Reconstruct Online Procedures - Substance Misuse | South West Safeguarding and Child Protection Procedures

Introduction
Good practice guidelines
Issues for a practitioner to consider when assessing parental substance use
Care planning
National resources

The following guidance is designed to help you assess how serious the situation is and offer ideas for future work. If you are concerned about any children or young people follow the guidance in ‘Managing Individual Cases’. This may mean you making a referral to children’s social care.

Introduction

This guidance encompasses the wider definition of substances to include consideration of both parental problem drug and/or alcohol use. Whilst not specifically focussing on the issues, the guidance could be applied when considering approaches where parenting is thought to be impacted by the use of prescribed (e.g. benzodiazepines etc) or over the counter medicines.

Problem alcohol and drug users generally aspire to be good parents but their efforts may be impaired. Whilst parental substance misuse increases potential risk to the child, it is important to note that children should not be routinely viewed as being at risk of abuse solely because their parents use substances.

For various and different reasons problem alcohol or drug use is often hidden. The determination of risk is a complex matter taking account of the environment, the age of the child etc along with parents’ behaviour resulting from the problem substance use.

The contribution that substance use makes to this judgement is more to do with the impact rather than the exact quantities and pharmacological effects:

Is the parent incapacitated through intoxication?
Is the family budget spent on drink or drugs?
Did the mother attend ante-natal appointments?
Are there other users in the home?
Are substances or paraphernalia left lying around?

Particularly of concern are parents who neglect their children because they are focused on their substance misuse, putting their children at risk when acquiring substances or using substances; putting money, time and effort into using substances rather than caring for their the children; not being available to their children when required; poor behaviour management, lack or routine, poor school attendance; poor state of the home, access to drink and drugs and drugs paraphernalia . There is evidence from serious case reviews and child deaths that parents may use substances on their children (including very small babies) and there are considerable risks associated with that. There may be concerns that children are being brought into contact (if not left with) adults who are unsuitable to be around children or who may be a risk to children.

Substance misuse is often associated with other significant risk factors, including violence, domestic abuse, mental health issues and parents with learning difficulties. Evidence from serious case reviews demonstrate that risks to children are significantly increased if one or more of these factors are a feature in a child’s life.

Practitioners must make a referral to children’s services if they suspect that children may be at risk in any of the ways described above.

Good practice guidelines

Good practice points:

1. Problem substance users normally want to be good parents.

2. Problem substance users should be treated in the same way as other parents whose personal difficulties interfere with their ability to provide good parenting.

3. Base your judgements on evidence, not optimism.

4. There will be many aspects of the child’s life that are nothing to do with drugs or alcohol and may be equally or more important.

5. Recognise that the parents are likely to be anxious. They may be worried that they could lose their children. Children, especially older ones, may also share similar anxieties.

6. Do not assume that abstinence will always improve parenting skills.

7. The family situation will not remain static. Assessment should be revisited every six months or whenever new concerns arise, whichever is sooner.

Issues for a practitioner to consider when assessing parental substance use

Do not ignore substance use.

As a matter of routine, all child protection assessments should consider whether substance misuse is a contributory factor. Open questions such as ‘Can you tell me about your use of alcohol and drugs?’ are more likely to prompt discussion than closed questions such as ‘Do you use illegal drugs?’

Use pre-birth assessments.

These can provide a valuable opportunity to engage expectant parents, who are often very highly motivated to make changes in their lives. Exposure to drugs during pregnancy may have had an effect on the child’s health before and after birth. Has the mother attended ante-natal appointments and followed the advice to reduce the potential risk to the baby? Click here for unborn baby protocol

Remember that most substance users want to be good parents.

Be aware that their aspirations may be too high: that expectant parents may want the child to compensate for past unhappiness or provide an incentive to remain substance free. They may set themselves unrealistic goals. Any expectation that a baby will make things better is flawed; the stress of caring for a baby may increase drug/alcohol consumption. It may lead to attempts to become abstinent too rapidly, with considerable risk of relapse. Detoxification whilst pregnant requires specialist interventions.

Consider the importance of substance use in the parent’s life.

If a parent’s primary relationship is with a drug or alcohol, then it will adversely affect their relationship with others including children. If household resources, financial, practical and emotional are diverted to substance use, there will be deficits for the children.

Ask for details of the drug and alcohol use and their effects.

‘Drug use’ or ‘Drinking’ are not single phenomena but include a wide range of behaviours. The parent who consistently drives under the influence with their child in the car, may be seen very differently to a parent leaving a ten year old in charge of the home whilst going out to buy drugs. This in turn could be viewed differently to being physically present but incapable through intoxication. There is no easy scale. Specific information about the nature of substances used, and the lifestyle implications of such use, is needed in order to assess the impact on parenting. Note that use of one substance does not preclude others: a range of illicit drugs, prescribed medication and alcohol. Also being in receipt of a prescription (e.g. methadone etc) does not always lead to stability or exclude use of other substances. Substance users are experts in substance use: if in doubt ask them to explain.

Do not assume that abstinence will always improve parenting skills.

Substance use may serve a function as an emotional or psychological crutch. There may be risks of relapse, or parents may struggle to adjust to a substance free lifestyle or relationship. Where applicable, stability in treatment might be a more realistic option.

Find out whether substance use is the only parental problem.

If so, then prospects for success are higher. Substance users face the same challenges as the rest of the population. Substance misuse makes all other problems worse. Where there are multiple parental problems (e.g. mental health difficulties, domestic violence), then prospects of being able to offer safe and long-term care to children are significantly reduced.

Consider age related risks.

A child born to a drug or alcohol dependent mother may need to be followed up to monitor any special health needs. It is important to consider these needs and the parent’s ability to meet them. Drugs and needles are a potentially serious hazard to young children. A number of very young children die each year from taking their parent’s methadone. It is therefore important to establish what substances are being taken, are needles used, where everything is stored and are they locked away securely.

• Are the children aware of where the substances are kept?

• At the older end of the age spectrum, are any of the child’s siblings using substances? This may increase the likelihood that the child will themselves become involved in substance use.

• What is their role, are they being cared for or have they become carers for siblings and/or parents?

• What are their hopes and fears?

• Who can they turn to? How does the child relate to other children?

• Do they have friends outside a drinking/drug using subculture?

• Children may be inhibited from developing relationships with other children or embarrassed by their parent’s behaviour. Friendships can provide vital support and a source of sanctuary from problems at home.

Base your judgements on evidence not optimism.

If substance use is enduring and chaotic, and there is no evidence of improvement, this will undermine other interventions or support offered. It is better to be realistic from the onset. Creating plans that are not fulfilled promotes a sense of failure in the parent.

Be aware of your own views and feelings about substance use.

Consider how these might affect your judgements. If you are unfamiliar with drug use and users, it may help to think how you would respond to an alcohol user or a smoker trying to change their behaviour. It is reported that one in three women continue to smoke during pregnancy and that 90% of professionals drink, so inevitably some will themselves have problems (BBC 1999). Assessments must be against evidence.

Recognise that parents are likely to be anxious.

Drug users in particular will worry about losing their children. This “fear factor” is likely to lead to a reluctance to seek help or a denial or minimisation of problems. Children may share this fear of being separated from their parents.

Include family members.

Include fathers, partners and relevant members of the extended family. Assessment can sometimes focus on mothers, but others may have an equal impact on the children.

Explore the child’s point of view.

What is the reality of home life?

A checklist for children’s social care managers

What does this worker know about substances?

What are their personal views and attitudes that may affect their judgements?

Is the assessment of parental substance use adequate?

Does it provide a picture of the substances used, how they are obtained, and the problems they cause? Informed knowledge about substance use is important because of the impact on behaviour, mood and lifestyle.

Does the information about substance use come from a reliable source?

Has information offered by parents about their substance use been accepted uncritically, and would it be useful to consult with an adult drug or alcohol worker? N.B. We all tend to under report our substance use.

Is the information complete?

Have all the key people with information been invited to contribute to the assessment?

Does the assessment include other family members?

Are these people engaged or could they be engaged with the child: partners whether resident or not, the child’s father, extended family including grandparents? If older children are involved is their input evident?

Is there an assessment of the impact of substance use?

There is likely to be an impact on the adult, on parenting, on the child, and on the context in which the family live. Judgements need to be based on these, rather than a simple description of what substances are used.

Can you picture what life is like for this child?

Does the case file give you a real sense of the day-today experiences of this child living with these parents? Now and in the future? Has the child been seen and spoken to alone?

Is a core assessment needed?

Would it be more useful than a series of repeated initial assessments that add little information to what is already known? Response to referrals can focus on the precipitating incident and not take account of the holistic needs of the child.

Is there a useful chronology?

Individual incidents or referrals may not have been serious in themselves, but do they indicate a pattern of chaotic parental behaviour related to substance use?

Has there been a genuine attempt to engage the family?

Or has the response to referrals been more about processing the case? Parents who use drugs in particular will be scared of social work intervention, and children may be trapped in secrecy. Home visits are likely to be much more effective than office appointments, which may not be reliably kept. ‘Warning’ letters may serve no purpose and may undermine the potential for a constructive relationship.

Care planning

Concentrate on the child, not the substances.

Your primary concern is the welfare of the child; substance use is one factor impacting on this. Does a focus on the substances presuppose that if the parent became abstinent there would be no need for social care involvement?

Be realistic about the prognosis for the future.

The birth of a new baby or the initiation of care proceedings may well be a catalyst for change, but substance use is often a chronic and relapsing condition and it is important to review the evidence and avoid unfounded hopes that the situation will improve.

Planning for young children needs to reflect their needs and time-scales.

These may be incompatible with adult time-scales for demonstrating stability of drug use or abstinence: the needs of the child are paramount.

Be supportive of kinship carers.

Whilst such placements are likely to meet the child’s needs, the complexity must be recognised. Issues around contact can be particularly difficult. The placements should be on a sound legal footing and supported practically, financially and emotionally. Do not withdraw support until or unless the child and family genuinely no longer need it.

Carers need full and honest advice from medical staff.

This should be offered prior to decisions about whether or not to take on children who may have been exposed to drugs ante-natally. They need to know that there are gaps in our knowledge about the implications for children’s future health.

Whose needs will be met by continuing contact?

Contact can be fraught if parents continue to use drugs; particularly if their use is unstable. It is important to keep contact under constant review to make sure the child’s needs are central.

The child will continue to face challenges as a result of their experiences.

They may have to give up the habit of secrecy and to learn how to rely on adults; they may have to reconcile complicated messages about the moral worth of drug users or abandon unhelpful coping strategies.