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Definition

Substance misuse refers to the abuse of drugs and/or alcohol. Whilst there may be different treatment methodologies for adults with these problems, the issues are considered together because the consequences for the child are quite similar. Substance misuse refers to both illicit drugs, alcohol, prescription drugs and solvents, the consumption of which is either dependent use, or use associated with having harmful effect on the individual or the community.

It is estimated that around 30% of children under-16 years (3.3–3.5 million) in the UK, are living with at least one binge drinking adult, 8% (around 978,000) with an illicit drug using adult, 72,000 with an injecting drug user and 4% (1/2 a million) with an adult problem drinker with a co-morbid mental health problem). It is also estimated that around 1% of children (12,000) witnessed parental violence due to alcohol use. (NSPCC 2015).

Many substance misusing adults also suffer from mental health problems, which is described as Dual Diagnosis and there may be several agencies, from both adult and children’s services, who are working with the family.

National Serious Case Reviews and Domestic Homicide Reviews have identified domestic abuse, parental mental ill health and drug and alcohol misuse as significant factors in families where children have died or been seriously harmed. Where all three issues are present, they have been described as the ‘toxic trio’, which practitioners should be alert to and consider in any assessments.


Risks

Substance misuse can consume a great deal of time, money and emotional energy, which will unavoidably impact on the capacity to parent a child. This behaviour also puts the child at an increased risk of neglect and emotional, physical or sexual abuse, either by the parent or because the child becomes more vulnerable to abuse by others.

Children’s physical, emotional, social, intellectual and developmental needs can be adversely affected by their parent’s misuse of substances. These effects may be through acts of omission or commission, which have an impact on the child’s welfare and protection.

Children may be introduced to drug and alcohol misuse at an early age by the behaviour of the parents and the availability of the substances within the home.

All agencies need to work together in tackling the problems caused by substance misuse in families in order to safeguard children and promote their well being. Parents who misuse drugs and/or alcohol may be good enough parents who do not abuse or neglect their children. It is important not to generalise or make assumptions about the impact on a child of parental/carer drug and/or alcohol use. It is, however, important that the implications for the child are properly assessed having full regard to the parents/carers ability to maintain consistent and adequate care. Equal regard should be given to each and every child's level of dependence, vulnerability and any special needs

Where there is concern that a parent is involved in substance misuse, the impact on the child needs to be considered, including:

  • The child’s physical safety when the parent is under the influence of drugs and/or alcohol;
  • Children can suffer chronic neglect, from before birth and throughout childhood;
  • Possible trauma to the child resulting from changes in the parent’s mood or behaviour, including exposure to violence and lower tolerance levels in the parent;
  • The impact of the parent’s behaviour on the child’s development including the emotional and psychological well-being, education and friendships;
  • Being unresponsive to the child’s emotional or material needs and/or failing to provide a stable nurturing environment;
  • The foetus can suffer direct harm due to exposure to toxins in utero and through the effects of withdrawal at birth;
  • The impact on newborn babies who may experience foetal alcohol syndrome, which may have lifelong effects, or other drug withdrawal symptoms;
  • Babies are at increased risk of Sudden Unexplained Death in Infancy (Cot Death), especially when co-sleeping with parents who have used alcohol and/or drugs;
  • Problematic drinking by parents is associated with negative features of parenting (such as low warmth and high criticism);
  • The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing and the children may come in to contact with risky adults;
  • How safely the parent’s alcohol and/or drugs and equipment are stored children can be at risk of ingesting substances or injuring themselves on drug paraphernalia;
  • Children are particularly vulnerable when parents are withdrawing from drugs;
  • The risk is also greater where there is a dual diagnosis of mental health problems and substance misuse and when both parents are misusing substances;
  • Dangerously inadequate supervision and other inappropriate parenting practices;
  • Poor monitoring can lead to accidents in the home due to impaired judgement, resulting from acute intoxication;
  • Intermittent and permanent separation;
  • Inadequate accommodation and frequent changes in residence;
  • Children being forced to take on a caring role and feeling they have the responsibility to solve their parent’s, alcohol and drug problems;
  • Factors such as poverty, social isolation, inadequate parenting skills and parental conflict can affect the impact of substance misuse.

The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare, for example, drug or alcohol use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.

There are many reasons why adults take drugs or drink alcohol. If doing so has negative consequences then it may be regarded as misuse. Parents may be aware that their behaviour has a negative impact on their child; there is a risk in focusing on the adult’s difficulty and in supporting their attempts to control their behaviour. The real impact on the child can be overlooked or seen as a secondary consideration.


Indicators and Assessment

To be healthy and to develop normally, children must have their basic needs met. If a parent is more concerned with funding an addiction, or is under the influence of drugs or alcohol, they are unlikely to be able to achieve this consistently. A chaotic or disorganised lifestyle is a frequent consequence of substance misuse. Parents may fail to shop, cook, wash, clean, pay bills, attend appointments, take children to school etc.

Substance misuse may affect a parent’s ability to engage with their child. It may also affect a parent’s ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions. Such parents may even become dependent on their own child for support. This can put stress on a child and mean they miss out on the experiences of a normal childhood.

Other consequences of substance misuse – lost jobs, unsafe homes, broken marriages, severed family ties and friendships, and disruption of efforts made by a local authority to help – are also likely to negatively affect a child.

Any practitioners, carers, volunteers, families and friends who are in contact with a child in a drug/ alcohol-misusing environment must ask themselves “What is it like for a child in this environment?

To determine how a parent/carer’s substance misuse problem may impact on their parenting ability and the child’s development the following questions need to be considered within an assessment:

  • Does the parent’s substance misuse affect the development of a secure attachment with the child?
  • Does the child take on roles and responsibilities within the home that are inappropriate?
  • Does the parent/carer neglect their own and their child’s physical and emotional needs?
  • Does the substance misuse result in chaotic structures within the home with regard to meal and bedtimes, etc?
  • Does the parent/carer’s substance misuse have implications for the child within school, attending health appointments etc?
  • Is there a lack of the recognition of safety for the child?
  • Does the parent/carer have insight into their substance misuse mental health problem and its impact on their parenting capacity and on their child?
  • Are there repeated incidents of hospitalisation for the parent/carer or other occasions of separation from the child?
  • Does the parent/carer have mental health problems?
  • Does the parent/carer’s substance misuse result in them being unavailable to the child?
  • Does the child witness acts of violence or is the child subject to violence?
  • Does the wider family understand the substance misuse of the parent/carer, and the impact of this on the parent/carer’s ability to meet the child’s needs?
  • Is the wider family able and willing to support the parent so that the child’s needs are met?

Confidentiality and Sharing Information

Confidentiality can never be an absolute principle and it is generally accepted that where children need protecting, their needs are paramount and information may be shared without their parents’/carers’ permission. It is critical that all practitioners working with adults, children and young people are in no doubt that where they have reasonable cause to suspect that a child or young person may be suffering significant harm or may be at risk of suffering significant harm, a referral to Children’s Social Care must be made without delay. Practitioners should seek to discuss any concerns with the family and, where possible, seek their agreement to making referrals to Children’s Social Care.

This should only be done where such discussion and agreement seeking will not place a child at increased risk of significant harm. The child’s needs are paramount and must be the overriding consideration in making any such decisions.

Where a child is not considered to be suffering significant harm, or at risk of suffering significant harm, consideration needs to be given to whether parental permission is required for the sharing of information. This should be considered on a case by case basis. This should be raised with parents at the beginning of professional involvement following agency guidelines, with emphasis on the help and support which can be accessed by the family as a result of sharing information with other agencies. In the process of finding out what is happening to the child, it is important to take into consideration their wishes and feelings.

The Overarching Information Sharing Protocol (OAISP) for the Pan-Dorset area and other Information Sharing Protocols may also give a framework to support this.

Each agency/organisation will have its own system with regards to undertaking an assessment using the Common Assessment Framework (CAF) /Early Help assessment. Parents should be asked if one has already been done and if so, it will mean that they have agreed to information being shared.

Practitioners should be aware of any protection plan around family members e.g. MAPPA, Child Protection Plans, MARAC, Vulnerable Adult Meetings and identify the need to be involved in those processes. These should be clearly documented with in the adults or child’s records.

Practitioners should always be mindful of risk and any risk assessment process and documentation should always be continually reviewed and updated to ensure that the information is always current and live.


Protection and Action to be Taken

Where there are concerns by practitioners involved with a family about a child living in the environment of substance misuse an assessment of the parent’s capacity to meet the child’s needs should take place to establish the impact on the child of the parent’s lifestyle and capacity to place the child’s needs before those of their own. A referral to Children’s Social Care in line with the Referrals Procedure should be made and the practitioners from adult services, or other relevant agencies, should work in collaboration with Children’s Social Care. The Threshold document should be used to identify level of need.

Similarly, a referral should be made to Children’s Social Care following any particular event which brings the underlying issues of substance misuse into focus. For example, if there has been an assault on a child by a parent under the influence of substances this would invoke a referral to Children’s Social Care in line with the Referrals Procedure.

Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children’s Social Care.

Please refer to the Protecting the Unborn Child Procedure.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the team that deals with Substance Misuse and Children`s services. The Care Planning Approach /Care Co-ordination will apply including input from the link midwives and a social worker from Children’s Social Care, who will be invited to any meetings taking place that address concerns about the parents capacity to care for their child. This work should lead to robust assessment and planning before the baby leaves hospital.

In addition where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral to Children’s Social Care in line with the Referrals Procedure before the child is discharged home- if this has not been addressed with a pre-birth referral.

On request from Children’s Social Care, substance misuse practitioners should:

  • Compile a summary of substance misuse services involvement and concerns;
  • Send the summary and substance misuees management plan, together with any other relevant facts or concerns to the social worker;
  • Contribute to the assessment by CSC as required;
  • Offer their professional opinion regarding the impact of the substance misuse on the children’s wellbeing.

Specialist Substance misuse services should be invited to and should attend any meeting concerning the implications of the parent/carer’s substance misuse problems for the child, including Child Protection Conferences and Child in Need meetings. A report should be prepared for Child Protection Conferences, using the local authority report template, which sets out and analyses what is known about the child and family. Relevant information should be provided for other multi-agency meetings regarding the child.

There is a clear need to assess the impact of the adult behaviour on the child as well as the wider family context. Some adult services may be reluctant to share information because of concern about confidentiality. However, the needs to safeguard children should be paramount and agencies with information regarding the parent will have a valuable contribution to make. In these circumstances, practitioners should seek advice from the Safeguarding leads in their organisation, if they are unsure as to what information should be shared, or what action should be taken. Where a number of services are working with the family, they should work together using the ‘Think Family’ approach and not work in ‘professional silos’.

When practitioners make a decision to end their involvement with a parent/carer with substance misuse problems, or a child who is living with a parent/carer with substance misuse problems, they should always discuss their plans with the other services who are working with the family, before the case is closed. This is to ensure that any on-going needs can be addressed, particularly if there is on-going risk to the child.


Issues

If a parent/carer disengages from substance misuse services, or is non-compliant with treatment, services should refer to the Working Harder to Engage with Children, Young People or Their Families More Effectively, Practice Guidance to Agencies. If there is on-going risk to the child in these circumstances, this should be discussed with Children’s Social Care.

If parental substance misuse escalates, substance misuse practitioners should consider how the escalation may impact upon the wellbeing of the child and inform social workers who are working with the family of any increased risks, without delay.

Substance misuse services should always use ‘respectful uncertainty’ and not readily accept parent/carer’s assertions that their substance misuse has ended, or when they are minimising the effects of their substance misuse on the care they provide to their children. Where there is any doubt in these situations, services should always err on the side of caution.

Parents’ own needs will need to be addressed and supported. Sometimes access to appropriate treatment resources is limited in particular areas which may cause delays in providing services, however the child’s needs must not be put on hold without a contingency plan.

Confidentiality is important in developing trust between substance misusing parents and practitioners in agencies working with them in relation to their substance misuse, however, practitioners must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult.

When a woman with a substance misuse problem attends for antenatal care, she should be encouraged to accept a referral to the Substance Misuse Team for assessment and advice on the treatment options available to her and if there are any risks to the unborn baby, a referral should be made to Children’s Social Care.

When in doubt as to what action to take when managing cases involving substance misuse and children’s welfare, practitioners should seek appropriate advice and support. When practitioners from different agencies cannot agree on a course of action, the LSCB escalation protocol should be used (see Documents Library).



Amendments to this Chapter

This chapter was reviewed and updated in February 2017. It has been substantially amended throughout and should be read in its entirety.

End.