title: The needs of mothers with an addiction who have had children removed from their care
Creators: name: Russell, Lynda
Publisher: name: University of Glasgow
Year: 2025

description: This thesis brings together three key papers that each contribute to the understanding of the needs of mothers with an addiction who have children removed from their care.

The first paper focuses on child related risk information and recording of such in parents’ electronic records. From 736 services users, 62.8% were parents with 38.3% of those having children aged 16 years and under. 78.4% of female service users were mother yet 54.7% of male service users were fathers. Of the 913 offspring, 32.1% were either in or had been in local authority care, the majority were in kinship care - 17.6% of offspring sample and 54.9% of the offspring in local authority care. Seven (0.8%) offspring were deceased, a two-fold increase in mortality rate compared to the general population. In the records of 53 parents (11.5%; 68 children) there was a discrepancy between the electronic records and staff knowledge.

The second paper focuses on parents and gender differences in child removal. Mothers in the Alcohol and Drug Recovery Service were more likely to have children removed than fathers (56.6 vs. 17.7%, p&lt;0. 001), had more children removed than fathers (2 vs. 1, p&lt;0.001) and were more likely to have a series of individual child removals (22.5 vs. 4.3%, p=0.014). Female gender, younger age, drug use, mental health issues and a history of suicide attempts were associated with child removal from parents in the service. Mothers who had children in their care were less likely to have made an attempt on their lives than mothers who had children removed or women who were not mothers.

Paper three is a qualitative analysis of 12 mother’s lived experiences of child removal and contact with services – before, during and after child removal using Interpretative Phenomenological Analysis (IPA). Four themes were identified – ‘safe/unsafe’, ‘changing identity’, ‘loss’, and ‘no way to win’. Services that can develop a sense of safety in their client through continuity in workers, clarity and consistency about boundaries and communication with other services and supporting mothers to feel respected and validated as a person and as a mother, regardless of whether their child/ren are removed, are more likely to engage their clients and achieve better outcomes.

The findings of these three papers resulted in three key messages: (1) the prevalence of parenthood and child removal is high in Alcohol and Drug Recovery Services, particularly of female parents, (2) mothers with substance use issues who have children removed have unmet support needs before, during and after removal, but it is impossible to understand these needs without understanding them in the context of their children’s needs and the needs of the family unit, and (3) services need to consider how to make services feel safer for mothers and to improve connections and relationships between mothers and clinicians which could lead to better engagement and outcomes for mothers and their children.

The findings of these studies add to the knowledge and understanding of the needs of this group of mothers. Recommendations are made for services working with these mothers included: 
• All service users in Alcohol and Drug Recovery Services need to be asked whether they have children, where those children live, and what level of contact they have with their own and any other children. This needs to be repeated regularly as circumstances can change. 
• Services need to be aware of the role of gender in parenting and child removal, especially in younger mothers with mental health issues. 
• Clinicians need to be aware of the link between child removal and suicide and provide increased support immediately after removal and for a period of time afterwards. 
• Clinicians need to understand the concept of disenfranchised grief, how it applies to child removal and offer support for this loss and the subsequent grief response. 
• Mothers suggested changes that services need to make them feel safe, such as consistency in staffing, clarity about roles, boundaries and information sharing, especially with child welfare services, and for staff to be persistent and provide outreach. 
• Services need to consider and develop ‘soft’ skills such as compassion and authenticity in their staff teams.

Recommendations for researchers included: 
• Further research into the high mortality rate in offspring, including the causes of these deaths and whether this is associated with parental substance use. 
• Strengthen our knowledge about these constellations of parental risk factors to allow for the identification of mothers at risk of the removal of children and to aid service development and provision of support. 
• There is a need for a better understanding of evidence-based treatment for women and mothers with substance use issues, as gender factors may have been overlooked in previous research. 
• There is a need for co-production research with this group of mothers who are keen to have their voices heard.