1 Children living in families with drug and alcohol problems: the extent of the problem and what we can do Sally Haw Professor of Public Health & Population Health University of Stirling
2 Presentation Drug and alcohol problems impair parenting skills and places children at risk of abuse and neglect that impacts health and wellbeing and life chances. Problems over and above substance use itself can have a greater impact on children (poverty, social isolation, lack of family/community involvement). Early years represents the most significant period for child development and therefore intervention. Focusing on risk helps identify the problems but services need also to focus on resilience and building on assets within families and communities. Programmes that engage, are flexible, goal oriented strengthsbased and promote resilience are most likely to work with families with multiple problems We urgently need to address some of the resource and organisational issues for effective multi-agency working.
3 Scotland has one of the highest rates of drug use in Europe In 2009/10, there were an estimated 59,600 opiate and/or benzodiazepine problem drug users. This represents 1.7% of the Scottish population aged years. 71% were male 19% were aged years 38% were years 43% were years 1 There was a wide variation in estimates for different council areas ranging from: 0.6% in Moray 3.3% in Dundee City 3.4% in Glasgow City Prevalence considerably higher in some communities 1 In 2006 it was estimated that 23,933 of 55,300 problem drug users were injecting drug users (IDUs) with highest rates in NHS Greater Glasgow & Clyde (circa 1%) 2 1 ISD Estimating National and Local Prevalence of Problem Drug Use in Scotland 2009/10. 2 Hay et al Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland. Glasgow University
4 Children living in families with drug or alcohol problems In 2009/10 there were 10,325 new clients attending drug services. 42% reported having dependent children It is estimated that there are between 40,000 and 60,000 children under 16 years living with a problem drug user. Scottish Government also estimated that 65,000 children live with one or more parents with an alcohol problem Recent study suggest that this is likely to be an underestimate and more research required to refine figures.
5 The rate of births with recorded drug misuse is increasing.. Drug Misuse Statistics Scotland Edinburgh:ISD
6 2009/10 Maternities with Drug Misuse In 2009/10 there were 925 maternities for which drug misuse recorded. Of 925 births, 76% were full term and normal birth weight and 15% were pre-term Nearly half (47%) were recorded for mother living in most deprived quintile. Opioids were recorded in 55%, cannabinoids in 39% and sedatives in 14% of maternities.
7 Risks Within Families with Parental Drug & Alcohol Problems Intoxication & withdrawal Impairs parents capacity to provide care Impairs parents capacity to respond to child s emotional needs Co-morbid psychological conditions Co-existing conditions may impair parenting capacity further Financial disadvantage Substance misuse compounded by low income/poverty, unemployment, unstable accommodation Social isolation & disadvantage Social isolation leads to lack of support and are at greater risk of poor parenting Child protection issues Substance use and co-occurring problems (including martial breakdown, domestic violence and sexual abuse) places children at higher risk of maltreatment Family, school & community connectedness Connectedness to the wider community can play a key role in emotional wellbeing of children and may protect them from negative consequences of parental substance misuse. Dawe et al (2008) Improving Outcomes for Children Living with Parental Substance Misuse. Melbourne: National Child Protection Clearing House
8 Beyond Risk. Parental drug and alcohol problems have major impact on parenting skills and parental attention. Domestic violence further increases negative impact on children Strong evidence of intergenerational transmission with parents with drug problems in particular having experienced child abuse and neglect. Factors over and above substance use itself impact the child (poverty, social isolation, lack of family/community involvement). Interventions need to address these issues, be holistic and integrated and build on assets within the family and community. Evidence suggests that this leads to better outcomes for both parents and children. Represents a shift from risk to resilience. Templeton et al. Looking Beyond Risk. Parental Substance Misuse: Scoping Study
9 Early Years matter!!
10 They set the stage for brain development...
11 Sensitive periods in brain development High Pre-school years School years Number Peer social skills Conceptualization Language Habitual ways of responding Hearing Vision Emotional control Low Years Source: Council for Early Child Development
12 Health Problems Related to Early Life 2 nd Decade 3 rd /4 th Decade 5 th /6 th Decade Old Age School Failure Teen pregnancy Criminality Obesity Hypertension Depression Addictions CHD Diabetes Premature aging Memory loss Hertzman C. Early Child Development: A powerful equalizer.
13 Stress Positive tolerable and short lived Caused by new social situations and frustration of everyday events. Tolerable may affect brain structure but alleviated supportive relationships Caused by significant life events such as bereavement, natural disasters. Toxic prolonged and sustained stress response Associated with abuse and neglect and absence of continuing supportive relationships McEwan et al 2007
14 The Case for Early intervention Early child development interventions can reduce health and psycho-social inequalities both in childhood and later life School achievement Delinquency, substance use and crime prevention, Life success Greatest effect in high risk children Mixed, two-generation approaches, that is, a combination of centre and home-based programmes focussing on children and parents, appear to be effective. Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support proportionate to risk These include universal interventions to promote breastfeeding and reduce smoking with intensive support for high risk mothers/children Geddes et al Interventions to promote child development for health.
15 What Works with Multi-problem Families What works for parents with a single discrete problem may not work for families with multiple problems Evaluations of home visiting programmes for families with substance misusing parents have a minimal effect on parenting or the risk of maltreatment. Intensive programmes show promise but improvements in child behaviour limited to younger children. Simply adding services to programmes that target discrete family problems does not appear to improve outcomes. Dawe et al (2008) Improving Outcomes for Children Living with Parental Substance Misuse. Melbourne: National Child Protection Clearing House
16 Working with Multi-problem Families: key messages I Engagement Adverse experiences with authority (health & welfare agencies) makes engagement difficult Treatment paradox: Parents know entry in treatment increases likelihood of keeping children but also increases likelihood of initiation of child protection procedures. Focus on goals Collaborative setting of meaningful and manageable goals can establish working relations with parents Rationale for family intervention Encouraging parents to identify the range of individual and ecological influences that make it harder and easier to achieve goals Overcomes potential focus on parental deficit Dawe et al (2008)
17 Working with Multi-problem Families: key messages II Individualised and flexible approach Any combination of problems may be hindering progress. There is no fixed sequence of intervention strategies that will be relevant to all families. Strengths-based approach Acknowledging the areas of family life that are not problematic is, in itself, helpful to families. Organisational pre-requisites to implement familyfocused programs Effective treatment with multi-problem families requires small case loads Critically it requires effective coordination across agencies A seamless service: Can we learn from models of service organisation for other groups with multiple needs (for example, Dawe et al (2008) elderly)
18 What is Resilience? Resilient children are those who resist adversity, manage to cope with uncertainly and are able to recover successfully from trauma (Newman, 2004).
19 In the antenatal period Adequate maternal nutrition throughout pregnancy Avoidance of maternal and passive smoking Moderate maternal alcohol consumption Good access to antenatal care Social support to mothers from partners, family and external networks Interventions to prevent domestic violence
20 In Infancy Adequate parental income Social support for mothers, to moderate perinatal stress Good-quality housing Parent education Safe play areas and provision of learning materials Breastfeeding to three months Support from male partners Continuous home-based input from health and social care services, lay or professional.
21 Pre-school years High-quality pre-school day care Preparatory work with parents on home school links Pairing with resilient peers Availability of alternative caregivers Food supplements Links with other parents, local community networks and faith groups Community regeneration initiatives.
22 Across the Life-course Strong social support networks. At least one unconditionally supportive parent/parent substitute. Committed mentor or other person from outside the family. Positive school experiences. Sense of mastery/belief that one s own efforts can make a difference. Participation in a range of extra-curricular activities. The capacity to re-frame adversities so that the beneficial as well as the damaging effects are recognised. Not to be excessively sheltered from challenging situations that provide opportunities to develop coping skills.
23 Are there other options?
24 Looked After Children At Home Foster Care Other Community Residential ,179 3,660 1,807 1,539 12, ,517 3,915 1,912 1,638 12, ,986 4,275 2,138 1,661 14, ,360 4,480 2,435 1,613 14, ,924 4,741 3,042 1,580 15, ,193 4,996 3,223 1,480 15, ,437 5,296 3,963 1,475 16,171 All Source: Children's Social Work Statistics Scotland, No.1: 2012 Edition
25 Educational Outcomes: school attendance
26 Educational Outcomes: exclusions (rate per 1,000)
27 Educational Outcomes: Average tariff score
28 Where do we go from here? We know that a seamless mixed, two-generation approaches, that is, a combination of centre and home-based programmes focussing on children and parents, appear to be effective. We know that programmes that engage, are flexible, goal oriented strengths-based and promote resilience are most likely to work with families with multiple problems BUT we also know that there are profound resource and organisational issues for effective multi-agency working Explore alternative models of delivery from other sectors Examine critically the roles that different agencies play as part of a systems analysis Be imaginative about the involvement of the third sector and communities.
29 One final question... Is there a conflict between the roles of ensuring child protection and support families, and if so, how can that be minimised?
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