Transcript Drugs, alcohol and safeguarding

Drugs, alcohol and
safeguarding
Patrick Ayre
University of Bedfordshire
[email protected]
http://patrickayre.co.uk
Key messages from the government
Children’s welfare is the most important
consideration;
 It is everyone’s responsibility to ensure that
children are protected from harm;
 We should help children early and not wait for
crises – or tragedies – to occur; and
 We must work together, in planning and
delivering services, in assessment and care
planning with families, and in multidisciplinary training.
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Who are we talking about?
Experimental drug users
 Recreational drug users
 People who use legal substances
 People who are dependent on illegal
drugs or alcohol
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But focus on ‘the stage when the use of
drugs or alcohol is having a harmful
effect on a person’s life’
Effects vary, but:
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Substance misuse may become central
preoccupation
Reduce or alter appetite
Reactions to pain and discomfort dulled
Self-neglect
Social relationships narrow
Trouble with money, housing and the law
Poor physical and mental health
Interpersonal conflict and poor family
relationships
Drug treatment population in
Scotland 2002
One third were women
 Four fifths were unemployed
 One in five living with dependent
children
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More Scottish statistics: Maternities
Diagnosis of drug misuse in:
 4.4 per thousand of all maternities
 19.2 per thousand of all neonatal
special care discharges
England and Wales statistics
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2–3% of children under 16 have
parents with serious drug problems
54% of parents had children who did
not live with them
9% had children in care
2% of babies were born to problem
drug or alcohol users
(Hidden Harm, 2003)
More statistics
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Between 50% and 90% of families on social
workers’ child care caseloads have parent(s)
with drug, alcohol or mental health problems
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Glasgow 1998/9: 40% of Child Protection
Orders cited drug abuse
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Dundee: Child protection conferences
involving parents with problems over drug or
alcohol use rose from 37% in 1998/9 to 70%
in 2000
Effects on children
‘Parental substance misuse alone is neither a
necessary nor sufficient cause of problems in
children’ (Mountenay, 1998)
“International literature on the children of drug
users does not support an assumption that child
abuse and neglect automatically follow when a
parent uses drugs” (Hogan,1998)
But, families need comprehensive assessment
and active support to promote resilience and
repair damage
Effects on children
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Alcohol and/or substance misuse greatly
increase the likelihood of family problems
(Sher 1991; Zeitlin, 1994)
 Substance use can become the central focus
of the adults’ lives, feelings and social
behaviour.
 CAMH services report substantial risk of poor
childhood mental health (Mountenay, 1999)
 Poor long-term outcomes for children (Rutter
and Rutter, 1992)
Effects on children
“I hated weekends when mum had all her
friends round drinking all night.”
Sarah – daughter of problem drinker
“She was just always dead moody, she was
always in her bed all the time and she would
never go out and buy food and she would never
have money to go out and get it.”
(Barnard 2002)
the children of problem drinkers: ‘forgotten
children’, a ‘hidden tragedy’, and or ‘unseen
casualties’ (Wilson 1982)
Specific effects (mainly US Studies)
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High risk of maltreatment, emotional or
physical neglect or abuse, family conflict and
inappropriate parental behaviour Famularo,
Kindscherff and Fenton, 1992; Wasserman
and Levanthal, 1993, Barlow, 1996).
 Exposed to drug-related activity and
associated crime (Hogan, 1998)
 Inconsistent and lukewarm care, ineffective
supervision and overly punitive discipline
(Kandel, 1990; Boyd, 1993).
Specific effects (mainly US Studies)
More likely to:
 display behavioural problems (Wilens et al,
1995),
 experience social isolation and estrangement
from family and peers, and stigma (Kumpfer
and De Marsh, 1986),
 misuse substances themselves when older
(Hoffman and Su, 1998; McKeganey 1998)
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In the longer term: isolation, difficulties with
change and learning to have fun (Barlow,
1996)
Pre-birth, infancy and pre-school
Risk of physical harm pre-birth
 Neglect and injury through drugged
state of parent, access to drugs
 Inappropriate emotional care through
unhappiness, tension, irritability,
preoccupation
 Cognitive and emotional development
affected by lack of stimulation and
inconsistent/unpredictable behaviour,
unstable environment
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Pre-birth, infancy and pre-school
Poor contact with other children
 Materially deprived environment
 Self-esteem and positive sense of
identity affected by physical and
emotional neglect
 Experience violence
 Where parents’ behaviour is particularly
unpredictable and frightening,
symptoms of PTSD
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Pre-birth, infancy and pre-school
“Baby Adele was carried along the harbour
wall by her father who was under the
influence of alcohol. Neighbours thought
this carried the risk of dropping her in the
water.”
(Scottish Executive 2002)
“My parents started giving me alcohol when
I was 1 (year old) to put me to sleep. I got
taken into hospital to have my stomach
pumped.”
Helen, aged 12
Primary school
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Symptoms of extreme anxiety and fear of
hostility
Boys more quickly exhibit behavioural
problems (but girls equally affected)
Self-blame and poor self-esteem
Academic attainment and social development
affected by neglect and poor attendance,
poor concentration
Shame and embarrassment lead to isolation
Young carers
Primary school
“I used to feel angry when my Mum was on
drugs ‘cause I used to think how could this have
happened to me? I was just sad all the time and
then I would get angry. And we would have
arguments all the time.”
Anne, aged 11
“I used to get really embarrassed at school
when mum turned up drunk to collect me. I
knew that I would have to make the tea when I
got in.”
Billy, aged 9
Secondary school
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Puberty without parental support
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Increased risk of conduct disorders,
bullying and sexual aggression
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Beyond parental control and increased
risk of injury by parents
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Socialised into substance misuse
Secondary school
“I knew they loved me but they just didn’t
care that I was there and I needed stuff as
well”
Elaine, aged 14
“At school, if your pals know your ma’s on
drugs you get called a junkie”
(Aberlour 2002)
Protective factors
Sufficient income
 A consistent caring adult
 Regular monitoring and respite
 Refuge from violence
 Regular school/nursery attendance
 Sympathetic and vigilant teachers
 Organised out of school activities
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Some principles for intervention
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The welfare of the child is the paramount
consideration
 Every child has the right to protection from all
forms of abuse, neglect or exploitation
 Every child has a right to be treated as an
individual
 Every child who can form a view on matters
affecting him or her has the right to express
those views if s/he wishes
Some principles for intervention
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All agencies in contact with families affected
by substance misuse should consider the
safety and welfare of the children of those
families.
 So far as is consistent with safeguarding and
promoting the child’s welfare, local authorities
should promote the upbringing of children by
their families
 Any intervention by a public authority in the
life of a child must be properly justified and
supported by services from all relevant
agencies working in collaboration
Seeing the child
All agencies which visit parents at home
should see the children regularly
 Parents may seek to avoid this by
evasion/aggression
 Workers must record any failed attempt
to see the child and follow this up
appropriately
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Deciding when a child needs help
Children have additional needs if they
need help to achieve the 5 ECM Targets:
Stay safe, Be healthy, Enjoy and achieve,
Make a positive contribution, Achieve
economic well-being
Deciding when a child needs help
“A child is in need if he is unlikely to
achieve or maintain, or to have the
opportunity of achieving or maintaining, a
reasonable standard of health or
development without the provision of
services by a local authority. Equally, he is
in need if his health or development is
likely to be significantly impaired or further
impaired without the provision of such
services, or if he is disabled”
Deciding when a child needs help
Children are in need of protection if their
circumstances are such that they are
‘suffering, or likely to suffer, significant
harm’. This may involve presence of
maltreatment or absence of care
The significant harm threshold
The threshold is probably passed when:
 Parental drug and alcohol use is adversely
impacting on the child’s health and
development
 There is no one parental figure able to
provide a stable secure environment for the
child
 There is no evidence that parental behaviour
will change within a timeframe congruent with
the needs of the child
(LSCB Safeguarding Inter-Agency
Procedures, 2006)
When enough is enough
When a parent consistently places procurement
and use of alcohol or drugs over their child’s
welfare and fails to meet a child’s physical or
emotional needs, the outlook for the child’s
health and development is poor. Problem
alcohol or drug using parents themselves
acknowledge this and it is the duty of
professionals to act in the child’s best interests
when parents cannot.
(Getting our priorities right, 2003)
Referral triggers
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Use of the family resources to finance the
parent’s dependency, characterised by
inadequate food, heat and clothing for the
children
 Children exposed to unsuitable caregivers or
visitors, e.g. customers or dealers
 The effects of alcohol leading to an
inappropriate display of sexual and/or
aggressive behaviour
 Chaotic drug and alcohol use leading to
emotional unavailability, irrational behaviour
and reduced parental vigilance
Referral triggers
Disturbed moods as a result of
withdrawal symptoms or dependency
 Unsafe storage of drugs and/or alcohol
or injecting equipment
 Drugs and/or alcohol having an adverse
impact on the growth and development
of the unborn child
(LSCB Safeguarding Inter-Agency
Procedures, 2006
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Screening
All agencies supporting adult alcohol or drug
users should ask new attendees:
 Are you a parent?
 How many dependent children live with you?
 Do you have any children who live with others
or are in residential care?
 What is your child(ren)’s age and gender?
 Which school or nursery do they attend?
 Are there any other relatives or support
agencies in touch with your family supporting
the child(ren)?
 Do you need any help with looking after
children or arranging childcare?
Assessment
Generic
 CAF
 GCP (assessment of parenting)
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Specialist substance misuse and/or
child protection assessment
Assessment principles
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Focus on the child
Consider outcomes for the child, not the
intent of the parent
Focus more on the child’s lived experience
than on specific incidents
Adults’ management of their own lives is a
good indicator of their ability to look after a
child
Take full account of historical information
Information from a variety of sources is better
than information from one
Working together
It is not sufficient to protect children from the serious
risks associated with parental substance misuse. It is
important to provide for the wider needs of the child and
family for therapy and support. This should include help
for parents to develop their parenting skills, and
intervention aimed at reducing or stopping substance
misuse. This will require re-orientation and better coordination of adult substance misuse services and
childcare services, geared towards early intervention.
All staff should recognise that their efforts to assist their
client are part of a complex set of interactions which will
impact on individual workers from single agencies and
the family as a whole. Not all problems can be solved,
and a single worker cannot solve them alone
(Getting our priorities right, 2003)
Working together
Complex network of intervention:
 Support parents and parenting
 Stabilise/reduce substance misuse
 Reduce risk and harmful effects on
children
These objectives may not always be
compatible, especially with regard to
timescales
Substance misuse workers vs child
care workers
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Mutual incomprehension and
misunderstanding
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Working on the same case but not working
jointly
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False expectations and assumptions
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Abdicating responsibility (both ways)
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Need for ‘interpreters’
9 Checks
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How often do members of either system consult with
the other?
 Do substance misuse staff ever ‘trigger’ child
protection enquiries/ procedures?
 Do you have joint protocols for the management of
childcare/substance misuse problems?
 Do you run inter-agency courses on (a) awarenessraising about child protection or substance misuse
issues and (b) the crossover between substance
misuse and child protection?
 How often are members of the substance misuse
system involved in child protection conferences, child
protection core groups for planning and joint
assessment work?
9 Checks
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Do your substance misuse staff routinely assess
parenting skills/ability?
 Do your Child Protection Committee, Drug and/or
Alcohol Action Team, social work service and
substance misuse related services have established
channels of communication/co-operation?
 Do you gather data or organise research on the
crossover between substance misuse and childcare
issues?
 Have you established any special posts which
‘bridge’ the divide between the two systems?
(Substance Misuse and Child Care, 2000)
Working with parents
“Even though we’re drug users, we want to be
treated with respect.”
Karen – recovering drug user
“Just because I drink does not make me a bad
mum. I love my kids.”
Liz – a mother with alcohol problems
“I need someone who knows the score. Knows
when I’m at it and challenges me.”
Sue – drinking mum
Working with parents
It is good practice to work in partnership
with parents
 Professionals should be open and
honest with parents about the problems
and risks they perceive
 Working with parents as partners does
not mean their wishes determine
decisions, but that their views are
sought and taken into account.
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Working with parents
It is important to recognise that:
 Parents will often hide the extent of their
problem for fear of the consequences
 They may find it very hard to change,
despite the consequences
 This means testing and checking their
accounts
Supervision
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Cases particularly demanding because of
their complexity
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A clear framework of supervision or
professional consultation should support the
workers involved.
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Particular attention should be paid to
ensuring that the case is considered
holistically and that a wide range of
perspectives is taken into consideration
Supervision
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Drug and alcohol supervisors should ensure
that child welfare concerns are always
considered, that consultation with social
services takes place where required and
that referrals are made whenever necessary
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Supervisors in the field of child welfare
should always ensure that issues
associated with problematic drug and
alcohol use are fully understood and taken
into account and that appropriate
consultation or collaboration is initiated
when required
6 Key Points on Information
Sharing
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Explain the position at the outset, unless this causes
risk or may prejudice the investigation of a serious
crime
Consider safety and welfare when making decisions
on whether to share information children Where there
is concern that the child may be suffering or is at risk
of suffering harm, the child’s safety and welfare must
be the overriding consideration.
Where possible, respect the wishes of children,
young people or families who do not consent to share
confidential information. You may still share
information, if there is sufficient need to override that
lack of consent.
6 Key Points on Information
Sharing
Seek advice where you are in doubt
 Ensure that the information you share is
accurate and up-to date, necessary for
the purpose for which you are sharing it,
shared only with those people who need
to see it and shared securely.
 Record the reasons for your decision –
whether it to share information or not.
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Information sharing
Sharing confidential information without consent will
normally be justified in the public interest:
 when there is evidence that the child is
suffering or is at risk of suffering significant harm;
or
 there is reasonable cause to believe that a
child may be suffering or at risk of significant
harm; or
 to prevent significant harm arising to children
and young people or serious harm to adults,
including through the prevention, detection and
prosecution of serious crime
(Information Sharing: Practitioners guide, 2006)