Children of Parents who Misuse Drugs and/or Alcohol

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Children of Parents who Misuse Drugs and/or Alcohol

AMENDMENT

This chapter was updated in May 2021 to reflect local practice.

Definition
Harm/Worries
Warning Signs
Strengths and Safety
Complications
Further Information
Local Documents

1. Definition

Substance misuse refers to the abuse of drugs and/or alcohol. Whilst there may be different treatment methodologies for adults with these problems, they 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.

Some drug and/or alcohol misusing adults also suffer from severe mental health problems, which is described as Dual Diagnosis and there may be several agencies, from both Adult and Children's social care, who are working with the family.

Child Safeguarding Practice 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.

2. Harm/Worries

Drug and/or alcohol misuse can consume a great deal of time, money and emotional energy, which can then impact on how well they care for their child. This behaviour can mean that the child is more likely to be neglected, or experience other forms of abuse like physical, sexual abuse or emotional abuse, either by the parent themselves or by other people who can take advantage of the situation.'

Children whose parents use drugs and/or alcohol can end up having their needs go unmet, e.g. they may go without enough food (physical needs), they may miss out on affection or praise (emotional needs), they may miss out on seeing their friends and family (social needs), they may miss more school or find it harder to concentrate in class (educational needs) or they may fall behind other children their own age (developmental needs). This could be because of things that their parents are doing, or things that their parents should be doing but they are not, due to them being under the influence.

Children may be introduced to drug and/or alcohol at an early age if their parents are drinking and using drugs and there are drugs and/or alcohol in the home.

All agencies need to work together with the parents, child and their wider network of support in order to make sure that children are safe and well. Parents who use drugs and/or alcohol may be able to look after the children well enough and keep them safe, especially if they have a good network of support around them. It is important that the impact of any parental drug and/or alcohol use on the child is properly assessed, taking into account how the parents drug and/or alcohol use affects the parents themselves, the child and the way that they care for their child as well as any support provided by their wider network. The assessment should also consider any complicating factors, e.g. how dependent a child is on their parent to look after them (e.g. very young children), whether a child has any special needs or other things going on in their life that could mean they are more vulnerable to their parent using drugs and/or alcohol.

Where there are worries about a parent misusing drugs and/or alcohol, the impact of this on the child needs to be understood. The Harm / Worry Matrix can be used to analyse harm or worries in relation to parents/ carers' drug and/or alcohol use, by focusing on the detail of the behaviour that was harmful or worrying, how often this behaviour has happened (timespan), how bad the behaviour is (severity) and how the harmful or worrying behaviour has affected the child (impact).'

When considering the impact of parental drug and/or alcohol use on the child, the child is best placed to say how this affects them however practitioners who do not have direct contact with the child may also base their worries on information shared by the parent or by speaking to other people in the child and parents network who know them well about what their worries are.

Questions to explore the impact of parent's drug and/or alcohol use on their child include:

What is the worst harm that the child has come to whilst in their parents care when their parents have been under the influence?
How long have there been worries about the parents using drugs and/or alcohol whilst caring for the children? What kind of things have the children missed out on due to their parents using drugs and/or alcohol? What kind of things have the children gone without because of their parents using drugs and/or alcohol? How might this affect the children as they grow up, e.g. how they feel about themselves, their mental health, their education, their friendships?
If the parent / carers' mood has changed because of their drug and/or alcohol use, how has this affected the child? What are the long term effects of this on the child if the parents mood has been up and down over a long period of time?
Some parents who use drugs and/or alcohol heavily are more likely to use violence in their relationship. If the child has seen fighting and arguing between their parents, how has this affected them and what has been the impact of this on them if this has been going on over a long period?
For pregnant mums, what has been the impact of mum using drugs and/or alcohol on her newborn baby? If the baby was born withdrawing, how bad was this?
How much does the parent's drug and/or alcohol use get in the way of their child's daily routines, what they do and who they see?
Have there ever been times when parents / carers have been dealing drugs or stealing to fund their drug and/or alcohol use? If so, how has this affected the child?
Who are the people that parents are spending time with that professionals' worry could be a risk to the children? What is it about these people that worries professionals?
Where do parents store their drugs and/or alcohol and any kit that they use to take drugs? Have the children ever found any of this and if so, what happened?
What are the worst things that have happened to the child when the parents have been too under the influence to know where their children are or what they are doing? How often has this happened and over what timeframe?
When the parents go into withdrawal from drink and/or drugs what are the most worrying things about this for the children? What is the worst thing that has happened when a parent has started to withdraw and how did this affect the child?
How has the parent's drug and/or alcohol use affected how much money they have and how able they are to keep a roof over their heads? What has been the impact of this on the children if money is really tight or the family have lost their home?
When parents are under the influence, how often does the child have to do things for themselves or do things to help their parents out, e.g. cooking, looking after brothers and sisters, getting themselves up for school, etc.
How has the parent's drug and/or alcohol use affected their own health, and how does this then affect the children or their care of the children?
How has the parent's drug and/or alcohol use affected their relationship with other people, and how does this then affect the children?

3. Warning Signs

There are many reasons why adults take drugs and/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.

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 and/or alcohol, they are unlikely to be able to achieve this consistently. A disorganised lifestyle is a frequent sign of drug and/or alcohol misuse. Parents may fail to shop, cook, wash, clean, pay bills, attend appointments etc.

Drug and/or alcohol misuse may affect a parent's ability to be 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 drug and/or alcohol misuse – lost jobs, unsafe homes (littered with half empty bottles or discarded syringes), 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 and may be signs that drug and/or alcohol use is getting out of control.

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

4. Strengths and Safety

Where practitioners have worries about a parent's drug and/or alcohol misuse, a referral to First Contact 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.

Where any agency encounters a woman who is pregnant and whose degree of drug and/or alcohol misuse suggests that this could affect how well they might care for their child, they must make a referral to First Contact and to Drug and Alcohol Services if appropriate.

The majority of pregnant women who are drinking heavily and/or using drugs 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 safeguarding midwife and a social worker from Children's social care, who will be invited to any meetings taking place in respect of the child/ren.

Midwives should follow relevant guidelines within their own organisation when working with drug and/or alcohol misusing pregnant women.

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 First Contact in line with the Referrals Procedure before the child is discharged home.

If there are concerns about the child's wellbeing rather than their safety, it may be that the child and family will find early help services supportive and an assessment of the needs of the child should take place at an early stage, for example through the Child & Family Assessment.

Landlords can hold vital information regarding their tenants. Where the property the child resides is rented from a social housing provider, a representative should be contacted for any relevant information they may hold in relation to the tenancy and, where applicable, invited to any multi-agency safeguarding meetings.

Where the property is a private rented tenancy, checks can be made with the Durham County Council’s Private Landlords’ Team for any relevant information. This team can also carry out checks with Environmental Health and the Council’s Anti-Social Behaviour Team, Neighbourhood Wardens for any relevant information. A check is also recommended to the Durham County Council Housing Solutions Housing Advice Team for whether the household have recently made contact for advice regarding homelessness or threats of homelessness.

Any assessment of the worries and impact of a parent/carers' drug and/or alcohol use on their child should also include questions about what works well in relation to the worries (strengths and safety), who the important people are around the parent and the child and how it is that they help.

Questions to explore strengths and safety include:

What would the children say are the things that they love most about their parents? What would the parents say that they love most about the children?
Who would the children say that they are closest to? Who do they think are the best people around their parents? What do they like about these people?
Who are the people that the children feel safest with? What do these people do that helps the kids to feel safe?
Have there been times that the parent wanted to get drunk or high but decided that they needed to do something different because they didn't want the children to see them under the influence? What did they do instead? Who helped?
Have there been times where parents could have argued and fought with each other but they did not want to frighten the children, so they did something else? What did they do instead?
When has the parent been most in control of their drug and/or alcohol use? What was different about that time? What else helped them to control their drink and/or drug use?
Who are the people that parents are least likely to get drunk or high around? What is it about these people that means they are a good influence on the parents?
What are all of the ways that the parents have tried to reduce their drinking and/or drug use? What has worked the best for them? What difference has this made to the children?
What are all of the ways that the parents try to make sure that the children don't miss out or go without due to their drink and/or drug use? Who can they count on to help out?
How do the parents try to make sure that their children can't come across their drink and/or drug supply? Where do they store things?

Children who have a network of supportive adults around them who look out for them and can step in to help when parents are struggling tend to do better than children who are isolated so the family's naturally occurring network of support (family, friends, neighbours) should always be explored as part of any assessment and the network should help to create plans so that children are kept safe and well. This work can be started through the Child & Family assessment and it should form the basis of assessments and planning in Children's Social Care.

Drug and Alcohol services must be invited to and must attend and provide information to any meeting concerning the implications of the parent/carer's alcohol and/or drug use for the child, including Child Protection Conferences and Team Around the Family (TAF) meetings.

There is a clear need to assess the impact of the behaviour on the child as well as the wider family and community context. Some adult services may be reluctant to share information because of concerns about confidentiality. However, the needs to keep children safe 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.

When practitioners make a decision to end their involvement with a parent/carer who is drinking and/or using drugs, or a child who is living with a parent/carer who drinks and/or uses drugs, they should always discuss their plans with the other services who are working with the family, before they end their involvement. This is to ensure that any on-going needs can be addressed.

5. Complications

Parents' own needs will need to be addressed and supported and consideration of referral to Adult Services. Sometimes access to appropriate treatment resources is limited which may cause delays in providing services however the child's needs must not be delayed without a contingency plan.

Family networks can have a huge role to play in making sure that children are safe when parents are using drugs and/or alcohol, e.g. by checking in on the parents and child; taking the child away from the situation where the parent is heavily under the influence. Networks should always be explored as part of the assessment and plan.

Drug and Alcohol Services should always use 'respectful uncertainty' and consider disguised compliance and not readily accept parent / carer's assertions that their drug and/or alcohol problems are not affecting the care they provide to their children. Statements made by the parents and carers should be verified through further assessment, for example checking with the child and the network about their views on how much parents are drinking and/or using drugs.

Confidentiality is important in developing trust between parents with drug and/or alcohol misuse issues 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.

When a woman with a drug and/or alcohol misuse problem attends for antenatal care, she should be encouraged to contact the Drug and Alcohol Services for assessment and advice on the treatment options available to her.