7.1.10 Practice Guidance for Assessing Risk to Children who have Substance and/or Alcohol using Parents and/or Carers

SCOPE OF THIS CHAPTER

This chapter was introduced into the Manual in October 2011.

This practice guidance is for workers within Walsall’s Specialist Children’s Services who are assessing children and families where there are concerns about parental and/or carer substance and/or alcohol use. The aim is to provide a systematic process to assist social work practitioner’s in gathering and analysing risks and protective factors relating to substance and/or alcohol use. It should be used while undertaking Single Assessments in accordance with the Framework for the Assessment of Children in Need and their Families (DOH, 2000) and when undertaking Section 47 Child Protection Enquiries.


Contents

  1. Introduction
  2. The Role of the Drug/Alcohol Misuse Team
  3. What is the Theoretical Basis for this Guidance?
  4. The Effects of Substance and/or Alcohol use on Parents and Carers
  5. The Effects of Substance and/or Alcohol use on Children
  6. Principles Underpinning the Assessment of Children and Families where substance and/or alcohol use is a Problem
  7. Practice Tool

    Appendix 1: Walsall Drug And Alcohol Agencies


1. Introduction

It is intended that this guidance provide a systematic process for assisting social workers in making judgements about a parent and/or carer’s ability to provide adequate and consistent care for a child and whether a child is suffering or likely to suffer continuing Significant Harm. Robust assessment will ensure that intervention plans are targeted, that change is more easily measurable and that decision making for children is timely.

Assessment is an ongoing and dynamic process as is the nature of family life and family responses to professional intervention. This guidance should therefore also be used as part of the continual assessment and reviewing process that takes place when children are subject to Child In Need and Child Protection Plans.


2. The Role of the Drug/Alcohol Misuse Team

Whilst undertaking Single Assessments social work practitioners should always consider whether the parent/carer is working with an adult drug/alcohol agency and if not whether the parent/carer will provide consent for a referral to be made. Given the nature of substance misuse it is often difficult to obtain accurate information, to verify information that is given by users themselves, or to rely on that information. Social workers should therefore seek to validate parental information with Lantern House where the DAT team in Walsall is based and/or with Addaction (see Appendix 1: Walsall Drug And Alcohol Agencies for contact details). The DAT team can provide an assessment of substance dependency, prognosis for change and an opinion on the possible effects of substance misuse on parenting performance. This information should then be further interrogated and examined as part of the Single Assessment using the Practice Tool (see Section 7, Practice Tool) outlined in this guidance.

Walsall also has a substance misuse family intervention lead (currently Sharon Latham - see Appendix 1: Walsall Drug And Alcohol Agencies for contact details). This worker can provide support and advise to social workers regarding specific drug and/or alcohol practice issues, support in working with specific clients of the DAT service where their children are subject to Child In Need and Child Protection Plans and co-working more complex Single Assessments.


3. What is the Theoretical Basis for this Guidance?

This guidance incorporates national guidelines relating to working with substance using parents (SCODA 1997). The SCODA guidelines are aimed at:

  • Assisting workers to gather and analyse information in order to obtain a robust assessment of parent/carer substance and/or alcohol use;
  • Assisting workers to understand the effects of substance/alcohol use on individual children within a family;
  • Supporting workers to produce a clear analysis about levels of need, risk and Significant Harm which will in turn underpin improved planning and decision-making for children and families;
  • Supporting workers to identify relevant support services in conjunction with preventative and targeted resources.

This guidance also encourages practitioners to consider the concept of Resilience as defined by Daniel and Wassell (2002). Resilience promotes protective factors in a particular child’s physical, social and emotional environment which in turn promote improved outcomes. One child may cope better with adversity than another in similar circumstances because they have more resilience factors at play. It is possible to manipulate and increase some resilience factors to lessen the impact of identified risks upon a child even if factors that cause adversity cannot be amended. This theoretical approach asserts that children are more resilient when they have a secure base i.e. a sense of belonging and security; when they have self-esteem which is associated with a sense of self-worth and also self-efficacy which is a personal sense of strengths and limitations. The importance of this for children who live with substance and/or alcohol using parents/carers is that it is child focused and child specific broadening opportunities for professional intervention.

Robust assessment relies upon workers having a good basic knowledge of substance use; having the professional skills to promote parental engagement and reduce denial and minimisation and having a knowledge of local Walsall resources that might be accessed as part of Child Concern or a Child In Need or Child Protection Plan. It also relies upon workers having a sound knowledge of child development as well as child observation and skills in communicating with children. It is beyond the scope of this guidance to explore this knowledge base in detail but if you have learning and developmental needs in these areas then you should consider what training is available through the Walsall Specialist Children training programme and discuss this with your team manager as part of your supervision and EPA process.


4. The Effects of Substance and/or Alcohol use on Parents and Carers

All substance and alcohol misuse is potentially harmful although it affects individuals differently, with some methods and patterns of use also being more harmful than others.

Negative consequences could include increased health risks such as accidents, disease, overdose, psychological problems and HIV/hepatitis for intravenous users. It could also include increased social problems such as antisocial behaviour; criminal activity; accommodation and financial problems. Destructive or violent relationships are often associated with substance and/or alcohol use as is the loss of effective support networks. Heavy and dependent drug use is usually associated with a chaotic and unpredictable lifestyle.


5. The Effects of Substance and/or Alcohol use on Children

Not all children affected by substance and/or alcohol use will experience difficulties although research indicates that it can have significant, damaging and long lasting consequences. Children’s physical, emotional, social, intellectual and developmental needs can be adversely affected both through acts of omission or commission by their parents/carers.

A child’s growth and development depends on a variety of interacting social and biological factors. Hidden Harm (ACMD 2003) identifies three categories that might contribute towards increased harm: factors relating to conception and pregnancy; factors relating to practical parenting and factors relating to a child’s environment.

  1. Conception and pregnancy:

    Substance misuse can lead to babies being born with low birth weight; an increased risk of premature birth; substance withdrawal at birth and physical deformity due to poor nutritional intake. Heavy alcohol use is associated with serious developmental problems; delayed neurological development and foetal alcohol syndrome.
  1. Parenting and environmental factors:

    Children may be at increased risk of physical and emotional harm for a number of possible reasons:
    • Children may have access to drugs or drugs paraphernalia within the home;
    • Substance misuse can act as a disinhibition that can lead to increased violence;
    • Children may be exposed to a number of strangers within the home who may be potentially dangerous to the child. Where families are entrenched in the drug culture this may include threats of violence;
    • Children may be at risk of Neglect - when substance dependency becomes the central organising influence of the family many parents’ strengths and competencies become overpowered by their drug/alcohol use. Their ability to meet some or all of their children’s needs may be diminished as a result e.g.;
      • The child’s basic physical needs may not be being adequately met;
      • The child may receive inadequate supervision for their age;
      • Health appointments for the child may not be kept or appropriate advice not sought for health problems;
      • The child’s education/ school attendance may be impacted upon;
      • The child’s own needs may not be acknowledged by their parent/carer;
      • The parent/carer may have unrealistic expectations of the child’s abilities;
      • Boundaries between family roles may become blurred with the child assuming a parenting role;
      • The child may not be afforded adequate boundaries and routines for their age;
      • The child may also fear that they may be abandoned; that their parent/carer may die; that their parent/carer does not love them; being afraid that other people may find out about their parent/carers substance misuse and feeling responsible for their parent/carers substance and/or alcohol misuse. Children who live with these daily stresses may present as sad, unhappy and withdrawn and their self-esteem may be affected because they feel they have no control.


6. Principles Underpinning the Assessment of Children and Families where substance and/or alcohol use is a Problem

  1. Assessment must take a multi-agency and multi-disciplinary approach - workers should liaise with Walsall’s DAT team at Lantern House and consult with the substance misuse family intervention lead as well as health visitor, police, probation and school;
  2. Assessment and analysis must focus on the specific circumstances of each individual child within the family. The impact of substance use and/or alcohol use must be considered from the perspective of the child, their specific ages and needs;
  3. Assessment should focus on the risks present for each child; the impact of the risks for each child taking into account their age and specific needs; the presence of protective factors and parental/carer motivation and capacity to change. Short-term risks of harm should be assessed with longer term risk to give the cumulative impact on the child’s physical, emotional and behavioural well-being;
  4. Direct work must be undertaken with the child to establish their wishes and feelings and to understand their experience of parenting from their own perspective. Find out whether the child feels safe; who they turn to for help and support; what it’s like for them when their parent/carer is under the influence and when they are not; what they like about living in their family and what they would like to see change; what friendships and networks they have and what activities they engage in;
  5. Analysis of the information gathered should focus on answering these questions:
    • Is the parent/carers’ drug or alcohol use significantly affecting parenting capacity?;
    • Is the parent/cares’ drug or alcohol use and associated behaviour significantly impacting upon the child’s health and safety, social, emotional and educational development?;
    • What are the resources and strengths in this family and how might they impact on the care of the child?;
    • What is the parents’ understanding and attitude on the need for change? Is change attainable? It would be incorrect to assume that detoxification or ceasing substance use would lead to better childcare as this focuses on the substance misuse rather than parenting skills;
    • What types of professional intervention will help reduce the harm to the children?;
    • Where, on the continuum of Children in Need/children in need of protection, does this particular family sit?


7. Practice Tool

  1. Understanding the Pattern of Parental/Carer Substance Misuse
    • Is there is a drug/alcohol free parent or carer, a supportive partner or a relative? What part does this person play and could he/she be encouraged to do more? If drug use is organised to enable one parent to assume responsibility for the child or alternative child care is arranged, then the effect of the drug/alcohol use on the child may be minimised;
    • Is drug use experimental (only used on a few occasions); recreational (not used every day but at weekends, parties etc); is it chaotic (where there are frequent periods of intoxication and withdrawal often associated with a variety of substances in varying amounts); or dependent (regular use, often daily which is associated with withdrawal symptoms). Risks will be increased if use is uncontrolled and chaotic and if there are states of heavy intoxication linked to withdrawal at which time a parent/carer may exhibit increased levels of anxiety, lack of awareness and reduced responsiveness to the child;
    • If the parent/carer is using alcohol what is their usual pattern of use? Are they binge drinking which may replicate the consequences of chaotic drug use or do they drink at times of stress?;
    • Ask the parent/carer exactly what drugs are used? Ask them to describe yesterday; the last week; the last month. Are drugs prescribed or illicit? If prescribed are they stored safely and are they taken as prescribed? How are the drugs used - injected or smoked?;
    • Is drug use combined? Are there any trigger factors that might increase use of likelihood of combination? Combination drug users may be more chaotic and the impact on the user and therefore their parenting ability may be greater;
    • What is the pattern of drug/alcohol use over the last six months - has it increased, decreased or remained stable? Is it a response to specific events or stressful periods? This might help to identify intervention strategies;
    • Have there been any significant drug/alcohol free periods - what were the circumstances affecting this? Could this be explored further and replicated?;
    • What are the behavioural implications for the parent? E.g. Inconsistent behaviour, drowsiness, unavailability, do they become unconscious or incapable, do they fail to follow up on injuries etc.;
    • Does the parent/carer also have mental health problems and how does the drug and/or alcohol use affect their mental health problems? Are these problems caused by drug use? Is the parent/carer involved with a mental health practitioner? Is there is history of self-harm and is the child aware of this?;
    • Is there a marked change in the level of childcare when a parent/carer is using?
  2. How does the parent/carer procure their drugs
    • Are there any risks to the child associated with the way in which the parent/carer procures their drugs e.g. Is the child left alone; are they exposed to unknown strangers; is the child being taken to risky places? Does the parent/carer deal from the home? Do other drug users use in the home?;
    • How much money is spent on drugs/alcohol, does this impact on the parent/carers capacity to buy adequate food, heating, bedding etc?;
    • How does the parent/carer fund their drug use? Are they prostituting or involved in criminal activity and how does this affect their availability for the child.
  3. Accommodation and the home environment
    • Is the family’s living accommodation suitable for the child? Is it adequately equipped and furnished? Are there appropriate sleeping arrangements for the child, for example does each child have a bed or cot, with sufficient bedding?;
    • Are rent, bills and other essential services paid for? Does the family have any arrears or significant debts? Does this raise any safety issues if debts are to dealers?;
    • How long have the family lived in their current home/current area? Does the family move frequently? If so, why? Are there problems with neighbours, landlords or dealers and as a result are there issues relating to family safety, stigmatisation and lack of social support networks? Stability is enhanced if a family remains in one locality whereas frequent moves can disrupt health and educational provision as well as the development of friendships and relationships with professionals;
    • Is the household at risk of losing their accommodation? If yes, what action has been taken by the landlord?;
    • Do other drug users/problem drinkers share or use the accommodation? If so, are relationships with them harmonious, or is there conflict? What is the impact of this on the child and do others have any childcare responsibilities?;
    • Is the family living in a drug-using/heavy drinking community? What impact does this have on the child?;
    • Does the child witness the taking of drugs/alcohol and what is the impact upon them? Ask the child how they feel about this;
    • Has the parent/carer ever overdosed intentionally or accidentally? Has the child witnessed this? Again what do they feel about this and what fears do they have?;
    • Is the child exposed to intoxicated behaviour/group drinking?;
    • Are drugs/alcohol and paraphernalia stored somewhere safe or does this pose a risk because they are accessible to the child.
  4. The child’s developmental profile and the provision of good basic care
    • How many children are there in this family? What are their names and ages and therefore their specific developmental and care needs? Are there any children living outside the family home and, if so, where? why? and with whom?;
    • Do the parents see any of the children as being particularly demanding? Why is this? Are there any other special circumstances such as illness and disability which need to be considered?;
    • Is there adequate food, clothing and warmth for the child? Are height and weight normal for the child’s age and stage of development? Ask to check cupboards, speak to the children about their meal time routines and speak with the health visitor or school health advisor to corroborate information;
    • Is the child receiving appropriate nutrition and exercise?;
    • Is the child’s health and development consistent with their age and stage of development? Has the child received necessary immunisations? Is the child registered with a GP and a dentist? Do the parents seek health care for the child appropriately?;
    • Does the child attend nursery or school regularly? If not, why not? Is s/he achieving appropriate academic attainment?;
    • Does the child present any behavioural or emotional problems? Some children may for example develop highly sophisticated fantasy worlds as a way of dealing with a non-stimulating home environment, they may be loners, a bully or be bullied. Children from chaotic substance misusing families may display temper tantrums, aggression or run away. Does the parent manage the child’s distress or challenging behaviour appropriately?;
    • Who normally looks after the child? What arrangements are in place and does the child understand these;
    • Is the child engaged in age-appropriate activities? Are they a regular school attendee? Speak with school about their observations of the child, their engagement and presentation, their friendship networks and their relationship with adults;
    • Are there any indications that the child is taking on a parenting role within the family e.g. caring for other children or excessive household responsibilities? Does this impact on their engagement with normal childhood experiences?;
    • Is the care for the child consistent and reliable? Are the child’s emotional needs being adequately met?;
    • Is there a risk of repeated separation for example because of periods of imprisonment e.g. short custodial sentences for fine default? What is the child’s understanding when this occurs and what support is provided to them by social support networks?;
    • How does the child relate to unfamiliar adults?;
    • Are there non-substance using adults in the family readily accessible to the child who can provide appropriate care and support when necessary? Is there a relative or mentor outside of the family who is a source of consistent and stable support who can develop resilience for the child?;
    • Does the child know about his/her parents substance use?;
    • Is there evidence of drug/alcohol use by the child?;
    • Is there any history of domestic abuse;
    • Are there known learning difficulties.
  5. Family and Social Supports
    • Do the parents primarily associate with other substance users, non-substance users or both?;
    • Are relatives aware of parent(s) problem alcohol/drug use? Are they supportive of the parent(s) and/or the child?;
    • Will parents accept help from relatives, friends or professional agencies?;
    • Is social isolation a problem for the family?;
    • How does the community perceive the family? Do neighbours know about the parent/carers substance use? Are neighbours supportive or hostile?
  6. Health Risks
    • What precautions do parents take to prevent their children getting hold of their drugs / alcohol? Are these adequate? Does the child know where the drugs/alcohol are kept?;
    • Does the child witness the parent/carer taking their medication either at home or at the pharmacy? There is a risk here of young children copying their parent/carer;
    • What does parent/carer know about the risks of children ingesting methadone and other harmful substances? Would they benefit from further support around this and do they acknowledge the deficits in their knowledge?;
    • Does the parent/carer know what to do if the child has or they suspect that they have consumed methadone, other drugs or alcohol?;
    • Are the parents/carers in touch with local agencies that can advise on issues such as needle exchanges, substitute prescribing programme's, detoxification and rehabilitation facilities? If they are in touch with agencies, how regular is the contact? Are they engaging consistently?;
    • Is there a risk of HIV, Hepatitis B or Hepatitis C infection?;
    • Are parents aware of increased risk of cot death if baby is co-sleeping when parents are using substances including prescribed or elicit drugs and alcohol;
  7. If the Parent(s) inject
    • Where is the injecting equipment kept? In the family home? Are works kept securely?;
    • Is injecting equipment shared?;
    • Is a needle exchange scheme used?;
    • How are syringes disposed of?;
    • What does the parent/carer know about the health risks of injecting or using drugs?;
    • If pregnant, are they aware of screening tests for blood borne viruses and appropriate immunizations;
  8. What is the parent‘s perception of the situation
    • What do parents/carers think about the potential impact of the substance misuse on themselves, their child and their family? Parents and carers who are aware are more likely to try and lessen the impact by stabilising or changing their substance/alcohol use. What is their capacity to work towards change and what support is needed to enable them capable of change?;
    • Is there evidence that the parents/carers place their own needs and procurement of alcohol or drugs before the care and welfare of their child?;
    • How do they explain their usage to their child and what is the child’s understanding of this?;
    • Do the parents/carers know what responsibilities and power agencies have to support and protect children at risk?


Appendix 1: Walsall Drug And Alcohol Agencies

Lantern House Community Drug and Alcohol Team

130 Lichfield Street
Walsall
WS1 1SY

Telephone: 01922 858463
Fax: 01922 858464

Walsall’s family intervention lead can also be contacted t Lantern House.

T3 Young Persons Substance Misuse Services
21 Jervis Court
Dog Kennel Lane
Walsall
WS1 2BU
Addaction

231 Stafford Street
Walsall
WS2 8DF

Telephone: 01922 646262
Fax: 01922 646766

Email: walsall.prj@addaction.org.uk

Addaction website

References

ACMD (2005) Government Response to Hidden Harm: The report of an inquiry by the Advisory Council on the Misuse of drugs. Department for Education and Skills.

Daniel B and Wassell S (2002) The early years: assessing and promoting resilience in vulnerable children 1.London: Jessica Kingsley.

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