Drug Deaths Taskforce response: cross government approach

5. Families

Taskforce Recommendation: Families must be involved in the process wherever possible, and steps should be taken to embed family-inclusive practice into all aspects of the sector's work. This means services should start with a presumption of family involvement. Family members must be part of the solution to the drug-deaths crisis. They have been active contributors to the development of the Taskforce recommendations and action points and must continue to be involved in the development of the response to this public health emergency. It is also critical that families have access to meaningful support that is not dependent on their loved one's treatment.

The impact of problem drug use is not only felt by the person using drugs, it has a significant impact on families, including children, carers and wider communities.

Scottish Families' 'Ask the Family' ^[30]research found that an average of 11 people were harmed for every person using substances, reaching across a wide range of family members and social relationships (e.g. friends, neighbours, work colleagues). It is vital that families are supported, and their voices are heard.

5.1 Embed a whole family approach and family inclusive approach

In December 2021, the Scottish government published Families Affected by Drug and Alcohol Use in Scotland: A Framework for Holistic Whole Family Approaches and Family Inclusive Practice^[31] which aims to develop a consistent high-quality holistic whole family approach and family inclusive practice in Scotland. Embedding this framework will ensure that families affected by a loved one's drug use are supported both as part of their loved one's treatment and, importantly, in their own right.

As part of the wider whole family wellbeing approach, we have provided grant funding of £800,000 to fund 13 organisations. These organisations will offer vulnerable women/parents that have lost a child(ren) to care, access to the help and support they need, when and where they need it. We will work with partners to provide support for mothers/parents with complex and challenging needs who have frequent pregnancies, but whose children are taken into care. We want to break this cycle by supporting women and creating the space for them to take control of their lives and develop new skills. Support should be fully accessible, holistic in nature, person-centric and built around the needs of the individual. The support offered will include addressing all barriers identified including parents that have substance use as an identified issue. Our ambition is that in the exceptional circumstances when it is not possible for families to stay together, that birth families across Scotland are able to access the support they need, where they need it, when they need it and for as long as they need it, so that they are connected and supported to be able to improve their health and wellbeing and ultimately have economic stability.

Key actions

• Scottish Government is working closely with ADPs and Children's Services Planning Partnerships to understand the current position locally and to deliver support to better embed the framework. This is an iterative process and will build on the substantial investment in families across government.
• Before the end of the financial year, we will undertake an audit of each local area's position in relation to a Whole Family Approach and Family Inclusive Practice. This will enable us to assess where ADPs are now and understand how we can support them to improve.
• A multi-agency working group has been formed to support this audit and the implementation of the national framework.
• We are implementing the national framework for families affected by drug and alcohol use in Scotland, published in December 2021. A multi-agency working group has been formed to support this implementation and the framework is supported by funding of £3.5m per year for ADPs and £3m per year in grant funding for the third sector.
• The Whole Family Wellbeing Funding is a significant programme of work to support families which is aligned with our framework. It supports the national whole system transformational change required to reduce the need for crisis intervention and seeks to shift help for families away from crisis to prevention and early intervention. This funding aims to ensure that families can access seamless support that wraps around their individual needs and takes a holistic and whole family approach to the provision of support.
• In 2023 we will develop Family Inclusive Practice pathways or frameworks at an operational level across the drug and alcohol workforce, linked to skill development for supporting families.

5.2 Ensure children affected by parental substance use are given the best start and high quality, evidence based support throughout their childhood.

Evidence suggests that the early stages of pregnancy are vitally important for infant development and are the time at which the baby is most vulnerable to the impact of adverse maternal circumstances. Pregnancy is also a time when women may be more receptive to making changes to their lifestyle and improving their health, for the sake of the baby. The Best Start: A Five Year Forward Plan for Maternity and Neonatal Services report, published in 2017^[32], recommended that pregnant women should be supported with compassion, with advice and support and with access to services during their pregnancy, and that all midwives are trained to identify and support women who are affected by substance use during the perinatal period, and women with the most complex needs should have access to a specialist team. Midwives in these roles should provide continuity of carer and coordination of team care, and their caseloads should be adjusted so they can provide the support needed. Implementation of the Best Start remains a government policy priority and is underway across Scotland.

All families receive the core Universal Health Visiting Pathway consisting of 11 contacts from birth to school entry, with 8 in the first year of life and 3 child health reviews using a GIRFEC approach. This support provides early opportunities for health visitors to identify additional needs, including addressing the root causes that can lead to problem drug or alcohol use. For young first time parents, who are more likely to have high levels of vulnerability, they are offered the Family Nurse Partnership programme to provide holistic support and advocacy from birth until their child is aged two. These services are designed to provide health promotion and preventative healthcare, alongside identifying social and economic challenges that can lead to adverse health outcomes and poorer outcomes for babies and children more generally.

We will also deliver the actions set out in 'Best Start – strategic early learning and school age childcare plan 2022 to 2026'^[33]. We will ensure, through access to rich and nurturing early learning and school age childcare experiences, children, families, and their communities are enabled to reach their full potential and the poverty-related outcomes gap narrows.

Since 2000, the Child Protection unit has invested in the Partnership Drugs Initiative (PDI), which is managed and match-funded by the Corra Foundation. The PDI provides funding to locally based projects and charities working with children and young people affected by substance issues and produces insights for policy and practice. In 2021/22 a total of 518 children and young people were supported and engaged in a variety of ways with services. 250 children and young people benefited from an improvement in their safety, 164 children and young people increased their engagement with education and 137 families reported improved access to and engagement with support services.

Key actions

• To support young people affected by alcohol and drugs we are expanding the successful Routes model, operated by Scottish Families Affected by Alcohol and Drugs, to five new areas in Scotland. Routes provides holistic support for young people to help them achieve their goals despite experiencing substance use harms at home. This is a total investment of nearly £4 million over four years.
• A Short Life Working Group will be developed to make recommendations to improve the provision of support and services to women, infants and families affected by substance use during the perinatal period. This work will be implemented from April 2023. This follows a review^[34] published in September 2021 and stakeholder engagement.
• The Children Young People Families and Adult Learners (CYPFAL) Third Sector Fund was launched by Ministers in July 2022 and is intended to replace the CYPFEI & ALEC third sector fund. Applications were invited to the new CYPFAL fund from organisations delivering positive outcomes for children, young people, families and adult learners over financial years 2023/24‑2024/25 including from organisations who are "Supporting children, young people, families and adult learners who are affected by substance use".
• Through the Whole Family Wellbeing Funding we want to ensure that families experience seamless support that is tailored to fit around the needs of each individual family, rather than being driven by structures and systems. Local services are expected to take a collaborative approach in the deployment of this funding; ensuring that those responsible for children's services and related adult services (such as drug or alcohol services for example) are involved in the planning and decision making on this funding, in order to take a truly holistic and family centred approach to support.