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Contents

1. Background
2. Safeguards and Concerns
3. Referrals
4. Assessment and Initial Child Protection Conference
5. Confidentiality
6. Services for Pregnant Women

1.  Background

The definition of Neglect now explicitly recognises the possibility of Significant Harm being caused during pregnancy as a result of maternal substance misuse.

The Advisory Council on the Misuse of Drugs (ACMD) Report 'Hidden Harm – responding to the needs of children of problem drug users' estimated that there are between 200,000 – 300,000 children of problem drug users in England and Wales, i.e. 2-3% of all children under the age of 16. The report also concludes that parental drug misuse can and does cause serious harm to children at every age from conception to adulthood. 

Parental drug misuse is strongly associated with a chaotic lifestyle, economic deprivation and other factors that affect parenting capacity. The adverse consequences for the child are typically multiple and cumulative and will vary according to the child's age and development.  See also

An appropriate response to these children often requires the close collaboration of a number of agencies both statutory and voluntary agencies.  All such agencies have a duty to safeguard and promote the welfare of children, irrespective of whether their targeted service is to the adult.

2.  Safeguards and Concerns

Drug use by parent or carer in itself is not a reason for considering a child to be suffering or at risk of suffering Significant Harm although it may be a contributing factor. 

Professionals working with children need to understand the complexity of the lives of drug users and gain confidence in working with people who use drugs.  In addition, they should seek specialist advice where necessary.

Professionals working with adults need to consider the impact of parental drug misuse on the children and young people in the household.

A thorough assessment by all relevant agencies is required to determine the extent of need and level of risk of harm to the child in every case.  This should include working in partnership with statutory specialist agencies – DASH (Hereford), Community Drug Team (Worcestershire) or Community Substance Misuse Team (Shropshire) – and any other specialist voluntary agencies.  See Contact Details Appendix.

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

Where there is concern that a parent is involved in drug use, the following need to be included in the assessment of the impact on the child:

• The child’s physical safety while drug use is taking place
• Possible trauma to the child resulting from changes in the parent’s mood or behaviour
• The impact of the parent’s drug use on the child’s development including the emotional and psychological well being, education and friendships
• The extent to which the parent’s drug use disrupts the child’s normal daily routines and prejudices the child’s physical and emotional development
• The financial circumstances of the family and whether the child’s basic needs for food, warmth and clothing are being met
• A lack of emotional availability on the part of the parent leading to attachment difficulties
• The impact on the child of being in a household where criminal activity is the norm particularly if the home is used for drug dealing
• Unsuitable visitors to the home
• How safely the parent’s drugs and equipment are stored
• Inadequate supervision and other inappropriate parenting practises
• Intermittent and permanent separation
• Inadequate accommodation and frequent changes in residence

3. Referrals

Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug-misusing environment must ask themselves “What is it like for a child in this environment?”  “Is the child safe?”

The Common Assessment Framework for the assessment of all children will assist in determining the level of vulnerability of the child and at what point a referral is made to Children and Young People’s Social Care Services – see the Referrals Procedure. 

Information gathered during the common assessment should form the basis for the referral including relevant forms.

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 and Young People’s Services.

Where a newly born child is found to need treatment withdrawing from substances at birth,  referral to Children and Young People’s Services must take place as soon as possible and before the child is discharged home.

4.  Assessment and Initial Child Protection Conference.

Following a referral where there is concern about likelihood of Significant Harm, Children and Young People’s Services will consider the need to undertake an Initial Assessment.

Where there are children in older age groups in a drug–misusing environment, consideration should be given to whether the child may also be misusing drugs with or without the parent’s knowledge.

As well as the issues listed in Section 2, Safeguards and Concerns, any assessment will consider and take account of whether the person concerned is hiding or denying their substance misuse; whether they are engaged in any rehabilitation programme; whether they receive support from a partner, family or friends; the impact of the drug misuse on the quality of care given to the child and the day-to-day environment of the child. 

Throughout the assessment process and where it is decided to hold  a Strategy Discussion and convene an Initial Child Protection Conference, those agencies who have worked with the parents in relation to their drug use must be asked to contribute to the assessment, be invited to participate in and attend all relevant meetings.

If the concerns are in relation to an unborn child, the maternity services, both hospital and community based, must be involved and invited to attend.

5.  Confidentiality

See also Information Sharing and Confidentiality Procedure

Confidentiality is important in developing trust between drug using parents and staff in agencies working with them in relation to their drug use.  Families with a drug-using parent need to be able to ask for advice from appropriate agencies and to work together with them to safeguard their children.  Services need to be accessible and attractive to drug using parents and pregnant women who use drugs.

However, no agency can guarantee absolute confidentiality; therefore this should never be promised.

Each agency, both statutory and non-statutory, should have its own in-house written procedures on confidentiality which provides for the sharing of information where there is concern about the wellbeing of a child who may be suffering or at risk of Significant Harm.  When agencies start any work with drug-using parents or with pregnant women who use drugs, these procedures must be explained to them.

6.  Services for Pregnant Women

All maternity services should have procedures for pregnant women who use drugs that encourage them to attend antenatal services and help them to stabilise, reduce or stop their drug use.

When a woman with a drug problem attends for antenatal care, she should be encouraged to contact DASH or Zig Zag (Herefordshire), the Community Drug Team, SPACE and Turning Point (Worcestershire) or the Community Substance Misuse Team (Shropshire) - for assessment and advice on the treatment options available to her.

End