
• Born into Care: One thousand mothers in care proceedings in Wales.  
• Born into Care: Newborn babies in urgent care proceedings in England and Wales. 
• Born into Care: Developing best practice guidelines for when the state intervenes at birth.  
• Born into Care: Best practice guidelines and other resources.  
• Born into Care: Understanding care pathways and placement stability for babies in Wales. 

• Alrouh, B., Broadhurst, K., Ford, D., John, A., Jones, K., Cusworth, L., Akbari, A., Smart, J., Thompson, S., & Griffiths, L. (2021). Health vulnerabilities of parents in care proceedings in Wales. Nuffield Family Justice Observatory. https://www.nuffieldfjo.org.uk/resource/health-vulnerabilities-parents-care-proceedings

• Bilson, A., & Bywaters, P. (2020). Born into care: Evidence of a failed state. Children and Youth Services Review, 116. https://doi.org/10.1016/j.childyouth.2020.105164

• Bywaters, P., Brady, G., Sparks, T., & Bos, E. (2016). Child welfare inequalities: New evidence, further questions. Child & Family Social Work, 21(3), pp. 369–380. https://doi.org/10.1111/cfs.12154

• Doebler, S., Alrouh, B., Broadhurst, K., Bedston, S., Cusworth, L., Akbari, A., Ford, D., & Griffiths, L. (2021). Explaining high rates of infants in care proceedings in deprived areas of Wales. Nuffield Family Justice Observatory. https://www.nuffieldfjo.org.uk/resource/infants-care-proceedings-deprived-wales

• Griffiths, L.J., Johnson, R.D., Broadhurst, K., & John, A. (2021). Born into care: One thousand mothers in care proceedings in Wales. A focus on maternal mental health. Nuffield Family Justice Observatory. https://www.nuffieldfjo.org.uk/resource/born-into-care-maternal-mental-health

• Broadhurst, K., Alrouh, B., Mason, C., Ward, H., Holmes, L., Ryan, M., & Bowyer, S. (2018). Born into Care: newborn babies subject to care proceedings in England. The Nuffield Family Justice Observatory: Nuffield Foundation. 
• Pattinson, R., Broadhurst, K., Alrouh, B., Cusworth, L., Doebler, S., Griffiths, L., Johnson, R., Akbari, A., & Ford, D. (2021). Born into care: Newborn babies in urgent care proceedings in England and Wales. Nuffield Family Justice Observatory.