Supporting the mental health and wellbeing of mothers at risk of repeat care proceedings and preventing care entry: a realist evaluation.

Background: The number of children being taken into care is increasing year-on-year around the world, with particular concern about mothers who experience repeat infant removal. These mothers have often experienced multiple disadvantages, which are compounded by the trauma of child removal. There is an urgent need to understand how to interrupt these cycles of disadvantage, trauma and child removal. Objective: To identify and explain the perceived influence of contextual factors and mechanisms of an intensive, relationship-based intervention upon: i) the mental health and wellbeing of mothers at risk of repeat care proceedings; ii) and the care outcomes of their infants. Participants and setting: The study was conducted in the North East of England. Participants of the were 159 mother-infant dyads (n = 79 intervention and n = 80 received usual care). Additionally, we recruited a total of 39 realist interview participants (n = 10 referring practitioners; n = 11; Startwell practitioners; n = 17 mothers and n = 1 partner). Methods: This mixed-method study employed a realist approach to service evaluation, using quasi-experimental and qualitative methods. Results: In iterative consultation with stakeholders, we developed three programme theories relating to: i) supporting the mother to safeguard the child; ii) safely challenging behaviour and beliefs; iii) grief and loss. Conclusion: We found that in the context of surveillance wherein mothers with longstanding negative and adversarial experiences of services, a mother-centred and empathic approach is likely to lead to more accurate and decisive assessment, increase reunification and support mothers to grieve following infant removal.