Safeguarding Children with Drug and Alcohol Using Parents

Transcription

1 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Produced by Nottighamshire ad Nottigham City Safeguardig Childre Boards. First Issued February 2004 Revised Editio May 2009

2 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Produced by Nottighamshire ad Nottigham City Safeguardig Childre Boards.

3 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Foreword I Jue 2003, the Advisory Coucil o the Misuse of Drugs published Hidde Harm, focusig o the actual ad potetial effects of paretal drug use o childre. Oe of the forty-eight recommedatios made withi Hidde Harm was that; Whe revisig child protectio policies ad procedures, full accout should be take of the particular challeges posed by paretal problem drug use, with the cosequet implicatios for staff traiig, assessmet ad case maagemet procedures, ad iter agecy liaiso. I the Govermet s respose to Hidde Harm, this recommedatio was accepted, with the recogitio that the ewly formed local Safeguardig Childre s Boards would be resposible for safeguardig childre icludig those who may be put at risk due to paretal drug misuse. To reflect this recommedatio, ad to support chagig agedas, legislatio ad curret research, (sectio 2.0) this practice guidace has bee revised ad updated from its origial release i February New iformatio relatig to the followig issues has bee icluded: The impact of alcohol use Commo Assessmet Framework (CAF), local assessmets ad screeig tools Natioal guidace ad strategies icludig :- Every Child Matters 2003 Childre s Act 2004 Workig Together to Safeguard Childre 2006 Alcohol Harm Reductio Strategy 2004 Drugs: Protectig Families ad Commuities Liks betwee drug / alcohol use ad domestic abuse Metal health issues Diversity Exteded family icludig gradparets Update of services ad accessibility. 3

4 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Cotets Page 1 Itroductio 5 2 Research & Natioal Guidace 7 3 Iformatio Sharig & Cofidetiality 11 4 Egagig Families 13 5 Idetificatio 16 6 Assessig Families 18 7 The Domais of the Assessmet 22 8 Support / Care Pathways 32 9 Pregacy Resources Traiig Refereces 45 Appedix 1 Guide to the Short Term Effects of Drugs 47 Appedix 2 Drug & Alcohol Screeig 49 4

5 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 1 Itroductio 1.1 The aim of the practice guidace is to assist staff i all agecies i idetifyig situatios where actio is eeded to safeguard a child ad promote their welfare as a result of their paret s drug ad / or alcohol use. This guidace should be read i cojuctio with: Nottigham City ad Nottighamshire Safeguardig Childre Board Safeguardig Procedures Workig Together to Safeguard Childre 2006 Commo Assessmet Framework Guidace NCSCB / NSCB Practice Guidace o related issues such as domestic violece. 1.2 For the purpose of this guidace, the terms: parets icludes carers ad / or guardias child / childre refers to both childre ad youg people uder the age of 18. drugs icludes legal ad illicit drugs ad volatile substaces substace (mis) use also icludes drugs, alcohol ad volatile substaces. 1.3 Although it is recogised that the secodary effects of tobacco ca be harmful to others especially childre, this is ot icluded i this practice guidace. 1.4 For the purpose of this guidace, Nottighamshire refers to the Couty ad City uless specifically stated i.e. Nottighamshire Couty ad Nottigham City. 1.5 Whilst ot codoig the use of drugs ad / or alcohol, it is recogised that such use i itself may ot affect a paret s capacity to look after their child well. Equally, paretal drug ad / or alcohol misuse ca become the cetral focus of the adult s lives, feeligs ad social behaviour ad therefore have a sigificat impact o their capacity to paret appropriately. 1.6 Whe assessig a child s eeds, paretal drug ad / or alcohol use should oly be a cocer whe it adversely affects the quality of care that a child receives ad cosequetly poses a risk to their health ad developmet, or has the potetial to do so. The assessmet is ot to determie whether someoe is depedet o a substace but to establish the extet to which substace use is affectig paretig capacity. 5

6 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 1.7 I some cases childre, youg people ad their families may have additioal eeds that require further assessmet ad a multi agecy approach, with uiversal, targeted ad specialist services. 1.8 It is essetial that childre whose welfare may be at risk as a result of their parets problematic drug ad / or alcohol use are idetified i order to protect them ad promote their welfare. Effective workig practices icludig iformatio sharig protocols should be i place across both adult ad childre s services to idetify these childre. 1.9 All staff i statutory ad volutary settigs should be i a positio to idetify childre who are at risk of sigificat harm ad should be aware of their ow agecy ad the NCSCB / NSCB Safeguardig Procedures ad the actios they eed to take Sometimes, practitioers ca be scared of opeig up a ca of worms ad parets are fearful of social care ivolvemet. Early itervetio, support ad ivolvemet however, ca reduce the risk of childre becomig subject to child protectio processes. Parets with drug ad / or alcohol problems remai resposible for esurig that their childre are adequately cared for ad this may mea that agecies eed to itervee agaist the paret s wishes o occasios i the iterests of the child. I these circumstaces staff should follow their child protectio procedures ad ask for advice ad support from their maagers/desigated child protectio advisor. The Local Picture 1.11 Nottighamshire Couty it is estimated that there were 2692 childre with parets i drug treatmet durig 2007/08. However, based o the estimated umber of problematic heroi ad / or crack cocaie users i the Couty, there could be over 4000 childre affected by paretal illicit substace use (2006/07). Up to 22,000 uder 18 year olds could be affected by paretal alcohol problems, of which betwee 7,000 ad 11,000 could be uder 10 years of age (2006/07) Nottigham City - it is estimated that there are approximately 4000 problematic drug users ad betwee 5,000 ad 15,000 problematic alcohol users, idicatig that betwee 9,000 to 20,000 childre ad youg people are adversely affected by paretal drug ad / or alcohol use (2008). 6

7 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 2 Research ad Natioal Guidace Hidde Harm 2.1 I 2003 the Advisory Coucil o the Misuse of Drugs (ACMD) published its report Hidde Harm respodig to the eeds of childre of problematic illicit drug users. The report idetified 48 recommedatios ad 6 key fidigs as follows:- There are betwee 250,000 ad 300,000 childre of problem drug users i the UK about oe for every problem drug user Paretal problem drug use ca ad does cause serious harm to childre at every age from coceptio to adulthood Reducig the harm to childre from paretal problem drug use should become a mai objective of policy ad practice Effective treatmet of the paret ca have major beefits for the child By workig together, services ca take may practical steps to protect ad improve the health ad well beig of affected childre The umber of affected childre is oly likely to decrease whe the umber of problem drug users decreases. 2.2 I 2005, the Govermets respose to Hidde Harm was published. This upheld all but 6 of the origial recommedatios. I February 2007, the ACMD published Hidde Harm 3 Years O; Realities, Challeges ad Opportuities as a update to the origial Hidde Harm report. The key fidigs withi this report are icluded withi this guidace. Bottlig It Up 2.3 I 2006, Turig Poit published their key fidig o the affects of alcohol misuse o childre, parets ad families. The report idetified that: there could be five times as may childre affected by paretal alcohol problems as by paretal drug use aroud oe third of all domestic violece icidets are liked to alcohol misuse alcohol misuse by parets was idetified as a factor i over 50% of child protectio cases. 7

8 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies The Alcohol Harm Reductio Strategy 2.4 I March 2004, the Prime Miisters Strategy Uit published the Alcohol Harm Reductio Strategy for Eglad which sets out the way forward for parterships betwee govermet, local authorities, police, health, idustry ad the public, i reducig specific harms associated with alcohol. 2.5 The strategy highlights four key areas for focus i order to reduce alcohol related harm ad makes a umber of proposals i each of these areas: educatio ad commuicatio idetificatio ad treatmet alcohol related crime disorder supply ad idustry resposibility. 2.6 I Jue 2007, the Departmet of Health, Home Office, Departmet for Educatio ad Skills ad the Departmet for Culture, Media ad Sport published Safe. Sesible. Social, reviewig progress sice the publicatio of the Alcohol Harm Reductio Strategy ad outliig further atioal ad local actio to achieve log-term reductios i alcohol related ill health ad crime. The Natioal Drug Strategy 2.7 The first te year Natioal Drug Strategy was published i 1998 ad updated i I February 2008, the Govermet published their secod Natioal Drug Strategy Drugs: protectig families ad commuities ad accompayig three year actio pla. The ew Strategy builds o the successes from 1998 across four key areas: Protectig commuities through robust eforcemet to tackle drug supply, drug related crime ad ati social behaviour Prevetig harm to childre, youg people ad families affected by drug misuse Deliverig ew approaches to drug treatmet ad social re-itegratio Public iformatio campaigs, commuicatios ad commuity egagemet. 8

9 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Childre s Act The Childre s Act 2004 aims to improve outcomes for all childre ad target services to specific groups of childre ad i localities where curret outcomes for childre fall beeath those for the geeral populatio. The overall aim is to ecourage itegrated plaig, commissioig ad delivery of services as well as improve multi discipliary workig, remove duplicatio ad icrease accoutability. Sectio 11 requires all services to be provided with attetio give to the eed to safeguard ad promote the welfare of childre ad youg people. This icludes those providig services to adults ad has a particular relevace for services directed at substace misusig parets. The Act also laid dow the legislative requiremets for the Commo Assessmet Framework (CAF) ad role of lead practitioer. Every Child Matters (ECM) 2.9 Every Child Matters: Chage for Childre is a ew approach to the well beig of childre ad youg people from birth to age 19. The Govermet s aim is for every child, whatever their backgroud or circumstaces to have the support they eed to: Be healthy Stay safe Ejoy ad achieve Make a positive cotributio Achieve ecoomic well-beig The aim is that the orgaisatios ivolved i providig services to childre - from hospitals ad schools, to police ad volutary groups - will be workig together i ew ways. The Commo Assessmet Framework will be used to share iformatio, udertake multi-agecy assessmets ad provide itegrated support at the earliest opportuity to support prevetative ad early itervetio work ad help childre ad youg people achieve their potetial uder the 5ECM Outcomes. Childre ad youg people should have far more of a voice about issues that affect them as idividuals ad collectively. Withi the Couty ad City parters are workig together, through Childre s Trust arragemets (strategic parterships), to explore what works best for childre ad youg people i their locality, ad act o it. Withi both authorities work is ogoig to esure the voices of childre ad youg people are heard ad ifluece plaig ad decisio makig. 9

10 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Chage for Childre Youg People ad Drugs 2.11 Chage for Childre; Youg People ad Drugs, liked youg people ad substace use to the Every Child Matters ageda. The report idetified childre of problematic drug ad / or alcohol users, as a specific at risk group, requirig a targeted itervetio approach. The aim is to esure that provisio is built aroud the eeds of vulerable childre ad youg people with more focus o prevetio ad early itervetio. Natioal Service Framework for Childre, Youg People ad Materity Services 2.12 I 2004, the Natioal Service Framework for Childre, Youg People ad Materity Services was published. This 10-year programme is iteded to stimulate log term ad sustaied improvemet i childre s health. It aims to esure fair, high quality ad itegrated health ad social care from pregacy, through to adulthood. It requires that parets with specific eeds such as addictio to drugs ad / or alcohol should have their eeds idetified early ad are provided with effective multi agecy support. It also outlies requiremets regardig materity provisio icludig eeds of pregat drug ad / or alcohol users. Workig Together I 2006, Workig Together to Safeguard Childre respoded to the report by the Advisory Coucil o the Misuse of Drugs (ACMD) by recogisig the impact that paretal drug misuse ca ad does have o childre throughout each stage of developmet. It calls for a thorough assessmet to determie the extet of eed ad the level of risk of harm i each case, requirig Local Safeguardig Childre Boards to take full accout of the complexities ad challeges of this area of work ad have i place: Local Safeguardig Childre s Board policies ad procedures Iteragecy protocols for the coordiatio of assessmet ad support particularly across adult drug services ad childre ad youg people s services Close collaboratio with local Drug (ad Alcohol) Actio Teams (or equivalet) ad drug services as well as a umber of other agecies that ca assist i the assessmets ad outcomes. Although i Workig Together 2006 alcohol is ot specifically referred to, this guidace promotes the same approach i respose to all substace misuse. 10

11 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 3 Iformatio Sharig ad Cofidetiality 3.1 Guidace o iformatio sharig ad cofidetiality ca be foud withi the NSCB/ NCSCB Safeguardig Procedures ad also withi Every Child Matters: Sharig Iformatio Practitioers Guide ( 3.2 Cofidetiality is a importat factor i eablig drug ad alcohol services users to egage cofidetly ad hoestly with treatmet ad support services ad this is a essetial requiremet for successful rehabilitatio. This imperative should be recogised by parters but it should ot be allowed to prevet iformatio sharig where this is ecessary to safeguard childre ad youg people. Each agecy should develop specific guidace that clearly sets out the limits to cofidetiality i these circumstaces. 3.3 Whe cocers about a child s safety or welfare require a practitioer or agecy to share cofidetial iformatio without the perso s coset, they should tell the perso that they ited to do so, uless this may place the child or others at risk of harm. Each agecy should make it clear to people usig their service that safeguardig childre is the most importat cosideratio whe decidig whether or ot to share iformatio with others. No agecy ca guaratee absolute cofidetiality as both statute ad commo law accept that iformatio may be shared i some circumstaces. 3.4 Oe key mechaism for meetig the eeds of vulerable childre ad youg people is through the implemetatio of the CAF. 3.5 Usig a CAF with a family requires iformed, writte coset to share iformatio across agecies ad practitioers must esure they agree with families what iformatio will be shared, with who ad the purpose of sharig it. The statutory resposibility to share iformatio without coset should also be made clear to families, specifically i relatio to the duty to share where a child is at risk of sigificat harm ad a referral to social care must be made. 11

12 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 3.6 People who use substaces may be particularly cocered about their support services sharig iformatio with other practitioers. They may fear they will be deied help, stigmatised or blamed if other agecies are give iformatio about them. This may have bee their experiece i the past. They may also fear ivestigatio by the police about illegal drug use or child protectio equiries beig istigated. I most circumstaces, users of treatmet of support services ca rely o cofidetiality. However there are importat exceptios to this icludig where there are cocers relatig to childre ad youg people. 3.7 Agecies, whe begiig work with ay service user, should iform the service users as a matter of course about their policy o iformatio sharig ad cofidetiality ad explai the kids of situatios where they may eed to share iformatio. Agecies should give some idicatio of why, ad with whom they may eed to share iformatio. They should ask for the service user s coset to sharig ecessary iformatio i advace. This will save time, misuderstadig ad potetial coflict later. 3.8 Cocers that a child may be sufferig sigificat harm, or is likely to, will always override a practitioer or agecy requiremet to keep iformatio cofidetial. Practitioers have a resposibility to act to make sure that a child whose safety or welfare may be a risk is protected from harm, sharig iformatio appropriately. 3.9 Whe practitioer s are askig for iformatio, they should be able to explai: What kid of iformatio they eed Why they eed it What they will do with the iformatio Who else may eed to be iformed if cocers about the child persist Coset should be sought prior to sharig iformatio uless to do so would put a child/ youg perso at icreased risk, iterfere with a possible crimial ivestigatio or put a member of staff at risk Whe seekig iformatio, it is importat to be specific about the reaso for eedig the iformatio ad what iformatio is required. Iformatio shared to be proportioate for the purpose it is required The reasos for sharig or ot sharig iformatio should be clearly recorded. 12

13 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 4 Egagig Families 4.1 Families ca be diverse with differet geeratios ad wider relatioships fulfillig the role of paretig childre. Whe referrig to family withi this guidace, it ca be made up of childre with the paretig role beig take up by; parets, loe parets, gradparets, carers, same sex couples, etc. It is ot ucommo for childre of drug ad / or alcohol usig parets to be looked after with other family members, particularly gradparets or withi private fosterig arragemets. Cosideratio also eeds to be give to the impact of parets or parters who have regular cotact with the child, but are ot livig i the family home. 4.2 Where there is paretal drug ad / or alcohol use there ca be the risk of practitioers ot workig i partership with parets ad families. Practitioers may see families as too difficult to egage, ot ope to chage ad ot likely to tell the truth. They may believe that parets who use drugs ad / or alcohol are ievitably ot providig good eough paretig, or that they are ot able to be ivolved i iformig the decisios ad plas that are made. 4.3 Parets may believe that they will be stigmatised, that their childre will be removed from their care, that they ad their childre will be treated differetly or give a lesser service. They may believe that they will have o cotrol or say i the decisios, which are made. Childre ad youg people may be reluctat to egage with support services, as they may also be afraid of stigmatisatio ad fear of beig removed from their parets. Childre uderstad from a early age the importace of keepig the family secret. 4.4 Cosideratio eeds to be give to the additioal potetial blocks ad barriers i accessig services for those from diverse groups relatig to their geder, ethicity or sexuality as well as other factors e.g. deprivatio or rural locatio. 4.5 Every Child Matters highlights how the best outcomes for childre are achieved whe agecies are workig i partership with families. The beefit of partership workig eeds to be commuicated clearly to families ad reiforced with positive practitioer s attitudes, approaches ad plas. 4.6 The ormalised ad legal ature of alcohol use ca mea that problematic use ca remai uchalleged for much loger tha illicit drug use. This ca therefore lead to delayed idetificatio ad ihibit early egagemet. The affects of problematic alcohol use should ot be miimised. 13

14 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 4.7 Where there is paretal drug ad / or alcohol use it is the resposibility of practitioers to cosider how to build trustig relatioships with families ad cosider how attitudes ad practice may act as barriers to egagemet. 4.8 Practitioers should recogise power imbalaces betwee agecies ad families ad esure the focus remais o the eeds of the child ad family whilst ot beig overly directive, makig ureasoable expectatios ad plas, which may ot be based i the reality of the day-to-day life of the child or the family. 4.9 Workig i partership, however, does ot mea always agreeig with parets, or always seekig a way forward which is acceptable to them. It does mea treatig all family members with digity, respect ad hoesty, recogisig the cocer that parets may have for their ow childre, their expertise i relatio to their childre s eeds Parets with problematic drug ad / or alcohol use should be assessed like other parets. Practitioers should always seek to ivolve the parets, ad where appropriate childre ad youg people as parters i the assessmet Where there is paretal drug ad / or alcohol use, families ca be isolated withi a commuity; it may mea that they are less likely to make use of the support services that are available to all families or that the services are ot appropriate to their eeds. Due to lack of aoymity, this ca be particularly stigmatisig i rural commuities. They may also have fewer positive social support etworks. Supportig ad eablig families to access services may be importat to prevet what are usual difficulties i carig for a child escalatig i to sigificat cocers Early support i place for the exteded family may prevet family breakdow ad eable better outcomes for childre ad youg people. 14

15 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 4.13 Poiters to eable egagemet: What are the parets cocers about their childre what support or help ca you offer? Be child focused ot substace use focused. Look at what is goig well together with what is goig less well What are the eeds of the child? How ca services support parets to eable those eeds to be met? Be ope, hoest ad clear i your expectatios ad cocers Idetify stregths ad positives withi the family Check out their expectatios What are the support eeds of the parets to eable their paretig? Do ot over look issues like housig, beefits, home safety ad safe storage for medicatio / drugs parapheralia. Offer advice ad assistace i eablig parets to maage these issues e.g. safe storage boxes Work closely with agecies with whom the family has a good workig relatioship Help the family to idetify support to eable egagemet i the assessmet / child protectio process Thik about the questios you will ask ad the iformatio it will give you. Be aware of the risk of askig questios which are based o your ow judgmets rather tha the eeds of the child, e.g. askig a mother where she keeps her eedles whe she does ot iject her substaces may lead her to believe that you have prejudged her Esure that Multi Agecy Actio Plas, Child i Need ad Child Protectio Plas are realistic ad focus o the eeds of the child e.g. a pla which expects a paret to detoxify may ot oly be urealistic but may also give o cosideratio to the care of the child whilst the paret is detoxifyig Use the guidace o assessig families. Match the iformatio you are give with the offer of support ad assistace Look at the barriers to accessig services Plas should iclude creative egagemet with the family both to meet the short ad loger-term eeds of the child ad the eeds of the parets. 15

16 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 5 Idetificatio 5.1 A commo theme for childre affected by paretal drug ad / or alcohol use is; their depth of uderstadig of paretal drug use ad the careful urturig of this family secret the impressio oe gets is of a world of mirrors where othig is as it seems. (Berard ad Barlow, 2002). 5.2 Childre ca be adversely affected by paretal drug ad / or alcohol use i may ways ad the potetial for sigificat harm as a result should ot be uderestimated. Although ot all childre whose parets abuse drugs ad / or alcohol will be adversely affected. However the followig are idicators that harm may be occurrig: Beig left home aloe or with iappropriate carers Emotioal difficulties e.g. cryig for o apparet reaso, iexplicable feeligs of ager Self harmig / suicidal behaviour School problems e.g. truacy, levels of attaimet droppig,, difficulty i cocetratig Offedig behaviour Neglect ad other forms of abuse, high levels of accidets i the home, possibly due to poor paretal supervisio Early use of substaces miimisatio of the risks associated with or a very strog dislike of substaces Attachmet issues ad behavioural difficulties e.g. bullyig Feeligs of gloom, worthlessess, isolatio, shame ad hopelessess, poor self-esteem, disempowermet Uwilligess to expose family life outside scrutiy, social isolatio, ot takig frieds home Tedecy to keep secrets Developmetal delay Role reversal ad cofusio e.g. protectig others, actig as a mediator ad / or cofidat, takig o a adult role Extreme axiety ad fear, fear of hostility, violece Family dislocatio e.g. movig schools, relatioship coflict, domestic abuse Presetig as ot beig used to a routie e.g. irregular attedace at ursery or school For dual heritage childre, there ca be issues aroud a sese of racial idetity that ca maifest itself i a rejectio of their ethicity relatig to the usig paret For childre with disabilities there ca be icreased risks to their safety ad icosistet approach to the maagemet of the child s medicatio. 16

17 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 5.3 Paretal drug ad / or alcohol use ca have far reachig effects o the safety of childre ad youg people. I a study by Barardo s to support sexually exploited youg people, paretal depedecy o drugs ad / or alcohol was sigificat ad ofte facilitated the youg persos ow depedecy ad route i to sexual exploitatio (Reducig the Risk, 2006). 5.4 Agecies idetifyig cocers will eed to assess the iitial level of cocer ad which aspects of the child s developmet are beig affected. This assessmet should focus o the impact upo the child rather tha the adult s drug ad / or alcohol use. 5.5 Whe decidig the appropriate respose to the cocers there will be a eed to evaluate the seriousess of the iformatio available. I order to do this, it may be helpful to: Speak to the parets about the cocers ad obtai their views about the situatio ad what services / support they thik they eed Speak to other colleagues icludig i other agecies (see Chapter 3 for further iformatio) who kow the child ad their parets Use a diary to moitor patters of behaviour or cocers over time Check your agecy records Produce a chroology Seek cosultatio from a agecy who is specialised i this area Speak to your lie maager, amed / desigated with resposibility for child protectio / safeguardig childre Seek coset of ivolvig exteded family members where appropriate Cosider triggerig a CAF usig agreed local procedures. 17

18 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 6 Assessig Families 6.1 Udertakig assessmet of families where there is paretal drug or alcohol use ca be a complex area of work ad it is essetial a focus is maitaied o the child at all times. I order to achieve this, at whatever stage of the care pathway a practitioer is workig, the followig guidace must be take ito accout. 6.2 The level of assessmet required will deped o whether the practitioer works withi uiversal, targeted or specialist services ad should be as i depth as required to determie their appropriate actio. (See Chapter 8 Support / Care Pathways). 6.3 The purpose of the assessmet is to idetify the impact of the drug ad / or alcohol problem o the paretig capacity of the adults i the family, the eviromet i which they live ad the impact of their use o the child s developmetal eeds ad safety. It is importat that each child s eeds be addressed separately. 6.4 The assessmet should be holistic, child cetred, evidece based ad use professioal judgemet to decide the most appropriate itervetio. 6.5 The assessmet must be recorded, usig CAF paperwork where this has bee implemeted, shared with the child / parets / carers ad iclude their views, wishes ad perspective. 6.6 The adults ability to care for ad paret the child adequately ca be affected by the: Substace or substaces take a combiatio of substaces may be beig used by the paret, icludig a combiatio of drugs, alcohol ad prescribed drugs Treatmet therapies, e.g. methadoe maiteace, residetial rehabilitatio Withdrawal, e.g. withdrawal from drugs ad / or alcohol ca sigificatly impair the ability of the adult to fuctio ormally Abstiece parets may struggle to adapt to a drug ad / or alcohol free lifestyle ad periods of abstiece may be brief Lifestyle issues e.g. fudig, obtaiig, usig / itoxicatio. 18

19 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 6.7 Some parets who misuse drugs ad / or alcohol have poor paretig skills for reasos other tha their drug ad / or alcohol use. Other sources of stress may combie to icrease difficulties with paretig e.g. domestic abuse, metal health issues. 6.8 Wome experiecig domestic abuse are up to fiftee times more likely to misuse alcohol ad ie times more likely to misuse other drugs tha wome i geeral (Stark et al 1996). I 2004, recorded crime data showed that perpetrators of violece had bee drikig i half of all violet icidets, which accouted for more tha 1.3 millio icidets of alcohol related violece per year (Simmos et al 2004). Whilst substace misuse is ofte used as a excuse for domestic abuse, it is ot a cause; domestic abuse is about power ad cotrol. For further iformatio ad guidace, please refer to the NCSCB ad NSCB Domestic Violece Practice Guidace ad the Stella Toolkit (Toolkit for frotlie practitioers makig assessmets i relatio to domestic violece where there is also problematic substace misuse) Please see Research idicates a awareess of the strog associatio betwee paretal metal illess, substace use ad difficulties i the developmet ad psychosocial fuctioig of childre. The child of a paret experiecig metal ill health ad / or drug ad / or alcohol use may be affected as a result of: Specific symptoms of a disorder that the paret is experiecig, for example delusios or self harm Paretal capacity to relate to ad paret their child Chage to family structure Paretal hospitalisatio Agecies must look at the paret s problematic drug ad / or alcohol use ad metal health issues from the perspective of the child to uderstad the impact that it has o the child s well-beig ad developmet It is importat to iclude all members of the family i the assessmet. This should iclude fathers or relevat male figures that are ot residet i the family home ad relevat exteded family members. Assessmet should be made of other family member s ivolvemet i drug ad / or alcohol takig, the impact of this o the child ad the implicatios for chage. For example, if both parets are takig drugs ad / or alcohol, it is likely that there will be a greater impact o the child, or if oe paret is more motivated to address their drug ad / or alcohol issues (or is abstiet) the likelihood of maitaiig ay positive chages is reduced. Oe paret ot takig drugs ad / or alcohol ca be protective for the child; however, cosideratio eeds to be made of the family disharmoy this may cause. Cosideratio should also be made to support the eeds of the o-drug ad / or alcohol-takig members of the house hold ad exteded family. 19

20 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 6.12 May childre do ot live with their biological parets; this may be a temporary arragemet or permaet. Hidde Harm idetified that 54% of childre of drug users did t live with their parets ad most were placed withi the exteded family, usually with gradparets. This may cause of umber of difficulties, which ca iclude fiacial hardship, isolatio ad poor physical ad emotioal health. Research idicates that gradparets from black ad miority ethic (BME), traveller ad gypsy commuities are more likely tha others to be brigig up their gradchildre. It appears that these gradparets are less likely tha other gradparets to access services ad face severe hardship ad isolatio (Mid the Gap, 2007) It is essetial that practitioers work closely with childre ad their families, icludig exteded families, whe udertakig assessmets The impact of paretal substace misuse o childre should be assessed usig the three domais below ad trackig the effects o the child: Parets & carers Family ad evirometal factors Child s developmet eeds The CAF assessmet triagle or the Framework for the Assessmet of Childre i Need should be used to udertake this. 20

21 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Assessmet triagle Family ad social relatioships Self-care ad idepedece Learig Health Emotioal ad social developmet Behavioural developmet Idetity Child Basic care, esurig safety ad protectio Emotioal warmth ad stability Guidace ad boudaries Parets ad Carers Developmet of the baby, child or youg perso Family ad Eviromet Family history, fuctioig ad well-beig Wider Family Housig, Employmet ad fiacial cosideratios Social ad Commuity elemets ad resources What substaces? How much? How obtaied? How take? Whe (patter of use)? Who with? Cost? Lifestyle implicatios?

22 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 7 The Domais of the Assessmet 7.1 Where substace misuse is a issue, the followig iformatio should be give specific cosideratio withi the assessmet, at all levels of the support pathway. 7.2 Parets ad carers Basic care, esurig safety ad protectio Whe ad where are the parets / carers usig drugs ad / or alcohol? Are the childre i their care whe usig drugs or alcohol? If so, what are the risks? Or are they left usupervised or i the care of usuitable others? Are levels of care differet whe a paret is usig drugs/alcohol ad whe ot usig? Is there adequate food, clothig ad warmth for the childre? Is there a healthy clea livig eviromet? Are the childre beig take to places where they could be at risk? Is a child ivolved i the drug ad / or alcohol use either as active participats, as messegers or as ruers e.g. obtaiig supplies? Are the premises beig used to sell drugs? Are the parets allowig their premises to be used by other drug ad / or alcohol users, or other iappropriate adults? If the drugs ad / or ijectig equipmet are kept o the premises, are they kept securely? Are the childre aware of where the substaces are kept? Are they kept out of reach? If the parets are o a substitute prescribig programme, such as methadoe, are the parets aware of the dagers of childre accessig this medicatio? Do they take adequate precautios to esure this does ot happe? Have appropriate safety measures bee take withi the home e.g. safety gates? Are there fire risks i.e. parets fallig asleep whilst smokig? Does the paret sleep with their baby after usig drugs or alcohol? Are the childre exposed to domestic abuse? Emotioal warmth ad stability Is the paret physically ad emotioally available for the child? Do they provide positive reiforcemet of who ad what their childre are ad celebrate their skills? Is the paret able to see the emotioal difficulties the child is experiecig? Is the child beig burdeed with emotioal difficulties experieced by the adult? 22

23 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Is the paret able to offer the child reassurace that the substace use is about the paret ot the child? To what extet are the parets able to place their childre s eeds before their ow? Cosider if the parets are able to stimulate the child, is the paret able to egage i meaigful play ad commuicatio with the child? Are they able to respod appropriately to stimulate the child? Are there appropriate toys, activities ad educatioal opportuities available for the child? Are there structured routies i the child s daily life? Are there dramatic differeces i paret s behaviour whe usig substaces or ot? Is there cosistecy i behaviour ad commuicatio? Have there bee periods of crimial activity, covictios ad periods of imprisomet or separatio through rehabilitatio or treatmet programmes? If so, what happeed to the childre? Has the child a cosistet carer ad livig eviromet? Guidace ad boudaries Is the paret able to set appropriate boudaries ad maage behaviour? Is there cosistecy ad expectatios of the child s behaviour? Is the paret able to demostrate ad model appropriate behaviour, emotios ad iteractios with other? Does the paret draw the child i to crimial activities? Other cosideratios are: Metal health does the paret have metal health issues? Do these impact o the ability to paret? Are they takig prescribed medicatio? Will this impact o their drug ad / or alcohol treatmet? Learig difficulties ad disabilities are parets beig give appropriate messages i a format they are able to uderstad? Do the parets eed additioal support to meet their paretal resposibilities? Youg parets has cosideratio bee give to the maturity, capacity ad uderstadig of the parets? Are the wider family ivolved i supportig the paret? Are appropriate childre s services ivolved i supportig the paret? Domestic abuse have you assessed for domestic abuse? Have you cosidered the safety eeds of the victim ad the impact o the child? Have you cosidered how chage i substace use may impact o levels of domestic abuse? 23

24 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 7.3 Family ad Evirometal Factors Family history, fuctioig ad well-beig Are both parets usig substaces? Has the child experieced the death of a paret though drug or alcohol use? Are there o-drug ad / or alcohol-usig parets? Is there coflict or violece as a result of substace use withi the family? Is there domestic abuse i the household? Is there a history of drug ad / or alcohol misuse withi the family or exteded family? Will parets accept help from relatives ad practitioers? What are the paret s hopes for the future for themselves ad the child? Are there metal health issues? Wider family Are the relatives aware of the drug ad / or alcohol misuse? If so, what are their attitudes regardig the drug ad / or alcohol use? Are they supportive? What support are they able to offer? Do they have ay support eeds? Are these relatioships stable? What is the quality of the relatioships? Are members of the exteded family ecouragig drug use? Is the child receivig regular support ad / or livig with exteded family e.g. gradparets? Do these members have relevat paretig skills ad support? Housig, employmet ad fiacial cosideratios Is the accommodatio adequate for the childre i.e. facilities, furiture, heatig, safety? Is the housig stable? Does the family remai i oe area or move frequetly ad if the latter, why? Is the family livig ear their support etworks (iformal ad formal)? Is the drug ad / or alcohol use havig a impact o employmet or traiig opportuities? Is the paret accessig relevat support agecies i regard to traiig ad employmet? Are the parets esurig that the ret ad bills are paid? Are they accessig appropriate beefits? How much are the substaces costig? How is the moey beig obtaied? Is this causig fiacial, social or legal problems? If the exteded family is carig for the child, are their fiacial eeds beig addressed? 24

25 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Social ad commuity elemets ad resources Is the family livig i a drug ad / or alcohol usig commuity? Is the family socially isolated from family, frieds ad commuity? Are there threats or harassmet from eighbours or the commuity? If the family is from a ethic miority backgroud, is this leadig to additioal issues of isolatio ad / or rejectio? Are the parets aware of ad i touch with local specialist agecies that ca advise o issues such as eedle exchage, substitute prescribig, detoxificatio ad rehabilitatio facilities? How regular is cotact? Are these relatioships positive ad how do they impact o family fuctioig? Are the family liked i to other commuity resources? How regular is cotact? Are these relatioships positive ad how do they impact o family fuctioig? 7.4 Child ad Developmetal Needs Health Are the parets accessig appropriate health care ad routie health appoitmets for the child? Is the child beig exposed to uecessary risks resultig i accidets ad ijuries? Are the childre physically at risk due to drug ad / or alcohol use, coflict or violece? Is the child / youg perso usig drugs ad / or alcohol or ivolved i other high-risk activities? Is there evidece of failure to thrive or poor geeral health? Is the child displayig health problems as a result of paretal drug ad / or alcohol use e.g. disturbed sleep patters, bedwettig? Does the child have a additioal eeds arisig from a disability are these eeds beig meet? Emotioal ad social developmet Is the paret / child iteractio warm ad positive? Is the child supported with problems, homework ad worries? If the parets are usig drugs ad / or alcohol do childre witess this use? Could other aspects of the drug ad / or alcohol use costitute a risk physically or psychologically to childre e.g. coflict with or betwee dealers, exposure to crimial activities related to drug ad / or alcohol use? Are the childre egaged i age appropriate activities? Are the child s emotioal eeds beig adequately met? Is the child aware of the paret s drug ad / or alcohol use ad what is their uderstadig of it? 25

26 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Does the child feel resposible for their parets drug or alcohol abuse; do they blame themselves i the evet of the paret relapsig? What is it like whe their paret is uder the ifluece of drugs ad / or alcohol? What is it like whe they are ot? Do they feel safe? Where do they tur for comfort, help ad protectio? Are there thigs that make them feel scared? Do they have fears, axieties ad hopes about their paret s behaviour? Is help available to assist them i developig decisio makig skills? Are childre beig deied the reality of what they see via use of euphemisms to describe or explai paret s behaviour? Are they expected to cover up their paret s use? Behavioural developmet How is the child beig taught about problem solvig ad copig skills? Is the child replicatig paretal behaviours? Does the child experiece difficulties i social situatios? Are they isolated, excluded or ivolved i crimial behaviour? Is the child aware of ad able to demostrate clealiess ad good hygiee? Is dress ad behaviour appropriate? Idetity Has the child got a positive self-idetity? Do they see themselves as lovable? Do they have guilty feeligs or feel resposible for parets? Are there feeligs of powerlessess or helplessess? Is there shame ad embarrassmet about paretal drug ad / or alcohol related behaviour? Is there support, cosistecy ad reliability from paret to help the child through ay difficulties? For childre with dual heritage, how is the paret s use impactig o their sese of cultural idetity? Family ad social relatioships Are there ay idicatios that ay of the childre are takig o a paretig role withi the family e.g. carig for other childre, excessive household resposibilities? Do parets ad childre associate primarily with other drug ad / or alcohol users, o-users or both? Are there a umber of people comig ad goig ad are the childre adequately protected from the possible adverse behaviours that they might exhibit? 26

27 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Are they able to form ad maitai friedships? Are they able to sped time at home ad feel safe? How do the childre sped their free time? Are the childre ivolved i leisure activities outside the family home? Are activities age appropriate? Self-care skills ad idepedece Has the child take o carig resposibilities for the paret, sibligs or themselves? Are these age appropriate? How log ad to what extet? Is there a demostratio of developmet of skills required for idepedece? Learig Are the child s pre school educatioal eeds beig met? Are parets supportive of their childre s educatio? Are the childre attedig ursery or school regularly ad o time? Are they experiecig difficulties learig? Are they displayig disruptive behaviour at school? Are there attedace issues? Assessmet Tools used by Specialist Drug ad Alcohol Services 7.5 A adult commo assessmet tool has bee developed as part of the itegrated care pathway which is used by specialist drug ad alcohol workers. Cliets will have a idividual care pla, which is regularly reviewed with their key worker ad other service providers e.g. traiig, employmet, housig as appropriate. All cliets i treatmet are routiely offered screeig for HIV, Hepatitis B, ad Hepatitis C ad give Hepatitis B immuisatio. Youg Parets 7.6 Youg people who are drug ad / or alcohol users ad who are or become parets should be assessed i accordace with this guidace. There are particular treatmet services that will be relevat, such as Face It, Compass Youg People s Service ad Head2Head (See Page 39 for cotact details.) 27

28 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies 8 Support / Care Pathways 8.1 The followig sectio ad the flowchart (Page 31) detail the agreed support pathway, based o holistic assessmet of the child / youg perso / family s eeds to esure the appropriate itervetio is provided at the appropriate stage. 8.2 Safeguardig ad promotig the welfare of childre i the cotext of paretal drug or alcohol use, like safeguardig more geerally, is a shared resposibility ad depeds o effective joit workig betwee agecies ad practitioers that work with childre ad youg people. All agecies should be alert to the risks ad be able to take actio, workig joitly where a issue is idetified. 8.3 If at ay poit i the assessmet process / support pathway, there is evidece that the child / youg perso is sufferig, or at risk of sufferig, sigificat harm, a immediate referral to Childre s Social Care must be udertake. Ay iformatio already gathered as part of the assessmet process, icludig the completed CAF if there is oe, should be shared with social care to support their assessmet. 8.4 I all cases, depedat upo the age ad uderstadig of the child, it is essetial they are offered quality, idividual support as part of the pla. Other useful support that ca be offered to childre icludes: Reassertig appropriate adult / child relatioships ad boudaries to miimise the burde upo childre Advocacy to esure the child s voice is heard Havig a amed perso to talk to Esurig that the child kows what is happeig i their life Flexibility of services e.g. aother perso to talk to durig periods of aual leave, easy access to services Drug awareess ad educatio Therapeutic itervetios e.g. play therapy. 8.5 Ope cases to Childre s Social Care I all cases where problematic drug or alcohol use has bee idetified, where a case is kow to be ope to childre s social care, cotact should be made with the resposible social worker, or their maager if abset, ad to share iformatio i relatio to the child / family ad support the multi-agecy assessmet ad itervetio. 28

29 Safeguardig Childre with Drug ad Alcohol Usig Parets Practice Guidace for all Agecies Uiversal Services 8.6 Practitioers workig i uiversal services (such as schools, health services, Coexios, youth work, etc) are well placed to idetify whe childre ad youg people may be affected by paretal drug or alcohol use. 8.7 Childre / youg people may preset with a chage i behaviour as result of the impact of paretal substace use, or with more log term, chroic use, there may be a build up of cocers over a period of time (See Sectio 5 for further iformatio o Idetificatio). 8.8 It is essetial practitioers i uiversal services are aware of the idicators of possible harm or additioal eeds withi childre ad youg people ad are able to act o these. 8.9 I cases where the child / youg perso is kow oly to uiversal services, the assessmet is udertake to decide if they require services from aother agecy (targeted or specialist) or the eeds ca be met withi the curret service provisio or through a sigle referral to a support agecy May childre ad youg people will be able to have their eeds met by a agecy workig specifically with substace use issues, through a sigle referral. For a full list of these, see Chapter 10 Resources. Additioal eeds requirig multi agecy support 8.11 Where childre ad youg people have more complex eeds, they will require a multi agecy respose from both uiversal ad targeted services, with writte, iformed coset of the parets/carers ad the child/ youg perso if they are cosidered to be of a age ad uderstadig to do so (Fraser Competet) If coset to share iformatio across agecies ad provide a multi agecy support pla is refused, it is essetial some support ad cotact is maitaied by the practitioer. Requestig aoymised support from a drug / alcohol agecy may help the practitioer with the ogoig provisio of support to the child / family, or the parets may coset to a sigle referral to oe agecy ad these optios should be explored. Practitioers should also explore the reaso for refusal of coset, be ope ad hoest about the impact of substace use o the child / youg perso ad the proposed assessmet process to be used, with the aim of allayig fears ad workig i partership with the family If parets cotiue to refuse coset to share iformatio, the implicatios of this o the assessmet ad level of risk must be explored. This may result i the eed to share iformatio without coset, where there risk of sigificat harm. 29