4.26 Substance Misuse in Parents

1. Definition

Government guidance uses ‘parents with problem alcohol and drug use’ to refer to parents or carers of children whose alcohol or drug use causes, or has the potential to cause, harm to children. Dependent and non-dependent problematic use are both included in this definition.

2. Issues and Risks

Not all children of parents who use alcohol or drugs problematically will experience significant harm, but children growing up in these families are at a greater risk of adverse outcomes.

Research shows that problem alcohol and drug use can reduce parenting capacity and is a major factor in cases of child maltreatment. Department for Education (DfE) research on the characteristics of children in need has found parents using drugs to be a factor in around 17% of child in need cases, and parental alcohol use to be a factor in 16%.DfE analysis of serious case reviews has also found that parental alcohol or drug use was recorded in over a third (36%) of serious case reviews carried out when a child has died or been seriously harmed.

Families affected by parental alcohol and drug use typically have multiple support needs. In addition to alcohol and drug use, their support needs often include:

• poverty;
• mental ill health;
• interparental conflict or domestic abuse;
• housing problems;
• worklessness;
• offending;
• child safeguarding concerns.

Parents’ dependent alcohol and drug use can negatively impact on children’s physical and emotional wellbeing, their development and their safety. The impacts on children include:

• physical maltreatment and neglect;
• poor physical and mental health;
• development of health harming behaviours in later life, for example using alcohol and drugs and at an early age, which predicts more entrenched future use;
• poor school attendance due to inappropriate caring responsibilities;
• low educational attainment;
• involvement in anti-social or criminal behaviour.

The harms children experience can cause problems in the short term and later in life. Evidence shows that this includes intergenerational patterns of:

• substance misuse;
• unemployment;
• offending behaviour;
• domestic abuse;
• child abuse and neglect.

3. Stigma and Barriers to Engagement

Families affected by parental alcohol and drug use may need significant support to address the long-term effects of stigma and exclusion. Children and parents may need support and encouragement to get the courage to ask for and accept help and to talk openly about issues in the family.

Guidance – Parents with Alcohol and Drug Problems: Adult Treatment and Family Services (gov.uk) lists examples of how to overcome barriers to engagement:

• recognising that people who use alcohol and drugs problematically are exposed to high levels of trauma, and using a trauma informed approach (physical and emotional safety, collaboration, choice, empowerment and resilience);
• involving parents and children in planning, developing and delivering support in age appropriate ways;
• practitioners raising the issue of stigma with parents (and children, where appropriate) to explore how it affects the family, and recognising that they may need other support to minimise the harmful effects of stigma;
• asking children to pass on written messages to other children joining the service, placing them on a ‘message tree’ or in a book, particularly in cases where there is no face-to-face peer contact;
• linking funded, regulated childcare to adult alcohol and drug treatment services;
• offering alcohol treatment and support outside the usual setting (for example home visits), linking treatment sessions to obstetric appointments for pregnant women or offering appointments in children and family support services when it is not possible to provide childcare in treatment services.

4. Reducing Parental Conflict

There is consistent evidence of an association between parental alcohol and drug use and conflict. Parental conflict is defined in government guidance as ‘conflicts that occur between parents or carers that are frequent, intense and poorly resolved’. So, parental conflict can include a range of behaviours that fall short of domestic abuse.

Where parental alcohol and drug use and conflict coexist, the risk of poor outcomes for children is greater than when either is experienced alone. The nature of these outcomes derive from internalising (for example, anxiety and depression) and externalising (for example, aggression and hostility) behaviour. These are the same outcomes as for children who experience either parental substance misuse or conflict in isolation.

Few interventions exist to address parental substance misuse and conflict. But treatment services that integrate interventions to reduce parental conflict into the support they offer report that addressing the two problems together is effective at:

• reducing parental alcohol and drug misuse;
• improving communication between parents;
• improving children’s emotional coping strategies and their outcomes;
• helping the whole family to recover beyond the support that treatment services provide.

5. Working Together and Information Sharing

Effective safeguarding work between practitioners depends on collaborative working between all relevant local agencies, and that they recognise that no single professional has all of the required knowledge or skills for this work. This should include multi-agency training and evaluating and sharing good practice between agencies.

Adult and family services should be alert to potential problem alcohol and drug use by parents who they are providing help and support to. Staff in these services should understand the potential impact of problem alcohol and drug use on children and how that combines with other risk factors. Staff should also be clear what support their own service might be able to offer as well as what local pathways exist, so they can identify, assess and refer parents and affected children.

Guidance – Parents with Alcohol and Drug Problems: Adult Treatment and Family Services (gov.uk) recommends that alcohol and drugs services should have a ‘designated practitioner’ or ‘dedicated and named practitioner’ to:

• support organisations to recognise the needs of children;
• to promote their welfare of children; and
• to have specific responsibility when there is a child with complex needs who is being referred to children’s social care or where there are safeguarding concerns.

Appropriate and timely information sharing between local partner agencies is essential to identify and support families.

Drug and alcohol treatment providers should (where relevant) ask adults who use their service if they or their partner are pregnant. Where they are known to have a child living with them (or may have a child live with them in the future), practitioners should make suitable enquiries as to the welfare of the children and share information with children’s social care and other agencies as appropriate.

The statutory guidance Working Together to Safeguard Children sets out the following principles in relation to information sharing:

• data protection legislation is not a barrier to information sharing;
• consent is not always needed to share personal information when there are safeguarding concerns;
• personal information collected by one organisation or agency can be disclosed to another;
• the common law duty of confidence and the Human Rights Act 1998 do not prevent personal information sharing;
• IT systems are not a barrier to effective information sharing.

For further information see Information Sharing and Data Protection chapters.

6. Safeguarding Children

6.1 Early help

There should be a focus on early help and prevention for families affected by parental alcohol and drug use. This means providing support as soon as signs of a problem emerge, at any point in a child’s life or pre-birth. This relies on organisations working together to identify children and families who might benefit from early help, undertaking an assessment of need and providing targeted early help services to children and their families with a focus on improving outcomes for children. Support can come from a wide range of statutory, health and community services according to the level of need assessed. See also Early Help chapter.

Where there is a low level of assessed need, alcohol and drug treatment services should use referral pathways to local agencies and organisations which provide universal and targeted help to parents with alcohol and drug problems, and their children.

Local alcohol and drug treatment services can take steps to help prevent later harmful consequences for parents and children, including:

• screening for problematic alcohol and drug use in parents who attend their services;
• assessing the impact their current use has on their children;
• assessing the risks to their children if their alcohol or drug use escalates;
• providing help and support at an early stage.

When alcohol and drug treatment and children and family services are considering the impact of parental alcohol and drug use on a child, they should jointly assess families using tools and guidance which factor in all the relevant information.

Collaborative assessment, information sharing and clear pathways between systems and services are vital to identifying families affected by drug and alcohol problems and ensuring they receive appropriate support early.

This can be strengthened locally by:

• inviting alcohol and drug treatment services to contribute to early help assessments and other relevant assessments and reviews led by children’s services;
• having referral pathways into treatment and support services for parents with problem alcohol and drug use and their children;
• referrals from children and family services into alcohol and drug services being treated as priority referrals due to the potential risk of harm to children;
• training adult and children’s services staff jointly on appropriate and timely information sharing;
• alcohol and drug treatment staff regularly reviewing parental status and child living arrangements to monitor potential safeguarding issues;
• social workers regularly monitoring parental alcohol and drug use and, where appropriate, engaging parents with treatment services;
• having a safeguarding lead in each treatment provider to be a main point of contact with children and family services;
• having a substance misuse lead in each children and family service who acts as a main point of contact and facilitates referrals to drug and alcohol services;
• treatment services considering the wider needs of the family, not only where there is a risk of significant harm to the child, and making appropriate referrals to lower threshold support services.

6.2 Pre-birth

NICE Clinical Guideline CG 110 Pregnancy and Complex Social Factors: A Model for Service Provision for Pregnant Women with Complex Social Factors sets out that where a pregnant woman has substance misuse issues, antenatal services should work with local agencies, including social care and substance misuse services, to coordinate antenatal care by, for example:

• jointly developing care plans across agencies;
• including information about opiate replacement therapy in care plans;
• co-locating services;
• offering women information about the services provided by other agencies;

• considering ways of ensuring that, for each woman who misuses substances:

• progress is tracked through the relevant agencies involved in her care;
• notes from the different agencies involved in her care are combined into a single document;
• there is a coordinated care plan.

The woman should be offered a named midwife or doctor who has specialised knowledge of, and experience in, the care of women who misuse substances, and provided with a direct line telephone number for the named midwife or doctor.

She should also be provided with information about the potential effects of substance misuse on her unborn baby, and what to expect when the baby is born, for example what medical care the baby may need and where the baby will be cared for.

6.3 Referral and assessment

Where a practitioner has concerns about a risk of significant harm to a child (including unborn children), they should make a referral to children’s social care (see Referrals chapter). If there is an imminent threat of serious harm, the police should be called and action taken to safeguard the child (see Immediate Protection chapter).

Substance misuse practitioners working with parents should be involved in, and provide relevant information to, processes and interventions such as early help, children in need and child protection enquiries, including attendance at strategy discussions and child protection conferences. Plans for parents and children should incorporate input from all relevant practitioners. See also Assessments chapter.

Assessment should take into account:

• the parent or carer’s background, medical history and current circumstances;
• the parent or carer’s ability to meet the child’s needs, and the reality of everyday parenting;
• the child’s wellbeing and development, wishes and feelings;
• whether the child has taken on a caring role;
• information from colleagues from other agencies who are involved with the family;
• whether the parent or carer has support from another parent or relative, or if they are coping with parenting alone.

All practitioners working with parents / carers with substance misuse issues must maintain a focus on their children’s wellbeing and the parents’ ability to adequately care for and protect their children. They should monitor and review children’s progress throughout the period of intervention and respond appropriately to any change in the circumstances of the parents and / or the child.

Where parents are to be discharged from substance misuse services, practitioners must consider the potential impact for children and engage with children’s social care colleagues as appropriate. If the situation deteriorates such that a practitioner considers there to be a risk of significant harm to the child, a referral should be made to children’s social care.