The decision to remove a child or young person from the care of their birth parents is a grave one that confronts child protection authorities daily. Removal occurs with the intention of protecting the child from harm and securing their safety. The wider community expects child protection authorities to intervene to protect children from harmful circumstances and secure their care and protection. Indeed, child protection authorities are often subject to intense media scrutiny and community outrage in circumstances where they are perceived to have not intervened to protect a child, and the resultant harm becomes known to the community.

There is positive intent in removal. But what are the negative impacts, if any, of this well-intentioned action to secure a child’s safety and protection from harm?

An intriguing group of children are those who are removed from the care of their biological parents at or very close to birth, and who remain in care long-term. Carers of these children are often perplexed when, years later, and notwithstanding loving care afforded to them, the children show many of the same complex and challenging behaviours commonly observed among children who have experienced abuse and/or neglect prior to their removal. This has led to consideration of the impact of pre-natal trauma on the developing child. However, my experience has taught me that there is another valid line of enquiry into why children removed at or close to birth exhibit maladjustment not dissimilar to those who are removed later, and which provides an insight into the potential negative impact of removal more generally.

Irrespective of when they are removed from the care of their birth parents, children who remain in out-of-home care appear to suffer from difficulties in the areas of self-worth, identity, and belongingness which, in turn, result in complex and challenging relational behaviour. When they are old enough to do so, these children and young people speak of a profound loss associated with not having had the opportunity to be raised within their birth family. They question their worth in relation to this. Why could their birth parents/family not make more of an effort? Didn’t they love me? Am I unlovable?are common insecurities. Who am I? and Where do I belong? are others.

As they seek answers to these questions through behaviours that are experienced by their caregivers at home, in school, and in other domains of their life as perplexing and challenging, these questions crystallise into an enduring sensitivity about self-worth, identity, belongingness, and relational connection. In turn, this sensitivity manifests in:

• self-defeating behaviours (such as precocious experimentation with drugs and alcohol, precocious sexual activity, and suicide and self-harm)
• disturbed relational behaviour (such as coercion, rejection, instability)
• identity concerns (such as gender dysphoria and sexuality concerns)

Too often, the reaction of well-meaning adults to these aspects of the child or young person’s approach to life and relationships only confirms and reinforces their fear that they are worthless and unlovable, and maintains maladaptive behaviour and identity concerns.

So, what is the answer?

My experience has taught me that we engage with and support these children and young people in ways that promote their self-worth and belongingness as a vital priority. Unfortunately, this can be a ‘double-edged sword’ as the more they are loved the more disappointed they feel about those who they perceive did not (or do not) love them enough; potentially compounding the issue.

In addition to engaging with these children and young people in ways that support their worthiness, identity, and belongingness, there needs to be greater recognition of the enduring role and importance of birth parents and family after removal. There needs to be greater recognition of the negative effects of removal, which present as an enduring sensitivity about worth, identity, belongingness, and connection to others.

Removing children often results in a worsening of the pre-existing maladjustment of birth parents as their own worth is eroded by the removal and associated reasons for it. Where it is possible and safe to do so, child protection authorities need to meaningfully engage birth parents in recognition of their enduring role and importance in the life of the child, and support the maintenance of best connections between the children and their birth parents/family.

As John Bowlby once wrote: If we value our children we must cherish their parents.

It is not anticipated that this is or will be easy. Community sentiment, echoed in the media, often asserts that child protection authorities need to remove all children at risk and give them the opportunity to grow up in a place of safety. My experience has taught me that support of an enduring connection with birth parents/family represents the best chance of meeting community expectations about outcomes for children and young people in need of protection and care.