Judith Harwin

Promotion of children's rights and prevention of child maltreatment

In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of childrens human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment. Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem. We describe how childrens rights provide a different perspective on child maltreatment, and contribute to both public-health and protective responses. Childrens rights as laid out in the UN convention on the rights of the child (UNCRC) provide a framework for understanding child maltreatment as part of a range of violence, harm, and exploitation of children at the individual, institutional, and societal levels. Rights of participation and provision are as important as rights of protection. The principles embodied in the UNCRC are concordant with those of medical ethics. The greatest strength of an approach based on the UNCRC is that it provides a legal instrument for implementing policy, accountability, and social justice, all of which enhance public-health responses. Incorporation of the principles of the UNCRC into laws, research, public-health policy, and professional training and practice will result in further progress in the area of child maltreatment.

Monitoring children's rights globally: can child abuse be measured internationally?†

UNICEF is developing indicators to measure the compliance of signatory states with the United Nations Convention on the Rights of the Child, 1989. This article explains the role of international indicators in relation to the reporting process integral to the Convention. It then discusses the possibility of developing an indicator to measure child maltreatment globally. Practical and definitional obstacles are considered and measures suggested by other authors, including the rate of child homicide, are critically considered. The article concludes that at present there is no valid measure that allows child maltreatment to be measured globally but that a number of positive steps can be taken to promote awareness and measurement of child maltreatment internationally and these are discussed. Copyright

The role of the court in cases concerning parental substance misuse and children at risk of harm

This article explores the potential of a specialist family drug and alcohol court, a new court‐based intervention to be piloted by government, for children at risk of care proceedings due to parental substance misuse. It examines the reasons for the initiative and considers its potential to improve outcomes for children. It concludes with a discussion of the key issues to be tested out through an independent evaluation of the pilot.

Vulnerable birth mothers and repeat losses of infants to public care: Is targeted reproductive health care ethically defensible?

This article aims to advance debate about the ethics of targeted reproductive health care for birth mothers who have experienced recurrent care proceedings. Making reference to new research evidence that reports the scale of the problem of repeat care proceedings in England, the article considers the role that enhanced reproductive health care might play in helping mothers exit a cycle of care proceedings. Emerging practice initiatives are introduced which are all stretching the boundaries of statutory intervention, by working intensively with mothers following removal of children to public care. The central argument of this paper is that a positive interpretation of rights provides a warrant for providing enhanced access to contraception, but this must be part and parcel of a holistic, recovery focused approach to intervention. Caution is also raised in respect of the reasons that may lie behind a pattern of rapid repeat pregnancy for this particular group of women. Issues of loss and grief are clear complicating factors in reproductive decision-making where an infant or child has been removed to public care, the magnitude of which must be firmly acknowledged. Charting novel theoretical ground, the discussion draws on a conceptual vocabulary from the literature on other forms of perinatal loss, suggesting that the notion of ‘replacement baby’ may help to explain why some mothers are caught in this negative cycle. Although this article is prompted by escalating concerns about the human and economic costs of repeat care proceedings in England, the discussion will be relevant to a number of international jurisdictions such as the USA, Canada and Australia where cognate systems of child protection give rise to similar patterns.

Strengthening prospects for safe and lasting family reunification: can a Family Drug and Alcohol Court make a contribution?

This article examines the contribution of the first Family Drug and Alcohol Court (FDAC) within care proceedings in England and Wales. It asks what FDAC can contribute to family reunification amid concerns about the safety and sustainability of return home and significant changes in care proceedings under the Children and Families Bill of 2013. Features of FDAC as a problem-solving court are outlined and findings of an independent evaluation are presented to consider FDAC’s contribution to safe return home at the end of the care proceedings. The likely impact of the Children and Families Bill of 2013 on FDAC’s reunification objectives and the rationale for an FDAC aftercare service are discussed. The article concludes that FDAC has the potential to play a useful role in promoting safe reunification at the end of care proceedings. The Children and Families Bill of 2013 creates both opportunities and challenges to the FDAC model in respect of its approach to enhance safe reunification prospects, and adaptations will be necessary. There is a strong case to develop an FDAC aftercare service to help promote lasting reunification and safe and committed parenting.

Applying the 5-Step Method to children and affected family members: Opportunities and challenges within policy and practice

The main aim of this article is to consider how the 5-Step Method could be developed to meet the needs of affected family members (AFMs) with children under the age of 18. This would be an entirely new development. This article examines opportunities and challenges within practice and policy and makes suggestions on how the Method could be taken forward. It argues that there is a strong rationale for developing the 5-Step Method and considers a range of settings where it could be introduced. Early intervention settings such as Sure Start Centres and schools are considered particularly promising, but childrens services, particularly targeting ‘children in need’, could also benefit considerably from this approach. This article counsels against its usage, at least in the first instance, in serious child protection cases. After considering implications for training and support, a number of practice barriers are identified and suggestions made as to how to address them. This article considers the policy opportunities and challenges and finishes with a brief discussion of some future avenues of inquiry to maximize the potential of the 5-Step Method evidence base in general.

How does FDAC Succeed with Parents with Substance Misuse Problems? Exploring Relational Practices within the English Family Drug and Alcohol Court: How does FDAC succeed with parents with substance misuse problems?

Parental substance misuse is a significant risk factor for child maltreatment and is frequently involved in care proceedings. Outcomes are often poor and family reunification is prone to breakdown. In this article, the contribution of the English Family Drug and Alcohol Court (FDAC) is examined. Adapted from the US family drug treatment court model, FDAC offers a radically different approach to ordinary care proceedings by treating parents as well as adjudicating. The article draws on a mixed‐methods evaluation of FDAC which reports better recovery and reunification rates than ordinary court. It presents findings from interviews with 42 parents and 154 court observations of 89 cases, focusing on FDACs relational practices. The article concludes that these relational practices offer hope to substance‐misusing parents and that the approach merits wider attention because of its therapeutic potential and distinctive approach to justice. Key Practitioner Messages FDAC is a helpful approach to care proceedings for substance‐misusing parents. Parents value clear, consistent and honest messages about their progress when delivered in the context of trusted relationships and intensive support. Parents need holistic help that takes into account damaging early‐life experiences.