Drugs, alcohol and safeguarding

1
Drugs, alcohol and safeguarding

• Patrick Ayre
• University of Bedfordshire
• pga_at_patrickayre.co.uk
• http//patrickayre.co.uk

2
Key messages from the government

• Childrens welfare is the most important
  consideration
• It is everyones 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 multi-disciplinary training.

3
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
• But focus on the stage when the use of drugs or
  alcohol is having a harmful effect on a persons
  life

4
Effects vary, but

• 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

5
Drug treatment population in Scotland 2002

• One third were women
• Four fifths were unemployed
• One in five living with dependent children

6
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

7
England and Wales statistics

• 23 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)

8
More statistics

• Between 50 and 90 of families on social
  workers child care caseloads have parent(s) with
  drug, alcohol or mental health problems
• Glasgow 1998/9 40 of Child Protection Orders
  cited drug abuse
• Dundee Child protection conferences involving
  parents with problems over drug or alcohol use
  rose from 37 in 1998/9 to 70 in 2000

9
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

10
Effects on children

• 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)

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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)

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Specific effects (mainly US Studies)

• 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).

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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)
• In the longer term isolation, difficulties with
  change and learning to have fun (Barlow, 1996)

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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

15
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

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Primary school

• 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

18
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

19
Secondary school

• Puberty without parental support
• Increased risk of conduct disorders, bullying and
  sexual aggression
• Beyond parental control and increased risk of
  injury by parents
• Socialised into substance misuse

20
Secondary school

• I knew they loved me but they just didnt care
  that I was there and I needed stuff as well
• Elaine, aged 14
• At school, if your pals know your mas on drugs
  you get called a junkie
• (Aberlour 2002)

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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

22
Some principles for intervention

• 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

23
Some principles for intervention

• 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 childs 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

24
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

25
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

26
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

27
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

28
The significant harm threshold

• The threshold is probably passed when
• Parental drug and alcohol use is adversely
  impacting on the childs 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)

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When enough is enough

• When a parent consistently places procurement and
  use of alcohol or drugs over their childs
  welfare and fails to meet a childs physical or
  emotional needs, the outlook for the childs
  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
  childs best interests when parents cannot.
• (Getting our priorities right, 2003)

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Referral triggers

• Use of the family resources to finance the
  parents 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

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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?

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Assessment

• Generic
• CAF
• GCP (assessment of parenting)
• Specialist substance misuse and/or child
  protection assessment

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Assessment principles

• Focus on the child
• Consider outcomes for the child, not the intent
  of the parent
• Focus more on the childs 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

35
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
  co-ordination 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)

36
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

37
Substance misuse workers vs child care workers

• Mutual incomprehension and misunderstanding
• Working on the same case but not working jointly
• False expectations and assumptions
• Abdicating responsibility (both ways)
• Need for interpreters

38
9 Checks

• 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)
  awareness-raising 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?

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9 Checks

• 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)

40
Working with parents

• Even though were 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
  Im at it and challenges me.
• Sue drinking mum

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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.

42
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

43
Supervision

• Cases particularly demanding because of their
  complexity
• A clear framework of supervision or professional
  consultation should support the workers involved.
  
• Particular attention should be paid to ensuring
  that the case is considered holistically and that
  a wide range of perspectives is taken into
  consideration

44
Supervision

• 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
• 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

45
6 Key Points on Information Sharing

• 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 childs
  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.

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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)