3.5 Guidelines, Monitoring and Surveillance of At Risk Groups

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1 3.5 Guidelines, Monitoring and Surveillance of At Risk Groups Children of Parents who are Affected by Drug and Alcohol Misuse Background There is overwhelming evidence that the misuse of drugs and alcohol may adversely affect the ability of parents to meet the physical, emotional and developmental needs of their children in both the short and long term. During pregnancy the misuse of drugs or alcohol may have a catastrophic effect on the fetus in terms of congenital defects or miscarriage. The substance use, and the commonly associated poor maternal nutrition, may also predispose the infant to prematurity, growth retardation and delays in emotional, physical, cognitive and language development. International research suggests that approximately ten percent of children live in households where there is parental drug and alcohol misuse. Substance misuse will impact on the parent s capacity to interact positively and consistently with their child and may result in an authoritative parenting style. During episodes of parental intoxication the child may be at an acute risk of harm as a result of the parental incapacity to monitor and intervene in risk situations. Parental substance misuse commonly co-occurs with mental health disorders, poverty or other complex social issues that contribute to, and maintain, the misuse of the drugs or alcohol. Factors contributing to the chaotic lifestyle commonly experienced by problem substance users can include social exclusion, poor housing, unemployment, low educational achievement, high levels of hopelessness and despair and severe psychological and family stress, often involving sexual and physical abuse. Drug and alcohol use and related harm are of significant concern amongst Aboriginal people. Problem drug use in this population is intertwined with broader social issues including the continuing impact of colonisation, family dispersal and widespread social disadvantage. The ongoing grief and trauma has contributed to drug and alcohol use which in turn, further exacerbates the situation. Parental substance misuse is therefore only one of many negative circumstances that collectively increase the child s risk for negative life outcomes. The level of this impact may be modified by the presence of any protective social, family and individual factors, including a secure relationship with extended family members.

2 Children of parents who are affected by drug or alcohol misuse may develop behavioural, physical, educational and emotional or psychiatric problems, including communication disorders or aggressive behaviour. Whilst some of these children will move forward to lead healthy and productive lives, many will go on to engage in substance misuse themselves and to replicate their parent s social disadvantage. Parental alcohol and other drug use is a contributing factor in many families being identified by the Department for Child Protection as requiring intervention. While the drug use alone may not be sufficient to trigger child protection mechanisms, there is a strong association between drug and alcohol use and child neglect. Other issues linked to drug and alcohol use which frequently result in child protection service interventions include domestic violence, physical abuse, homelessness/transient lifestyle, emotional abuse and psychological problems/psychiatric illness. This presents a range of challenges to service providers in being able to effectively prevent, reduce and/or treat harms. Tackling the drug use in isolation is unlikely to be effective in improving child outcomes in substance-abusing families. The key social determinants of health that sustain the drug lifestyle and negatively impact on the parenting role must also be addressed in order to enhance the parent s capacity to seek out and sustain social services and community support systems. Government and non government agencies which provide services related to parental drug and alcohol misuse are guided by the National Drug Strategy and the WA Drug and Alcohol Strategy The National document provides the broad policy framework for coordinating and integrating approaches to drug issues in Australia whilst the state document identifies the need for family focused strategies to assist parents with drug and alcohol problems to address their use, strengthen their parenting skills and prevent their children entering care. Pregnancy and parenting can be a strong motivator to change drug using behaviour, and therefore services in contact with these clients are in a good position to provide appropriate information, support and referral. As the wellbeing of all children is of the highest priority, service providers coming into contact with pregnant women and children also have a responsibility to ensure that the rights of children are upheld. All CCHN s have a duty of care in the assessment and appropriate intervention for at-risk children. Grandparents or other family members are increasingly assuming the care for children in response to concerns for the welfare of these children due to the presence of substance misuse. These carers may require help and support in caring for the children but there is currently no Australian best-practice model for providing this support.

3 General Principles Pregnancy and parenting are recognised as key motivators for changing drug use behaviour, therefore it is vital that services in contact with these clients develop strong relationships to ensure appropriate information, support and referral are provided to capitalise on this motivation. Responding to drug issues through family based interventions which enhance parental social supports and improve parental functioning can improve outcomes for the client as well as facilitating best care for their children. Community Health Nurses can target the parent s capacity to better manage the daily stresses associated with their socioeconomic disadvantage in order to reduce the impact of this risk factor on child outcomes. Therapeutic interventions that directly address the impact on parental responsibilities can effectively reduce child maltreatment risks. Addressing parenting issues recognises the vital role that this plays in a drug and alcohol user s life and assists in helping to prevent cycles of intergenerational problems. With appropriate parenting support and management of the combined factors contributing to the drug and alcohol misuse, it is possible for parents to provide a nurturing and positive environment for their child s development. However, the safety of the child is the first priority and it is important that the risk factors are regularly reassessed and reduced and the protective factors within the family are enhanced. Children of parents who misuse alcohol and other drugs can be supported in the child health environment by services that; Have a skilled and responsive workforce; Develop partnerships with other service providers to enable families with needs to be linked into appropriate services i.e. Drug and Alcohol Service Providers; Child Protection Services Implement evidence-based services that are long term and address multiple risk factors; and, Provide service delivery that is responsive to the needs of families, including outreach services and parenting groups. Role of the Community Child Health Nurse Community child health nurses (CCHN) are ideally placed to support parents with additional needs and provide relevant information, parenting support, intervention and referrals where indicated. CCHN s are acceptable to parents, non-stigmatising and use a family partnership approach which allows them to relate to parents in a facilitative manner and develop genuine relationships with families. This allows for the on-going assessment of the physical, social and emotional health and wellbeing of children and their families when drug and alcohol misuse has been identified.

4 As the safety of the child is paramount, an on-going assessment of the child s risk of neglect, physical/sexual abuse, or emotional maltreatment is required. Refer to the Department of Health guidelines and notify via Health Service if necessary. Community child health nurses play a key role in supporting vulnerable parents to care for their young children through a universal child health and development focused prevention, early detection and early intervention service. All community child health nurses are engaged in working with at-risk families, but some are also involved in specialist home visiting programs such as the joint DCP and Department of Health initiative Best Beginnings. Supporting vulnerable families to engage with specialist health and social service interventions such as this is vital to improving outcomes for their family. Due to the high rates of coexisting mental health issues experienced by people with drug and alcohol misuse, it is important to monitor the emotional health and wellbeing of the parent and their family. This may involve the CCHN facilitating access to appropriate information and support services that are available in local communities. It is suggested that CCHN refer to the Children of parents with perinatal depressive or anxiety disorder guidelines in this series. Staff working with Aboriginal parents with alcohol or drug issues should demonstrate an appreciation and awareness of Aboriginal culture and recognise the importance of facilitating access to culturally appropriate information and support services within the local community. It is suggested that CCHN refer to the Aboriginal and Torres Strait Islander guidelines in this series. Follow-Up and Monitoring Once a family has been identified as being affected by drug or alcohol issues, they will benefit from appropriate follow-up and monitoring. The CCHN, together with the parents/caregivers, will develop a plan outlining frequency of visits and referral needs. Additional contacts or a more intensive home visiting service should be offered as appropriate and where resources allow. Consider if the child is at risk of neglect, physical/sexual abuse, or emotional maltreatment. Refer to the Department of Health guidelines and notify via Health Service if necessary. Monitor the emotional health and wellbeing of the parent and their family and referral to specialist perinatal mental health agencies as indicated. Complete Edinburgh Postnatal Depression Scale (EPDS) at recommended intervals and at other times if indicated (see universal guidelines). Utilise appropriate referral pathways for families within health and other agencies. Assist parents to overcome barriers to accessing health and social services. The CCHN will also follow the Guidelines outlined in the Universal Meeting Schedule in regard to contacts and documentation.

5 Useful resources Websites The Drug and Alcohol Office is the government agency which works across the government and non-government sector to address drug and alcohol issues in the community. RUAH Community Services: Works in partnership with citizens marginalised by mainstream society to enable them to overcome their disadvantage, improve the quality of their lives, and increase their participation in the community Phone: (08) BeyondBlue: Information on mental illnesses such as depression, anxiety, schizophrenia, and bipolar disorder Child & Adolescent Mental Health Service: Provides specialist assessment, treatment and service to children facing mental health problems Phone: COPMI: A Resource Centre for Children of Parents with Mental Illness Department of Health WA: A list of Mental Health Services in WA Mental Health Emergency Response Line (MHERL): 24-hour hotline providing emergency help for people who have mental illness and are in a crisis Phone: Supporting and/or related policies Guidelines for Responding to Child Abuse, Neglect and the Impact of Family and Domestic Violence (2004) Guidelines for Responding to Family and Domestic Violence (2007) National Drug Strategy WA Drug and Alcohol Strategy Strong Spirit Strong Mind - Western Australian Aboriginal Alcohol and Other Drugs Plan

6 Reference List Australian National Council on Drugs Drug use in the family: impacts and implications for children. Drug and Alcohol Office. (2008) Addressing the Impact of Parental Drug and Alcohol Use on Children: Background & Issues Paper. Drug and Alcohol Office. (2008) Impact of Parental Drug and Alcohol Use on Pregnancy, Newborns and Infants: A Policy Framework. Social Care Institute for Excellence (SCIE). (2005). SCIE research briefing 6: Parenting capacity and substance misuse

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