A Family Affair? Supporting children living with parental substance misuse. A report of a national conference held in October 2011

Transcription

1 A Family Affair? Supportig childre livig with paretal substace misuse A report of a atioal coferece held i October 2011

2 Natioal Advisory Committee o Drugs. December 2011 Photography by Coor Healy

3 Cotets Preface 2 1. Itroductio 6 2. Backgroud 7 3. Proceedigs 9 4. Workshop Presetatios ad Discussio 17 Appedix 1 Participats 23 Supportig childre livig with paretal substace misuse 1

4 Preface This coferece origiated from the fidigs of a literature review carried out by Dr. Justie Horga, Seior Researcher Natioal Advisory Committee o Drugs o the impact of paretal substace misuse o childre. The mai fidig of this review was that paretal substace misuse ca, ad does, egatively impact o the health, developmet ad welfare of childre icludig both abuse ad eglect. As childre s welfare ad protectio is a major govermetal ad societal priority, this coferece was timely ad the ivitatio by the NACD to the HSE ad Alcohol Actio Irelad to become co-sposors of the coferece esured the widest possible dissemiatio of the fidigs. The orgaisers welcomed the presece of two Miisters who were fully supportive of the aims of the coferece. The presece of seior maagers from the HSE Addictio ad Childre ad Families Services was also key to the recogitio of this as a cojoit maagerial resposibility. This was the first atioal coferece addressig the impact of paretal substace misuse o childre ad the first combied gatherig of staff workig i addictio, child welfare ad protectio services from the commuity, statutory ad volutary sectors. Such a large gatherig eabled the sharig of observatios ad experieces ad a exchage of views o the challeges ivolved i early itervetio ad iteragecy work i the cotext of dimiishig resources. The coferece also highlighted the importace of public policy with local implemetatio supported by adequate resources. Oe such policy, the Hidde Harm strategy i Norther Irelad, highlights the eed, as a mai objective of policy ad practice, to reduce the harm to childre from paretal substace misuse. This strategy also recogises that effective treatmet of the paret ca have major beefits for the child ad that by workig together, services ca take may practical steps to protect ad improve the health ad well-beig of affected childre. Furthermore, recogitio that problems affectig childre will oly decrease whe the umber of people with harmful drikig patters ad problem drug use dimiishes is of critical importace as are the relevat strategies aimed at implemetig such reductios. Poits from the Hidde Harm strategy are re-iterated by the followig key fidigs from our atioal coferece as follows: 1. All services, icludig child, family ad adult services eed to view the welfare of the child as paramout. Agecies eed to work together, takig a child-cetred approach, supportig the whole family to meet their child s eeds. 2. Adult drug ad alcohol services have a duty to cosider ad assess how the adult s behaviour may be affectig the childre i their care 3. Ivest i prevetio ad early itervetio services 4. Provide services ad supports directly to childre 5. Esure orgaisatios are clear about their resposibilities uder Childre First. Puttig Childre First o a legislative basis would esure that orgaisatios have a duty to work together i the iterests of the child. 6. Policies that reduce substace misuse cosumptio levels ca reduce the level of harm to childre livig with paretal substace misuse problems. Drawig o the experieces articulated at the coferece, a series of questios was developed. This is available overleaf ad is iteded as a reflective tool to support service providers ad magers i their day to day work with childre i the cotext of paretal substace misuse. 2 A Family Affair?

5 This coferece provided a forum to respod to a literature review which clearly idetifies that paretal substace misuse is a most serious challege to child welfare ad child protectio i moder Irelad. The challege ow is to recogise this issue as curret, eve though largely ivisible ad to take the ecessary steps to implemet the policies ad measures required to safeguard ad protect childre ow ad for future geeratios. The aticipated Natioal Substace Misuse Strategy ad the emergig Child ad Family Agecy are key policy iitiatives that ca icorporate a focus o childre affected by paretal substace misuse ad that icrease the emphasis o family support. We georously ackowledge ad thak Pegí Doyle who drafted this report. Natioal Advisory Committee o Drugs Alcohol Actio o Irelad HSE Social Iclusio Departmet December 2011 Supportig childre livig with paretal substace misuse 3

6 Supportig service providers ad maagers workig with childre i the cotext of paretal substace misuse. Drawig o the experieces articulated at the coferece, this reflective tool i the table below was developed to support service providers ad maagers i their work with childre i the cotext of paretal substace misuse. Readers may fid it useful to read the sectio o paretal substace misuse i the Child Protectio ad Welfare Practice Hadbook (HSE, 2011) Objective Questios for service providers Additioal questios for drug ad alcohol services Questios for maagers Stregtheig kowledge ad uderstadig about the impacts o childre Do I eed to icrease my kowledge about the potetial impacts of paretal substace misuse o childre? Do I recogise the impact of paretal substace misuse problems? How do I work to stregthe paretig skills? To provide support to the paretig role? Do I iform ad advise wome service users about the risks to the child of substace misuse durig pregacy? Am I clear as to what to do with ay cocers I may have about a child s welfare? About their safety? How ofte do I see the child, liste to the child? Do I recogise ad assess the eeds of service users as parets? How do I work to stregthe paretig skills? To provide support to the paretig role? How do I assess the potetial impact of the cliet s substace misuse o their child(re)? How ca I support the child whe the paret is i treatmet? How ca I support the differig eeds of parets? For example, parets who are active drug users/recoverig drug users? What is our service policy for the care ad maagemet of cliets who are misusig alcohol/drugs durig pregacy? Does the service have policies ad procedures i place to cosider ad assess the welfare ad safety of childre who atted the service or who are i the care of parets attedig the service? Are cocers about child welfare ad safety discussed with/reported to the HSE Childre ad Family Services? How does the service collect data o childre affected by paretal substace misuse? Is the child s eed for stability, cosistecy ad care beig met? What is my role vis a vis the childre where there is family violece? Do I kow whether other orgaisatios also work with this family? Is domestic abuse a factor i this family? Where a child is usig alcohol/drugs ad has a paret(s) with substace misuse problems what is effective cliical practice i helpig the child? Is the child usig alcohol ad drugs? 4 A Family Affair?

7 Objective Questios for service providers Additioal questios for drug ad alcohol services Questios for maagers Examiig our shared resposibility Am I clear as to my resposibilities i relatio to Childre First? Work with school? Work with other orgaisatios Am I clear as to my resposibilities i relatio to Childre First? Is the service compliat with the Childre First Guidace? What are my resposibilities i this regard? Does the orgaisatio eed traiig? Does the orgaisatio have policies ad procedures i place to support iteragecy workig? To address issues relatig to cofidetiality ad iformatio sharig? Is there clarity about roles ad resposibilities? Learig what works well i service desig ad delivery How ca I support the protective factors i this child s life? For example, a stable adult who ca esure the child receives cosistet care, love ad security? Do I eed egage with exteded family? Are supports ad services provided directly to the child, i their ow right? Is there a itegrated pla for workig with this child ad family? Do I lik families with childcare services, where eeded? Does the orgaisatio have the skills, resources ad ethos of iterveig early or do we ted to itervee i respose to a crisis? Do we refer families to services that provide family support, paretig skills ad early itervetio? Do we kow what services exist locally ad what they do? Are there particular issues for Travellers? Ca we provide a service outside of regular hours? If ot, ca we refer to services who do? Do we eed to develop liks with childcare services? Supportig childre livig with paretal substace misuse 5

8 1. Itroductio The Natioal Advisory Committee o Drugs, Alcohol Actio Irelad ad the Heath Service Executive co-hosted a coferece, A Family Affair? Supportig childre livig with paretal substace misuse, i Croke Park, Dubli, o 18 October The purpose of the coferece was to preset the results of a literature review carried out by the seior researcher at the NACD, Dr Justie Horga, etitled Paretal Substace Misuse: Addressig its Impact o Childre. The review was carried out i the cotext of Actio 55 of the Natioal Drugs Strategy (Iterim) which required the NACD to research paretal substace misuse ad its cosequeces for childre ad to idetify effective resposes. The objective of the literature review was to provide a up-to-date sythesis of the most recet research fidigs ito paretal substace misuse ad its effects o childre i order to idetify the eeds of childre. A secod objective was to report from the literature o how services assess the eeds of childre ad respod to them. The aim of the coferece was to iform people ad orgaisatios cocered with the welfare of childre, ad with issues of addictio, about major iteratioal research o the effects of paretal substace misuse o childre ad o families. A further objective was to provide a forum for frotlie workers, iterested orgaisatios ad policymakers to cosider the research fidigs i the light of their direct experiece, discuss the challeges they ecouter ad share the resposes they have foud to be effective. I facilitatig such discussio, the orgaisers aimed to stregthe policy developmet o child welfare ad protectio, promote iter-agecy collaboratio ad develop effective itervetios. The literature review, ad the key recommedatios arisig from it, is also iteded to advise govermet ad iform the desig of policies to meet the eeds of childre livig with paretal substace misuse ad to break the cycle of substace misuse affectig childre over successive geeratios. 1.1 Structure of report This coferece report is preseted i four chapters. Chapter 2 explais the policy cotext of the research ad coferece, outlies the coferece programme ad provides brief profiles of the three bodies that joitly orgaised the evet. Chapter 3 opes with the address by Róisí Shortall TD, Miister of State with Resposibility for Primary Care. It the presets the key results of the literature review ad subsequet recommedatios arisig from it. It the summarises the poits made by participats i roud-table discussios, which focused o three thematic questios. It cocludes with the address by Norah Gibbos, Director of Advocacy at Barardos ad Chairperso of Alcohol Actio Irelad. Chapter 4 gives a overview of the presetatios made at four workshops ad the ope forum that followed each oe. The cocludig address by Fraces Fitzgerald TD, Miister for Childre ad Youth Affairs, is also summarised. A full list of participats is provided i Appedix 1. The pleary sessios ad keyote presetatios were recorded by Mr Ady Osbore ( Drugs ad Alcohol Iformatio ad Support, HSE) ad the video ca be accessed at ad at Alcohol Actio Irelad A copy of the literature review Paretal Substace Misuse: Addressig its impact o Childre is available for dowload from 6 A Family Affair?

9 2. Backgroud The coferece was co-hosted by the Natioal Advisory Committee o Drugs, Alcohol Actio Irelad ad HSE Social Iclusio. The Natioal Advisory Committee o Drugs was established i 2000 to research ad aalyse issues relatig to drug use i Irelad ad to advise govermet o policy developmet i this area. Its curret brief ad actios are set out i the Natioal Drugs Strategy (Iterim) It reports to the Miister of State with Resposibility for Primary Care at the Departmet of Health ad Childre. Alcohol Actio Irelad is the atioal charity for alcohol-related issues. It works to raise awareess of ad reduce the damage caused by alcohol through campaigig, research ad advocacy. The HSE Social Iclusio Departmet works to reduce the impact of health iequalities. It co-ordiates ad itegrates measures by a rage of commuity, volutary ad statutory bodies that aim to address the eeds of socially excluded groups. 2.1 Policy cotext The Natioal Drugs Strategy (Iterim) recogises the implicatios of paretal substace misuse for childre ad paretig. Research shows that childre whose parets misuse drugs ad alcohol are more likely to experiece difficulties i their psychological ad social developmet, family eviromet, academic achievemet ad quality of life. Without proper support for childre i these circumstaces, paretal substace misuse may harm the developmet ad quality of life of oe geeratio ad these effects may be replicated amog succeedig geeratios. Actio 55 of the Natioal Drugs Strategy required the NACD to research paretal substace misuse ad its cosequeces for childre ad to idetify effective resposes. The NACD coducted a literature review of major iteratioal research o paretal substace misuse. The report of the literature review, etitled Paretal Substace Misuse: Addressig its Impact o Childre, is available o The key fidigs of the literature review, ad recommedatios based upo the research, were preseted to the coferece, A Family Affair? Supportig childre livig with paretal substace misuse. This report summarizes the mai proceedigs of the coferece. 2.2 Programme The coferece was orgaised ito two mai sessios. I the morig Miister Rósí Shortall opeed the coferece. The primary messages ad recommedatios from the literature review were preseted by Dr Justie Horga. This was followed by roud-table discussios after which Norah Gibbos, chairperso of Alcohol Actio Irelad, spoke o the theme of Prioritisig childre i policy ad practice. The afteroo sessio cosisted of four themed workshops i which there was a keyote presetatio followed by a group discussio. These were followed by a ope forum with paellists cotributios. The coferece cocluded with a address by the Miister for Childre ad Youth Affairs, Fraces Fitzgerald TD. Supportig childre livig with paretal substace misuse 7

10 Coferece Programme am Arrival ad Registratio am Opeig Address. Róisí Shortall TD, Miister of State with Resposibility for Primary Care am Dr Justie Horga, Seior Researcher, NACD. Paretal Substace Misuse: Addressig its impact o Childre. Key messages ad recommedatios from a review of the literature am Roud-table discussio based o three themes: How do the literature review fidigs reflect your experiece? Share what your orgaisatio does to support childre livig with paretal drug ad alcohol misuse. Explore challeges i supportig childre experiecig paretal substace misuse i the cotext of adult drug ad alcohol services ad wider health ad social services pm Norah Gibbos, Chairperso, Alcohol Actio Irelad ad Director of Advocacy ad Cetral Services, Barardos. Prioritisig childre i policy ad practice pm Luch pm Workshops Workshop A: Learig from service resposes: Ballyfermot STAR. Réalt Beag iitiative of the Ballyfermot STAR Child ad Family Cetre, which is a early learig cetre for childre that supports paretig skills withi families. Preseter: Suiva Filay, Orgaisatio Maager, Ballyfermot STAR. Workshop B: Learig from service resposes: The Families Matter Programme. North West Alcohol Forum (NWAF) Doegal. This iitiative is based o the iteratioally recogised ad evidece-based paretig ad family skills iitiative, the Stregtheig Families Programme. Preseter: Doa Butler, Programme Maager, Families Matter Programme, NWAF. Workshop C: Buildig kowledge ad skills for better outcomes for childre the role of Childre First. Preseter: Theresa Barett, Traiig ad Developmet Office Childre First, HSE, ad Mary Ega, Pricipal Social Worker, Traiig ad Developmet Office, HSE. Workshop D: Hidde Harm Actio Pla, a partership approach for better outcomes for childre livig with paretal drug ad alcohol misuse. Preseter: Davis Turkigto, Seior Officer, Health ad Social Wellbeig Improvemet, Public Health Agecy, NI pm Reflectios o issues arisig from coferece proceedigs. Chair: Paul Barro, Assistat Secretary, Departmet of Health, Pael members: Mary Forrest, Cliical Director, Crosscare Tee Cousellig, Phil Garlad, Assistat Natioal Director, Childre ad Families Social Services, HSE, Michael Coroy, Pricipal Officer, Drugs Policy Uit, Departmet of Health pm Closig address. Fraces Fitzgerald TD, Miister for Childre ad Youth Affairs. 3.45pm Evaluatio ad close. Close: Dr Des Corriga, Chairperso, NACD. 8 A Family Affair?

11 3. Proceedigs Dr Des Corriga, chairperso of the NACD, said that the curret Natioal Drugs Strategy was workig to safeguard the future of childre by targetig measures aimed at breakig the cycle of substace misuse recurrig amog childre of problem substace users. 3.1 Opeig Address Opeig the coferece, the Miister of State at the Departmet of Health with Resposibility for Primary Care, Róisí Shortall TD, urged a holistic approach to the eeds of the families of problem substace misusers. Miister Shortall referred to the particular importace of supportig the childre of drug misusers i their ow right, stregtheig their cofidece as a way of helpig them avoid drug misuse ad explorig the potetial of childre to stay coected with their parets while they received treatmet. She stressed the importace of usig targeted measures aimed at breakig the cycle of substace misuse i oe geeratio cascadig ito the lives of followig geeratios. She urged a greater emphasis o movig people o from drug treatmet to the opportuity of a drug-free life. Miister Shortall called for icreased awareess of the risks associated with drug or alcohol cosumptio durig pregacy, referrig to the worryig level of Neo-atal Abstiece Sydrome ad Foetal Alcohol Spectrum Disorders. The amout of alcohol cosumed i our society ad the ready availability of cheap alcohol were a public health issue ad a matter of cocer for all, she said. Expressig cocer also at the purchase of prescriptio drugs over the web, Miister Shortall said a Natioal Substace Misuse Strategy icorporatig alcohol ad drugs was early complete ad measures to deal with alcohol misuse would be available shortly. Roísí Shortall, Miister of State at the Departmet of Health with Special Resposibility for Primary Care reviews the report i the compay of left to right Fioa Rya, Alcohol Actio Irelad, Dr. Des Corriga ad Dr. Justie Horga, NACD. Miister Shortall said the literature review ad the combied efforts of the NACD, HSE ad Alcohol Actio Irelad i orgaisig the coferece were examples of iter-agecy actio, which was eeded to tackle problems of substace misuse. 3.2 Key messages of literature review Dr Justie Horga said the literature review was udertake to provide a up-to-date sythesis of the most recet research fidigs ito paretal substace misuse ad the effects ad outcomes for childre. Two objectives had guided the review, to idetify the eeds of childre of substace misusers ad to lear how service providers assess ad respod to childre s eeds. The literature had very few solutios i relatio to Irelad ad there was very little research here, Dr Horga said. Supportig childre livig with paretal substace misuse 9

12 The literature review showed that key areas of a child s developmet, otably attachmet, self-regulatio ad stress resposes, were affected. Paretal substace misuse hidered childre from developig key skills ad capacities, resultig i poorer psycho-social developmet ad academic achievemet. There was a greater risk of child substace misuse, with earlier oset ad shorter trasitio to depedecy. These effects combied i a cascade of academic, social, peer group ad substace misuse problems alog with stress ad depressio. Dr Horga highlighted key mechaisms whereby adult behaviour affected childre. These were: Pre-atal exposure through materal misuse of alcohol or drugs, leadig to specific physical ad developmetal problems ad to substace depedecy i ewbor ifats; Lowered paretig skills. Paretal substace misuse ca lead to a poorer quality of paretig ad disruptio of family life. Paretig styles are ofte Debate from the coferece floor icosistet, o-resposive, over-puitive or poor at settig boudaries. Icosistet or o-resposive paretig ca impair bodig ad attachmet for the child. Disruptio ad stress withi the family. Family life ca be disrupted by domestic violece, impaired relatioships ad ecoomic ad psychological isecurity. The child may experiece iformal or statutory out-of-home care. Dr Horga said that, havig aalysed the impact that substace misuse has o a perso s ability to paret ad o the quality of family life experieced by the child, three areas stood out for attetio: 1. The eed to reduce or stop paretal substace misuse; 2. To improve paretig skills; 3. To improve childre s life chaces by stabilisig the family Resposes Key resposes to these priorities ivolve treatmet/rehabilitatio of the perso misusig substaces ad support for the child ad the family. Treatmet reduces substace use, thereby improvig the child s eviromet. The effectiveess of treatmet could be stregtheed by icludig a paretig perspective ad by supportig substace misusers i their paretig role. Wome-cetred treatmet should iclude childcare, trasport to treatmet, home visits ad specialised metal health ad health services. Relatives should be supported i their ow capacity i order to stregthe their copig skills, which over time ca have a direct positive impact o paretig of childre ad also o the relatioship with a parter who is misusig substaces. People s role as parets, ad the effect of substace misuse o this, eeded to be discussed as part of treatmet. 10 A Family Affair?

13 Dr Horga ackowledged the challeges ivolved i this work ad stressed the importace of fidig ways to ourish the trust that is essetial to the therapeutic relatioship whilst also icludig a focus o paretig ad the child. Statutory, commuity ad volutary sectors should co-operate i stregtheig paretig skills ad i learig how to itervee to support the child s well-beig. Fraces Fitzgerald, Miister for Childre ad Youth Affairs receives a copy of the literature review from left to right Clioa Murphy, Alcohol Actio Irelad, Dr. Des Corriga ad Dr. Justie Horga, NACD ad Mario Rackard HSE Social Iclusio. A addictio perspective aimed at uderstadig ad iterveig i the specific dyamics of substace depedecy should be icluded i family ad child supports. It is importat that services co-operate i providig itervetios to eable the cliet seek appropriate help log before a crisis itervetio is ecessary to remove the child. Agecies eed to co-operate ad support each other o matters like assessmet, motivatio techiques, case maagemet ad home visits. Roles eed to be defied ad protocols put i place to esure agecies do ot pursue coflictig goals ad that cliets eeds are properly assessed, case outcomes are cosistet amog agecies ad resources are ot duplicated. This requires the traiig of frotlie workers i collaboratio ad i combiig the dual perspectives. 3.3 Key recommedatios of literature review 1: Improve existig data ad idetify the ature ad extet of the problem. 2: Map existig services ad idetify gaps. 3: Examie paretig roles ad paretal substace misuse. 4: Icrease awareess of drugs ad alcohol cosumptio amog me ad wome ad of the risks of cosumptio durig pregacy. 5: Childre First guidace should be used by all those workig with childre who experiece paretal substace misuse ad with their parets. 6: Assess service provisio to esure drug ad alcohol services iclude a paretig dimesio, ad to gauge the level of iteractio amog services dealig with drugs, alcohol, family, child support, domestic violece ad other issues. 7: Provide adolescets with opportuities to talk with sigificat others. 8: Assess if relevat educatio ad traiig curricula address paretal substace misuse. 9: Recogise the role of family support groups i respodig to paretal substace misuse. 10: Take a culturally sesitive approach. 3.4 Summary of roud-table discussios The coferece provided a forum for frotlie workers, service orgaisatios ad policymakers to cosider the relevace of the research fidigs ad recommedatios to their work experieces. Thirty- Supportig childre livig with paretal substace misuse 11

14 five groups cotributed to the roud-table discussios. Discussio was guided by three prompt questios or themes which are reported o i sectio below: 1. How do the literature review fidigs reflect your experiece? (Idetify effective practice ad what eeds to be doe.) A attetive audiece 2. Share what your orgaisatio does to support childre livig with paretal drug ad alcohol misuse. 3. Explore challeges i supportig childre experiecig paretal substace misuse i the cotext of adult drug ad alcohol services ad the wider health ad social services. Core messages from discussios Discussios emphasised the followig priorities: The importace of puttig the welfare of childre ad youg people first, with provisio of itegrated, log-term support throughout childhood idepedet of parets treatmet status; Buildig resiliece ad copig skills amog childre ad youg people; The eed for early itervetio to safeguard the child; Workig with the family as a uit to promote a stable family eviromet; Helpig the child develop commuicatio ad social skills ad to egage with their peers; Iter-agecy collaboratio with itegrated care plas based o eeds assessmet of the whole family; Itegratio of paretig ad addictio perspectives i child ad adult services; The potetial role of the school i idetifyig problems ad supportig the child; Egagig parets i seekig supports for the child ad i ackowledgig the effects of their substace misuse o the child; Flexible ad accessible service resposes; Childcare supports to care for the child ad to help parets, especially mothers, access treatmet How do the literature review fidigs reflect your experiece? Participats idetified the followig examples of effective practice: Early itervetio with parets ad childre. Examples of iitiatives that give good support iclude the Public Health Nurses, Family Support Agecy, Stregtheig Families Programme, Icredible Years, Family Resource Cetres, Ballyfermot STAR ad drug liaiso midwives. Stregtheig families ad paretig skills, icludig work with the exteded family as a uit. Idetifyig the protective factors i the child s life, talkig directly to childre ad egagig them ad the wider family i improvig their outcomes. Good iter-agecy collaboratio ivolvig liks betwee professioals i health, educatio ad gardaí ad referral to other services such as materity ad public health services. Whe there is co- 12 A Family Affair?

15 ordiatio betwee school, family ad services, a child s problems are more likely to be idetified ad addressed early. It is helpful whe people kow what services are i their locality ad what each agecy provides. Esurig the child has a daily outlet, through a homework club, Step by Step programme ad geeral child-orieted work, to give the child a break from stress. What eeds to be doe? Participats stressed the overridig eed to provide services to the child i their ow right ad to put the child s well-beig, ot addictio, at the cetre of resposes. Other priorities icluded: Liste to the child s cocers ad esure there is stability, cosistecy ad care i their life; Help the child to stay where their attachmet bod is, usually with the parets; Recogise the uique circumstaces of each family ad commuicate hoestly with everyoe; Provide itegrated care ad ogoig log-term support from pre-atal stage to 18 years; Esure early itervetio whe risk factors are recogised; Ecourage early recogitio of pre-atal alcohol problems through primary healthcare teams; Collaboratio betwee social workers ad addictio teams; Itegratio of child protectio policies ito adult drug services ad provisio of supports to childre whose parets are receivig treatmet; The use of itegrated care plas ad case coferecig; Access to commuity-based services for childre ad families; Educate schools o the impact of substace misuse o childre; Help childre to talk ad egage with their peers ad sigificat others through support or friedship groups Share what your orgaisatio does to support childre livig with paretal drug ad alcohol misuse. A wide rage of activity was reported, focused strogly o supportig childre directly ad o supportig parets i relatio to their childre. Supportig the child May supports focused o buildig the resiliece, commuicatio ad life skills of childre ad youg people. Differet strads of programmes addressed specific age groups, ragig from 12 to 17 years. Creatig structures whereby childre could express their feeligs was a importat focus. This raged from idividual support to formig peer support groups. Helpig the youg perso fid their voice could also improve commuicatio betwee paret ad child. Educatio ad the child Educatio ad school was a importat focal poit. Commuity-based orgaisatios helped childre to atted school; they advocated for the child with the school or supported out of school childre with educatio or referral to services. May commuity projects helped with homework, though participats reported isufficiet time to give childre the full support they eeded. For youger childre play therapy was sometimes used. Providig meals before ad after school was a importat measure. Supportig childre livig with paretal substace misuse 13

16 Supportig parets May projects provided traiig i paretig skills, supported educatio ad persoal developmet ad stregtheed the family through a variety of measures to maitai a stable family life. This icluded providig idividual paretig support i the home for those who do t egage with groups. I child protectio situatios parets are referred to family support services, which work with them to chage their behaviour. Some projects provide family-friedly treatmet facilities with crèche ad childcare services. Childcare was oe of the mai supports offered. It raged from collectig childre from school to fudig childcare ad providig it whe parets atteded treatmet. Help with trasport was aother effective support. Participats stressed the importace of cosultig parets o the supports they eeded for their child. Flexibility was importat i family support ad some programmes, such as Stregtheig Families, adjusted their activities to the parets readiess to egage i commuicatio ad relatioship buildig work. Some services helped parets to access diagosis ad treatmet for Foetal Alcohol Spectrum Disorders. It was stated that childre with the coditio sometimes are ot diagosed because they preset with ormal itellectual capacity ad appearace. Family support work ofte followed a care pla based o eeds assessmet, where outcomes for paretig skills ad childre s social skills were measured agaist the origial assessmet Explore challeges i supportig childre experiecig paretal substace misuse i the cotext of adult drug ad alcohol services ad the wider health ad social services. Discussio of challeges related to six key areas the child; the family; addictio; services; resources ad awareess. Oly poits additioal to those reported i ad above are reported here. The child Where there is paretal substace misuse it is a major challege to esure a child actually has a childhood whe ofte they are forced to play the parets role. There is a sigificat problem of poverty ad child huger. Whe seekig to give the child a voice, there is a issue of overcomig the eed for paretal coset. Childre ad substace misuse Childre s access to services depeds o the addictio or treatmet status of the paret but the child eeds support before a crisis arises. There is a gap i age appropriate services for childre. Most programmes are for recoverig addicts ad there is ot eough support for childre of chaotic drug misusers. There is also a care gap for childre whe parets are i treatmet particularly if gradparets are addicted also. I cases of child drug misuse, it is difficult to work with a child without the ivolvemet of the paret, who may also be a substace misuser. The solutio is to refer the child for treatmet. Followig treatmet or care itervetio, the child may eed to be rehabilitated back ito the family, as well as the paret who misuses. Suicide is a issue for childre. Participats said that up to half the childre i a project may be affected by suicide, ofte liked to drug debts. 14 A Family Affair?

17 The family Participats expressed cocer over the breakdow of the traditioal family uit with multiple parets, step-parets ad half-sibligs, which caused attachmet difficulties for the child. Work with parets was challegig if they did t wat to commit themselves to chage. Participats wared of the risk of acceptig lower paretig stadards for fear of parets withdrawig from services. Targeted paretig courses were eeded, with the suggestio that childre also lear about paretig i schools. May foster parets have difficulty dealig with childre from a drugs backgroud. As a first step i addressig the complex relatioship betwee domestic violece ad substace misuse, it was suggested that a iter-agecy iitiative be piloted i a domestic violece refuge. Participats urged a greater emphasis o child ad family supports i the Natioal Drugs Strategy. Addictio The key poit raised was the eed to itegrate child welfare ito services for substace misusig parets. Helpig the addict to ackowledge their addictio, helpig the abstiet paret to come to terms with the situatio ad prevetig relapse by the addict will all help the child. However, the stigma surroudig addictio may block parets from ackowledgig their misuse ad gettig support for the child. I the case of alcohol, it is more difficult to get adults to accept that their misuse is a problem for the child. A youg perso s misuse of substaces is associated with paretal misuse but egagig parets who are misusig substaces is difficult. There is a lack of residetial assessmet services while a lack of childcare ad family support makes it harder for mothers to eter loger i-patiet programmes. Addictio services eed to provide childcare or lik with childcare services. Those workig i adult addictio ad i child-focused services eed traiig i both areas. Drug misuse is a sigificat challege for the Travellig commuity ad drug services eed to be aware of Traveller culture. Schools could help idetify problems experieced by Traveller childre livig with substace misuse. Services Discussio dealt with scarce resources; crisis rather tha proactive resposes; fragmetatio, with differet roles, resposibilities, policies ad target groups; poor co-ordiatio ad lack of uderstadig of child protectio ad addictio. Budget cuts are affectig services ad a geeral lack of resources prevets proactive resposes. For the well-beig of childre, there is a eed to chage families poor perceptio of social services. Parets may refuse to egage with services if they believe that referral will mea the loss of their child. Commuity orgaisatios lack the resources to offer to everyoe the sort of extesive supports a mother i crisis eeds, such as feedig childre ad gettig them to school. Addictio services also lack the resources to deal with substace misusers childre. Participats emphasised the eed for services to be flexible ad available outside stadard hours but also expressed cocer that madatory reportig requiremets would swamp services. Awareess A atioal awareess programme o substace misuse is eeded icludig a publicity campaig aimed Supportig childre livig with paretal substace misuse 15

18 at childre whose exposure to substace misuse remais hidde. Educatio about drugs ad alcohol ofte require the child to act at variace with what is ormal i their home ad for this reaso families should be educated first, the the commuity ad wider services. 3.5 Prioritisig Childre i Policy ad Practice : Norah Gibbos Norah Gibbos, chairperso of Alcohol Actio Irelad ad Director of Advocacy, Barardos, spoke about Prioritisig childre i policy ad practice. Ms Gibbos said society igored the impact of paretal substace misuse o childre yet childre livig with paretal substace misuse were amog the most vulerable. Substace misuse affected parets capacity to give structure ad care to their childre. A ISPCC study showed that 100,000 childre were egatively affected by paretal alcohol problems ad oe i every six cases of child abuse was attributed to substace misuse. Idetifyig the child s eeds ad, i Debate from the coferece floor particular, idetifyig a stable adult who could esure the child received cosistet love, care ad security were cetral to effective delivery of resposes. She stressed that the welfare ad eeds of the child should be put first, ad that agecies eeded to work together. Uder the Child Care Act 1991, the HSE had a statutory duty to promote the welfare of a eglected child ad make the child s welfare the first ad paramout cosideratio. The revised Childre First Guidace ad the HSE s Child Protectio ad Welfare Practice Hadbook were positive developmets. The key priciples of Childre First were that the welfare of the child was paramout ad that those workig with adults who could ot meet their child s eeds should always act i the child s best iterests. Childre First emphasized iter-agecy or multi-discipliary workig i idetifyig ad puttig the child s iterests to the fore. Norah Gibbos outlied curret challeges to effective iter-agecy workig. Frotlie staff eeded traiig o the impact of substace misuse ad eeded to iclude i their assessmets the effect of addictio o paretig capacity ad o childre. Cliet cofidetiality could deter professioals from sharig iformatio. Policies ad procedures to support iter-agecy workig were eeded. Fiacial costraits ad cutbacks were leadig to loger waitig lists ad workload pressure o staff. Basic data was eeded to establish how may childre are harmed by paretal substace misuse ad to establish the impacts o health, developmet ad welfare. 16 A Family Affair?

19 Ms Gibbos recommeded some key measures. 1. Ivestmet i prevetio ad early itervetio services 2. Policies that reduced alcohol cosumptio levels would reduce the level of harm to childre livig with paretal alcohol problems. This would require collaboratio by may orgaisatios icludig protocols betwee service agecies ad the itegratio of alcohol services with family support ad child welfare services. A whole family approach, where the child s eeds were the priority, would best provide positive outcomes for childre ad families. May alcohol services provided supports to parets with alcohol problems but ot for the family or the childre. 3. Provide services ad supports directly to childre Support ad services should be provided to childre i their ow right. Such services could iclude self-referral services, helplies, i-school cousellig, therapeutic support ad emergecy accommodatio. 4. Esure orgaisatios are clear about their resposibilities uder Childre First. Puttig Childre First o a legislative basis would esure that orgaisatios would have a duty to share iformatio ad co-operate i the iterests of the child. 5. Costitutioal amedmet Settig childre s rights ito the Irish Costitutio would esure their iterests were paramout i decisios that affected their lives ad that policy ad services would be child cetred. Childre whose parets abused substaces were forced to grow up too fast, were burdeed with too much resposibility ad with feeligs of shame, fear, isolatio ad cofusio. They should ot be overlooked i policy developmet ad service delivery, Norah Gibbos cocluded. Supportig childre livig with paretal substace misuse 17

20 4. Workshop Presetatios ad Discussio The afteroo sessio ivolved four workshop presetatios o differet iitiatives for addressig substace misuse, followed by discussio. 4.1 Workshop presetatios Workshop A: Learig from service resposes: Ballyfermot STAR Preseted by Suiva Filay, Maager, Ballyfermot STAR. Ballyfermot STAR works with people who use illicit drugs, who abuse alcohol ad prescribed ad over the couter medicatio, who are stable o methadoe ad coected to services or who are drug free ad eedig aftercare. It also works with family members icludig parets, parters ad childre. Its iitiatives comprise Réalt Nua, for rehabilitatio, educatio ad traiig; Réalt a Cla, family support services; Réalt Beag, childre ad family services; Réalt Solus, cocaie iitiative; ad Réalt Eolas, etry/assessmet programme. For Ballyfermot STAR, iter-agecy work is essetial. It eables service users to access maistream services ad it eables Ballyfermot STAR to develop progressio paths for cliets, protocols that allow people move seamlessly through relevat agecies, to develop programmes that stregthe its work ad to work proactively with local ad atioal agecies. Ballyfermot STAR seeks to address the specific challeges of how to support parets who have difficulty with paretig skills, ad how a multi-discipliary team with differet skills ca collaborate to support the whole family. The project adopts a child-cetred approach with very early learig support. It follows the High Scope curriculum of active participatory learig with physical, emotioal ad itellectual support. It recogises ad supports parets as the child s primary educators. It ecourages high expectatios for its childre ad aims that they become idepedet, resposible, cofidet, ope to learig, able to pla ad able to express themselves. The quality, affordable childcare ad family support Ballyfermot STAR provides are critical to eablig drug users to udertake rehabilitatio. Research shows that vulerable childre who have quality childcare ad early childhood educatio are happier, better prepared for school, closer to their caregivers ad better able to co-operate ad commuicate. Quality childcare reduces the effects of a ustable eviromet while parets remai ivolved i the daily care of the child. Staff members have completed commuity addictio studies courses ad uderstad the target group ad their eeds. Workshop B: Learig from service resposes: The Families Matter Programme Preseted by Doa Butler, Programme Maager, Families Matter, North West Alcohol Forum. The North West Alcohol Forum is a state-fuded, commuity-based respose to alcohol misuse. Through commuity cosultatio it idetified a strog eed for a structured, whole-family support programme ad it piloted the Stregtheig Families Programme to test its suitability. It takes 10 people to deliver oe Stregtheig Families Programme ad so iter-agecy collaboratio ad doated time are essetial. Agecies release staff for two-day group leader traiig. Traiig equips 18 A Family Affair?

21 oe to refer or lik people to the programme or to be a group leader. I March 2010, the pilot programme started with 11 families. The programme cosists of weekly sessios over 14 weeks. Traiig i paret, tee ad family lifeskills is provided simultaeously, each requirig iput from two to three group leaders. The Stregtheig Families Programme cosists of a ie-stage jourey: 1. Family referral applicatio through programme lik perso, 2. Programme screeig pael, 3. Lik perso supports family for 14 weeks, 4. Lik perso atteds Night Oe, 5. Family atted for 14 cosecutive weeks, 6. Post-programme debrief ad feedback, 7. Lik perso give weekly update, 8. Parets ad childre complete a evaluatio, 9. Graduatio at sessio 14, with a follow-up booster sessio/reuio. A stadardised evaluatio is used to measure the immediate chage objectives of the parets, the child ad the whole family. The evaluatio to date showed 100 per cet retetio rate ad sigificat improvemet i paretig ad i five family outcomes for all participats. The five family outcomes were orgaisatio, cohesio, commuicatio, coflict ad resiliece. There was sigificat improvemet i five out of seve youth outcomes, comprisig decreased depressio, reduced attetio deficit, less covert ad overt aggressio ad icreased social skills. A small chage was reported i crimial behaviour ad hyperactivity. Paretal alcohol ad drug misuse dropped sigificatly. A exteral evaluatio attributed the programme s impact to its whole-family approach, its skills base, itervetio ad iter-agecy collaboratio. Sice the programme bega, 54 families have atteded, over 100 people have bee traied ad there are close likages with commuity, volutary ad statutory orgaisatios. Workshop C: Buildig kowledge ad skills for better outcomes for childre the role of Childre First Preseted by Theresa Barett, HSE Traiig ad Developmet Officer, ad Mary Ega, Pricipal Social Worker, Traiig ad Developmet Office, Childre First, HSE. The preseters explaied the differeces betwee the 1999 ad the 2011 Childre First guidelies. The substace ad priciples were the same but the cotet had bee updated to reflect chages i policy ad legislatio ad the establishmet of ew agecies like the Departmet for Childre ad Youth Affairs. The cotet reflected recommedatios from recet reports ad the growig awareess of the impact of eglect o childre. The term Guidace had replaced Guidelies i the title. There were five key priciples for best practice i respodig to child protectio ad welfare cocers. Supportig childre livig with paretal substace misuse 19

22 1. The child s welfare is paramout; 2. Childre have a right to be heard; 3. There is a balace betwee protectig childre ad respectig parets; 4. Early itervetio ad family support; 5. Professioals workig with adults who have serious difficulties meetig their childre s eeds for safety ad security should always cosider the impact of the adult s behaviour o the child ad act i the child s best iterest. There were four forms of abuse; eglect, emotioal abuse, sexual abuse ad physical abuse. Neglect was defied as whe the child suffered sigificat harm or impairmet of developmet by beig deprived of food, clothig, warmth, hygiee, itellectual stimulatio, supervisio ad safety, attachmet, adult affectio ad medical care. Chroic eglect occurs whe parets fail to provide for the child s basic eeds over time. Adult problems such as stress, poverty or addictio ca ever justify the eglect or harm of a child by the parets. The child s welfare must always be the primary cosideratio. Those who treat people with metal health ad addictio problems must cosider the welfare ad safety of ay child i the perso s family or i regular cotact with them, ad ay cocers must be discussed with ad reported to the HSE Childre ad Family Services. The Child Protectio ad Welfare Practice Hadbook complemets Childre First 2011 ad is a aid to deliverig accoutable, cosistet ad trasparet practice. It is a quick referece book ad sets out key issues for differet stages. Workshop D: Hidde Harm Actio Pla, a partership approach for better outcomes for childre livig with paretal drug ad alcohol misuse Preseted by Davis Turkigto, Seior Officer, Health ad Social Well-beig Improvemet, Public Health Agecy, Norther Irelad. The UK Advisory Coucil o the Misuse of Drugs produced the report Hidde Harm: Respodig to the eeds of childre of problem drug users, which stated that reducig the harm to childre from paretal drug misuse should be a mai objective of policy ad practice. I Norther Irelad the UK report recommedatios were icorporated i the New Strategic Directio for Alcohol ad Drugs , which stipulated that a Hidde Harm strategy o alcohol misuse should be developed. Based o figures for UK substace misuse, it was estimated that approximately 40,000 childre i Norther Irelad could be livig with paretal alcohol misuse. Forty per cet of childre o the child protectio register ad 70 per cet of childre i care outside the home were there because of paretal substace misuse. A regioal Hidde Harm Actio Pla was produced joitly by the Public Health Agecy ad the Health ad Social Care Board i 2008 ad this made provisio for the developmet of local Hidde Harm actio plas. Oe of the priciples of the pla was that services should be built o what childre said they eeded ad that resposes to child ad family eeds should be itegrated ito maistream adult ad childre services. It emphasised prevetio ad early idetificatio ad buildig o family stregths. 20 A Family Affair?

23 Phil Garlad, Assistat Natioal Director, Childre ad Families Social Services, HSE addresses the pleary sessio. Left to right Paul Barro, Assistat Secretary, Departmet of Health, Mary Forrest, Cliical Director, Crosscare Tee Cousellig, Phil Garlad, Assistat Natioal Director, Childre ad Families Social Services, HSE ad Michael Coroy, Pricipal Officer, Drugs Policy Uit, Departmet of Health. The pla focused o childre livig i households where there was misuse of substaces icludig medicies. It held that Hidde Harm had to be viewed primarily as a issue of childre ad youg people, if the problems were to be successfully tackled. The pla evisaged a joit approach betwee staff of the Health ad Social Care Board ad the Public Health Agecy. Priority work areas comprised regioal traiig ad workforce developmet; joit leadership ad iter-agecy co-operatio; regioal baselie iformatio; regioal public awareess ad best practice ad local services. Protocols to promote iter-agecy workig have bee draw up. These deal with the effect of paretal misuse o childre; cofidetiality ad iformatio sharig; roles ad resposibilities betwee adult addictio ad family ad childcare services; assessmet ad referral ad traiig. There is joit agreemet betwee adult ad childre s services i respodig to the eeds of parets with metal health or substace misuse issues, their childre ad families. At preset baselie ad moitorig data is beig compiled. 4.2 Pael ad ope forum The workshops were followed by a ope discussio with iput from paellists Michael Coroy, Pricipal Officer, Drugs Policy Uit of the Departmet of Health, Mary Forrest, Cliical Director, Crosscare Tee Cousellig, ad Phil Garlad, Assistat Natioal Director, Childre ad Families Social Services, HSE. It was chaired by Paul Barro, Assistat Secretary, Departmet of Health. Mary Forrest urged the Departmet of Childre ad Youth Affairs to lead a strategy for deliverig best services for childre ad tees but said the challege would be for agecies to implemet such a strategy. The plaed costitutioal referedum o childre s rights would give the Govermet the opportuity to group together all the issues relatig to childre. She suggested that future atioal policies should be child-proofed i the same way as measures are geder- ad poverty-proofed. A research questio was eeded to gather data o tees ad childre of substace misusers who self-harm. Where parets preset for treatmet, there should be cousellig services for the childre, she added. She said troubled tees faced very serious risks of self-harm, actig out, crimial activity ad gag activity. Self-harm, rather tha drikig, was ow the alarm sigal ad drugs ad alcohol were factors i tee suicide. She called for cosideratio of the marketig pressures ad availability of alcohol o childre ad welcomed the fact that a substace misuse strategy would be i place shortly. Phil Garlad said his key role was to implemet Childre First aroud the coutry ad a cross-departmetal group was workig to esure every departmet ad agecy worked together towards this. A traiig the traiers programme o Childre First was beig developed to make sure that everybody workig i Supportig childre livig with paretal substace misuse 21