SCHOOL OF SOCIOLOGY, SOCIAL POLICY & SOCIAL WORK COMPENDIUM OF EVIDENCE BASED PROJECTS

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1 SCHOOL OF SOCIOLOGY, SOCIAL POLICY & SOCIAL WORK COMPENDIUM OF EVIDENCE BASED PROJECTS January

2 Introduction It is my great pleasure to introduce this compendium of Evidence-Based Projects based on the work of seven final year social work students on the Bachelor of Social Work at Queen s University Belfast. Each dealing with a very different and relevant theme for social work, they share a high quality use of literature, a direct focus on the relationship between research and practice and an underpinning commitment to values and anti-oppressive practice. It is very rewarding to see work of such a high standard produced by our final year students which shows a finely tuned awareness of the importance of evidence based and research informed practice. Each project pays close attention to the subject matter and together, they produce a variety of well-thought out conclusions covering an impressive array of social work concerns including: specific interventions with children and young people; gaps in research and policy in specific areas of practice and the need for policy change across a number of sectors. I would like to congratulate the students for this fine work and thank them for allowing us to produce this compendium which will be of great benefit to fellow students, practice teachers & practitioners, academics and managers of services who I hope will be inspired to take forward some of the critical insights and recommendations discussed in these projects. I would also like to thank the tutors, lecturers and practice teachers who contribute to the BSW social work programmes for their dedication to working alongside their students to help them to integrate practice, theory and research throughout their qualifying experiences. Special thanks to Berni Kelly for putting together this compendium and starting a process that we intend to continue to develop on an annual basis. Dr Caroline Skehill Director of Social Work Education, QUB 2

3 Contents Foreword pp. 4-5 Berni Kelly The Impact of Parental Problem Drug Use on Children and pp Implications for Practice. Marianne Darragh An Exploration of Outcomes for Children in Kinship-Foster care pp and the Experience of Kinship-Foster Carers: Implications for Social Work Practice in Northern Ireland. Shaneen McKeown Parenting Programmes as Effective Supports in Enhancing pp Maternal Parenting Capacity and Minimising Risk to Children. Kelly Anne Loughran Sexuality and Dementia: Identifying good practice in care home pp settings, with regard to issues of competency. Robyn Lennox From the Horse s Mouth: The Effectiveness of Equine-Assisted pp Psychotherapy with At-Risk Adolescents. Lindsey Kirk A Critical Examination of the State s Role as a Corporate Parent: pp Considering the Impact on Outcomes for Children in Care in Northern Ireland. Karen Mooney Is there an Association between Childhood and Adolescent pp Trauma and Offending in Later Life? Implications for the Practice of Probation within the Criminal Justice System. Catherine Gregg 3

4 Foreword I am delighted to introduce this compendium of Evidence-Based Projects produced by seven social work students at the end of their final year on the Bachelor of Social Work at Queen s University Belfast in June In the final semester of the degree, social work students undertake a full-time placement in practice. As part of this practice learning opportunity, students are encouraged to critique and apply research evidence in practice. In order to facilitate this learning process, students undertake an evidence-based practice module and submit a project focusing on an issue relevant to the programme of care in which they are placed. Using critical enquiry and evidence appraisal skills, students build their knowledge about the context, needs and services relevant to this specific area of interest, including consideration of service user perspectives. Due to ethical considerations students are not expected to engage in primary data collection, therefore, projects are based on reviews of extant research literature and are restricted to a 5,000 word limit. The completed project should provide the reader with an up-to-date account of the current knowledge base in the chosen area and draw together relevant historical, sociological, psychological and policy perspectives. Reflecting the range of practice learning opportunities available for social work students in Northern Ireland, the topics chosen by students cover a range of social work issues across various practice contexts and service user groups. Despite the demands of other coursework alongside practice related duties, many students enjoy the experience of researching an issue relevant to their practice and produce projects that demonstrate a high standard of critical understanding and reflection. Therefore, as module co-ordinator, I liaised with colleagues involved in marking projects to identify a sample of the higher scoring projects for inclusion in this first compendium of student projects. The projects of those students who were available to provide their consent for their work to be shared publicly were then selected. Although these are only some examples of the variety of student projects submitted, they represent a range of interests relevant to social work practice in family and child care, mental health, addictions, criminal justice and older people. The first project by Marianne Darragh addresses the impact of parental problem drug use on children and the implications for practice, drawing on a range of national and 4

5 international literature. It is argued that there is a need to further develop interagency approaches in order to safeguard and promote the welfare of children living with families affected by substance misuse. In the second project, Shaneen McKeown critically examines the experiences and outcomes of kinship care and highlights areas for further policy and practice development in order to improve support for kinship carers. Kelly Anne Loughran then provides a critical review of the role of parenting programmes in relation to enhancing maternal parenting capacity and minimising risk to children. The fourth project by Robyn Lennox shifts the focus from family and child care practice to explore the issue of sexuality and dementia. This project highlights ethical practice dilemmas relating to consent and capacity and recommends clearer policy guidance and further research incorporating service user perspectives. The fifth project by Lindsey Kirk explores the novel approach of applying equine-assisted psychotherapy to social work with at-risk adolescents. A critical analysis of the effectiveness of this approach is presented, drawing on a range of supporting international literature. In the penultimate project, Karen Mooney presents a critical review of the corporate parent role and the impact on outcomes for children living in public care. Aspects of good corporate parenting are identified, including a focus on relationships with children. Further research on the effectiveness of various corporate parenting approaches is recommended. The final project by Catherine Gregg examines the association between child and adolescent trauma and offending in later life, highlighting implications for probation and criminal justice services and recommending further local research addressing the impact of the Troubles in Northern Ireland. Overall, it is intended that this compendium will be useful for future students, academics, practice teachers and agency partners who are all actively involved in social work education and/or practice. The aim of collating a sample of projects into a compendium is to continue to foster a culture of research informed practice and knowledge transfer between social work practice and academia. I hope that readers find these projects informative and relevant to their own areas of interest and that this compendium marks the first of many future contributions from our final year students. Dr Berni Kelly Lecturer in Social Work, QUB 5

6 The Impact of Parental Problem Drug Use on Children and Implications for Practice. Marianne Darragh Summary A growing body of research highlights the potentially negative impact of parental problem drug use upon children (Barnard and McKeganey, 2004; Kroll and Taylor, 2003). The aim of this literature review is to examine parental problem drug use and its impact on children. By highlighting the UK and international historical, legislative and policy context and giving consideration to sociological and psychological perspectives this review provides some understanding as to why children of parents who misuse drugs have poorer developmental outcomes (Rubenstein, 2003; Velleman et al., 2008). This review has been prompted by my own practice experience with problem drug users, many of whom are parents. Information has been sourced through books, journal articles and reports via Queens Library, SCIE and The Research in Practice website, from legislation and policies via government websites and through information held in my placement and in other agencies and their websites relating to parental problem drug use. It will incorporate the view of both service users and providers. Furthermore it will offer a critical evaluation of local policies, practices and provision of services. In conclusion a summary of implications for practice will be provided, highlighting the need to promote inter-agency working with families affected by substance misuse if we are safeguard and promote the children s welfare and full potential (Devaney et al., 2009; SCIE, 2003). 6

7 Introduction The author was provided with a practice learning opportunity (PLO) in a specialist addiction service offering treatment to dependant drug users living within the Northern Health and Social Care Trust (NHSCT). Underpinning the work is a commitment to Harm Reduction (UKHRA, 2011), prompting the author to develop knowledge in this area. Much of the literature on harm reduction was related to the drug user (Coomber, 2000; Inciardi and Harrison, 2000) however in contrast one particular article discussed harm reduction in relation to children affected by parental drug use (Rhodes et al., 2010). Rhodes et al. (2010) highlight a growing policy agenda concerned with reducing harm to children affected by parental drug use, based on a premise that parental drug use is potentially harm producing to children at every age from conception to adulthood (ACMD, 2003). Kroll and Taylor (2003:15) note that for most children living with chronic substancemisusing parents, life can be very painful, difficult, frightening or dangerous. The above mentioned article (Rhodes et al., 2010) piqued an interest in relation to the authors PLO. Through her PLO experience awareness was gained of efforts being made in recent years to identify the impact of parental drug use on children and it was decided to conduct a critical review exploring these efforts. Key considerations for conducting the review included: Substance Misuse: Much of the literature sourced was concerned with substance misuse in general, highlighting impacts of both parental problem alcohol and drug use on children (Harwin and Forrester, 2005; Cleaver et al., 2007). Despite many shared characteristics of parental problem drug and alcohol use there are also distinct differences (Aberlour, 2006). This review will focus on parental problem drug use, including information from research studies that have taken a broader perspective by including alcohol use and thus employed the term substance use. Consequentially a significant amount of issues highlighted will also be relevant to parental problem alcohol use, despite this not being a focus of this review. 7

8 Parental Problem Drug Use: This review accepts that not all drug use is incompatible with adequate parenting thus it will focus on parental problem drug use. Problem drug use is defined as Drug use with serious negative consequences of a physical, psychological, social and interpersonal, financial or legal nature for users and those around them. Such drug use will usually be heavy with features of dependence. (ACMD, 2003: 7). Scale of the Problem: It is estimated that there are between 250,000 and 350,000 children of problem drug users in the UK- roughly one child for every problem drug user (ACMD, 2003). Here, in Northern Ireland it is estimated that there are 40,000 children living with parental substance misuse (DHSSPS, 2008). Figures specific to parental problem drug use have been more difficult to establish, however the Northern Ireland Drug Misuse Database report that 412 adults problem drug users, presenting for treatment, were living with children (Percy et al., 2008). However the number of children has not been identified and this figure only relates to those parents in treatment. Any impact of parental problem drug use on children cannot be assumed, indeed evidence that some children can grow up in families with problem substance use without developing significant problems has been accumulating in recent years (Velleman and Templeton, 2008). Nonetheless this discussion is beyond the realms of this review. It is hoped that by conducting this review I will not only increase awareness of the impact of parental problem drug use upon children, but provide evidence of potential implications for practice. Evidence-based practice is defined as the integration of individual practitioner expertise with the best available research evidence, while also taking account of the values and expectations of clients. (Johnston and Austin, 2008: 239). In summary this review will draw upon a range of evidence and aims to: 8

9 Provide a critical review of both UK and international literature relating to the impact of parental problem drug use upon children and in doing so include historical, sociological psychological, service use and service provider perspectives. Provide a critical evaluation of the local policies, practices and service provision. Detail implications for practice. Critical Review of UK and International Literature o Historical, Legislative and Policy Context Ingram (2006) argues that substance misuse has been a growing problem since the 1980 s. However initially this was seen from an individualistic perspective with research and practice concerned with effects on the individual substance user (Royal College of Physicians, 1986), reducing crime (Marsh and Kirby, 1992) or assisting the individual to change their problematic behaviour (Ellis et al, 1988). Policy responses were almost entirely focused on punitively controlling individuals who used drugs (Reuter et al., 2007; Thom, 1999). This including passing legislation such as The Misuse of Drugs Act. (1971) which set up the system classifying drugs according to their perceived harmfulness and created the offence of intent to supply and The Criminal Justice Act (1991) which enabled enforcement of attending treatment. It is argued that one aspect of the problems caused by substance misuse that has been largely overlooked in the UK until recently is the fact that a significant number of adults affected by problem substance use are also parents (Ingram, 2006). This is in contrast with International material reviewed. In USA and Australia a vast research agenda has long since identified parental substance misuse as a major factor in child maltreatment (Black and Mayer,1980; Deren,1986; Kroll and Taylor, 2003) and systems have been implemented to deal with this (Harwin and Ryan, 2007; Dawe et al., 2008). American studies, in particular have extensively suggested that children of parents with problem drug use are more likely to have emotional and behavioural difficulties, poor school attendance, substance misuse problems in later life and to attempt to commit suicide (Deren, 1986; Bays, 1990; Greene and Ringwalt, 1996). 9

10 Furthermore research shows they are at a much higher risk of coming into public care (Besharov, 1994; Barth et al., 1993). In the UK the introduction of the Children Act 1989 and subsequent Children (NI) Order 1995 led to greater recognition of children s welfare being a paramount concern, introducing the concept of significant harm. However research highlighted that following implementation of the legislation, childcare work became increasingly dominated by the child protection processes established from 1974 Maria Colwell inquiry (Skehill, 2003). Children in need were being overlooked in favour of children at risk (Horwath, 2001; Katz, 1997) and this contributed to evolving research that emphasised the importance of an increased understanding and awareness of children s needs (Rose, 2001). Consequentially in more recent years, the impacts of parental substance misuse upon children has emerged as a UK research agenda highlighting that parents with problem substance use are more likely than other parents to maltreat their children (Famularo et al, 1992; Jaudes et al., 1995; Kelleher et al., 1994). McMahon and Luthar (1998) report two main research findings regarding such children. Firstly, they have poorer developmental outcomes (physical, intellectual, social and emotional) than other children and secondly, they are at risk of substance misuse themselves. This point was particularly poignant as one service user the author worked with on PLO was a 19year old male who has been injecting heroin since 13yrs of age. Both of his parents were problem drug users. McMahon and Luthar s arguments are consistent with other more recent research (Velleman, 2004; Forrester, 2000; Murphy and Harbin, 2000). In addition research has emerged highlighting how many drug users have dependent children and this has led to a growing awareness of the interplay between drugs and parenting (Ingram, 2006). A considerable amount of research suggests that problem drug use is associated with poorer parenting skills. For example Famularo et al. (1992) argue that apathy and listless as a result of problem drug use may lead to parents having difficulty organising everyday structure. Low income and material deprivation were found to be a noticeable consequence of problem drug use, adversely impacting upon children through, for example, clothing not being replaced, 10

11 food not being provided or family tensions (McKeganey et al., 2002). Other research highlighted physical hazards for children, with drugs or equipment such as needles being left within reach (Hogan& Higgins, 2001). Nonetheless it must be noted that in spite of the negative view of drug users, many parents who use drugs maintain a caring and organised household. Indeed the use of illegal drugs does not necessarily amount to problem drug use. However any parental drug use that has an adverse impact on the lives of their children must be highlighted within this realm (Cousins and Milner, 2006). This emerging body of research prompted an Inquiry by the Advisory Council on The Misuse of Drugs (ACMD). The ACMD was established by The Misuse of Drugs Act 1971 and has a statutory duty to advise the government on issues related to the misuse of drugs, particularly any potential health or social problems. The ACMD was concerned about research highlighting growing numbers of children being affected by parental problem drug but receiving little attention. Thus the Inquiry and subsequent Report (ACMD, 2003) placed children of problem drug users as the focus and aimed to establish the nature of the problem. This report, perhaps for the first time (Macrory and Murphy, 2011) exposed the true extent of parental problem drug use in the UK. The report, entitled Hidden harm: responding to the needs of children of problem drug users, was compiled over three years through an extensive research and literature review. The report proposed 48 recommendations to Government incorporating 6 key messages including reducing the harm to children from parental problem drug misuse should become a main objective of policy and practice. Furthermore The Hidden Harm report clearly detailed a long list of adverse impacts of parental problem drug use upon children, highlighting parental problem drug use as having potential to affect every aspect of a child s upbringing and development. The report further highlighted that the adverse impacts, whether to a child s physical health, education or cognitive ability, relationships or identity, emotional and behavioural development, or some or all of these, had potential to be long lasting. The publication and distribution of the Hidden Harm report generated extensive media interest and this contributed to the decision to establish a Hidden Harm Working Group. The Working Group s role was to monitor and promote the 11

12 implementation of the recommendations throughout each UK region (ACMD, 2007) and this became a main driving force for policy addressing the impact of parental problem drug use upon children.. Policy specific to here in Northern Ireland will be explored below in relation to implications for local practice and service provision. o Sociological Perspective The family environment into which a child is born will exert the most powerful and long-lasting influence over his or her development and future life chances (Cousins and Milner, 2006:105). Rutter (1993) argues that early family experiences will not only have a bearing on later environments children will be likely to encounter, but will also impact upon the skills, behaviours and attitudes with which they will interact with these environments. Furthermore, it is argued that a large part of shaping a child s identity is through socialisation, the process by which we learn how to act according to the rules and expectations of a particular culture, (Newman, 2008:127). Newman explains that primary socialisation is mainly taught by the family during childhood and then in later life other influences provide secondary socialisation, including peers, media, education and the workplace. This can be somewhat problematic for children living in families with parental problem drug use where the lifestyle of drug-using parents can be unstable (NTC, 1998) and care-giving roles can be reversed (Childline, 1997; Kroll and Taylor, 2003). Instability and insecurity during times of escalating drug use (Hogan and Higgins, 2001) can lead to household routines being undermined and childrens needs accorded less priority, potentially leaving them vulnerable to not being properly fed, clothed or cared for (Barnard and McKeganey, 2004). However It should be recognised by agencies that children are not adversely impacted upon solely as a result of their parents problem drug use (SCODA, 1997:2).Parental problem drug use should be considered within the context of families experiencing multiple stressors thus it is important to consider external factors, not just those present in the home environment (Barnard,2002). In a Northern Ireland study whereby a group of looked after children family backgrounds were examined, despite a high prevalence (41.8%) of parental problem drug use being an issue, it was the main reason for the child coming into care in only 5.9% of the cases (Cousins and Milner, 2006). Caution must be exercised with these 12

13 figures, however, as this may be resultant from practice determined by thresholds of significant harm (Children Order 1995). Research gaps exist as to whether or not these thresholds are right in terms of addressing the needs arising from the impact of parental problem drug use upon children (Cousins and Milner, 2006). There is an abundance of research highlighting external factors that may be contributing to the adverse impact of parental problem drug use upon children. Research shows that children living with parental substance misuse may also be experiencing poverty, social exclusion, domestic violence, exclusion from school, exposure to criminal behaviour and lack of family support. (Alison, 2000; Mahoney and MacKechnie, 2001; Bancroft et al., 2004; Harwin and Forrester,2005) Some of these factors may relate specifically to the impact of the problem drug use but for many families existing problems are exacerbated by the problem drug use. Furthermore the problem drug use may be a way of coping with a multitude of problems stemming from social deprivation and exclusion (Gilman, 2000). Concomitant with social work value base, this research highlights that practitioners must not make assumptions or generalise about the impact of parental problem drug use on the child. Parental problem drug use should not be addressed in isolation but should be viewed as part of the whole picture (DoH, 1999) to ensure that the implications for the child are properly assessed. For example research shows that many families with parental problem drug use will experience financial difficulties or significant poverty (The Parenting and Alcohol Project, 2006; Devaney et al., 2009) and research has shown a link between poverty in childhood and poorer employment prospects in adulthood (Feinstein and Sabates, 2006). Similar to the above, further research argues that it is not substance misuse itself that is problematic, but the impact of substance misuse on parenting and family routines. Hogan (1997) states that daily routines of children living with parental problem drug use are often chaotic with inconsistent caregiving as a result of the parents focus the drug. Preoccupation with drugs can lead to inconsistent regard to children s safety or supervision, leaving children vulnerable to injury, medical needs not being met or other dangers (Wasserman & Levanthal, 1993; Kroll and Taylor, 2003; Shulman et al., 2000). Furthermore Hogan (1997) illustrates that there is often 13

14 a low level of parental involvement in children s education, leading to their poor attendance and performance at school and ultimately lower educational achievement (Paulson,1994; Steinberg et al.,1992). Consistent with this, having reviewed available literature, University of Glasgow (2004) published a Briefing Paper suggesting parental problem drug use as having a vast amount of negative social and developmental impacts upon children. Nonetheless upon critical consideration of the research findings important caveats are presented. Firstly, as the available research was from USA as a majority, differences in substances used, ethnicity, levels of poverty, culture and legislation may be difficult to apply from a UK perspective (Forrester and Harwin,2006). Secondly a high prevalence of parental problem drug use is most usually geographically associated with social deprivation and this can have a compounding effect when considering the relationship between problem drug use, parenting and the impact upon children. As a majority of the research studies have been completed with samples and cohorts from areas concomitant with social deprivation this raises the question as to whether the findings are generalisable. Nonetheless the vast amount of research evidencing the adverse impact of parental problem drug use upon children as highlighted above, the fact that parental misuse of drugs is overrepresented in child deaths and serious abuse inquiries (Reder and Duncan, 1999) and the fact that children of parental problem drug users are over represented on child protection register and in care (ACMD, 2003; Barnard,2002; Forrester and Harwin, 2005;2006) suggests that, generalisable or not, attention needs to be paid to this area of concern and practice implications considered (Forrester and Harwin,2006). o Psychological Perspective A vast quantity of the available literature encompassed psychological perspectives. A number of studies indicate that children growing up with parental drug problems are at elevated risk of behavioural problems. Low levels of parental involvement, including lack of supervision and minimal communication with children that is consistent with parental problem drug use (Kandel, 1990), has been linked to a vast array of problem behaviours in children. These include fighting, non-compliance and delinquency (Larzelere and Patterson, 1990; Hogan, 1997) and more serious 14

15 psychological implications, including depression and somatic problems (Simons et al., 1994). Johnson (1991) reports parental problem drug use as being associated with children who are tense, anxious and with behaviours symptomatic of depression. Furthermore these children are more likely to have school and social problems (Ornoy et al., 1996), feel isolated (Barnard and Barlow, 2003) and find it difficult to make or sustain friendships (Dore et al.,1996). Secure attachment between children and their parents/caregiver has been considered the cornerstone of healthy psychological and emotional development across the life cycle (Bowlby, 1988; Howe et al., 1999; Howe, 2005). The concept of attachment includes the child s need for physical security in times of anxiety in addition to the emotional closeness that comes with believing the caregiver is available psychologically (Devaney et al., 2009). Research has shown parental drug problems can interfere with the processes of secure attachment (Cleaver et al., 1999). For example, in many instances the parent s main attachment is to the drug and this can have implications for their capacity to emotionally attach to their child (Kroll and Taylor, 2003). Furthermore parents who use drugs can sometimes be absent, for example, through hospitalisation or imprisonment, disrupting and contributing to poor physical attachments (Murphy and Harbin, 2006). Research evidence is clear that an unhealthy attachment in early childhood has significant adverse consequences for the child (Pearce, 2009) which can lead to the child having difficulties with intimacy and relationships in adulthood (Robinson and Rhoden, 1998). This is an important consideration for practice as children living in these situations may have adapted coping behaviours that may not be considered appropriate in a caring environment (Howe et al., 1999) that a child may be removed to. In this situation carers need to understand how difficult it may be for the child to trust another adult in a parenting role, thus relinquishing their coping behaviours, and should focus on initiating attachment and creating a secure base from which the child can grow (SCIE, 2003). Another important psychological perspective that has been highlighted in research is in relation to Prochaska and DiClemente (1992) the process of change (Harbin and Murphy, 2006). Children sometimes find the process of change more emotionally traumatic than the parental problem drug use itself (Kearney et al,2005). Although 15

16 this is an accepted model of intervention for necessary adult behavioural change in relation to problem drug use, it is important to consider how this impacts upon the child. Most literature takes an adult focus and does not consider the process of change within a parenting context (Prochaska and DiClemente, 1992; Hamer, 2005). Nonetheless messages from this limited research body suggest that children living through parental change in relation to their problem drug use, experience complex emotional turmoil and practitioners need to consider ways in which to alleviate the inevitable pain and trauma that the children experience during this process (Kearney et al., 2005; Harbin and Murphy, 2006) o Service User Perspectives A central theme to ethical social work practice is the ability of practitioners to listen to service users. Parton and O Byrne s (2000) analysis of studies involving service users, repeatedly found the same message; that the important factor for them is talking through their experiences and being listened to. This is consistent with SCIE (2007) whom emphasise the need for culture change in organisations to enable meaningful user involvement. Listening to children has been consistently highlighted in recent years, through legislation and policy. Laming (2003; 2009) emphasised the importance of, not just setting eyes on children involved in services, but talking to them. He emphatically stated that a point that was returned to time and time again was the need for a relationship of trust between practitioner and child (2003: 353). A child s rights to having an opinion is determined by UNCRC Article 12 and as social workers, we have a duty to Protect the rights and promote the interests of service users and carers (NISCC, 2002). Furthermore Children s Order (NI) 1995 Art 3(4)(a) makes specific reference to ascertaining wishes and feelings of the child, so it is reasonable that research on the impact of parental problem drug use upon children would include the child s perspective. There is ample research highlighting the child s perspective. Kroll s (2004) analysis of seven published studies featuring accounts from children about growing up with parental problem drug use and Barnard & Barlow s (2003) 2 year qualitative study highlight similar emerging themes. One such theme was that of stigma and secrecy 16

17 and the difficulties that the children faced as a result. To ensure that social work practice is guided by anti-oppressive values it is essential to explore the manifestation of oppression. When exploring the theme of stigma and secrecy in relation to parental problem drug use Thompson (2006) PCS model proved helpful in understanding how this impacted on the child by analysing Personal, Structural and Cultural levels of society. Personal: Research shows how children themselves feel shame and stigma of substance misuse very strongly and employ tactics that contribute to manifestation of oppression. For example, they keep information secret in fear of what might happen and they conform with an unspoken rule not to talk (Kroll, 2004; Barnard and Barlow, 2003; Kroll and Taylor, 2003;Wilson et al., 2004). Cultural: Drug misuse connects children to a subculture of secrecy, due to anxieties about consequences of criminal activity (Brisby et al., 1997; Hogan 1997; Hogan and Higgins, 2001) This conspiracy of silence has potential then to cut the child off from wider family and community, effectively isolating them from sources of support (Kroll and Taylor, 2003). Furthermore, in their communities, children of drug using parents can be belittled and bullied as a result of society s attitude towards drugs, further isolating them (Harbin and Murphy, 2006). Structural: Another theme emerging from research was that children living with parental problem drug use are often a hidden group, invisible to professionals unless they come to attention of welfare services, mostly for another reason. Furthermore their needs often remained unseen as services focus on the drug user (Kroll and Taylor, 2003). Kroll and Taylor (2003) highlight how children, most importantly, wanted someone to notice what was happening and then to be listened to and understood. Consideration of the manifestation of oppression as an impact of parental problem drug use upon children in this way should promote empathy and understanding and enable the social worker to practice in this way. Caution must be exercised when considering the above service user perspectives however as children are not interviewed directly in some research (Kroll and Taylor, 2003; Kroll, 2004). It is imperative that we acknowledge potential for bias as a result 17

18 of the researchers choosing topics to search for as opposed to writing about topics that arise in interviews (Sheppard, 2009). Furthermore as much of the information above has been gained retrospectively from adults who grew up with parental problem drug use there may be discrepancies in accounts (Barnard and Barlow, 2003). In an attempt to address this gap there has been research emerging in recent years from studies that engaged directly with children and young people that have reported similar themes to the above, in particular Manchester Highs and Lows (Murphy and Ingram, 2007) had the specific aim of giving children a voice on the impact of parental problem substance use on their lives. Furthermore Gorin (2004) collated research findings from research that had been undertaken directly with children about their experiences of living with parental problem drug use. The impact of parental problem drug use from the child s perspective included a long list of adversities including living with stigma and shame, instability, living in poverty, inappropriate level of responsibility, living with fear and secrecy, not having normal childhoods (for example not bringing friends home), loss of family/parent/siblings as a result of parental imprisonment, hospitalisation, death or being placed in care, exposure to violence and offending, being unable to get help as isolated or scared to talk, feeling abandoned or let down and severe emotional burdens of trying to fix everything or feeling it s my fault (Bancroft et al,2004; Childline, 1997; EMCDDA, 2010; Gorin, 2004; Kearney et al., 2005; Murphy and Ingram, 2007). This list is not exhaustive and it is limited in that it has been extracted from a small body of research that is still emerging and. Nonetheless it represents some of the experiences of children living with parental problem drug use and helps to create a clearer picture of the impact of parental problem drug use upon children (Harbin and Murphy, 2006) and thus could be argued as a gap in research that should be developed. Critical evaluation of local policies, practice and provision of services. From 1969 Northern Ireland has experienced enduring community violence known as the Troubles (Ramon et al., 2006). McElrath (2002) suggest that any existing drug problem in Northern Ireland was probably masked by the wider political conflict and highlights research stating that, coincidentally or not, problem drug use only 18

19 appeared to enter the public domain shortly after the 1994 ceasefire (O Neill,1995). Furthermore Northern Ireland has high levels of social need and is one of the most deprived areas in the UK (Moore et al., 1996; Kenway et al., 2006) and there are insufficient resources and services (DHSSPSNI, 2004). Despite this there is evidence of local policies being implemented in Northern Ireland, recommending implications for practice and paving the way for services to be developed. In Northern Ireland, in response to hidden Harm (ACMD, 2003) the New Strategic Direction on Alcohol and Drugs (NSD, 2005) identifies children born to and living with substance misuse as a priority group and a regional Hidden Harm Framework was developed and launched in November 2008 (Webb and Nellis, 2010). This Regional Hidden Harm Action Plan: responding to the needs of children born to and living with parental alcohol and drug misuse in Northern Ireland (DHSSPSNI, 2008) emphasises inter-agency working across sectors, something which has been highlighted time and again (Laming, 2003, 2009; Munroe, 2010; Kroll and Taylor, 2008). Interestingly the initial Laming Report (2003) gave no mention of parental problem drug use, however post Hidden Harm the progress report in response to the death of Peter Connelly (Laming, 2009) included findings from the Hidden Harm Report and emphasised the urgency to ensure that all staff, when assessing need, draw on the information of all agencies and include information about the impact of adult drug dependency on children and young people. Similar messages are highlighted in other key policy development in Northern Ireland, including Our children and young people, our shared responsibilities (DHSSPS, 2006), Our Children and Young People-Our Pledge (OFMDFM, 2006), Families matter (DHSSPSNI, 2009) and Bamford Review (DHSSPS, 2005). More recently the Inquiry Madeline and Lauren O Neill s deaths (W&EHSSB, 2007) and the McElhill Inquiry (DHSSPSNI, 2008) highlighted deficits in working relationships between mental health services and children s services, suggesting implications for practice. The Think Child Think Parent Think Family project (SCIE, 2009) is a direct response of the McElhill Inquiry and further argues a need for improvement in the way in which mental health services and children s services work together. 19

20 Research completed by SCIE (2003) reported similar findings,however, highlighted social workers workloads as contributing to the problem. Nonetheless The Think Child Think Parent Think Family Project (SCIE, 2009) has published a guide, based on extensive research over a period of three years. This guide and also the Northern Ireland Children s Services Plan (ACYCP, 2008) promote inter-agency working and the use of a family model as a conceptual framework. Furthermore both commit to future research and publication of outcomes of using this framework. The EH&SSB (2008) piloted a draft Protocol to Promote Inter-Agency Working With Children and Families Affected by Substance Misuse and the subsequent evaluation (Devaney et al., 2009) highlighted that not only did staff in both adult and children s services welcome the protocol but there was a general consensus that the protocol should be adopted. Upon critical evaluation however it must be highlighted that a paper protocol is meaningless if not used by the staff at whom it is aimed. Many of the service providers interviewed suggested that each Trust should establish a local forum made up of staff from both services, to complete joint training and jointly plan services (Devaney et al., 2009). Improving the assessment process and considering external influences in addition to the drug use has been highlighted as a critical component of enhancing professional practice and interagency working in relation to parental problem drug use (Harbin and Murphy, 2004; Forrester and Harwin, 2006; Kroll and Taylor, 2003). It is hoped that he new inter-agency assessment model developed in Northern Ireland, UNOCINI,will address this as it aims to capture data in relation to the needs of the child or young person, the capacity of their parents or carers to meet these needs and also the wider impacting family and environmental factors. A range of Local Hidden Harm initiatives have been developed including the Barnardos PHAROS Service and The Dove House Hidden Harm Project both providing individual support for children affected by parental problem drug use, the Ego Project, providing counselling to young people at risk of hidden harm and training initiatives(dhsspsni, 2008). In addition NHSCT (2010) have adopted childcare champions in each adult team, for ease of interagency communication. 20

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