Professor Janet Boddy

The Department for Education (DfE) has published an independent evaluation of Pause, led by Professor Janet Boddy at the University of Sussex in collaboration with Research in Practice and Ipsos Mori.

Pause is a national non-governmental organisation (NGO) which supports local practices to deliver intensive relationship-based support to women who have experienced removal of at least one child and are judged to be at risk of further removals of children.

The Sussex-led two-year study included in-depth interviews over time with 61 women who have worked with Pause, as well as interviews with Pause staff and local authority managers, analysis of Pause administrative data on the needs and characteristics of all the women who work with the programme, and analysis of local authority data on rates of infant care entry.

Most women who work with Pause have very significant histories of trauma and adversity, including the loss of children into care and adoption. The research shows that they are living with complex and chronic disadvantage, often in poverty, with unmet health, welfare and housing needs. Working with Pause is associated with significant improvements in women’s lives, during and after intervention.

One key area of positive change was in women’s experiences of contact and relationships with children and their carers, and this was true across diverse placement arrangements ranging from kinship care (with family or friends) to adoption.

As one woman explained, support from Pause made a crucial difference: "A few months ago, my child wanted to ask me a lot of questions, and my Pause practitioner came along with me to that meeting. And it was a big help, do you know? My child wanted to know why they were in care, and stuff like that. Social Services gave the questions to my practitioner, and she brought me the questions. So, I could plan what to do, what to say. It went really well in the end. Because my child didn’t know whether to still see me, and stuff like that, but in the end, they decided to see me."

Women also reported improved emotional well-being and reductions in psychological distress, and greater financial and housing security, with the number of women who were homeless or in unstable accommodation almost halved over the course of the intervention. These findings highlight the need for holistic, trauma-informed approaches that link child and adult services, with a critical role for benefits, housing and health services in particular.

The study demonstrated that the long-term presence of Pause in a local authority area is linked to significantly reduced rates of infant care entry, as increasing numbers of women go through the service and continue to avoid further child removals post-intervention.

In addition to the human costs avoided, this corresponds to significant financial savings to the public purse. In the five areas where Pause has operated continuously since 2015, the number of infants entering care was reduced by an average of 14.4 per annum per local authority – equivalent to 215 children over three years in the five sites. The estimated benefit to cost ratios associated with these effects are £4.50 saved per £1 spent on Pause over four years and £7.61 saved for every £1 spent over 18 years.

Interviews with women and practitioners indicated that stabilisation in women’s lives and positive change in their sense of self appeared to be critical ingredients in scaffolding long-term positive change. These impacts were consistently described as being enabled by an intensive, relational, trauma-informed approach.

Small caseloads and long-term involvement gave women time to build trust and relationships with their practitioners and with other women during group activities.

As one woman observed: "To everybody else we’re just a number on a piece of paper; with them we’re humans and they treat us like we are."

The research showed the importance of a skilled and well supported workforce with multi-disciplinary knowledge, and women and professionals also highlighted the value of flexible post-intervention support to provide a ‘safety net’ that helped to maintain change over time in complex lives.

The evaluation did not compare the impact of Pause with alternative models of support for women who have experienced the removal of children into care or adoption, but one distinctive feature of Pause compared to other approaches is the expectation that women should use a method of long-acting reversible contraception.

The majority of women in the study did not express any concerns about this contraceptive requirement, but some discussed problems with side effects or raised questions about the lack of choice. Pause have listened to these concerns, and commissioned a further independent project to review women’s experiences with contraception and sexual health.

The evaluation found that the Pause model of support was equally effective for different groups, including younger women, care-experienced women, and those who have had their first child removed as well as those who had experienced more than one child’s removal into care or adoption.

Prof Boddy, Professor of Child, Youth and Family Studies in the School of Education and Social Work, said: “Overall, these findings provide convincing moral and fiscal arguments for the national development of trauma-informed, relationship-based support for women following the first removal of a child. This may be especially important for young care-experienced women who are at heightened risk of a child being removed into care or adoption.

“For young people in care, the state has a legal duty to act as ‘corporate parent’ – which DfE guidance describes as 'acting as any good parent would'. We think this should include acting as ‘corporate grandparent’. The evaluation shows the value of long-term, trauma-informed, relationship-based practice – and that means there is a clear ethical argument for extending this kind of support to care-experienced women who might otherwise be at risk of having a child removed from their care."