GETTING OUR PRIORITIES RIGHT (GOPR)

Chapter 2

DECIDING WHEN CHILDREN NEED HELP

This Chapter gives advice to services - including adult focused services - about what to look for when deciding whether children need help.

Children in need here includes children and young people who provide care or support for parents with problem alcohol and/or drug use - often termed "young carers".

This chapter also describes some guiding principles of intervention for services. It is divided into three main sections:

• What services should look for when deciding whether children need help - gathering information and including key principles of intervention.
• Related Issues - these often co-exist with substance use and can include, for example, Mental Health, Domestic Abuse, Young Carers etc.
• What to do once a concern about a child's well-being has been identified.

For practitioners' ease of reference, the key messages from this Second Chapter are summarised below.

SUMMARY MESSAGES FROM SECOND CHAPTER - 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 problem alcohol and/or drug use and at an early stage.

The welfare of the child is always paramount.

When working with parents with problem 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 substance 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 substance use to unborn children.

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

Substance 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.

DECIDING WHEN CHILDREN NEED HELP - GATHERING INFORMATION

"There were so many things had to keep quiet so I just didn't bother to say anything in case I let something slip out that I shouldn't have done so whenever they started talking about things I'd just say I didn't know".
Fixy, aged 15
(Barnard and Barlow, 2002)

93. Chapter one described some of the problems that can be experienced by children and their families where problem alcohol and/or drug use is a factor. This chapter provides advice to services - including those providing treatment and care to substance using adults - about what they might look for when considering whether children and families are in need of help.

94. A key message here is that, when working with parents with problem alcohol and/or drug use, services should always 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.

95. Section 93 (4) of the Children (Scotland) Act 1995 defines a child in need as:

Being in need of care and attention because:

• s/he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining a reasonable standard of health or development unless there are provided for him/her, under or by virtue of this part, services by a local authority;

or

• his/her health or development is likely significantly to be impaired, or further impaired, unless such services are so provided.

GUIDING PRINCIPLES

96. Services, such as local authorities, Health Services, Housing Agencies, Courts and Children's Hearings, and other services in contact with families) have a range of responsibilities to promote the welfare of children and protect them from danger.

97. Relevant legislation, and key roles and responsibilities here, are described in the 2010 national Child Protection Guidance. This Guidance should be read together with that document.

98. Some key themes and principles apply whether a service has a principal focus on adults or children and should inform their work with families where problem alcohol and/or drug use is a factor.

99. These key themes and principles are:

The welfare of the child is the paramount consideration

When working with families affected by drugs and/or alcohol, the welfare of children should always come first.

Every child has a right to be treated as an individual

Parental, problem alcohol and/or drug use cannot be considered in isolation by services. Their assessment should take into account the wider family context and individual circumstances.

Every child who can form a view on matters affecting him or her has the right to express those views if he or she wishes

Children should be considered and consulted when parents and professionals make important decisions that affect them. This might include decisions about with whom they should live, their schooling, their relationships and lifestyle. Their rights should be respected.

Every child has the right to protection from all forms of abuse, neglect or exploitation

All agencies in contact with families affected by problem alcohol and/or drug use should consider the safety and welfare of the children of those families.

Parents should normally be responsible for the upbringing of their children and should share the responsibility. So far as is consistent with safeguarding and promoting the child's welfare, local authorities should promote the upbringing of children by their families

Agencies should help parents to acquire the necessary parenting skills and put children's welfare first. Where a child cannot be looked after safely by his or her own parents, local authority services should try to help extended family to care for the child if that is possible. Where a child's welfare cannot be promoted or safeguarded in his or her family, or extended family, local authorities should make alternative arrangements promptly.

Any intervention by a public authority in the life of a child must be properly justified and supported by all relevant services working in collaboration

Parental problem alcohol and/or drug use will often be a cause for concern. Local Authorities - normally through social work and other support services and other agencies - should assess the child's and family's circumstances and offer help and support to enable parents - where possible - to provide the necessary care for their children at home. Agencies should also take account of other wider principles - e.g. equality issues and the rights of the child etc.

WHAT SERVICES SHOULD LOOK FOR - GENERAL

CHILD AND ADULT SERVICES

100. All services have a part to play in helping to identify children affected by parental problem alcohol and/or drug use at an early stage. They should gather basic information about the family wherever possible.

101. Although parental alcohol and/or drug use can have a number of impacts on children and families, it does not necessarily follow that all children will be adversely affected. On the other hand, it is also true that parents and children hide problems - sometimes very serious ones. For example, children are often wary of talking about their needs for fear of losing their parents. Parents may also have concerns about their children being taken into care.

102. Generally, where substance use is identified, this should act as a prompt for all services - whether in an adult or child care setting - to consider how this might impact on any dependent child.

103. How this is done may vary - dependent on that service's role with the family. This could be achieved through direct observation of the child or through initial discussions with the parents/carer.

104. Other factors that might impact on a family's ability to manage and parent effectively (for example domestic abuse, poverty etc. - see Related Issues part below) should also be considered and assessed by services.

105. As part of early engagement with vulnerable adults and children - and where gathering information - practitioners should also identify and build on any strengths when identifying areas where the adult, or child, may require support. These strengths, along with any concerns about well-being should be conveyed to the child's Named Person.

ADULT SERVICES

106. Adult services will play a vital role in the support and protection of children. While their main role is with the adult service user, they have an important role in the identification of children living with - and being cared for by adults with problems associated with problem alcohol and/or drug use. They should be aware of the possible needs of children in the care of these adults.

107. Adult services should be equipped to provide information and advice to parents about the possible impacts of their problem alcohol and/or drug use on dependent children, together with other information and advice about alcohol/drugs and their effects. They should always explore how problem alcohol and/or drug use may affect an adult's responsibilities for child care.

108. Some vulnerable adults with alcohol and/or drug use issues may be at risk of unwanted pregnancies. In these circumstances, staff should generally gather information from them about family planning. They may want to discuss - for example, and where appropriate - options with vulnerable adults around the use of long-acting reversible contraception (LARC).

109. Staff should also consider any specific risks to any unborn children and liaise with other services where necessary.

KEY PRACTICE POINTS FOR ADULT SERVICES

Wider questions may be relevant - dependent on individual case circumstances - but all services supporting adults with problem alcohol and/or drug use should consider asking new attendees the following questions:

• Are you a parent or living in a household with children?
• How many dependent children live with you?
• Do you have any children who live with others or are in residential care?
• What is your child(ren)'s age and gender?
• What school/nursery or pre-school facility do they attend?
• Are you registered with a GP?
• Are there any other relatives or support agencies in touch with your family who are supporting the children?
• Do you need any help with looking after children or arranging childcare?
• Are you planning to have any more children? If yes, and this is not a good time for you to have a baby, can we help you to access LARC ?
• Has there been any change in family circumstances - e.g. a new partner has moved in?
• What other services are supporting you?

KEY PRACTICE POINTS FOR WHOLE FAMILY/CHILD SERVICES

All services supporting parents and children should consider the following:

• Are you seeking support for your substance use at the moment? If so, what support/treatment are you receiving?
• Are your children aware of any support you are receiving?
• Have you any other children who are not living with you at the moment?
• Is the parent/carer on any prescription medication?
• Is there anyone living in the home who is being supported by alcohol/drug treatment services?
• Are there any other adults visiting the home who may be using illegal substances?
• Are there signs of illegal substance use within the home environment?

RELATED ISSUES

110. As mentioned above, all services should consider any wider factors when gathering information about vulnerable children and adults. This is because problem drug and/or alcohol use cannot be understood in isolation. There are many factors that can affect the well-being of children and their families.

111. Children often live with multiple challenges (parental problem alcohol and/or drug use, domestic abuse, parental mental health issues, parental learning disability, poverty and homelessness) and face cumulative risks (Cleaver et al., 2010). Some of these related issues are summarise below.

DOMESTIC ABUSE

112. Domestic abuse describes any behaviour that involves the exerting of control over a partner or ex-partner to an extent that undermines their personal autonomy. Although most victims are women, men can also suffer domestic abuse, and it can also occur in same-sex relationships.

113. Children and young people living with domestic abuse are at increased risk of significant harm, both as a result of witnessing the abuse and being abused themselves. It is estimated that 100,000 children in Scotland live with domestic abuse. The impact of domestic abuse on children and families has been well documented elsewhere and further information on it can be found in the National Domestic Abuse Delivery Plan for Children and Young People (2008).

114. Alcohol and/or drug use can co-exist with domestic abuse - by the perpetrator, the victim or both. Some victims also self medicate with alcohol or drugs as a coping mechanism and some abusers use dependence on alcohol or drugs as a means of controlling the victim. Domestic abuse is not a one-off incident, it is a systematic and sustained set of behaviours used over a period of time to control and exert power over the victim.

TRAUMA

115. Traumatic experiences in childhood and adolescence (for example, sexual abuse, emotional neglect and lack of attachment in early childhood) can be a major hindrance to recovery if not dealt with through support and advice.

MENTAL HEALTH

116. Problem alcohol use is associated with a number of psychological and psychiatric problems, such as depression, anxiety and psychotic illness. Many people use alcohol as a means of coping with stressful social circumstances and this may lead to harmful drinking, as well as exacerbating depressive mood disorders and anxieties. Alcohol is also known to be a risk factor for suicide.

117. Research shows problem drug use may lead to, or exacerbate, psychiatric or psychological symptoms or syndromes. The most common associations for problem alcohol and/or drug use are with anti-social personality disorders, depression and schizophrenia.

118. Special attention should be given to the potential of psychiatric co-morbidity in assessment during pregnancy. In the light of the dual diagnosis of e.g. depression, anxiety and problem drug/alcohol use, appropriate treatment of both disorders should be initiated.

YOUNG CARERS

119. In some cases, children can become young carers when the parent's health is so poor that they are unable to manage daily household tasks (e.g. shopping, cooking and cleaning) and other responsibilities around the children (i.e. taking them to and from school).

KINSHIP CARE

120. A 'kinship carer' can be a person who is related to the child or a person who is known to the child and with whom the child has a pre-existing relationship.

121. Looking After the Family: a Study of Children Looked After in Kinship Care in Scotland (2006) found that the majority of children came to placements because of neglect as a result of their parents problematic alcohol and/or drug use. Relatives and extended family can be a crucial source of support and help for the child and his or her problem alcohol and/or drug using parent(s). However, this may not always be straightforward.

122. Family relationships may become strained by the parent's problem alcohol and/or drug use and also by relatives' anxiety and anger about their health, or the well-being and care of children (Zuckerman, 1994). Kinship care can have important benefits for the children in these placements but these benefits should not be gained at the cost of the kinship carer's well-being.

123. Catering for the interests and needs of the child(ren), the problem alcohol or drug using parent(s), and extended family members involved, requires skill, sensitivity and tact. The situation can create conflict between family members. The child and/or extended family may need protection from this and also from the stresses of the assessment process.

124. The welfare of the child is always the paramount consideration for practitioners, but services should also assess and provide for the needs of extended family carers to enable them to help as best as they can. Care for children by extended family arrangements will need sensitive and effective support from local services. This should include:

• financial and material support when needed;
• help to negotiate agreements and decisions with the child's parent(s) and other agencies;
• support, where appropriate, to become permanent carers for the child if he/she cannot be brought up by his/her birth parents;
• advice about their family member's substance use and when and how to talk to children about this;
• respite care when needed;
• help with accommodation issues; and
• offering or facilitating support groups for kinship carers is seen as helpful and non-stigmatising.

125. When gathering information about families, all services should be aware that the collective needs of those families should be addressed in a comprehensive way.

QUOTES

"I was looking about for them 'cos they said they'd come but they never. I thought they must no' care about me then.....things like racing, yer school sports and they said they would come but they never....when I think about it now, it was like heart breaking......it wisnae very nice."
Susan - aged 14 years
(Barnard and Barlow, 2002)

WHAT TO DO ONCE A POSSIBLE CONCERN HAS BEEN IDENTIFIED

"It sometimes feels like the support is only there either for us or for our children but not for both of us. Somebody needs to realise that helping us be better parents does give our children a better chance"
Sheila - problem drinker with two children
(Castlemilk, 1998)

126. 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. Any immediate risk should be considered at the outset. Where immediate risk is not identified, practitioners should consider the five questions highlighted below.

127. They should also consider sharing information with the Named Person or Lead Professional - where one is in place - to ensure that appropriate help can be organised.

128. While all services are responsible for identifying problems and gathering information, services will vary in their ability to assess harms to children. In these circumstances, it is important that all services have arrangements in place to pass on information and to work with other services, both universal and targeted, 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.

KEY PRACTICE POINTS

At each stage of an intervention, practitioners should ask themselves the following questions:

• What is getting in the way of this child or young person's well-being?
• Do I have all the information I need to help this child or young person?
• What can I do now to help this child or young person?
• What can my agency do to help this child or young person?
• What additional help, if any, may be needed from others?
• What might happen if I do not intervene.

129. 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 (see Chapter 3 for further information here).

PRACTICE STUDY: EARLY INTERVENTION

Quarriers Carer Support Service (Moray) aims to delivers an approach to identify hidden young carers affected by parental substance misuse aiming to respond to the challenges of identifying and engaging with young carers. Initial funding was provided by the local ADP to pilot to identify children affected by parental substance issues.

Posters and flyers aim to promote the service to young carers affected by parental substance misuse. All of the promotional materials were designed by young carers affected by parental substance misuse. We believe services are more effective when those they are designed to support are placed at the centre of design and delivery. By promoting the service and helpline, we encourage young people to self-refer to the service and encourage their peers to support them to access the service. A Facebook page has been developed for Quarriers Carer Support Service (Moray), recognising the accessibility of social media to young people, and the non-threatening nature of this medium. Since developing this tool, many young people have chosen this as a method of engagement with the service.

Recognition that self referral, even with the support of a friend, will not suit all young people. Therefore, promotion of the service to other agencies throughout Moray (education, social work, police and health) so that they may recognise the signs of a young carer and refer them for support. We also work closely with Studio 8 (a support service for those affected by substance misuse, delivered by Turning Point) for cross referrals.

Recognising the barriers which young people affected by parental substance misuse face when asking for support we work closely with schools and youth groups in Moray to raise awareness of the issue, and identify young carers. Group drama sessions in schools offer a non-stigmatising environment where young people are given the opportunity to ask for help for themselves or a friend. This has proven to be the most effective route to identify young carers and we intend to continue with this. However, in order to continually use the best methods, we will consult with young people about the design and delivery of the sessions, possibly developing a music workshop or sport based workshop.

Practice Points (what has worked in relation to early engagement):

• Involvement of children and young people and asking them what makes it easier to ask for help or support.
• Helping other professionals understand what to look for in terms of children in need.
• Local strategic support that recognises the importance of early identification and how this links with other local plans.