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2.3 Children of parents who misuse substances
- Definition(Jump to)
- Risk and impact(Jump to)
- Indicators(Jump to)
- Protection and action to be taken(Jump to)
- Issues(Jump to)
- Further information(Jump to)
Drug and/or alcohol misuse refers to: illegal drugs, alcohol, solvents and the misuse of prescription and over the counter medications, the consumption of which is either dependent use, or use associated with having harmful effects on the individual, other members of their family or the community.
Many adults misusing drugs and /or alcohol often have a range of complex needs including mental health problems, criminality, and have experience of adverse child trauma. There may be several agencies, including both adult and children’s services, who are working with the family.
Parents/Carers are referred to throughout this document to recognise that children can often be living in family environments where their parents may not always be providing primary care or supervision.
National Child Safeguarding Practice Reviews and Domestic Homicide Reviews have identified drug and alcohol misuse as one of a three significant factors present in families where children have died or been seriously harmed (domestic abuse and parental mental ill health are the other 2). Practitioners should be alert to and consider multiple factors of concern and how this might lead to cumulative risk of harm to a child; but also what strengths and support are in place and how this minimises risk in their assessments.
Drug and/or alcohol misuse can consume a great deal of time, money and emotional energy, which will unavoidably impact on an adult’scapacity 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/carer or because the child becomes more vulnerable to abuse by others within and/or outside of the family environment.
Children’s physical, emotional, social, intellectual and developmental needs can be adversely affected by their parent/carer’s misuse of drugs and/or alcohol. 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/carers and the availability of the drugs and or alcohol within the home.
All agencies need to work together in tackling the problems caused by drug and/or alcohol misuse in families in order to safeguard children and promote their well-being. It is important not to generalise or make assumptions: not all children of parents who misuse drugs and alcohol will suffer harm. It is, however, important that the implications for the child are properly assessed; having full regard to the parent’s/carer’s 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/carer is involved in drug and/or alcohol misuse, the impact on the child needs to be considered, including:
- the child’s physical safety when the parent/carer 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/carer’s behaviour on the child’s development including the emotional and psychological well-being, education and friendships
- the impact on newborn babies who may experience foetal alcohol syndrome or other drug withdrawal symptoms
- the extent to which the parent’s/carer’s drug and/or alcohol misuse disrupts the child’s normal daily routines and prejudices the child’s physical and emotional development
- 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 as children can be at risk of ingesting substances or injuring themselves on drug paraphernalia
- children are particularly vulnerable when parents/carers are withdrawing from drugs
- dangerously inadequate supervision and other inappropriate parenting practices
- intermittent and permanent separation
- inadequate accommodation and frequent changes in residence
- children being expected to take on a caring role and feeling they have the responsibility to solve their parent’s alcohol and drug problems.
If any practitioner believes that a child or young person is at immediate risk from a parent or carer who appears to be incapacitated by drug and/or alcohol misuse and they cannot otherwise safeguard them, this should be reported without delay to the police as a 999 emergency. They should make a note of their actions and record this on file.
Because drug and/or alcohol misuse affects an individual’s cognitive functioning and behaviour; the impact on their capacity to parent and meet the child’s needs are compromised. Practical skills, perceptions, control of emotions, judgement, attention to basic physical needs, attachment to or separation from a child are all behaviours that may be present when a person is misusing drugs and/or alcohol
To be healthy and to develop normally, children must have their basic needs met. If a parent/carer ‘s focus is funding their drug or alcohol misuse, or they are under the influence of drugs or alcohol, they are unlikely to be able to achieve this consistently. Parents/carers who misuse drugs and/or alcohol may have difficulty managing daily living tasks, such as shopping, cooking, washing, cleaning, paying bills, attending appointments etc.
Drug and/or alcohol misuse can affect a parent/carer’s ability to engage with their child. It may also affect a parent/carers’ 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 parent/carers 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 drug and/or alcohol misuse include unemployment, poverty, unsafe homes, severed family ties and friendships. Families affected by drug and/or alcohol misuse may also try and disrupt efforts made by a local authority to help.
Any professionals, carers, volunteers, families and friends who are in contact with a parent/carer, child/ren in an environment where there are indications of drug and/or alcohol misuse must ask themselves: ‘What is it like for a child in this environment?’
Identification and assessment
Where there are concerns by practitioners involved with any members of a family about a child living in an environment in which drug and /or alcohol misuse is taking place this will always override legal, professional or agency requirements to keep information confidential. Services that only work with adults, should always enquire and record information about the parental/caring responsibilities the person they are seeing may have, to continually consider if there should be any concerns for the child/ren’s wellbeing raised. Some adult services may be reluctant to share information because of concern about breaching the parent/carer’s confidentiality. However, the need to safeguard children should be paramount and agencies with information regarding the parent/carer 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.
An assessment of the parent/carers’ capacity to meet the child’s needs should take place to establish the impact on the child of the parent/carer’s lifestyle and capacity to place the child’s needs before those of their own. This assessment needs fully explore the nature of the drug use to demonstrate consideration has been given to understand the difference between use, misuse and addiction and the possible impact on behaviour; for example the evidence from this review highlights that “Men who abuse substances, especially drugs, to a degree that encourages increased levels of stress and anxiety, sleeplessness, lowered levels of frustration tolerance, heightened impulsivity, poor emotional and behavioural regulation and poor decision making.” (The Child Safeguarding Practice Review Panel)
The need to focus on the child’s welfare is a priority and the impact of the behaviour on the child, as well as the wider family and community context, should be assessed. Workers should build up a picture of the child based on cumulative information.
Drug and/or alcohol misuse can often be triggered by underlying issues. Professional curiosity should be employed to successfully obtain this information when conducting assessments.
Practitioners should refer to: their local area safeguarding threshold tools; drug and alcohol tools and pathways; and the Referrals Procedure to determine the level of support required for the child and their family and/or whether a referral to children’s social care is required.
Parents/carers should be offered an assessment of their own needs for care and support by the Local Authority where their drug and/or alcohol use are affecting the ability to manage on a day to day basis. Practitioners should refer to their local Adult Social Care Teams where the parent/carer agrees. In circumstances where there are concerns that the parent/carer has needs for care and support and they too are experiencing abuse or neglect, practitioners should also follow the West Midlands Adult Safeguarding Policies and Procedures and raise an adult safeguarding concern to the Local Authority.
Practitioners from all agencies working with the child and the parents (including adult services), or other relevant agencies, should work in collaboration with one another.
Drug and/or alcohol misuse during pregnancy
Where any agency encounters a pregnant female who is misusing drugs and/or alcohol to a degree that indicates that their parenting capacity is likely to be seriously impaired; they must make a referral to children’s social care in line with the Pre-Birth Procedures
When a woman with a drug and/or alcohol problem attends for antenatal care, she should be supported to contact the local drug and alcohol service for assessment and advice on the treatment options available to her.
Consideration must be given to the impact and harm continued drug and/or alcohol misuse has on the unborn child. A failure to access or engage with services designed to support the pregnant female should be viewed as a potential risk to the unborn baby. Referrals should be fast-tracked for immediate support to the mother and her baby. Where appropriate, the partner should also be fast-tracked.
The majority of pregnant women who are misusing drug and/or alcohol will have been identified by maternity services and referred to drug and alcohol services. The Care Planning Approach/Care Co-ordination Approach 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 in respect of the child/ren.
It is important at this stage that every effort is made to also identify and engage the father, or any other partner living with the mother to be. Some men struggle to articulate their fears and anxieties about fatherhood, may be poorly prepared for its demands and resort too quickly to violence, creating very significant risks to children, including those unborn. If they themselves are also abusing drugs or alcohol, this may encourage increased levels of stress and anxiety, sleeplessness, lowered levels of frustration tolerance, heightened impulsivity, poor emotional and behavioural regulation and poor decision making (The Child Safeguarding Practice Review Panel)
Where a newly born child is found to need treatment to withdraw from drugs and/or alcohol at birth, a referral to children’s social care should always be made in line with the Referrals Procedure before the child is discharged home.
Planning and Interventions
Specialist drug and/or alcohol misuse services should be invited to and should attend and provide information to any meeting concerning the implications of the parent/carer’s drug and/or alcohol misuse problems for the child, including Early Help, Child Protection Conferences and Child in Need meetings.
If the child is to remain with a parent/carer who is misusing drugs and/or alcohol, the lead professional working with the family should coordinate the production of a plan to minimise risk to the child and to support the parents/carers. This should be agreed by all agencies involved with the child and the parent/carer who is misusing drugs and /or alcohol (including children’s services and drug and alcohol services where they are involved), and should include a clear statement of:
- what the intervention intends to achieve with regard to the child and to the parents/carers, and how progress will be measured
- the expectations of practitioners and of parents/carers, expressed as targets and timescales and what will happen if the targets are not met
- the arrangements for child care should the parents/carers be unable to care for their children at any time; treatment programmes may be very demanding.
When practitioners decide to end their involvement with a parent/carer with drug and/or alcohol misuse problems, or a child who is living with a parent/carer with drug and/or alcohol 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 ongoing needs can be addressed and risks monitoring, including contingency plans in the event of an increase in concerns.
Addressing and supporting Parent/carers’ own needs. Assistance with the misuse or addiction to drugs and or alcohol can be achieved through appropriate treatment accessed through the local drug and alcohol treatment service, it should however be recognised that the misuse may also be a consequence with an underlying cause that will also need to be fully explored and factored into any assessment. Parents need to consent to the involvement of these services. Where they do not consent, this must be considered as part of the assessed risks and needs to the child. The child’s needs must not be put on hold without a contingency plan if there are delays or a lack of consent from parents to access drug and alcohol, or any other appropriate services to meet their needs.
Confidentiality is important in developing trust between parents/carers who are misusing drugs and /or alcohol and staff in agencies working with them in relation to their drug and/or alcohol misuse. However, practitioners must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult.
Factors that reduce the risk of harm to the child. The adverse effects of parental drug and/or alcohol misuse on children are less likely when:
- the misuse is not associated with violence, family discord, or disorganisation in the family’s day-to-day living
- the household includes a parent/carer or family member who does not have a problem with alcohol or drugs, and is able to respond to the child’s developmental needs
- there are good physical standards in the home
- the family has sufficient income to cover household necessities
- the substance-misusing parent/carer acknowledges the problem and engages with services to address the issue
- the child attends nursery, day care or school regularly
- the extended family is aware of the drug and/or alcohol misuse and is able to provide effective support in maintaining adequate child care standards.
Drug testing refers to the use of biologic sources, such as urine, saliva, sweat, hair, breath, blood, and meconium to identify specific substances or their metabolites in an individual’s system. However, drug tests do not provide enough information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of the parent/carer’s ability. The most effective way to identify a substance use disorder or determine if a child is at risk for maltreatment or neglect is to continually use & review a combination of screening and assessment tools, including safety and risk assessments: clinical instruments, random drug testing, self-reports, and observations of behavioural indicators.
- Public Health Practitioner Guidance: Parents with alcohol and drug problems
- Hidden Harm: Responding to the Needs of Children of Problem Drug Users
- Safeguarding Children affected by Parent alcohol and drug use A guide for local authorities and drug and/or alcohol misuse services
- Adfam (support to families affected by drugs and alcohol)
- Dual Diagnosis Toolkit
- NHS Choices Care Programme Approach
- NSPCC Learning from Serious Case Reviews
- Think Child, Think Parent, Think Family
- Children’s Needs – Parenting Capacity