Assessing the Impact of Parental Substance and or Alcohol Misuse on Children

This guidance is to be used when considering the likelihood and severity of the impact of an adult’s substance or alcohol misuse on a child. It involves the practitioner thinking about the nature of risk and also the protective factors for the child.

1. Introduction 

1.1 Substance misuse is the problematic use of drugs and/or alcohol. It usually refers to someone who inappropriately uses or is dependent on illicit drugs, alcohol, prescription drugs or solvents; and their use of these is associated with having a harmful effect on the individual, their family or the community. However, professionals should be mindful that a single use of alcohol and/or drugs can have consequences which are equally as devastating as long-term use.

1.2 Substance misuse affects different people in different ways depending on what is used, how it is taken and the physical/psychological state of the person and their circumstances. The impact on the individual may range from negligible to extremely serious. Any drug, including alcohol, has the potential to impact on the adult’s ability to care for their children.

1.3 Substance misuse by parents / carers does not on its own automatically indicate that children are at risk of abuse or neglect. However where substance misuse is causing physical, psychological, social, interpersonal, financial and or legal problems, the implications for children and families must be properly assessed. Parental substance misuse can impact on children of any age and the impact may be cumulative.

1.4 Practitioners working with parents / carers should remain aware that misuse of drugs and / or alcohol is strongly associated with harm to children, especially when combined with other features such as Domestic Violence and Abuse and / or mental illness. Children who live with adults who misuse substances may require additional services to ensure that their needs are met and it is essential that information is shared appropriately in order to aid the assessment of needs and risks.

2. How substance misuse affects children

2.1 Parental alcohol and drug misuse affects children and their experiences of family life in a number of ways. 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.

2.2 The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare. For example, substance misuse may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks. Substance misuse may also impact on the ability of a parent or carer to assess and manage risks to their children, including the risk of harm.

2.3 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 can include:

  • physical and emotional abuse or negelct as a result of inadequate supervision, poor role models and inappropriate parenting
  • behavioural, emotional or cognitive problems and relationship difficulties
  • taking on the role of carer for parents and siblings
  • preoccupation with, or blaming themselves for, their parents’ substance misuse
  • infrequent attendance at school and poor educational attainment
  • experiencing poverty and inadequate and unsafe accommodation
  • exposure to toxic substances and criminal activities
  • separation from parents due to intervention from children’s services, imprisonment or hospitalisation
  • increased risk of developing drug or alcohol

 

3. Assessment of the Child's Needs 

3.1 Any assessment must consider the nature of the substance use, its effect on the parent’s ability to look after and meet the child’s needs and the subsequent impact on the child. Other risk factors such as parental domestic abuse and / or parental mental health issues must also be considered. The effect of parental substance misuse on an individual child will depend on numerous factors. Research identifies the potential impact across many aspects of health and development and some children will present as though all is well, others will act out their feelings.

3.2 There are specific risks arising from substance misuse and they may impact on an adult’s ability to look after and meet the needs of the child. In particular consideration should be given to the implications for a child in relation to:

  • Adults’ focus on alcohol / drugs and activities related to this and the extent to which they prioritise the needs of the child;
  • Inappropriate behaviour and a lack of boundaries;
  • Poor home environment including unsafe storage of substances, injecting equipment or other paraphernalia;
  • Increased irritability, emotional unavailability, irrational behaviour and reduced parental vigilance;
  • Adverse impact on growth and development of an unborn child / child;
  • Impact of intoxication and withdrawal symptoms including mood disturbances;
  • Co-sleeping whilst under the influence of substances.

3.3 If a drug or alcohol service user is a parent or carer, the outcome of their treatment is likely to be affected (positively or negatively) by the demands being placed on them in caring for their children. Failing to recognise this and seek any necessary support could put both the service user’s treatment outcomes and those of their children at risk. Parental poor engagement, non-compliance with or active resistance to treatment plans should raise particular concerns about the wellbeing of children. Drug and alcohol services should ask all service users whether they are parents, carers or if they have childcare responsibilities.

3.4 Where there are concerns that a child is living in the environment of substance misuse, an assessment of the parent or carer’s ability (capacity) to meet the child’s needs should take place to establish the impact on the child of the parent or carer’s lifestyle and capacity to place the child’s needs before those of their own.

3.5 Issues which should be covered by an assessment of harm/potential harm to a child living with parents / carers who misuse substances include:

  • The pattern of parental drug use;
  • Accommodation and home environment;
  • Provision of basic necessities;
  • How the drugs are procured;
  • Health risks;
  • Family’s social network and support system;
  • When intervention is necessary;
  • The child’s perception of the situation;
  • The parent / carer’s perception of the situation.

3.6 The risk of harm to the child may be reduced by effective treatment and support of the affected parents / carers and by other factors such as the presence of at least one other consistent caring adult; a stable home with adequate financial resources; maintenance of family routines and activities; and regular attendance at a supportive school. It is important therefore to fully assess and understand the protective factors and resilience of the family when undertaking assessments.

3.7 Protective Factors

  • The presence of a stable adult figure (usually a non-problem drinker);
  • Close positive bond with at least one adult in a caring role;
  • A good support network;
  • Low separation from the primary carer in the first year of life;
  • Characteristics and care style of parents;
  • Being raised in a small family;
  • Larger age gaps between siblings;
  • Engagement in a range of activities;
  • Individual temperament;
  • Positive opportunities at times of life transition;
  • Further, much research shows that, if family cohesion and harmony can be maintained in the face of substance misuse, then there is a high chance that the child will not go on to have any problems (Cleaver et al, 1999; Velleman and Orford 1999).

3.8 Resilience factors

  • Deliberate planning by the child that their adult life would be different;.
  • High self esteem and confidence;
  • Self efficacy;
  • An ability to deal with change;
  • Skills and values that lead to efficient use of personal ability;
  • A good range of problem solving skills;
  • The young person feeling that they have had choices;
  • The young person feeling that they were in control of their lives;
  • Previous experience of success and achievement.
  • Parental poor engagement, non-compliance with or active resistance to treatment plans should raise particular concerns about the wellbeing of children.

3.9 Engaging and working with parents who misuse substances may be particularly challenging. However, it is important to acknowledge that many parents recognise harmful effects on their children and that change is often motivated by these concerns.

3.10 All practitioners, including those from adult services, should be aware of their responsibilities to safeguard children and this should be made clear in their work with adults. Practitioners should be able to provide information about the possible impact of parental substance misuse on children. This should be explored with parents who should be supported to understand any concerns and to make changes to safeguard their children's welfare. All agencies, including adult treatment agencies and those providing antenatal care should carry out screening which identifies parental substance use and possible risks to children. All services should also consider any non-substance misusing parents / carers in the household and how they look after and meet the child’s needs.

3.11 Adult service practitioners have a duty to ascertain whether the adult with whom they are working is a parent / carer and whether there are children in the household or whether they are in a relationship with someone who has children. Adult services practitioners should always be alert to the impact of substance misuse on the child and the possibility of the child being a Young Carer. All meetings regarding substance misusing parents including MAPPA, Integrated Offender Management and MARAC arrangements should include consideration of any needs or risk factors for the children concerned and any protective factors that are present. Where there are concerns about the welfare of the child, Children's Social Care must be given the opportunity to attend and contribute to such discussions.

3.12 Children's practitioners, who become aware that a parent / carer is receiving services from a substance misuse agency, must make sure that they understand the nature of that contact. Services may include: needle exchange, counselling, detoxification programmes, prescription for medication, Alcohol or Drug Rehabilitation Requirements as mandated by the courts or a combination of all.

3.13 There should be a discussion about the best way to establish services and support for the parent/s. Practitioners in children’s and adults services must proactively work together using a Think Family approach to ensure there is a full understanding of the parent / carers needs and the potential impact of this on their ability to care for their baby or child.

3.14 All agencies and practitioners should refer to the relevant the Framework of Need (Threshold document) (Practitioners working in Middlesbrough should consult the Middlesbrough Threshold of Need Document) to identify the level of need and the appropriate assessment and interventions.

3.15 Any assessment of the child's needs should involve the parent / carer's substance misuse worker. Specific professional knowledge and skills must underpin the competence of an assessment of parental substance misuse.

3.16 It is essential that practitioners regularly review the situation of the family and the impact that the parental substance misuse (and other issues if they are present) has upon the child. Changes in substance use, including stabilisation or abstinence, should result in a re-assessment of the child’s and family’s needs. Advice should be sought from the designated lead for Child Protection if necessary.

 

4. The Welfare of Unborn Children

4.1 Any concerns about the pregnant woman’s substance misuse (or her partners) should be raised with the midwife or GP. It is important to assess the needs and give support to parents with substance misuse needs as early as possible. Close liaison between midwifery services and Children's and Substance Misuse Services should ensure that early help or pre-birth assessments are undertaken whenever there is concern about the ability of a pregnant woman's ability to care for her expected child (and jointly with her partner where applicable). See Safeguarding the Unborn Baby procedure.

 

5. Babies Withdrawing from Substances 

5.1 Withdrawal in babies can result from many medications used during pregnancy not only when illicit substances are used. In the majority of cases this is known to be a risk factor during the pregnancy and a plan to monitor the baby appropriately will be in place. Where a baby, who is not already subject to any kind of inter-agency plan, is unexpectedly observed to be experiencing withdrawal symptoms, as diagnosed by a paediatrician, the midwifery service and / or nurses in the Neo Natal Intensive Care Unit must request a pre-discharge meeting with Children's Social Care and the health visiting service. Clear plans for on-going assessment and services should be made to ensure that the child's needs can be adequately met within the family.

5.2 A baby affected by the mother's alcohol use, during pregnancy, may experience long term effects including foetal alcohol syndrome which may not be apparent in the immediate post natal period. It is important that concerns about alcohol use and possible related effects are recorded to enable an informed assessment and appropriate level of services to be provided. See relevant Threshold document in the Early Help section of the Tees Procedures

 

6. Parent / Carer Withdrawal from Substances

6.1 Withdrawal from drugs and / or alcohol can significantly impair capacity to tolerate stress and anxiety and is likely to have an impact on the adult’s ability to care for their child effectively.

6.2 Withdrawal from drugs and / or alcohol may be unplanned as a result of an inability to access either non prescribed or prescribed drugs or it could be planned. Planned withdrawals are usually managed though a detoxification programme via community based treatment or can also be completed in hospital as a rapid detoxification. Detoxification can be difficult and the family are likely to need additional support during this process. The child may also need support in their own right to understand what is happening.

6.3 The impact on the child of any planned or unplanned parent / carer withdrawal from drugs and / or alcohol should always be considered. Practitioners preparing a parent/carer for detoxification must ensure that that appropriate childcare arrangements have been made and that any other agencies involved with the child are aware of the plan.

6.4 It is incorrect to assume that abstinence from drugs or alcohol will in itself lead to better child care. Families who have had a chaotic lifestyle may need significant levels of support before they can effectively care for their children. Any changes in drug and / or alcohol use should trigger a re-assessment of the children's needs.

 

7. Young Carers 

7.1 From an early age children may assume the responsibility of looking after their parent. As young carers these children should be offered an Early Help Assessment to ensure their needs are identified and any services which are required. Young carers who are not coping and / or have needs which cannot be met by early help assessment as they are complex or serious should be referred to Children’s Social Care.

 

8. Responding to Concerns 

8.1 If any practitioner or agency has any concerns about the capacity of the parent to meet the needs of their child, or where there are serious or complex needs or where there are Child Protection concerns, they should consult with their designated lead for Child Protection and make a referral to Children's Social Care. Concerns should be discussed with a parent unless it is judged that this action will jeopardise the child's safety.

8.2 See also Making & Response to a Referral to Children’s Social Care Procedure.

8.3 See also Guidelines for Gathering Information about the Needs of Children whose Parents have Drug / Alcohol Problems.

8.4 Following the referral to Children's Social Care, the service manager will make a decision as to whether the matter requires assessment as:

  • A Child in Need (s17);
  • Or child suffering or likely to suffer Significant Harm (s47);
  • Or neither.

8.5 Where there are concerns that a child may be or is likely to suffer Significant Harm Children’s Social Care will convene a Strategy Discussion involving health, police and other relevant agencies. See Initiating Section 47 Enquiries and Outcome of S47 Enquiries procedures

8.6 In addition to considering whether or not the threshold for a Section 47 Enquiry has been met, a strategy discussion may also look at appropriate multi-agency interventions early in the process and seek to minimise risk.

8.7 Practitioners working with the parents should be involved in the strategy discussion / meeting. The strategy discussion / meeting should give particular consideration to:

  • Ensuring that there is sufficient information about the parents substance misuse and any other risk factors such as domestic abuse, on their ability to care for their child/ren and the impact on the child/ren;
  • Whether specialist advice or assessment should be sought, who should undertake the investigation, where and how it will take place.

8.8 Given the potentially complex nature of Section 47 Enquiries it may be appropriate to hold additional strategy discussions to ensure that informed decisions are made. Expertise in both safeguarding children and substance misuse must be brought together to ensure that there is appropriate assessment and planning of services.

8.9 In addition to the information gathered and analysed within the Single Assessment, adult services should be requested to provide information in relation to:

  • Patterns of substance use;
  • Current and previous treatment / intervention and capacity to change and the timescale required for this;
  • Their assessment on the impact of substance misuse on the ability of the adult to looks after and meet the child’s needs;
  • The parents' views about their substance misuse and the impact it has on them and their children;
  • What support and services are needed, if any to enable the adults to effectively look after the child/ren.

8.10 Where there is no involvement of a specific drug or alcohol service, Children's Social Care should seek general advice if they have concerns about a parent's substance use. Parents / carers should be encouraged to seek support / treatment for their substance related issues.

8.11 Practitioners who participate in the formal child protection process do so as a representative of their agency and not as an advocate or supporter for a parent. They will be involved in the decision making process in which the welfare of the child remains paramount. They may be identified as important members of a Core Group which will develop and implement a Child Protection Plan for the child. See the Child Protection Plan & Core Group Procedure.

8.12 Parents are also entitled to be accompanied by a supporter or advocate at child protection conferences and in core groups.

 

9. Useful Guidance:

Tees Safeguarding Children Partnership's Guidance for Gathering information and assessing the needs of children whose parents have drug/alcohol issues

 

10. Useful Links and websites