GETTING OUR PRIORITIES RIGHT (GOPR)

GETTING OUR PRIORITIES RIGHT SUBSTANCE USE GUIDANCE 2012

EXECUTIVE SUMMARY

1. This document has been produced as an accompaniment to the 2012 updated Getting our Priorities Right practice Guidance which is for use by all child and adult service practitioners working with children, young people and families where problematic alcohol and/or drug use is a factor.

2. The main purpose of this Executive Summary is to provide a pull-out quick reference document for use by practitioners. It summarises the main contents of the 2012 Guidance including a summary of the key practice points from each of the Chapters.

SUMMARY OF INTRODUCTION AND CHAPTERS

INTRODUCTION TO GUIDANCE

3. The Introduction to Getting our Priorities Right stresses that the purpose of the Guidance is to provide an updated good practice framework for all child and adult service practitioners working with vulnerable children and families affected by problematic parental alcohol and/or drug use.

4. It also describes the main themes that run through the document. In particular, it stresses that it has been updated in the particular context of the national Getting it right for every child and the Recovery Agendas both of which have a focus on 'whole family' recovery.

5. Another theme prioritised is the importance of services focusing on early intervention activity. That is, working together effectively at the earliest stages to help children and families and not waiting for crises - or tragedies - to occur.

6. The impact of alcohol on families is also given higher prominence.

7. The Introduction also refers to a Scottish Government policy update (included as an Annex to the main Guidance) about the wider range of relevant national policies and strategies here.

8. It also mentions that a number of local practice examples and other key tools for reference by practitioners can be accessed through the Multi Agency Resource Service (MARS).

9. This should include the Learning and Development Framework (to help local practitioners set consistent standards for local child protection training) and the Risk Assessment Toolkit (to help with the consistent assessment of risk) that are currently being developed by the Scottish Government. These are expected to be finalised by the summer of 2012.

10. Ultimately, parents with alcohol and/or drug use problems need professionals to take responsibility for their children's welfare when they are no longer in a position to care for them adequately. That may mean intervening against their wishes. The responsibility to provide supports to vulnerable children and families affected by problematic drug and/or alcohol use will rarely sit with just one child or adult service. All services - whether adult or children focused - must always consider the individual child or adult within the wider context of the family. This updated guidance is intended to help all child and adult focused services to achieve this.

11. The Guidance first summarises - up-front - the key principles and features of the Getting it right for every child and the Recovery agenda. It is expected that the key principles and features of Getting it right for every child will soon be given a statutory basis. Services are therefore encouraged to ensure that these are included in any local protocols that they may develop or update in light of this guidance.

12. The key messages for practitioners from this Opening Section are summarised in the table below:

SUMMARY MESSAGES FROM OPENING SECTION - KEY POLICY FRAMEWORKS RELEVANT TO THIS GUIDANCE - GIRFEC AND THE RECOVERY AGENDAS

Getting it right for every child - Key Principles

All child and adult focused services should ensure that the roles of the Named Person, Lead Professional and the Co-ordinated Support Plan (CSP) Co-ordinator - and also the local channels to engage with these - are clearly described in locally agreed substance use protocols.

All services should also be clear that they have a shared understanding of the eight indicators of a child's well-being.

Recovery Agenda

All child and adult services should focus on a 'whole family' approach when assessing need and aiming to achieve overall recovery. This should ensure measures are in place to support ongoing recovery, where necessary.

There needs to be effective, and ongoing co-ordination and communication, between services working with vulnerable children and adults.

Possible barriers to recovery should also be considered where partners are developing local protocols.

All services need to make every effort to effectively engage with men to improve outcomes and wider recovery for the family.

Effective adult recovery is often linked to effective follow-up and peer support to ensure that these individuals can parent effectively and minimise any additional pressures that they may be facing.

Services should ensure that they take account of local providers of these services when developing local protocols for addressing problem alcohol and/or drug use.

Also, quick access to appropriate treatments that support a person's recovery can improve the well-being of, and minimise risks to, any dependent children.

When generally considering the wider possible impacts on children, adult services need to be aware that recovery timescales set for adults may differ from timescales to improve the immediate circumstances, and longer-term outcomes for, children.

Adult services should therefore always keep in regular contact with child services to agree any contingency or supportive measures that might need to be put in place.

This is particularly the case where any planned withdrawal of services may be planned.

In these circumstances it is vitally important to keep the child visible in the professional community.

MAIN CHAPTER SUMMARIES

CHAPTER 1 - DESCRIBING THE CHALLENGE

13. The First chapter of this Guidance describes the challenge of problematic alcohol and/or drug use and its specific impacts on children and families. It also provides child and adult service practitioners with a brief overview of the supporting evidence base. It then summarises the impacts on children and families.

14. The key messages for practitioners from Chapter 1 are summarised in the table below:

SUMMARY MESSAGES FROM CHAPTER ONE - DESCRIBING THE CHALLENGE

Describing the Challenge

Substance use is associated with a large variety of drugs from all major groups, illegal, prescribed and legal. Its effects on families can vary greatly.

For the purpose of this guidance we generally refer to problematic alcohol and/or drug use as the stage when the use of drugs or alcohol is having a harmful effect on a person's life.

Pregnancy and pre-conception stages are the earliest - and most critical stages - at which services can put in place effective interventions that will prevent long-term harms to children and families.

Early identification of concerns should indicate level of interventions required to safeguard and protect children.

Examples of Impacts

No safe level of alcohol use during pregnancy has been established. Ideally services should be looking for early signs where children might be at risk.

Guidance at these stages tends to highlight lower thresholds of adult substance use before services should consider these interventions to protect children.

When considering an adult's ability to care for their child and to parent effectively, services should account for the combined effects of the use of different substances (including alcohol) at any one time - and also over time.

Services should take account of this when considering interventions to protect vulnerable babies and prevent longer-term harms.

Infants and children with Fetal Alcohol Spectrum Disorder - which may result from mothers drinking during pregnancy - can be particularly challenging to care for.

This condition has potential lifelong consequences.

In light of these severe impacts, it is vitally important that services work effectively at the critical pre-conception and pregnancy stages to advise women about sexual health planning, the consequences of drinking alcohol before and while pregnant and otherwise using substances.

In doing so they should follow the advice given by Scotland's Chief Medical Officer.

Injecting drug use is also associated with an increased risk of blood borne virus infections (i.e. HIV, hepatitis B and hepatitis C). Children can be at risk of these infections through mother-to-child transmission (during pregnancy, childbirth and breastfeeding), 'Household contact' (sharing items that nick/cut eg. razors and toothbrushes) or accidental injury involving used injecting equipment (e.g. a needle-stick injury). Affected children and families require additional support to help them cope with the diagnosis, treatment, illness and stigma.

It is important that services take account of the effects of problematic alcohol and/or drug use on all members of a family.

Having done so, they should put in place effective, strength focused supports that promote children's resilience to the harms caused by damaging alcohol and/or drug use.

CHAPTER 2 - DECIDING WHEN CHILDREN NEED HELP

15. Chapter 2 gives advice to services about what to look for when gathering early information about children, individuals and families that may be at risk. It describes some key principles of intervention. It also describes some issues (e.g. mental health issues) that often co-exist with alcohol and/or drug use and that services should also be aware of.

16. The key messages for practitioners from Chapter 2 are summarised in the table below:

SUMMARY MESSAGES FROM CHAPTER 2 - DECIDING WHEN CHILDREN NEED HELP

All Services

All services have a part to play in helping to identify children that may be at risk from their parent's problematic alcohol and/or drug use and at an early stage.

The welfare of the child is always paramount.

When working with parents with problematic alcohol and/or drug use, all services should consider the possible impacts on any dependent children, be alert to their needs and welfare and respond in a co-ordinated way with other services to any emerging problems.

They should gather basic information about the household and family wherever possible. When gathering this information all services should consider possible impacts on any dependent children.

This information should also take account of any wider factors that may affect the family's ability to manage and parent effectively. It should also take account of any strengths within the family that may be utilised.

The child's Named Person should be kept informed of developments.

Adult Services

Adult service staff should be equipped to provide information to parents about the impacts on children of their alcohol and/or drug use.

This may include family planning discussions with vulnerable adults at risk of unplanned pregnancies.

It may also involve discussions about any risks of continued alcohol and/or drug use to unborn children.

Information and advice on the risks of blood borne virus infections (HIV, hepatitis B, hepatitis C) to children as a result of parental injecting drug use and how to reduce the risk of transmission.

Local protocols should be in place describing what to do when a possible risk is identified and how to share information and who with.

Related Issues

Alcohol and/or drug use may co-exist with other issues that can affect a child's well-being - e.g. mental health issues, domestic abuse etc.

All services should consider these wider factors that may impact on a family's ability to recover when gathering information about vulnerable children and adults.

They should also take account of any strengths within the family that may be harnessed when considering supports. Extended family members, for example, can provide supports. Practitioners should consider how they might enable them to do that.

The collective needs of families then need to be addressed in a comprehensive and co-ordinated way by services.

The child's Named Person should be kept involved.

What to do when a concern about a child's well-being has been identified

Information gathering by services is not a one-off event. All services should be alert to changes in a family's circumstances and consider any detrimental impacts on their ability to look after children.

Immediate risk to a child should be considered at the outset.

Where concerns about a child's well-being come to a service's attention, staff will need to determine both the nature of the concern and also what the child may need.

While all services are responsible for identifying problems and gathering information, services will vary in their ability to assess harms to children.

To enable them to do this, it is important that all services have arrangements in place to pass on information and to work with social work services to assess and continue to work with the family.

This may result in other services being asked for information or for their view of a child's or family's needs.

Services should not make decisions about a child's needs without feeling confident that they have the necessary information to do so.

The child's Named Person or Lead Professional may be the most appropriate first point of contact to seek more information from or share information with.

Local protocols should reflect the agreed arrangements for sharing information and with whom.

Care should be taken to ensure that information is shared appropriately and proportionately and should not be shared without consent unless there are concerns about the child's well-being.

Where there are concerns about a child's well-being, adult services should seek advice from Social Work services and then take appropriate action.

Each service working with parents with problem alcohol and/or drug use should have child protection procedures in place. They should consult with Child Protection Committees about the content of these procedures.

CHAPTER 3 - INFORMATION SHARING

17. Chapter 3 offers advice to services about when and how to share information securely.

18. The key messages for practitioners from Chapter 3 are summarised in the table below:

SUMMARY MESSAGES FROM CHAPTER 3 - INFORMATION SHARING

Legislation

The purpose of legislation surrounding information sharing is not to prevent information sharing, but to ensure that information sharing is necessary, proportionate and appropriate.

The default position here is that information should always be shared where a child is considered to be at risk of harm.

Confidentiality

Practitioners working with children and families should be aware of the Common Law Duty of Confidentiality.

Not all information is confidential. Confidentiality is not an absolute right.

Confidentiality should not be interpreted as absolute secrecy.

There are circumstances in which confidential information can be shared, for example if there are concerns about a child's safety.

Consent

Consent must be informed and unambiguous.

Consent must always be recorded.

• If consent is refused or withdrawn, it may still be necessary to share information - e.g. where a practitioner feels that there are sufficient grounds to believe that a child is at risk.
• The reasons for sharing information in these circumstances should always be recorded.
• Consent should not be sought where this may cause risk to a child - and again - the reasons for this should always be recorded.

CHAPTER 4 - ASSESSING RISKS AND IMPROVING OUTCOMES

19. Chapter 4 describes the next key stages of Assessment - and also responding to - identified concerns about children. In doing so it reflects the Getting it right for every child practice model and also the principles of early intervention and Recovery.

20. The key messages for practitioners from Chapter 4 are summarised in the table below:

SUMMARY MESSAGES FROM CHAPTER 4 - ASSESSING RISKS AND IMPROVING OUTCOMES

Assessing Risks and Needs

All services must look at the parent's alcohol and/or drug use from the perspective of the child to understand the impact that this has on the child's life and development.

Services should also consider each child in a household separately as their needs may differ significantly.

Assessment should be continuous to take account of changing circumstances that may impact on the child and family.

Children and parents should be included in the process to maximise chances of overall recovery.

Where the child's predominant needs are within universal services, it is likely that the Named Person will be in universal services and also act as Lead Professional to co-ordinate the help that is to be given.

Where a single agency assessment of a child/families risks and needs identifies that multi-agency support and care planning is required, the Named Person should arrange for this transition into multi-agency support.

They should follow locally agreed arrangements for this to happen and should use their assessment as the basis for agreeing that transition.

The Lead Professional should co-ordinate the delivery of any agreed Child's Plan. That is, the agreed action plan that sets out what actions are to be taken and by what service.

The Child's Plan requires that the views of the child and family are included.

Services should ensure that these key elements of the Getting it Right for every child practice model are included in any local protocols.

The assessment, support and interventions set out in a Child's Plan should focus on the family strengths as well as the pressures that are impacting on the child's well-being - with actions designed to reduce these. These should be features of any Child's Plan - whether single or multi-agency. Any Plan should also focus on the child's outcomes.

Plans should also cover critical times where extra and seamless support for the family may be needed - e.g. where an adult is being released from prison or is accessing treatment.

Outcomes and Review

The Child's Plan will include targets and outcomes to be met by individual services delivering supports to a family.

Any planned withdrawal of a specific service should be communicated to the Named Person in the event that the Child's Plan needs to be adjusted to include any contingency measures.

Early and co-ordinated interventions focused on the recovery of the whole family are best to avoid problems becoming more complex, resource intensive, and difficult to manage further downstream.

The Child's Plan should be reviewed to regularly take account of any missed targets etc.

CHAPTER 5 - WORKING TOGETHER

21. Chapter 5 looks at the strengths and challenges of multi-agency working and the individual roles and responsibilities of services.

22. The key messages for practitioners from Chapter 5 are summarised in the table below:

SUMMARY MESSAGES FROM FIFTH CHAPTER - WORKING TOGETHER

Problems in alcohol and/or drug using families are often complex and cannot usually be solved by one services alone.

The welfare of the child is always paramount.

Any care plans agreed by services should include a definite timescale by which a child must be seen by services.

Any care plans agreed by services should a definite timescale by which a child must be seen by services.

To help ensure effective working, all services should ensure that the key features of Getting it right for every child (see opening Policy Framework Section) are included in local protocols. This has a focus on early, proactive intervention by services in order to create a supportive environment and identify any additional supports for a family that may be required.

The key to making effective decisions in determining the degree of risk to a child is good inter-agency communication and collaboration at all stages - i.e. assessment, planning and intervention.

Evidence shows that children affected by parental alcohol and/or drug use are more likely to experience repeated separations from parents and multiple care placements. In these particular circumstances it is vitally important that all services have agreed contingency plans and maintain communication about these.

All alcohol, drugs, children's services and childcare agencies have an ongoing part to play to ensure continued support to families through all stages of assessment, planning, interventions and follow-up supports to work towards recovery.

CHAPTER 6 - STRATEGIC LEADERSHIP AND WORKFORCE DEVELOPMENT

23. Chapter 6 sets out the expectations for strategic leaders and local planning forums to support operational service planning and delivery.

24. The key messages for practitioners from Chapter 6 are summarised in the table below:

SUMMARY MESSAGES FROM CHAPTER 6 - STRATEGIC LEADERSHIP AND WORKFORCE DEVELOPMENT

Strong strategic leadership and a committed workforce underpin effective front-line service delivery.

Effective partnership working is at the core of this.

Strategic partners should ensure that Community Planning takes a coherent response to problematic alcohol and/or drug use. This included in relation to impacts on children affected by their parent's alcohol and/or drug use.

Jointly agreed protocols between key strategic partners - including the area Alcohol and Drug Partnerships and the Child Protection Committees as key bodies responsible for co-ordinating local child and adult services - should be in place,

All strategic partnership agreements and local delivery action plans should be coherent and agreed and underpinned by strong accountability and governance arrangements.

Services should ensure that local mechanisms are in place to provide learning and development opportunities for staff. This should include opportunities for all levels of staff, including practitioners, operational managers, specialist services and strategic leaders and Elected Members.

CPCs and ADPs should develop a joint training programme and strategy for all staff working with children, individuals and families where alcohol and/or drug use is a factor.

DIAGRAMS FOR REFERENCE

The GIRFEC diagram below describes the assessment routes (whether single agency or multi-agency) and the points where the Named Person and Lead Professional would usually have a role.

FLOWCHART - DESCRIBING BROAD STEPS TAKEN FROM IDENTIFICATION OF A CHILD IN NEED TO ASSESSING RISKS AND CARE PLANNING

The diagram below summarises the key information sharing considerations for practitioners. This includes what information to share, who to share with, and how the information should be shared.