3.3.3 Safeguarding Children Living in Families with Drug and / or Alcohol Misuse Protocol

1. Introduction

Families where parents / carers drink problematically, use drugs or misuse prescribed medication can still provide a safe, secure and supportive family environment for children.

However for some families, drug and / or alcohol misuse can become the central focus of the adults' lives, feelings and social behaviour, and has the potential to impact on a child at every age from conception to adulthood. It is therefore essential that the implications for each child in the family are carefully assessed (Hidden Harm 2003 and 2007). See Advisory Council on the Misuse of Drugs (2007) Hidden Harm: Three Years on. London: Home Office.

Adults who misuse drugs and / or alcohol may be faced with multiple problems including homelessness, accommodation or financial problems, difficult relationships, domestic abuse, mental health issues, lack of effective social support systems, issues relating to criminal activities and poor health. Assessment of the impact of these stresses on the child is as important as the drug and / or alcohol misuse itself.

2. Lessons from Research

2.1 The potential impact on children and young people

Children can be affected by parental drug and alcohol misuse in many different ways and this should never be under estimated. This could include:

• Pre-natal exposure to drugs and alcohol - may have an affect on baby/child's health before and after birth. Some affects will only become evident as the child develops, some will affect the child for the rest of their life;
• Impaired parenting capacity - the use of drugs and alcohol can be an all-consuming activity that leaves little time or space for parenting;
• Provision of basic needs for children who are physically dependent on their parents - money, time and effort is put into acquiring and using substances rather than caring for the children;
• Poor emotional development and attachment - parent being pre-occupied and not being available, both physically and emotionally to their children when required;
• Normalisation of substance misuse and criminality;
• Lack of consistency and boundaries / unpredictable parenting;
• Disruption to household routines;
• Children taking on increasing responsibilities in relation to household tasks, child care and parent care;
• Impact on education attendance and attainment;
• Physical health risks including ingestion of drugs /alcohol, lack of attention being paid to the child's medical and dental needs;
• Secrecy, stigma and shame leading to the children having poor peer relationships.

The short and long term impact on children will depend on a combination of factors including their age, level of understanding, personality, circumstances, coping strategies and degree of external support. Additionally, children's responses can alter over time as circumstances change and children adopt alternative coping strategies.

2.2 Risk Indicators

Research shows that there are some factors associated with a parent's / carer's drug / alcohol misuse which have the potential to increase the risk to children living in these households. (Hidden Harm, 2003 and 2007).

• Both parents being poly drug / alcohol misusers and misusing substances together at the same time;
• Parents using illicit drugs or drinking alcohol in addition to their prescribed medication;
• Drug / alcohol misuse taking place in the home and the house being used by other drug / alcohol misusers;
• The family not engaging with services, a pattern of not attending appointments;
• Parent believing that their drug / alcohol misuse doesn't affect their children;
• The absence of extended family support;
• Child care arrangements being ad hoc, child being cared for by other substance misusers;
• The presence of the child (though not necessarily in the same room) when substances are being used;
• Children witnessing drug use and the dangers associated with the drug using paraphernalia;
• Domestic abuse and / or mental health issues in the household.

N.B There is a cumulative effect of these risk factors, i.e. the more that are present, the higher the risk of negative outcomes.

2.3 Strengths / Protective factors

At the same time as recognising the potential risk factors, it is important to identify what protective factors are present in the home environment and how to build on these strengths. These include:

• Parents' recognising the true extent of the affect of their drug and alcohol misuse on their family life and wanting to make appropriate changes;
• Parents/carers putting in place safeguards for the child;
• Parents' engaged with services and complying with drug / alcohol treatment;
• The extended family are fully aware of the drug / alcohol problem and offer support to the children;
• For the child to develop a close positive bond with at least one adult in a caring role (including parents, siblings and grandparents) who can provide them with consistent attention and support and ensure that family activities are maintained;
• The family to maintain contact with the universal services that can provide support;
• For the child to be engaged in a wide range of activities, within which they can recognise that they are separate from their parents' problems and therefore develop their own sense of self and self-esteem.
• The family have good support networks outside of the nuclear family;
• The children have regular attendance at school / nursery.

3. Identifying the Needs of Children and their Parents or Carers who Misuse Substances

Parents / carers who misuse substances may have difficulties which impact on their ability to meet the needs of their children. This protocol acknowledges that children living in these households may be in need of assessment for services provided by a range of agencies, from universal and early intervention to specialist services for those with more acute or complex needs.

All agencies are responsible for identifying families where there are substance misuse issues who may be in need of additional services and support (including making appropriate referrals for drug / alcohol treatment).

See Sheffield Health and Social Care website for Referral and Accessing Drug and Alcohol Services.

Pointers to enable engagement

• Be child focused not substance focused. What are the needs of the child and how can services support parents to enable those needs to be met?
• Are there any issues the parents are concerned about regarding their children? - What support or help do they want? What can you offer? Where can you signpost / refer them to?
• Consider what is going well for the family (their strengths) together with what is going less well;
• Work closely with the agencies with which the family has contact, especially substance misuse practitioners. Ensure that plans for the family are realistic and focused on the needs of the child;
• Consider possible barriers to the family accessing appropriate services; work with the family to address this.

Agencies / practitioners working with the child

When any practitioner or agency is involved with a child:

1. The possibility that the child and / or their parents / carers may be misusing substances should always be considered and explored;
2. At initial contact parents / carers should be asked whether they have, or have ever had, problems with drugs and / or alcohol;
3. Information regarding any agencies involved with the adult / family should be recorded on case records detailing what the involvement entails;
4. If the parent / carer is not already accessing substance misuse services, advice should be given regarding how to access the service most appropriate to meet their needs.

See Sheffield Health and Social Care website for Referral and Accessing Drug and Alcohol Services.

Agencies / practitioners working with the adult

When any practitioner or agency is involved with an adult who misuses substances:

1. An assessment should be undertaken with all clients at the beginning of each new episode of contact. This will include ascertaining whether the person has caring / parenting responsibilities for a child under 18;
2. Where the person is identified as a parent / carer, the assessment needs to identify whether there are any indicators that may suggest that the parents' drug / alcohol misuse is impacting upon their parenting capacity;
3. If the parent / carer is not already accessing substance misuse services, advice should be given regarding how to access the service most appropriate to meet their needs. See Sheffield Health and Social Care website for Referral and Accessing Drug and Alcohol Services;
4. All information should be recorded in client's case file;
5. Consent must be sought from the family to establish whether the family is known to other services and to discuss whether any information needs to be shared.

Review and ongoing work

Assessment and identification of parents, carers and / or children's need for services is not a static process. The assessment should also inform future work and build in evaluation of the progress and effectiveness of any intervention. Agencies should always take into account the changing needs of adults and children.

Where more than one agency continues to be involved in a joint assessment or provision of services for parents or carers who misuse substances and their children, regular review dates must be set to jointly review the situation and to ensure that inter-agency work continues to be co-ordinated. Each agency should document their own actions and responsibilities clearly and also the roles and responsibilities of other agencies.

There should always be the flexibility for cases to be reviewed at any time, or jointly reassessed before planned review dates, if new concerns or support needs are identified.

4. Reporting Concerns and Making a Referral

Where any professional, volunteer or any person in the community has concerns about a child or young person they should consider contacting Children's Social Care in accordance with the Referrals Procedure.