Transcript Document

New ACMD report
http://www.drugs.gov.uk/Reportsand
Publications/NationalStrategy/10547
33801?batch_start=1
http://www.drugs.gov.uk/
ReportsandPublications/National
Strategy
John Mosley. Visit www.drugsandstuff.co.uk
Six key messages from the Inquiry
Estimate of between 250,000 and 350,000 children of problem
drug users in the UK – about one for every problem drug user.
Parental problem drug use can and does cause serious harm to
children at every age from conception to adulthood.
Reducing the harm to children from parental problem drug use
should become a main objective of policy and practice.
Effective treatment of the parent can have major benefits for the
child.
By working together, services can take many practical steps to
protect and improve the health and well-being of affected
children.
The number of affected children is only likely to decrease when
the number of problem drug users decreases.
John Mosley. Visit www.drugsandstuff.co.uk
Child protection and substance use
We should particularly be concerned with
substance use that is dependant or chaotic.
For the practitioner and the client, the ability
to distinguish recreational use from
problematic misuse is a crucial skill.
Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.
John Mosley. Visit www.drugsandstuff.co.uk
Links between problematic use and child protection
To suggest that all parents who suffer from
problem drug use present a danger to their
children is misleading. Indeed, much
research indicated that in isolation problem
drug use of a parent presents little risk of
significant harm to children.
Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23,
London; HMSO.
John Mosley. Visit www.drugsandstuff.co.uk
Family alcohol problems
Double the risk of divorce/separation
40% of domestic violence incidents
25% of known child abuse cases
60% of Child Protection Register
Robinson (2000)
John Mosley. Visit www.drugsandstuff.co.uk
It’s not the drinking, but...
Violence in the home
Marital/relationship conflict
Separation, divorce, loss of parent
Inconsistency and ambivalent parenting
Unpredictability
Drinking/parent centred not childcentred.
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Effects on Family Life
Inconsistency, changing moods
Role reversal
Communication
Routines and rituals
Social life
Finances.
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Effects on Family Functioning 1
Family conflict and disharmony
Cruel, passive or neglectful parental
attitude
Inconsistent and unpredictable
parenting
Parents do not set clear or safe limits.
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Effects on Family Functioning 2
Children take on parental role
Parents are emotionally unavailable and
distracted
Outing and social events fraught with
uncertainty
Child fears parent might die or
otherwise leave them
Deprivation caused by poverty.
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Effects on Children
Anti-social behaviour - aggressive,
delinquency, conduct disorders, hyperactivity
Adolescence – problems associated with
using drugs and alcohol
Emotional problems - psycho-social
problems, asthma, bedwetting, negative
attitudes to self
School environment - academic problems,
difficulties learning, loss of confidence,
conduct disorders.
John Mosley. Visit www.drugsandstuff.co.uk
Problem drinking parents are often:
Unpredictable
Aggressive
Chaotic
Inconsistent
Unreliable.
John Mosley. Visit www.drugsandstuff.co.uk
Adverse consequences
Typically multiple and cumulative
Failure to thrive
Blood-borne infections
Incomplete immunisation and inadequate health care
Wide range of emotional, cognitive, behavioural and
other psychological problems
Early substance misuse and offending behaviour
Poor educational attainment
ACMD (2003)
John Mosley. Visit www.drugsandstuff.co.uk
Longer Term Effects
Effects on transition to adulthood
Friendship difficulties
Division between home and peers - home seen as
negative
Drinking alcohol/drug-taking at an earlier age
Leaving home early - by comparison with others
Prescribed psycho-active drugs as children and
adolescents (27% v 3%) by age 17
Earlier marriages - seeking social stability.
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Children of Problem Drinkers
Do not expect adults to provide well for them
Do not anticipate love, warmth or friendship
Are hyper-vigilant towards changing moods
Take too much or too little responsibility
See positive outcomes to problems as exceptions
Do not trust adults to be fair
Find it difficult to relax and enjoy things
Expect and even create conflict in relationships.
John Mosley. Visit www.drugsandstuff.co.uk
Protective Factors
A non-drinking parent
Cohesive parental relationship
Cohesive family
Rituals maintained
Influence of important others
Engaged with things outside the home
Deliberate planning.
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How to Increase Resilience?
Help a young person:
See themselves as separate from family
problems
Develop belief in own abilities
Understand and express feelings and
emotions
Cope with difficulties and problem solve
Engage in activities outside family
Develop their own plans for the future
John Mosley. Visit www.drugsandstuff.co.uk
Alcohol, Childcare and Parenting
Information from:
Wendy Robinson, NSPCC/ARP Family Alcohol
Service
To receive a copy of the NSPCC publication ‘Alcohol, Childcare and Parenting - A Handbook for
Practitioners’ send an A4 SAE with £1.58p in
stamps to:
Administrator, Family Alcohol Service,
88-91 Troutbeck House,
off Robert Street,
London NW1 4EJ
John Mosley. Visit www.drugsandstuff.co.uk
Prevalence of problematic use
Research shows that many people
experiment with drugs, with most trying them
only once in a lifetime. Fewer, but a
significant minority, use drugs regularly.
Around one-third of people who have ever
used drugs become regular drug users, and it
has been predicted that roughly ten percent
become problem drug users.
SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. p10.
London: LGA Publications.
John Mosley. Visit www.drugsandstuff.co.uk
Child abuse
Child abuse is an interaction that involves
the significant mistreatment of the relatively
powerless participant (usually the child or young
person) by the participant with more power
(usually the parent or adult). This interaction will
frequently be affected and partly defined by the
child’s chronological age, legal status, dependency,
and developmental immaturity.
The definition of what is child abuse will change over
time and is affected by the perspectives and values
that are influential in society.
Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.
John Mosley. Visit www.drugsandstuff.co.uk
Substance misuse
Substance misuse is a compulsion or desire to
continue taking a drug, or drugs in order to feel good
or avoid feeling bad. The compulsion or desire is
usually initiated following previously repeated use of
the drug and is difficult to control. When the
compulsion is to avoid physical discomfort, it is
physical dependence; when it is to avoid anxiety or
mental distress, or to promote stimulation or pleasure
it is known as psychological dependence.
SCODA. (1997). Drug Using Parents: Policy Guidelines for Interagency Working. London: LGA
Publications.
John Mosley. Visit www.drugsandstuff.co.uk
Child protection and substance use
We should particularly be concerned with
substance use that is dependant or chaotic.
For the practitioner and the client, the ability
to distinguish recreational use from
problematic misuse is a crucial skill.
Murphy, M. (1996). The Child Protection Unit. p 11. Aldershot: Avebury.
John Mosley. Visit www.drugsandstuff.co.uk
Links between problematic use and child protection
To suggest that all parents who suffer from
problem drug use present a danger to their
children is misleading. Indeed, much
research indicated that in isolation problem
drug use of a parent presents little risk of
significant harm to children.
Cleaver H., Unell, I., and Aldgate, J., (1999) Children’s Needs Parenting Capacity, P.23,
London; HMSO.
John Mosley. Visit www.drugsandstuff.co.uk
Treatment and care for adult substance users
Community Based Services might include
Counselling / support
Drop-in support
Needle exchange
Complementary therapies – acupuncture
Medical based services might include
Methadone prescriptions
Community detox
Access to inpatient detox
John Mosley. Visit www.drugsandstuff.co.uk
Treatment and care for adult substance users
Social Services might include
Counselling / support
Access to funding for rehabilitation services
Rehabilitation Services
(a) Day centres and (b) residential services
The services offered by rehabilitation services vary:
Therapeutic input
Vocational training
Relapse prevention
Support in gaining housing, employment, access to health
services, access to children
John Mosley. Visit www.drugsandstuff.co.uk
Screening & Assessment
Screening
Refers to any process (reactive or proactive) used to
identify whether someone is using drugs
Assessment
Occurs after drug use has been identified. Its
meaning is a process that informs intervention
planning by ascertaining the severity and pattern of
drug use, and how the drug use affects the young
person concerned.
John Mosley. Visit www.drugsandstuff.co.uk
The screening and assessment
process
1
2
3
4
Screening
Parental
substance
use
what substance
how much / how obtained / how taken
when (pattern of use)
who with
cost
lifestyle implications
Effect on
parenting
capacity
history of own parents
expectation of self as parent
basic care
ensuring safety
stability
Effect on
child's needs
development
basic needs
protection
self esteem
relationships
love and affection
control
child care demands
stages of development
personality
special circumstances
availability of other adults
Stage 3 Assessing ability to parent
Ensuring safety
Stability
Income
John Mosley. Visit www.drugsandstuff.co.uk
Stage 4 - Assessing the needs of the child
Basic Care
Emotional and behavioural development
Stimulation
Family and social relationships
John Mosley. Visit www.drugsandstuff.co.uk
why drugs?
“That humanity at large will ever be able to
dispense with Artificial Paradises seems very
unlikely. Most men and women lead lives at the
worst so painful, at the best so monotonous,
poor and limited, that the urge to escape, the
longing to transcend themselves if only for a
few moments, is and always has been one of
the principal appetites of the soul.”
Huxley, A. (1951). The Doors of Perception. London:
Penguin.
John Mosley. Visit www.drugsandstuff.co.uk
DATs are responsible for:
assessing the need for services to tackle drug
use/misuse locally and co-ordinating a response;
providing information about local patterns of drug
misuse;
agreeing a local drug misuse strategy and
planning/purchasing appropriate services;
setting local targets;
encouraging joint commissioning between member
agencies;
developing links with all relevant agencies;
signing off local spending plans;
reporting on progress towards objectives and targets;
allocation of pooled treatment funding.
John Mosley. Visit www.drugsandstuff.co.uk
Young Person’s Holistic Needs Assessment
Identifying
substance
related needs
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Full assessment
of substance
related needs if
required
DrugScope / Home Office (2003: 9)
Purpose of identifying
substance related needs
To identify:
the young persons knowledge of drugs, alcohol and
solvents
if the young person uses drugs, alcohol or solvents
if the young person misuses drugs, alcohol ir solvents
if the young person is in immediate danger
if substance use is part of complex, or troubling
behaviour
unusual behaviour for that age group in relation to
their substance use.
John Mosley. Visit www.drugsandstuff.co.uk
Assessment Process Flowchart
Assessment Process
(Including identification of
substance related needs
No Further Action
Review of
young person’s
needs
Advice and
Information
Immediate Action
needed
Tier 2
Intervention
Referral to
tiers 3/4
Plan to meet young
person’s needs
John Mosley. Visit www.drugsandstuff.co.uk
Other interventions to
meet non-substance
needs
DrugScope / Home Office (2003: 26)
Process for identifying young people’s substance related needs
Step 1
When you should screen for substance use
When a young
person seeks
advice/information
about drugs, alcohol
or solvents
Step 2
Following
identification
or suspicion or
drug taking
When a drug
related incident
occurs
When a vulnerable
young person
comes into contact
with your service
e.g.
Young:
Homeless
Looked After
Carers
Offenders
Excluded
Confidentiality
Practitioners are advised to explain their service’s confidentiality policy. Explain the consequences of identifying
substance related needs, including information about what you as a practitioner can provide and information on
any agency you refer them to.
Step 3
What should the process establish?
Knowledge of
drugs, alcohol
and solvents
Step 4
No further
action
If they take
drugs, alcohol
or solvents
If they misuse
drugs, alcohol
or solvents
If the young
person is in
immediate
danger
If substance
use is part of
troubling
behaviour
Unusual behaviour
for that age group
in relation to their
substance use
Referral to meet a
tier 3 need
- complex
treatment, e.g.
prescribing
and/or
complimentary
therapy
If there is a
child
protection
concern,
refer to
social
services
Outcomes of identifying substance related needs
Provision of
drug and
alcohol
education in a
universal
setting
Targeted
information
and advice
Referral to
meet a tier 2
need
- ‘counselling’
or a drug
related
prevention
programme
CAGE Test to screen for potential alcohol problem
Have you ever:
Cut back or Changed your drinking pattern?
felt Annoyed of people criticised your drinking?
felt Guilty about drinking?
Needed a drink Early in the day to steady yourself (Eye
opener)?
2 out of 4 yes answers is a positive screen
Mayfield et al. (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American
Journal of Psychiatry. 131: 1121 - 1123.
John Mosley. Visit www.drugsandstuff.co.uk