The Family Drug and Alcohol Court: a new approach to care proceedings, Tavistock and Portman NHS Foundation and Coram

Themes this local practice example relates to:

  • Safeguarding
  • Families, Parents and Carers
  • General resources

Priorities this local practice example relates to:

  • Protecting children living in families where they are at high risk of abuse, harm or neglect
  • Improving the safety, health and wellbeing of children through improving the physical and mental health of mothers, fathers and carers
  • Improving children’s outcomes by supporting parental and carer couple relationships and reducing conflict within families, including domestic violence

Basic details

Organisation submitting example

Tavistock and Portman NHS Foundation Trust and Coram charity
In conjunction with London Borough of Islington

Local authority/local area:

Islington, Camden, Westminster and Hammersmith and Fulham (H&F)


The context and rationale

An independent evaluation of the Family Drug & Alcohol Court (FDAC) Evaluation was conducted by Professor Judith Harwin and a team at Brunel University. It was funded by the Nuffield Foundation and the Home Office. The final evaluation report and highlights are available at www.brunel.ac.uk/fdacresearch andwww.Nuffieldfoundation.org 
Harwin, J., Ryan, M. and Tunnard, J., with Pokhrel, S., Alrouh, B., Matias, C. and Momenian-Schneider, S. (2011) The Family Drug and Alcohol Court (FDAC) Evaluation Project Final Report. Brunel University.

The Family Drug and Alcohol Court (FDAC) is a new approach to care proceedings, in cases where parental substance misuse is a key element in the local authority decision to bring proceedings. It is being piloted at the Inner London Family Proceedings Court in Wells Street. Initially the pilot was to run for three years, to the end of December 2010, but is now to continue until March 2012. The work is co-funded by the Department for Education (formerly the Department for Children, Schools and Families), the Ministry of Justice, the Home Office, the Department of Health and the three pilot authorities (Camden, Islington and Westminster).

FDAC is a specialist problem-solving court operating within the framework of care proceedings, with parents given the option of joining the pilot. Working with the court is a specialist, multi-disciplinary team of practitioners, the only such team in the UK.

The multi-disciplinary team is provided by a partnership between the Tavistock Portman NHS Foundation Trust and Coram Family. The team carry out assessments, devise and co-ordinate an individual intervention plan, help parents engage and stay engaged with substance misuse and parenting services, carry out direct work with parents, get feedback on parental progress from services, and provide regular reports on parental progress to the court and to all others involved in the case. Attached to the team are volunteer parent mentors to provide support to parents.

Cases in FDAC are heard by two dedicated district judges, with two further district judges available to provide back up for sickness and holidays. Cases are dealt with by the same judge throughout. Guardians are appointed to FDAC cases immediately. Legal representatives attend the first two court hearings, but thereafter there are regular, fortnightly, court reviews which legal representatives do not attend, unless there is a particular issues requiring their input. The court reviews are the problem-solving, therapeutic aspect of the court process. They provide opportunities for regular monitoring of parents progress and for judges to engage and motivate parents, to speak directly to parents and social workers, and to find ways of resolving problems that may have arisen. 

The independent evaluation notes that FDAC is distinctive because it is a court-based family intervention which aims to improve children’s outcomes by addressing the entrenched difficulties of their parents. It has been adapted to English law and practice from a model of family treatment drug courts that is used widely in the USA . The catalysts for the FDAC pilot were the encouraging evidence from the USA and concerns about the response to parental substance misuse through ordinary care proceedings in England: poor coordination of adult and children’s services; late interventions to protect children; delays in reaching decisions in court; and soaring costs of proceedings, linked to the cost of expert evidence. 

The main aim of the initiative and its evaluation was to test out the following:-

• To discover whether the FDAC model improves outcomes for children in terms of either better rehabilitation or earlier placement outside the family if parents fail to engage. 
• To see whether parents are successful in controlling or giving up their substance misuse and whether there is greater engagement and retention with substance misuse services - as opposed to parents not able to access the FDAC. 
• To examine whether it is possible to increase the Court’s confidence in making decisions without the need for receiving reports from a wide range of external experts.

The practice

A Steering Group was formed in 2003 to look at the possibility of developing a Family Drug and Alcohol Court in a Family Proceedings Court in England. In 2005, the FDAC Steering Group commissioned a study to establish the feasibility of developing a similar model to the Family Treatment Drug Courts (FTDC) within the English legal and social care system. The study, published in July 2006, supported the piloting of the FDAC initiative. The formal, public launch of FDAC took place on 25 November 2007 and the court began hearing cases on 28 January 2008.

The Intervention

The aim of the FDAC is to help parents stabilise/stop using drugs/alcohol and, where possible, to keep families together. Instead of a normal care proceedings court process, a family chosen for the FDAC process will go through a slightly different process, with more regular court hearings with the same judge for the whole process. The key differences between FDAC and ordinary care proceedings are: 
• judicial continuity – FDAC has two dedicated District Judges
• frequent non-lawyer review hearings in which the judges encourage and motivate parents to turn their lives around
• a multi-disciplinary specialist team attached to the court, providing speedy expert assessment, support to parents, links to relevant local services, and parent mentors who have overcome similar difficulties in the past
• quick access to a dedicated team of children’s guardians
• a rapid and co-ordinated treatment and parenting intervention.


The process has been set up specifically to help tackle any drug or alcohol problems. The process involves co-ordinating a range of services so that the family’s needs, concerns and strengths are all taken into account, with everyone working towards the best possible outcome for the children - a stable and safe family which is able to stay together.
Like any care proceedings, there is still a potential for the family to lose their children, but the FDAC process has been set up to encourage success and to be as supportive as possible. Whilst they must take the process seriously, as they would do for normal care proceedings, families need not be fearful that the FDAC is there to trap or trick them in any way.
Once a family is referred for FDAC (similar application and listing procedure as normal care proceedings) they do not have to make a decision immediately. They will be asked at the first hearing on a Monday if they want to commit to the process and it begins immediately if they do give their consent. If they feel they need more time to think about it, they can ask the Court for another week. The family will be encouraged to talk to their Social Worker, and the FDAC team, if they have any doubts or questions over the process. 
If the family sign up to enter this Court, they will have Court hearings fortnightly every Monday, starting 2 or 3 weeks after the first hearing. Between the first and second hearing they will be asked to take part in an assessment day by the FDAC team, who will formulate an intervention plan by the second Court hearing. After the second hearing, interventions will begin and the subsequent fortnightly hearings will be used to provide encouragement, review progress, review the intervention plan, problem solve any difficulties that arise and make decisions in order to reach permanency as quickly as possible.

Support given to the Families

The Court Process

Once the process has started, there will be frequent Court hearings, every 2 weeks until the final review. The whole process will take around 9-12 months, but may be shorter, depending on progress. 
The same District Judge, or one of a small team of District Judges, will oversee the whole process and will be able to review progress at the hearings and offer support and encouragement.
There is an expectation that the family is honest with the FDAC team and the professionals involved, and that they engage with the relevant treatment services to address their substance misuse issues, as well as any other relevant services identified for them. They will also be expected to attend the fortnightly FDAC hearings to review progress of the case. These hearings provide the opportunity to address problems as they arise and review the Intervention Plan. The legal representatives, guardians and other professionals do not need to attend every hearing.
If the parent drops out of the process at any time, the case returns to a regular family proceedings court in a seamless manner, without the need to instigate a whole new set of proceedings. 

Involvement of Parent Mentors and others involved

The following are the intended outcomes of the Pilot:

• A higher proportion of children will be successfully reunited with their parents compared to traditional service delivery.
• A higher proportion of children will achieve permanency, more rapidly, where reunification is not possible.
• Parents are able to access and maintain treatment for their substance misuse.
• Parents are successful in achieving and maintaining controlled substance use or complete abstinence.
• Parents are successful in addressing related psychosocial difficulties (mental health, domestic violence, housing, family planning).
• Children are able to achieve positive outcomes as defined in the Every Child Matters agenda,
o safety, health, education, achievement and enjoyment, and economic well-being.

Evidence and evaluation - making a difference to children, young people and families

The independent evaluation of FDAC reported better outcomes for FDAC children and their parents. 

The evaluation study tracked all cases (55 families, with 77 children) entering FDAC in the first 18 months and compared them with ordinary care cases involving parental substance misuse heard during the same period (31 families, with 49 children). All 86 cases were followed up for six months from the first hearing, and it was possible within the research timescales to follow 60 of them (41 FDAC, 19 comparison) as far as the final order. 

Interviews were held with parents, FDAC judges, the specialist team and the court staff and commissioners involved in the set-up and implementation of FDAC. Focus groups were held with parent mentors and with the professionals involved in FDAC cases (lawyers, children’s guardians, social workers, adult substance misuse workers).

Key Findings from the FDAC Evaluation: 

Substance misuse: more FDAC parents controlled their misuse
• Of the 41 FDAC mothers tracked to final order, 48 per cent (19) were no longer misusing substances by that time. This was higher than the 39 per cent (7 of 19 mothers) in the comparison group. In relation to fathers, 36 per cent of FDAC fathers (8 of 23) were no longer misusing substances, but no comparison father stopped misusing. 

Reunited families: higher rate of FDAC family reunification
• More FDAC than comparison parents were reunited with their children. Of the 41 FDAC mothers, 39 per cent (16) were reunited with their children by the final court order, as opposed to 21 per cent (4 of the 19 mothers) in the comparison group.

Services: more FDAC parents engaged in treatment and other services
• FDAC parents accessed substance misuse services quicker, received a broader range of services in the first six months, and were more successful at staying in treatment throughout the proceedings. More FDAC parents received help from housing, benefits and domestic violence services.

Length of proceedings: a more constructive use of court time
• The average length of cases was the same as in conventional proceedings. The FDAC cases where parents and children stayed together at final order took about eight weeks longer than similar cases in the comparison sample. This can be seen as ‘purposeful delay’, to help consolidate recovery and safe parenting.
• It took on average seven weeks less for children to be placed in a permanent alternative family when parents could not control their substance misuse. Swift decision making when parents cannot address their substance misuse is in line with FDAC’s aims.
• FDAC’s fair approach to parents meant that fewer cases became contested hearings.

Parents and professionals want FDAC to expand
• Parents particularly liked seeing the same judge every time and getting practical and emotional support from the FDAC team. They wanted other parents to have this, too. All the professionals considered FDAC to be a better approach than ordinary care proceedings
and were clear that it should be rolled out. So did the parent mentors.

Engagement with Fathers was better than the comparison boroughs. No comparison father stopped misuse, whereas a small number of FDAC fathers did so. 

Sustaining and replicating your practice

Costs

The independent evaluation team carried out a costs analysis. More information on the costs analysis can be found on the website together with the final evaluation report. 
Savings for local authorities and potential savings for courts and the Legal Services Commission
• The average cost of the FDAC team per family is £8,740 over the life of the case. This cost is offset by the savings to local authorities from more children staying within their family.
• FDAC reduced costs in other ways, too: through shorter care placements (£4,000 per child less); shorter court hearings and less need for legal representatives at hearings (saving local authorities £682 per family); and fewer contested cases. In addition, the specialist team carries out work equivalent to that done by experts in ordinary care cases. This saves £1,200 per case.
• FDAC has the potential to save money for courts and the Legal Services Commission and, in the longer term, for adult treatment, health and probation services. The costing method used for this evaluation provides a solid basis for investigating the cost effectiveness and cost benefits of the FDAC model.

Challenges

This report, alongside the interim and final independent evaluation reports, highlights the challenges the FDAC had to contend with during the pilot phase, and on going challenges. We have highlighted some of these below:
- Longer period between appointment of the team and the Go Live date would have been useful (was approximately 2 weeks and Court started without team in place).
- Challenge of parent mentors recruitment, retention and funding.
- Changing the culture of a Court system and resistance initially from professionals (training, one days and focus seminars were really important to address this).
- Identifying the right cases by the local authorities.
- Bringing together adult and child perspectives and developing relationships with local agencies took time and effort.

Replication

The promising findings from the FDAC evaluation suggest there would be merit in limited roll-out of the intervention. 

The following recommendations were made:

• The evaluation found that the majority of parents who entered FDAC had longstanding and entrenched difficulties which made these ‘hard cases’ in which to achieve good outcomes. Bringing cases to court earlier might improve the chances of success. This would have cost implications, but it also has the potential to produce savings in the long term if outcomes are improved.
• The provision of a pre-birth assessment and intervention service provided by the specialist team is now being trialled by the FDAC team. The aim is that this will improve outcomes in relation to controlling substance misuse and families staying together. Poor parental engagement at this stage would, however, lead to quicker planning for alternative permanent care. This development is in line with the Allen Review’s emphasis on the importance of effective interventions in the first three years of a child’s life.
• FDAC could also play a valuable role for families living together at the end of the case through the provision of a short term aftercare service. Its purpose would be to help parents sustain their recovery and continue to parent effectively once proceedings end. Research shows that reunifications when parents have misused substances are particularly fragile. 
• The evidence suggests that FDAC is a promising approach that is leading to better outcomes for children and their parents than conventional care proceedings and service delivery. Setting up FDAC in one or two further sites would provide lessons about how the model might be developed in different circumstances. 

We are now exploring how this model can be rolled out across the country.

Key considerations when planning any wider roll-out are: 

• ensuring there is sufficient volume and concentration of work to merit the creation of an FDAC, and 
• determining how best to ensure judicial continuity
• a good network of local substance misuse services and parenting support, and strong local authority partnerships and joint commissioning to share the development costs involved, and 
• Champions for the project within the courts and local authorities. 


FDAC will continue to be evaluated by Brunel University with funding from the Nuffield Foundation. A two year second stage study (June 2011-December 2013) is under way to compare parental substance misuse and child outcomes on the basis of larger numbers of FDAC and comparison cases. The new study will also follow up families that have shown success in FDAC and monitor the success of family reunification and cessation of parental substance misuse.

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