Children of parents who misuse alcohol

Children Of Parents Who Misuse Alcohol Or SubstancesIntroduction

It is estimated that there are between 200,000 and 300,000 children in England and Wales where one or both parents have serious drug problems. Research and local knowledge have shown that substance and alcohol misuse in parents or pregnant women can have a significant impact on parenting and increase risk, especially for babies and younger children (Hidden harm 2003). This does not mean that parents who experience substance / alcohol misuse are poor parents. However the impact of substance misuse problems can, on some occasions lead to children and families needing additional support; or in a small number of cases support and multi agency disciplinary action to prevent significant harm.

The most effective assessment and support comes through good information sharing, joint assessment of need, joint planning, professional trust within the interagency network and joint action in partnership with families.

These guidelines apply whenever there are professional concerns about the wellbeing or safety of children whose parents or carers have substance/ alcohol misuse problems, specifically where these difficulties are impacting, or are likely to impact, on their ability to meet the needs of their children. These guidelines also apply to professionals working with pregnant women who have substance/ alcohol misuse problems, where their partners are known to have substance/alcohol problems or where someone with substance misuse problems is living in a household where children are present.

Aims

2.1. To increase the professional’s understanding of the impact of an adult’s substance misuse problems on children’s lives.

2.2. To enable universal and specialist services to improve their identification of children in need where adult substance/alcohol misuse is a problem

2.3. To enhance the provision of co-ordinated services to families in which there are dependant children of parents, carers or pregnant women with substance/ alcohol misuse problems.

Principles

3.1. All those who come into contact with children, their parents and families in their everyday work have a duty to safeguard and promote the welfare of children.

3.2. Parents, carers and pregnant women with substance/ alcohol misuse problems have the right to be supported in fulfilling their parental roles and responsibilities.

3.3. A multi agency approach to assessment and service provision is in the best interest of children and their parents/ carers.

3.4. Risk is reduced when information is shared effectively across agencies.

3.5. Risk to children is reduced through effective multi agency and multi disciplinary working.

3.6. While many parents, carers and pregnant women with substance/ alcohol abuse problems safeguard their children’s well being, children’s life chances may be limited or threatened as a result of these factors, and professionals need to consider this possibility.

Identifying The Need Of Children, Their Parents Or Carers, Or Pregnant Women With Substance/ Alcohol Misuse Problems

4.1. The birth of any new child changes relationships and often brings new pressures to parents. Agencies need to be sensitive and responsive to the changing needs of parents with substance/ alcohol misuse problems.

4.2. Parents, carers or pregnant women with substance / alcohol misuse problems may have difficulties which impact on their ability to meet the needs of their children, unborn child or new baby.

4.3. The adverse effects of alcohol/substance misuse on children are typically multiple and cumulative and will vary according to the child’s stage of development. They may include fetal alcohol syndrome, failure to thrive, blood-borne virus infections; incomplete immunisation and otherwise inadequate health care; a wide range of emotional, cognitive, behavioural and other psychological problems; early substance misuse and offending behaviour; and poor education attainment. These can range greatly in severity or may often be subtle and difficult to detect.

4.4. There is growing evidence to suggest that children often take on a caring role in families where there is parental drug or alcohol use. In some cases, it is particularly hard for children to cope with one or more parents with drug or alcohol dependency and they need help and support.

4.5. The risk of harm to the child may be reduced by effective treatment and support for the affected parent(s) and by other factors such as the presence of at least one other consistent, caring adult; a stable home with adequate financial resources; maintenance of family routines and activities; and regular attendance at a supportive school.

Guidelines For Referral And Assessment For Pregnant Women With Substance/ Alcohol Misuse Problems

5.1 All agencies are responsible for identifying pregnant women with substance/ alcohol misuse problems who may be in need of additional services and support.

5.2. When a professional identifies a pregnant women experiencing substance/ alcohol misuse problems an assessment must be undertaken to determine what services she requires. This must include gathering relevant information from her GP, PDAC, the Midwifery service, in addition to any other agencies involved, to ensure that the full background is obtained about any existing or previous diagnosis, or treatment for mental illness.

5.3. Consideration must be given to the impact and harm continued substance misuse has on an unborn child. Where this assessment identifies that a pregnant woman has substance / alcohol misuse problems a referral must be made to Powys Children’s services for a pre-birth assessment.

5.4. Where the need for a referral is unclear, this must be discussed with a line manager or the Safeguarding Children’s Team. If a referral is not made this must be clearly documented. Staff should ensure that all decisions and the agreed course of action are signed and dated. Section 10 gives guidelines in relation to assessment of risk.

5.5. A pre-birth assessment should be undertaken on all pre birth referrals and a multi agency meeting held to share information. If a pre-birth multi agency meeting is not needed this must be endorsed by a manager and the reason for the decision clearly recorded on the agency’s records.

Guidance For Referral To Pdac

6.1. In the case of pregnant women where there is evidence of problematic use of illicit, proprietary or prescribed drugs or alcohol, agencies becoming aware of the evidence should initially discuss the benefits of a referral to PDAC with the individual. If there is agreement referral should then be made to the appropriate area office of PDAC. This referral may be made initially by phone, but should be followed up immediately with a written referral. In the event that the woman is already a client of PDAC it would be appropriate to confirm that the pregnancy is known to them.

In the event of a woman refusing to agree to a referral being made it is the responsibility of the agency to consider whether a referral can be made without consent on Child Protection grounds. This would need to be subject of discussions between all the appropriate agencies – Children’s Services, Police, Health etc. PDAC will always be willing to discuss the appropriateness of referral prior to formal contact being made.

Guidance For Referral To Powys Children’s Services

A referral for an initial assessment to Children’s services must always be made if a parent carer or pregnant woman is considered to have significant substance/ alcohol problems. A referral should be discussed with a line manager.

NB If a child is in immediate danger then a referral to the police/social services should be made.

Partnership Working

Assessment and identification of parents, carers and children’s needs for services is not a static process. The assessment should also inform future work and build in an evaluation of the progress and effectiveness of any intervention.

Where more than one agency continues to be involved in a joint assessment or provision of services for parents or carers with substance misuse problems, and their children, regular review dates must be set to jointly review the situation and to ensure that interagency 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.

References

All Wales Child Protection Procedures

Children Act 1989

Children Act 2004

DOH (2000). Framework for the Assessment of Children in Need and their Families.

Hidden Harm (ACMD) 2003

Appendix A
Guidelines For Professionals For Assessing Risk When Working With Drug Using Parents

The following assessment guidelines were developed by the Standing Conference on Drug Abuse (SCODA) [May 1997] to assist professionals in identifying children who may be in need or at risk as a result of parental substance/ alcohol misuse. They should be used as guidelines in the holistic assessment of the family.

Parental Drug Use

1. Is there a drug free parent, supportive partner or relative?

2. Is the drug use by the parent Experimental? Recreational? Chaotic? Dependent?

3. Does the user move between categories at different times? Does the drug use also involve alcohol?

4. Are levels of childcare different when a parent is using drugs and when not using?

5. Is there any evidence of coexistence of mental health problems alongside the drug use? If there is, do the drugs cause these problems, or have these problems led to the drug use?

Accommodation And The Home Environment

6. Is the accommodation adequate for children?

7. Are the parents ensuring that the rent and bills are paid?

8. Does the family remain in one area or move frequently, if the latter, why?

9. Are other drug users sharing the accommodation? If they are, are relationships with them harmonious, or is there conflict?

10. Is the family living in a drug using community?

11. If parents are using drugs, do children witness the taking of the drugs, or other substances?

12. Could other aspects of the drug use constitute a risk to children (e.g. conflict with or between dealers, exposure to criminal activities related to drug use)?

13. Is there adequate food, clothing and warmth for the children?

14. Are the children attending school regularly?

15. Are children engaged in age-appropriate activities?

16. Are the child’s emotional needs being adequately met?

17. Are there any indications that any of the children are taking on a parenting role within the family (e.g. caring for other children, excessive household responsibilities etc)?

Procurement Of Drugs

18. Are the children left alone while their parents are procuring drugs?

19. Because of their parent’s drug use are the children being taken to places where they could be “at risk”?

20. How much are the drugs costing?

21. How is the money obtained?

22. Is this causing financial problems?

23. Are the premises being used to sell drugs?

24. Are parents allowing their premises to be used by other drug users?

Provision Of Basic Needs
Health Risks

25. If drugs and/or injecting equipment are kept on the premises, are they kept securely?

26. Are the children aware of where the drugs are kept?

27. If parents are intravenous drug users:

Do they share injecting equipment?

Do they use a needle exchange scheme?

How do they dispose of syringes?

Are parents aware of the health risks of injecting or using drugs?

28. If parents are on a substitute prescribing programme, such as methadone:

Are parents aware of the dangers of children accessing this medication?

Do they take adequate precautions to ensure this does not happen?

29. Are parents aware of, and in touch with, local specialist agencies who can advise on such issues such as needle exchanges, substitute prescribing programmes, detox and rehabilitation facilities? If they are in touch with agencies, how regular is the contact?

Family Social Network And Support Systems

30. Do parents and children associate primarily with:

Other drug users?

Non-users?

Both?

31. Are relatives aware of the drug use? Are they supportive?

32. Will parents accept help from the relatives and other agencies?

Parents’ Perception Of The Situation

33. The degree of social isolation should be considered particularly for those parents living in remote areas where resources may not be available and they may experience social stigmatisation.

Do the parents see their drug use as harmful to themselves or to their children?

Do the parents place their own needs before the needs of their children?

Are the parents aware of the legislative and procedural context applying to their circumstances, (e.g. child protection procedures, statutory powers?