Evans family case study

Childhood Neglect: Improving Outcomes for Children

Family Case Studies

F1

Evans family case study Background The Evans family live in a three-bedroomed terraced house in a poor housing estate. Fiona does not work, and Steve has a part-time job. There are no concerns about parental drug and alcohol misuse or domestic abuse, but there are concerns that both parents suffer from depression. Money is tight, but the family are reasonably connected within the community. The family did take advantage of various youth clubs and drop-in community centres, but have not been seen as regularly in the last 9-12 months.

Fiona Evans

Fiona is mother to all three children, white and 38 years old.

Steve Evans

Steve is father to the youngest two children, and step-father to Liam. Steve is black and 36 years old.

Liam Evans

Liam is the eldest of three children, white and 15 years old. He has been in increasing trouble within the community and police throughout his teenage years. Liam has not had contact with his father for many years. When Fiona married Steve, Liam was three and his mother changed his surname to Evans.

Shirene Evans

Shirene is 10 years old and of dual heritage.

Lewis Evans

Lewis is 8 years old and of dual heritage.

F1 Evans family case study

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Family Case Studies

F1.1

Fiona Evans’ story “I know that I am not the perfect parent but my kids do ok…

…they get a lot more than I did when I was a kid. The main problem is Liam…he is not a bad kid but he just seems to cause problems between me and Steve all the time, so he is better off out of the house because those two can’t stand the sight of each other…but even when he is out of the way, he still brings trouble to my door with the police and the ASB team as the neighbours are always complaining about him. He’s nearly 16 now and it’s time he stood on his own two feet…sorted his own life, he has got lots of older mates with places of their own, so he won’t end up on the streets. He’s got a lot more going for him than I did at his age – he knows where I am if he needs me. My other two – Shirene and Lewis are doing just fine. The problem is that people keep poking their noses in to our business – neighbours, school and probation. Yes, they have missed some time off school and they don’t always make it to the school trips but so what? That school is rubbish anyway and all the teachers look down their noses at us because some of them know me from when I was a kid and remember me being taken into care…and you see we won’t have our kids being pushed around and we tell them to stand up for them selves with the others…if school don’t like it then that’s tough. School are always saying that Shirene has got nits and that she is passing them on to the others, but how do they know it is her? I have done her hair loads of times and she just keeps getting them again so I don’t bother now…we can’t afford to keep buying the lotion.


I don’t go down to the school much because I like to keep myself to myself. My mum made the mistake of telling our business to the school and the social workers and it didn’t do her any good – I ended up in care as a kid and I don’t have anything to do with my family now. Steve and I have our tough times and sometimes I push Steve too far – but we are as bad as each other, especially when we have had a drink. Steve brings in a bit of extra money doing the taxiing, but we are broke most of the time and we just can’t afford that expensive stuff that kids want these days. The house is a mess – I know, but when you can’t afford to do it up, what is the point in keeping it nice – I just can’t be bothered… I used to go round to the local community centre once a week for a coffee when the kids were younger, so they could play with the other kids but I stopped once they were both a full time school. I know that they do courses down there but it is not for me…I would feel daft going there on my own now…I would love a job but who would employ me? I wouldn’t know where to start”

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Family Case Studies

F1.2

Steve Evans’ story

“Our life is pretty rubbish at the moment…

…there is just not enough money to go around and that makes me feel guilty but I can’t do anything about it. I love my kids but they don’t make things easy…especially Liam. He brings nothing but trouble to my door and I’ve told Fiona that if it carries on I’m leaving. I have done my best with him but at the end of the day he is her son and not mine and he is at an age where he can go it alone – sometimes I tell her ‘It is him or me’… Shireen and Lewis are good kids but they seem to think that money grows on trees…Shireen is going through a stage where she won’t get out of bed in the mornings and that is causing stress because the school are always on Fiona’s back – I leave her to get on with it because she knows how to deal with them. Fiona deals with all the family stuff and the school stuff…she likes it that way.

I bring in a bit of extra cash when I get can a bit of work in the local pizza place and that is the only thing that keeps me going at the moment – the extra money means that I can get down to the social club and have some time away from the family – without this I would go crazy but Fiona doesn’t understand that and it causes a lot of rows…she is always winding me up. The house is a real mess, but what is the point in keeping it tidy if it is all falling apart…we avoid letting anyone in the house because it looks so bad and the upstairs is even worse… It would be good if I could get back in with my family, because I know that they would just love the kids if they got to know them…they would be able to help us out with all sorts of things… babysitting, and help with the kids home work, that kind of thing…but Fiona won’t hear of it because she thinks they look down on her.

I want a better life for Fiona and the kids but we are trapped and I can’t see a way to make things better.” F1 Evans family case study

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F1.3


Family Case Studies

Liam Evans’ story

“Yes, I did steal a Playstation from my mate…

…and I got in to trouble with the police. He gets everything and that year I didn’t even get present from my mum. The only thing that I got for Christmas that year was £20 from my nan…the other time I got into a fight at school because the other lad was calling my mum names…making fun of us and saying that we were scruffs…my mum to told me to give him a good hiding if he said anything about our family – so I did…it takes me half an hour to get to the youth offending team on the bus and I don’t have the money to get there…they say that they will give me the bus fares, but that’s no good to me ‘cos I don’t have the money in the first place to shell out.

as I can because I don’t get on with my mum’s boyfriend and he likes a drink at night so I keep out of his way.

I go out every night so that I don’t have to be in the house, sometimes I don’t even go home after school because there is no reason to. I usually get my tea around a mate’s house or get some chips if I can blag some, or I go without. I usually stay out as long

I feel awful most of the time – tired, fed up, freezing cold and I can’t stop coughing – I can’t go to the doctors though cos my mum said I don’t have one. We moved house a couple of years ago…

I used to get in the neighbours shed with a coat over me, but they found out and rang the police, they thought I was trying to nick stuff. A few times I haven’t realised that it was even morning, and have gone there straight from school. The neighbours all complain about me because I have got pissed a few times in the street – but what else is there to do? I can’t go to the youth club any more cause I’m banned from there.

…so I’m not sure where to go now.” F1 Evans family case study

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Family Case Studies

F1.4

Shireen Evans’ story

“I like school but sometimes it is just too hard to get up in the mornings…

…and I would rather stay in bed and watch the telly - especially when it’s a cold day. Anyway it is embarrassing if I have to go in without the proper uniform on, and I only have one set - I’m not going if I look mucky…sometimes my mum forgets to put it in the wash. Anyway the teachers get on at me and it shows me up in front of the others…where’s your homework Shireen?…where’s your P.E kit Shireen…Why weren’t you in school yesterday Shireen?…you see my mum doesn’t like writing the letters when I have been off, so I get all the questions. I did feel really bad this year when all the others in my class got to go to the adventure park and I didn’t, but it was ok because my friend Natasha didn’t go either so we just went around to her house for the day and watched telly.


I love music and dancing and there is a street dance class that goes on at the community centre on a Thursday…me and my friends sometimes watch through the window…it looks great and the womanasked me if I wanted to come in but I didn’t. If my mum had the money she would let me go…I know she would. I don’t want to ask for too many things anyway because I don’t want to stress my mum. Sometimes when I ask for things she gets cross…not with me but with my dad for not having a proper job…I just don’t ask because it causes arguments…sometimes I can hear them arguing when they think I am asleep. I love going round to my friends for tea because they all sit down together for a meal and we don’t do that at home. I wish I could have them back over to my house sometimes but it is embarrassing…my mum usually forgets that they are coming…the house is a mess and we end up going for some chips instead…”

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Family Case Studies

F1.5

Lewis Evans’ story

“When I grow up I want to be like my dad…big and strong…

My favourite thing is watching wrestling on telly…sometimes me and Liam watch the cage fighting…I want to be a cage fighter when I grow up…I practice on Shireen but she doesn’t like it! (laughs). We sometimes do wrestling in the school playground - I get in to trouble but I don’t care. My dad say’s that I need to know how to look after myself and I don’t want the others calling me a wimp. They used to call me names like smelly and stinky, but they don’t come near me now ‘cos I stand up for myself. I can’t be bothered to go to school and my dad says that I don’t have to go if I don’t want…it’s all boring and it won’t help me in real life. Sometimes my dad takes me on taxiing jobs to the airport instead of going to school and the people give me tips – it’s great! Sometimes I sneak out at night to meet my mate Danny and they don’t notice that I have gone until ages after…my cousin works in the pizza takeaway and he passes us stuff out of the back door so me and Danny get a real feast!


I sneak back in the house when it’s late and go up to my bedroom and I get away with it without anyone noticing. I once got caught though because me and Danny thought it would be fun to steal some of Liam’s cider and we got drunk and forgot to go home. A police woman found us, took us home and gave my mum and dad a warning……they gave me what for the next day! Sometimes at the weekend I stay at Danny’s house and it is great. I like it there because they have nice beds with soft sheets on them – they all get a bed each and they don’t have to share like we do. The first time that I stayed at Danny’s I didn’t know what was going on, when I woke up I thought that it was still night ‘cos it was dark and I realised it was because they had curtains up at the bedroom windows…”.

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Family Case Studies

F1.6

Liam Evans’ history

Records tell us that Liam is 15 years old and that he has a criminal record for offences of damage, violence and theft.

Liam’s mum says she is ‘fed up to the back teeth of him because he brings trouble to her door’.

The local Youth Offending Team Officer tells us that he doesn’t come to his appointments, he is in breach of his supervision order and he is likely to go to prison if he continually non-complies.

The Anti-Social Behaviour Team has him listed for discussion at their next case conference meeting. The local Youth Service have banned Liam from their activities following an incident where he came into the youth club drunk, disrupted the activities and was suspected to have stolen a coat on his way out.

A colleague from Children’s Social Care Services tells us that she knows his 19 year old brother who is addicted to heroin and is currently serving a 2 year prison sentence for burglary. The Police say that he is a nuisance and school says he is often absent and when he does attend he is late and disruptive in lessons. Liam never brings his PE kit and he goes missing at lunch times, presumed to be smoking down the high street.


Liam appears to have a constant cold and a deep, hacking cough but his is GP has not seen him since he was 11 years old. The manager of the local supermarket says that he makes his life a misery with his drunken and abusive behaviour outside his shop late at night. Neighbours on the estate say that they are fed up with the family, and need to lock up garden gates to keep their possessions safe from Liam.

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Family Case Studies

F2

Henderson/Miller/Taylor family case study Background This family live in a three-bedroomed terraced house in a poor housing estate; the same housing estate as the Evans family. Claire does not work; Darren has no regular employment although there are worries that he supplements his income through lowlevel drug dealing. There are concerns about parental drug and alcohol misuse, and possible domestic abuse. There are also concerns about whether Michelle is also using drugs on a regular basis. Money is tight. The family are connected to a small tight-knit group within the community, but not the wider community and, in particular, Claire’s network has decreased since Darren Miller moved into the house.

Claire Henderson

Claire is the mother of all five children, white and 30 years old. She is divorced from Michelle’s father. Claire has some learning disabilities and struggles with her mental health. More recently, her use of drugs and alcohol has increased to levels causing concern

Darren Miller

Darren is Claire’s partner and father of the three youngest children. Darren is white, 45 and was known to children’s services from an early age. He regularly uses drugs and alcohol, and is sometimes involved in low-level dealing. Darren’s temper is well-known within family and friends; neither Claire or the children have yet been hit, but have felt threatened at times.

Michelle Henderson

Michelle is 16 years and pregnant. The whereabouts of her own father is unknown and the father of her unborn child is Jim. Jim is 30 and a friend of Darren’s.

Troy Taylor

Troy is 12 years old and white. Troy is settled and doing well in school. He is sometimes in trouble at school for behaviour, but this is considered to be within the normal spectrum and is managed within the classroom. He is Michelle’s half-brother and sees his father occasionally, but stays overnight some weekends with his paternal grandparents.

F2 Henderson/Miller/Taylor family case study

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Family Case Studies

F2

Susan Miller

Susan is 6 years old. She has learning and mild physical disabilities.

Ryan Miller

Ryan is 3 years old and unsettled. Staff at his local nursery have noticed that, when Ryan attends, he has limited ability to concentrate such as during group storytime or working oneto-one with staff completing jigsaws. Concerns are being raised about possible foetal alcohol syndrome.

Kimberley Miller

Kimberley is the youngest and only 12 months. She is described by her parents as a “good baby” and undemanding compared with her siblings at this age.


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Family Case Studies

Claire Henderson’s story “What is the problem…? It is my business if I drink and smoke a bit of stuff now and again…

…everyone has a drink these days don’t they? I am not rolling about drunk and I can still look after my kids so what’s the big deal? Anyway, it helps me get through the day…after Kimberley was born, I felt very down again, like I did after the other babies and sometimes I need a bit of something to get through the day…I am not addicted to anything…I can’t afford to be! Money is very tight, but everyone needs a blow out now and then or they would go mad. Our Michelle is pregnant but she’ll be ok – Jim will see her alright. I know that he’s a bit old for her, but they make their own choices don’t they? Any case, she needs him now, she is his responsibility and I have enough on my plate with the younger ones… Jim has known Michelle for years…he has seen her grow up. I wasn’t keen when they first got together, but what can you do?

She is 16 now. The midwives keep coming round trying to see her but I don’t know what all the fuss is about…pregnancy is not an illness. I was 6 months pregnant with my first before I even knew, never mind the doctors! Women have been having babies since day dot without nosey parkers doing checks and tests. The younger kids are ok, they do just fine - Troy is a bit of a handful but what boy his age isn’t? Susan is no bother at all - she loves the telly and she never makes a peep. Ryan and Kimberley were not planned - I admit that, and before they came along, Darren had made it clear that he didn’t want any more kids so it has been hard. They all do as they’re told and they know when to keep quiet - their dad has a foul temper and we all get out of his way when he starts. Me and Darren like to get out a couple of times a week but we can’t afford a sitter - if Michelle is in she will look after them, but if not, there is always someone on the street that will sit for a couple of hours…

…it usually only costs us the price of a few cans so that’s not bad…” F2 Henderson/Miller/Taylor family case study

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Family Case Studies

F2.2

Darren Miller’s story

“I am getting angry now…

…People keep sticking their noses in our business and I am not having it…school have got the message…they don’t bother us any more cause I gave that teacher what for…

away with doing nothing once the baby was born, but we got it sorted and showed them all that we didn’t need anyone else interfering.

These kids get more than most on this estate. We don’t just wait for the benefit handouts like the others do…I get off my backside and bring in some extra for the family - you have to don’t you?

Once we had the neighbours reporting that we weren’t looking after the kids properly and the social came in and helped us for a bit - you know with those support workers, helping to get the kids up in the mornings and taking Claire down to the shops and that…it would help if we could get that sorted again.

The social have been around here loads of times in the past, and they always end up saying that things are ok - we have our bad times, but we always come good in the end. We did have some problems after Susan was born and the house got pretty bad, but that was Claire’s fault, ‘cause she thought that she could get

Anyway who says we are not looking after our kids? I want to know and I will sort them out?…I am not answering any more questions…

…go away and bother someone else…” F2 Henderson/Miller/Taylor family case study

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F2.3


Family Case Studies

Michelle Henderson’s story

“I love Jim, and he loves me…

He lives with his mum just now, but when our baby’s here we’ll be getting our own house. Jim’s going to get his other children to live with us and we’ll be a proper family. He isn’t like my mum and Darren - ok he likes a bit of a smoke just like me, but we’re not junkies, we know how to say ‘no’. Darren is a bit of a creep, Jim says he’s a good bloke, but he’s really bossy to my mum and all of us - I’ll be glad to be away from him, although I am worried about the other kids. They could come and stay with us sometimes though.

I know I’ll be a good mum not like my mum. I’ll make sure my kid goes to school and gets qualifications and a good job and a house and car. I couldn’t keep up at school because I missed too much when I stayed at home to help with the little kids. Anyway, the teachers didn’t like me and the other girls didn’t like me - they called me fat and smelly. I’m fed up with social workers always coming round - they never helped my mum one bit. The nurses are the same. Jim says I should make sure his baby is all right so I did go, but the nurse was really nosy and cheeky about my weight.

If everyone gets off my back I’ll be fine.” F2 Henderson/Miller/Taylor family case study

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Family Case Studies

F2.4

Troy Taylor’s story

“I used to love school…

…it was great in the juniors and my teacher was really kind to me but it is not the same now that I have gone to High School. I want to do the homework but I get in trouble ‘cos I don’t get it in on time. I can never find my stuff and there is nowhere quiet in our house to do it - if I put it down anywhere it get’s thrown out or messed up. My favourite lesson is food tech because we get to cook and then take the stuff home, but it’s got really embarrassing because I never have the ingredients that I am supposed to take in so I use my mates stuff and we share. I love P.E. especially when we go swimming but I can’t go now ‘cos I have really bad verrucas and the P.E teacher says I need to get rid of them before I can go in the pool. They sent a letter home, but my mum didn’t get the stuff to get rid of them - she says they will go away on their own. I have a really short temper, just like Darren and it is worse when I’m tired. Sometimes the other kids wind me up about stuff…I’ve lashed out a couple of times at school but nothing serious. My mum and Darren are really chilled…not like some of the other parents. They let me stay up ‘till past midnight if I want


and I play on the playstation. As long as I don’t go in the room where they are…they don’t mind me being up. Sometimes I fall asleep playing games and wake up the next morning on the floor or in the chair. I am late for school most days, but I get away with it…I think my teacher expects it now and he doesn’t say much. We used to have some women that came in from the social to help my mum, and it was better for a while. They helped her with the tea and house and stuff but she doesn’t need them anymore ‘cos I am getting older now and I can help out more. There are some after school clubs that I would like to join - the boxing and the football but my mum says that she wants me to come straight home so that I can pick Kimberley up from school on my way back home. I know it’s hard for my mum…having the younger kids and all, and I don’t want to cause problems between her and Darren, ‘cos he can get nasty. So I just do as I am told and help out with the younger kids ‘cos Darren says I am lucky really - he gives me a roof over my head and he doesn’t have to, ‘cos I’m not his…”

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Family Case Studies

F2.5

Susan Miller’s story

“I love going to school - it is my favourite place in the world…

My teacher is really kind to me and she looks after me. This morning, she gave me a biscuit for my breakfast and a glass of juice. When the other kids say I smell, she tells them off and sticks up for me. I love the school dinners, they are the best thing I have ever tasted. I wish we could have food like that at home…but most nights we have a plate of chips for tea but sometimes for a treat, my dad lets us have just sweets…that’s all…just loads of sweets - its great! Sometimes we don’t have anything at all for tea and I go to bed with a rumbling tummy, but it goes off… Some nights I can’t get to sleep because there is loud music playing and I keep hearing the doors banging. I think that it is dad’s friends coming in and out…I sometimes hear them laughing and shouting.


Troy plays on his Playstation in my room and it is fun because he sometimes lets me play. Saturdays nights are fun because we get a baby sitter…sometimes it is Chloe or Jenny from down our street and they bring their boyfriends with them…they let us do anything we want and once, I played out in the garden until my mum and dad came home. My teeth hurt a lot and the other kids say that I have smelly breath. My dad jokes that if I don’t stop complaining, he will pull them all out for me! A lady that came to our school to do a check said that my mum needs to take me to the dentist but I haven’t been yet…”

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F2.6


Family Case Studies

Michelle Henderson’s history

Records tell us that Michelle is just 16 years old and has been known to agencies for many years in relation to her mother’s learning disabilities, mental health problems and substance misuse. Her mother, Claire, tells us that during a family argument Michelle screamed, ‘Anyway, I’ll be out of here soon. I’ll be moving in with Jim, and we’re having a baby!’ Claire says she’ll need help with the younger children if Michelle moves out. The nurse from the local surgery tells us that Michelle is 6 months pregnant and has only recently attended the surgery under pressure from her partner, Jim, whom they understand to be a friend of Darren - Claire’s partner. Apparently Michelle frequently misses appointments and the records show that she was not brought for appointments as a baby or younger child. On the basis of a couple of short meetings there are already some con-


cerns. Michelle is a heavy smoker, but says she is totally hooked and could never give up, and anyway, it will be an easier birth if the baby is smaller. She also says it helps stop her getting too fat, and Jim wouldn’t love her if she was fat. She says she doesn’t need any advice about babies because she had to look after her siblings all the time because her mother is a ‘junkie’. The local school records indicate that Michelle had enjoyed primary school, and although was often late, attended regularly. Her attainment was in line with the average for her class. At secondary school her attendance rates fell dramatically. A range of efforts were made by the school to tackle this, with little success. Her reading remained at the level it was when she left primary school and she made minimal progress in other subjects. She virtually ceased attending school from 15.

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Family Case Studies

F2.7

Michelle Henderson’s chronology 1994

Michelle born. Single parent family. Her mother, Claire, has some learning disabilities; mental health problems and misusing substances.

1995

Michelle’s immunisations not completed.

1996

Michelle seen at GP surgery with mother who had a black eye? A happy, lively two year old.

1997

Appointment for pre-school immunisation missed.

1998

Half-brother, Troy, born. Michelle immunised. Query re hearing. Michelle starts Primary School. Regular attendance.

1999

Satisfactory progress in class; but often late. Teacher reports Michelle is always trying to catch up with other pupils. Tries hard. Often on her own.

2000 2001 2002

Troy, her brother sees his father.

2003

Mother’s new partner - Darren - moves in to live with the family. Michelle moving to Secondary School in the summer. Missed introductory visit. Darren is getting her school uniform. Troy’s grandmother says she will get his.

2004

Sister Susan born. Learning disabilities? Physical disabilities? Michelle moves to Secondary School. Attendance good. Often seems distracted. Linked with a peer educator for 6 months.

2005

Attendance poor. Parent invited to Parents’ Evening. No response. No parental contact before or after school. Primary School report that Michelle takes her brother in each morning. Her brother waits at the school gate for Michelle to collect him. Michelle says that Darren says that this is her job. Mother’s partner confronts Headteacher of Primary School about her questions about Michelle dropping off and collecting Troy from school.

2006

Michelle shares her bedroom with Susan, her 3 year old sister. Injury to her left hand – lowering side of cot to lift her sister out. Not able to complete written work because of bruising. Clothes crumpled but cleanish. Susan checked for squint. Appointment arranged with opthamologist.

2007

Brother Ryan born. Possible fetal alcohol syndrome. Nursery informed about baby crying in family home. No lights on or movement. Mother in neighbour’s house all evening. Ryan’s father not around. Troy reported to be wandering around the neighbourhood. Family Support worker provides practical support in the family home. Troy is linked with a befriender.

2008

Significant concerns about Michelle’s school attendance. She arrives late and leaves early. In class, she seems to be totally preoccupied. Her teachers find it difficult to get through to her. Family Support worker reports improvements in family life. Family to get further support from local nursery, where Ryan has a place on three days of every week.

2009

Mother pregnant. Family move to stay with Jim and his mother. Troy stays with his grandparents. Community Police Officer tells Darren that Troy is stealing cars.

2010

Sister Kimberley born. She is not demanding. Michelle, aged 16, is found to be 6 months pregnant when she attends the G.P. surgery. Jim, aged 30, says he is the father and that Michelle will be a great mum as she is naturally caring so will do whatever the baby needs. Darren states that Kimberley is a good baby and that Claire is a great mother and that he, as the father, will provide whatever is needed; and Michelle is still there to help out whenever they need her help


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Family Case Studies

F2.8

Troy Taylor’s history

Records tell us that Troy is 12 years old and that he has been known to children’s social care services all his life as a member of a family where there have been ongoing concerns about neglect. They have sketchy records about his father, who has been separated from his mother for many years. Troy is known to see his father occasionally and his paternal grandparents, but is very reluctant to discuss anything to do with his father with social workers. The focus of social work intervention has, over recent years, been upon the care of his three younger siblings, especially as Troy has been assessed as developing reasonably well. There is now increased social worker activity in relation to his older sister’s pregnancy. Troy is rarely at the house when the social worker visits. Between the ages of 9 and 10 Troy was in contact with a befriender, but the service ceased when his befriender moved away from the area and Troy declined to meet with a different person.


School says Troy has a good attendance and attainment record, although he is often late. He is especially good at English and writes imaginative stories and essays. His teacher is aware of the lack of care at home - it is evident in Troy’s clothing, general levels of tiredness and unwillingness to be involved in any discussions that might touch on his home-life. He has some friends in school, but has been known to be involved in fights, often stemming from perceived slights about his mother or family. He is recently showing some signs of loss of interest in schooling. His mother says Troy is a good boy, but that he doesn’t respect Darren which is wrong because he has been ‘like a dad to him.’ Troy is underweight for his age and height, but his general health appears to be reasonable, except for his dental health, which is very poor. Troy has recently occasionally come to the attention of the local community police officer for being on the fringes of a group of young men, older than him, who are suspected of stealing cars.

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Family Case Studies

F3

Akhtar family case study Background The Akhtar family live in a new housing development on the edge of a large town. They moved there two years ago shortly after their first baby was born. The house is immaculately clean and well maintained.

Saleem Akhtar

Saleem Akhtar is 30 years old and works in a bank. He works long hours and with work and his commuting, he spends limited time at home. He was born in Pakistan but left when he was 2 years old, when his family relocated to the UK for employment reasons. His parents and extended family live 50 miles away in London and visit only a couple of times per year.

Mabina Akhtar

Mabina Akhtar is 26 and she gave birth to the couple’s first baby 2 years ago. Prior to the birth Mabina had worked as a benefits adviser in the town where they lived, but no longer keeps contact with her work colleagues since they relocated to their new build house. She doesn’t know anyone on the estate and she doesn’t tend to use any of the local services. She does her shopping at an out of town complex and has no real regular social contacts. All her family still live in London, but she has telephone contact with her mother once a week.

Wasim Akhtar

Wasim Akhtar is their two year old son. He spends most of his time at home with his mum. The health visitor has continued to do regular home visits as she had concerns during Wasim’s early months that he appeared to spend lots of time sleeping in his bedroom, but when he was brought downstairs, there were no indications that he had been asleep. He has no speech and communicates by pointing and gesturing. There is no apparent eye contact between Mabina and Wasim and the health visitor has never seen Wasim approach his mother for comfort or reassurance. He is a slim boy and his weight is in the 5th percentile (low weight for age), but Mabina reports that he eats well. The health visitor has never seen any evidence of food preparation or cooking in the home and there are no toys visible in the downstairs of the house. There is a travel cot in the hallway that Mabina says she uses to keep Wasim safe when she needs to go upstairs or answer the phone. Twice when the HV has called around recently, she has seen Wasim sitting in the cot, which is immaculately clean but there are no toys to be seen anywhere in the house.

F3 Akhtar family case study

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Family Case Studies

F3.1

Mabina Akhtar’s story “Why does the Health Visitor keep calling out to see me?

I am getting very tired of this now and I would like some privacy. I don’t understand why she wants to see Wasim - he is fine and she can see that. My house is immaculately clean…surely she can see that - there isn’t a thing out of place and Wasim wants for nothing…she needs to pay more attention to the other children in this town - you see them in their buggies filthy, with food around their faces - shouting and crying in the street. They are the families that really need support. She keeps suggesting that I take Wasim to the parent and toddler group, but I don’t want him mixing with the others - children that age pass things around and I don’t want him picking up headlice, colds, and goodness knows what else - I don’t want him picking up bad habits either - he is a well behaved boy and I want it to stay like that. In any case, I don’t think that my husband would like me associating with some of the other families around here and Wasim doesn’t need it, he gets everything he needs right here with me…do you hear him crying? Do you see him badly behaved? No, so what is the problem?

home from work. When I do go out it is usually to the shopping outlet in the car - Wasim enjoys going around the shops and we have our lunch there…there is a play area but Wasim is too young for that yet, and what would I do whilst he played - I would feel silly sat there on my own. I do get down at times…but I cope. I used to have friends at work but I didn’t bother keeping in touch once I had Wasim - there didn’t seem much point as none of them live close by. I get very lonely at times because Saleem works long hours and he doesn’t seem to be at home much. But he is right when he says that I am very lucky, I have much more than my parents had when their family was young… At some point I might go back to work, but not for a few years yet, I have a different job now…to be a home maker and a mother and this is the most important job. I would like to get some more qualifications and maybe do a night school course, but that would be impossible at the moment, with all my other responsibilities”.

We don’t go out much - we don’t need to. I spend most days at home cleaning and preparing food for when my husband comes


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Family Case Studies

F3.2

Saleem Akhtar’s story “My wife and I are getting very tired of people calling round to ask us questions and to see Wasim…

Mabina does a very good job with him, she is an excellent mother and he wants for nothing. We have a beautiful house - you can see that! I am never there when the Health Visitor calls…but I understand that she asks lots of questions - I don’t like that…we are very private people. Wasim is fine, he is usually asleep by the time I get in but I see him at weekends and he does not cry…he is a quiet, well behaved boy. He does not speak yet, but I am not worried about that - he will do things in his own time.

I don’t particularly want Wasim mixing with the other children in this town, we made a mistake by moving here - the house is fantastic but we don’t have anything in common with the people here. We will move at some point in the future - probably when Wasim is due to start school. There are some good schools in London, and we would prefer to be there, nearer our families, but the prices are out of our reach at the moment. If my wife or my son needed something…I would provide it. It is my job to make sure that Mabina has everything she needs and I do that.

I work hard and long hours, but the pay off is that I bring home a good wage…” F3 Akhtar family case study

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Family Case Studies

F3.3

Wasim Akhtar’s chronology

2007

Mabina is pregnant with her first child. She has worked through her pregnancy as a benefits adviser. She has enjoyed support from her husband’s parents and extended family; who all live locally.

2008

Wasim born. Family moves to a new house 50 miles from London and family members. They have a new G.P. and Health Visitor. Wasim has his own bedroom. The family home is immaculate, with everything, in its place. Wasim, in his bedroom or in a travel cot in the hallway, waits for his mother to come to see him. His mother responds immediately when he points or gestures, giving him respect as the first son. It is not clear whether he is given toys to play with. He is used to being on his own and to entertaining himself.

2009

Health Visitor contact. Wasim in his bedroom but not asleep. He is not speaking, but his mother understands what he needs and, as a result, he is well behaved. His mother is busy every day keeping the house clean and tidy, and then preparing food in the early evening, for a family meal with her husband and son. She has the company of her husband and son, and speaks to her mother on the phone once a week.

2010

Health visitor calls to see Mabina, but does not understand why the health visitor feels the need to call her. Wasim is said to be fine because he does not cry or misbehave. His mother responds to his needs immediately and he is accustomed to this. He is not speaking - either Urdu or English - but neither his mother nor his father is concerned about this, having decided that this is a sign that he does not need anything. His mother takes him to the shops in the car and Wasim enjoys going around the shops. He does not play in the play area. His father and his mother are both reluctant to get involved in the local community. His father’s view is that they have nothing in common with the local community. Mabina’s view is that associating with these children will encourage Wasim to develop bad habits and expose him to unnecessary health risks.


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Family Case Studies

F4

Maxwell family case study Background The Maxwell family live on a housing estate, which predominantly houses families experiencing worklessness and living in poverty. The local economy has been in decline for many years and there are few employment opportunities that are accessible to people living on the estate. Natalie became a single parent during her second pregnancy when her partner Ian left the family following a period of significant domestic violence and a serious assault upon Natalie, breaking her arm. Others in the community were not aware of the level and extent of the domestic violence, and Natalie tells people that Ian moved away to find work. Natalie is socially isolated, as she is main carer for her two children – Robbie and baby Luke. Her only close family member is her mother, and she is not on speaking terms with her at the moment following a row about money. Natalie has a friend in similar circumstances to her, who lives on the same street, and the two young women take it in turns to visit each other’s houses in the evenings to drink alcohol and chat. A concerned neighbour has noticed this and she is worried that Natalie’s children are left alone in the house. She recently reported this to the Police and they are investigating the allegation.

Natalie Maxwell

Natalie is 19 years old and is separated from her long-term partner, and father of her children – Ian. She left school early, without any formal qualifications and she has spent the last 4 years as main carer to her two young children. She has always lived in the area, but despite this has no significant supportive relationships in her community. Her mother lives close by but they do not speak to each other. Since her relationship breakdown with Ian, Natalie has suffered from low moods and low self-esteem, and her only social outlet has been to meet with her friend to have a drink in the house at the weekends. She cannot afford a sitter, so she sometimes leaves the children in the house unattended whilst she visits her friend’s house on the same street. She knows that this is wrong, but she doesn’t think that the children will come to any harm as she is still close by. Sometimes she has a lot to drink and struggles to get up with the children the following day.

Robbie Maxwell

Robbie is 4 years old and he goes to the local pre-school nursery. He will start full time at his local school later this year. Robbie misses his daddy, and he hasn’t seen him for almost a year now. Robbie loves his little brother Luke and helps his mum with feeding him, changing his nappy and taking him for a walk in the buggy. Robbie is very clingy with his mum at the moment and doesn’t like her to be out of sight. He won’t go to bed now in the evenings, as he is frightened that his mum will leave him alone with baby Luke. Robbie is frightened of the dark.

Luke Maxwell

Luke is 6 months old and came into the world prematurely, 6 weeks prior to his due date. His premature birth is thought to have been induced by trauma experienced by Natalie during a physical assault on her by Ian. Luke has been late in meeting all his milestones, and has only just started sitting up. Luke spends a lot of time strapped in his buggy, but he is a quiet baby who self comforts by sucking his thumb. Luke will be ready to start exploring his environment by crawling and pulling himself up on furniture, but Natalie cannot encourage this at the moment, because the home is not safe. There is no fireguard or stairgate.

F4 Maxwell family case study

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F4.1


Family Case Studies

Natalie Maxwell’s story

“I started drinking when I was about 12 or 13…

…There was nothing to do on the estate where we lived, so we used to hang around near the shops and get the older kids to buy us drink – nothing major – cider mainly…it gave us something to do and my mam worked nights so she didn’t know what I was up to…it got out of hand a bit when I started nicking my mam’s booze – wine, lager, vodka – anything that she had in really and that caused loads of problems between us and she kicked me out… I didn’t go to school much so I didn’t get any qualifications… there is no work around here anyway. Perhaps if I had had a choice, I wouldn’t have had the kids so young, but I am no different to my mates, most of them had kids by the time they were 18 too. I’m 19 now and I have two bairns –(Robbie 3 and Luke 1) to look after on my own. Their dad was my boyfriend for 4 years… but he knocked me about…he used to go out drinking a lot and he’d come back from the footie most weekends and if his team

hadn’t won or he was wound up about something he used to take it out on me…He’s moved away now to get work and I am left to cope with the kids on my own. It is really lonely…I see my mates through the day sometimes but it is hard sitting in at home night after night on your own with only the 4 walls to look at. I am not like some…out every weekend…but surely I deserve a night out every now and then? The nearest I get to a night out is when my friend asks me to go round to hers for a drink – it is just round the corner so I don’t need a sitter, but I keep popping back to check that the kids are still asleep…what harm can they come to when they are asleep?. I have a really nosey neighbour and she watches every move I make…I can’t believe that she reported me for leaving the kids alone. I have never left them for the full night, like some people do. She said that I was drunk when I came home

…everybody drinks don’t they?! I can still look after my bairns…” F4 Maxwell family case study

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Family Case Studies

F4.2

Robbie Maxwell’s story

“Where is my mammy?

…I can’t see anything…it is dark and it is all quiet in the house… my mouth is all dry and I need a drink…Mammy…where is my Mammy…? I will shout her to see if she comes…Mammy! Mammy! She can’t hear me…she isn’t coming… Oh no! I have woken baby Luke and now he is crying too…he needs his bottle…I will go and see if I can find it. It is cold…I am really cold and I can’t see because I can’t reach the light…it is

very dark…I hurt my food…I think I stood on a toy…it hurts… Mammy!…Mammy! I love my wee brother…my mammy lets me feed him sometimes…but I can’t feed him now because I don’t know where the bottle is…I can’t get down the stairs because the gate is shut…I can see a bit now…light from the street coming through the glass in the front door…I am cold and I need a drink…I am scared of the dark…where’s my mammy?…Is she asleep?…Wake up Mammy!…has she gone out?…come home mammy!

Please stop crying baby Luke…please stop crying… Mammy will be home soon…” F4 Maxwell family case study

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Evans family case study

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