The health needs of mothers and children in family court cases

The Nuffield Foundation has funded a number of highly influential projects in family justice using administrative data from the case-management system held by the Children and Family Court Advice and Support Service (Cafcass).  These projects have looked at: the enforcement of contact orders in private law; the use of supervision orders and special guardianship orders as alternatives to adoption in public law; and the proportion of cases that involve mothers who have had one or more children subject to potential removal by the state.

This new, path breaking project, co-led by Professor Ruth Gilbert and Dr Linda Wijlaars, builds on the third of these studies, which highlighted the very limited availability of interventions to address the needs of vulnerable mothers who repeatedly appear before the family courts. It will link together administrative health and courts data for the first time, in order to explore the potential for healthcare services to reduce the chances of mothers or children becoming involved in care proceedings, once or multiple times.

The first part of the project linked Cafcass data to mental health service use data in South London held in the Clinical Record Interactive Search (CRIS) database, and was completed in 2021 (see publications below). The data from this linkage was used to describe the frequency, type and severity of mental health problems in mothers involved in care proceedings, patterns of mental health service use before and after involvement with the family courts and investigate characteristics associated with subsequent involvement with the family courts (particularly recurrent vs non-recurrent proceedings).

This work found that in South London around two-thirds (66%) of mothers involved with care proceedings had a record of contact with mental health services between April 2007 and March 2019. Amongst women who had a record of contact with mental health services, four-fifths (79%) were known to mental health services prior to the initiation of care proceedings, around 1 in 5 women had a diagnosis of schizophrenia spectrum disorders (19%) and personality disorders (21%), and 1 in 3 (33%) had a record of substance misuse. Approximately 20% of women involved in an initial set of care proceedings and known to mental health services prior to initiation will return to court with a subsequent infant within eight years.

Part two of the study involves linking Cafcass public law data to national hospital data (Hospital Episode Statistics) for all women giving birth in England. The linked data will be used to identify mothers involved in care proceedings and to follow them up in their anonymised hospital records to understand their health needs and hospital contacts before, during and after court proceedings.

The aim of these analyses are to identify whether additional inputs from healthcare services could reduce the chance of a mother or child becoming involved in care proceedings, and improve their health and welfare outcomes. In addition to generating substantive outputs, the data linking process will be both ground-breaking and methodologically challenging.  All linkage algorithms would be made available for future research, and a methodological paper will be produced to inform future studies.