In December the mother is referred to a different service called Family Matters, and they take over from the drugs workers in January 2009. One of the things which is well recognised is that continuity is helpful and that families value it. But by now this mother and child are on to their 2rd health visitor and their second drugs service. It is true that Family Matters have been involved in supplying the methadone: but that is quite a different kind of service from a family role. Despite the name, the service offered in this case was support for mother's detox, so the focus was largely on her. That meant that no social worker was involved, and that is quite usual for that service.Their remit is described as
QUOTE
Provides intensive support on an individual and groupwork basis to highly vulnerable families with
pre-school children.
Once again there is an immediate problem. At the outset, for this service, there is normally a meeting involving staff from Family Matters; the referrer; and the client. The aim is to sign a "Support Agreement". In this case the mother did not turn up for the meeting; so this piece of paper is not completed until April. It is clear from the outset that the mother does not want to engage with this service because she avoids mich contact with them. The allocated worker sees her but not the baby, and she therefore asks the health visitor, in February, to see the child, and she does. Mother and baby are fine.
One significance of this is that it is clear evidence that the professionals were communicating and cooperating. But that positive is not really emphasised in the review: it prefers to focus on the pieces of paper. For myself I would probably have piggy backed on the health visitor's visit: sometimes if you are being avoided it helps if a known worker introduces you, and that can make a difference. Doesn't always work, and I have no idea what other priorities might have been in play. I am a children and families worker so that is natural to me: but this person was a drugs worker and at this point had no reason to be particularly concerned about the baby. In any case the review notes that the Family Matters worker accompanied the mother to the GP on 6th March, and that the health visitor had seen mother and child on that date.
Both the health visitor and the drugs worker seem to me to have done a good job. The drugs worker, in particular, starts to be concerned about mother's possible alcohol abuse and she reports this to the GP and the health visitor in March. At this point the health visitor is about to move to another job, and this is concerning because she is the only person regularly seeing this child.
Throughout April the mother does not make herself available to the drugs worker and this is duly reported to her supervisor: they decide to try unplanned visits but these are not successful either. The review notes that a referral should have been made to the children and families social work team at this point: this is based on the GOPR guidlines: which were not in play. Nevertheless the safeguard of regular contact with the health visitor was not now in place and nobody was seeing this child. The review takes the view that there was by now clear evidence of risk: I don't see it myself: I think that is more hindisght. But it is open to debate. From my point of view there was growing concern and a lot of reasonable actions taken given what was known at the time.
Two staff from Family Matters do make contact towards the end of April: and this visit gives the first concrete evidence of risk, that I can see. The condition of the house had deteriorated and the child was unresponsive. Once again they ask a Health visitor to call: but the only health visitor available is the one who left: and now she only works on Fridays in that practice. She asks the mother to bring the child to the clinic, but she does not do that and there is no further record of health visitor action until August. Not surprising since the child is not actually anyone's responsibility in health visiting terms by now.
Family matters staff continue to work with the mother as best they can in the circumstances but they do not see the child: by August mother is off methadone and this is the point that service normally withdraws. The case can be transferred to the social work children and families team if either there are statutory measures in place; there are child protection procedures in place; or if she agrees The baby's mother made it plain she did not want a referral to social work services for further support, and the case was therefore closed in the absence of either of the other two conditions.
It should be noted that the health visitor who knew them had left: and the senior social worker at Family Matters had also now left: this may well have contributed to the fact that the case was closed without further review. The allocated drugs worker telephoned the new health visitor who was in post by august. She advised they were closing the case and asked the third health visitor to monitor the baby. This does not go at all well and the upshot is that there is no agreement between them: once again the importance of continuity is seen: and that is also a resourcing problem, not an individual failing.
The third health visitor took up her post on 3rd August. Despite the difficult exchange noted above she did attempt to visit twice that month without success: and in September a neighbour told her that the family were staying with the mother's parents (she had moved into her own tenancy the previous September).Further failed appointments are noted and there are telephone contacts during which mother explains that she has been staying with her father in England. Turns out neither of those are true: but that does not emerge until much later, after the child is dead.
The health visitor eventually contacts the social work team the following March.They make two failed visits and decide to close the case. Grandparents then find the baby dead on 30th March: and he has been dead for a long time
In face of all this there are a number of recommendations made by the review: I will consider those tomorrow.
