GETTING OUR PRIORITIES RIGHT (GOPR)

Chapter 5

WORKING TOGETHER

Working with a child and their family requires a co-ordinated response by services that identifies and meets all of the needs of the child and the family. These needs might extend beyond the problem alcohol and/or drug use.

This chapter is divided into two main sections which specifically look at:

• Multi-agency working - strengths and challenges/barriers.
• Individual roles and responsibilities of individual services.

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

INTRODUCTION

202. The last chapter described how agencies might assess risks and needs for vulnerable children and their families. It also described how - having done so - they might plan supports and interventions and that these should ordinarily be co-ordinated through the Child's Plan (see opening Policy Framework section).

203. This chapter gives advice to services about how to work effectively together to provide supports needed for a child and family up to and following assessment.

MULTI-AGENCY WORKING - STRENGTHS AND CHALLENGES

GENERAL

204. It is not sufficient to protect children from the serious risks associated with parental alcohol and/or drug use. It is important to provide for the wider needs of the child and family for overall, therapy, support and recovery.

205. Co-ordinated interventions might include help for parents to develop their parenting skills and interventions aimed at reducing or stopping substance use. This will require re-orientation and better co-ordination of adult substance use services and child services and geared towards early intervention.

206. All staff should recognise that their efforts to assist their client are part of a complex set of interactions which will impact both on individual workers from single agencies and also on the family as a whole. Not all problems can be solved, and often no single worker/service can solve them alone.

207. Working together means working across boundaries and with a range of partners including children, parents, families, communities and other professionals. Different services have different types of expertise that can benefit families, where this is shared. For example, a childcare professional may need assistance in recognising problematic substance use and understanding its impact(s) - whereas a drug and alcohol worker may need support to understand children's developmental needs and also to recognise those situations where they can be put at risk.

208. Effective partnership working is an underpinning principle of Getting it right for every child which has a focus on early, proactive intervention in order to create a supportive environment and identify any additional supports for a family that may be required.

209. To help ensure effective working, all agencies should embed the GIRFEC National Practice Model (in particular the shared understanding of a child's well-being, the role of the Named Person and also the Lead Professional) into local protocols for tackling substance use (see Opening Policy Framework Section).

PRACTICE STUDY: JOINT WORKING

The Midlothian Family Support Service was established as a partnership with the ADAT (now ADP) and Children 1st and had two priorities: firstly, to establish the service in the same offices as the Midlothian Substance Misuse Service, so there was improved working with adult substance misuse professionals and secondly, to provide an early intervention support service for children who are affected by parental substance misuse.

All referrals into the MFSS are directed through the Midlothian Substance Misuse Screening Group, a multi-agency forum that aims to ensure that the needs of any child living with the impact of parental substance misuse are met.

Most referrals come from Community Psychiatric Nurses when patients in the substance misuse service indicate that they are struggling with some element of their parenting, or their child's behaviour is causing concern. Family members are made aware of the close working relationship between the Midlothian Family Support Service and substance misuse partners, who will work collaboratively to ensure the adult patient has the best support in terms of their substance use and in their parenting role. As lapse and re-lapse is symptomatic of the recovery process, there is an inevitable direct impact on how the family functions with intermittent levels of chaos and potential risks to children.

Midlothian Family Support Service is likely to be the primary support provider with access to the family at home during a crisis period and has a key role in ensuring that other agencies involved are working in unison, information is being shared and importantly, that appropriate action is taken to safeguard the wellbeing of children and young people in the family.

Practice Points (what has worked in relation to this joint working approach):

• Co-location supports effective communication and information sharing
• Co-located partners compliment each other's role and responsibilities
• Shared knowledge base
• Consideration of service delivery across all elements of service provision
• Robust monitoring of the home environment - able to challenge discrepancies
• Parents and children and better supported.

Local Developments that supported the approach:

• Children 1st and Adult Social Work were co-located with NHS substance misuse service
• Establishment of Multi-Agency Screening Group
• Every children affected by parental substance misuse was to be referred through the Screening Group
• A child focus was to be part of all adult assessments

"not one service can provide everything for everyone - that's why it's important to be involved in joint working, sharing skills and opportunities to co-workers." Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010))

BARRIERS TO MULTI-AGENCY WORKING

210. A perceived lack of communication between children's and adults' services is frequently mentioned as a key concern in individual cases where problem alcohol and/or drug use is a factor. This lack of effective communication can put children and families at risk of falling through the gaps.

211. Other services, such as the police or schools, also come into contact with families affected by problem alcohol and/or drug use. Communication between them is also vital to ensure that all vulnerable families in need of support are able to access it.

212. It is unlikely that one service will be able to fulfil all the support needs of a family. For example, children's and families' workers may wish to refer parents on to other support services, such as counselling, anger management, help with domestic violence or employment services. To do so, they need to be aware of the availability of these services locally.

213. Cleaver et al (2008) - A study of child protection, domestic abuse and problem parental substance use found that wider adult services, such as domestic violence and alcohol and drug use services, were not routinely involved at all stages of the child protection process. The study identified some key issues as barriers to good working relationships. These include:

• a lack of clear systems in place to resolve confidentiality issues;
• insufficient resources (including time, workloads, costs and staffing);
• a lack of trust and negative preconceptions of parents with problematic alcohol and/or drug use, and;
• parents believed that services to help families could be improved if practitioners co-ordinated better with other services.

ENABLERS TO MULTI-AGENCY WORKING

214. The study also found that the following factors were necessary to both overcome some of these barriers, and also to support good working relationships:

• understanding and respecting the roles and responsibilities of other services;
• good communication;
• regular contact and meetings;
• common priorities;
• joint training;
• knowing what services are available and who to contact;
• clear guidelines and procedures for working together, and;
• low staff turnover.

215. The table below summarises some of these barriers and enablers to effective partnership working.

KEY PRACTICE POINTS

ENABLERS AND BARRIERS TO JOINT WORKING

Enablers

Barriers

Establishing clear roles Fostering commitment to inter-agency working at all levels within organisations Promoting trust and respect between professionals Raising awareness of the context, culture (including belief systems and values) and remit of other agencies Addressing issues of power, status and hierarchy Clear communication Consulting with service users and member agencies on issues, needs and priorities Establishing clear and realistic aims and objectives that are understood and accepted by all agencies Adequate resourcing in terms of funding, staffing and time including explicit agreements about how partnerships will share resources

Lack of commitment to interagency working Role ambiguity and blurring of professional boundaries Stereotypical thinking and failure to recognise contribution made by other agencies Lack of communication Lack of a shared vision

Fiona Mitchell, SCCPN, 2010

TYPES OF SITUATIONS THAT ILLUSTRATE THE IMPORTANCE OF STRONG MULTI-AGENCY WORKING

DIFFICULTIES IN MAINTAINING CONTACT AND SEEING CHILDREN

216. A number of reports have highlighted situations in which professionals failed to identify children suffering neglect and poor parenting resulting in significant harm, when parents had refused entry to the family home and professionals did not persist in gaining access to the child.

217. It can be very difficult for individual services either to establish or maintain regular contact with people who have substance misuse problems. Planned appointments or visits may not be kept and parents may not respond to letters or calls. Parents may go to great lengths to avoid contact and they may be evasive and/or aggressive. Also, in some circumstances, parents may have stronger incentives to keep in touch with treatment and support agencies.

218. When keeping appointments with, or visiting their patients or clients, services should keep children in mind and alert child welfare agencies if families' problems intensify or conditions deteriorate to a level likely to present risks to children.

219. Services responsible for child welfare should include both planned and unplanned home visits in their contact with families, observe the child and his/her interaction with the parents, and gather information about daily routines and sleeping arrangements. Workers should persist in their efforts to contact the family or see the child until they are satisfied that the child is not at risk of significant harm.

220. Even though professionals gain access to a household, the child(ren) in the family may not be seen. Staff should record every unsuccessful attempt to see the child(ren) and follow up to make sure that the child has been seen by someone, either by checking with other professional colleagues or agencies, or by repeating the visit quickly.

221. Services should ensure that staff have access to advice from specialist colleagues or child protection services if they are persistently unable to see a child. Their expectations of staff in these circumstances should be clearly described in local policies and guidance. It is essential that every child in the family is seen and assessed.

222. Any Child's Plan - whether single or multi-agency - should include a definite timescale within which children must be seen by a staff member from one of the services involved.

223. Where professionals responsible for children's welfare in health or social work services repeatedly fail to gain access to a child(ren), the local authority should consider whether there may be a need to apply for a Child Assessment Order, requiring parents to make the child available to professionals (see Appendix 1). If there is any concern that a child may be in immediate danger the social work service or the police should be contacted promptly.

224. Where the parent does not accept help or agree to a referral to another service - and worries about the child persist - practitioners should contact the social work service without delay.

225. Alcohol and drugs agencies' responsibilities - to both support their adult clients and also maintain a focus on child welfare - do not end after referral to the social work service or other child protection services.

226. Parents will continue to need support from familiar professionals with whom they have established relationships. It is crucial that specialist alcohol and drugs-related professionals and children's support agencies continue to work closely together to help families make best use of the help available.

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

228. This demands open and honest communication between professionals in different agencies and sharing of information about progress and regression. For example, a parent's encouraging signs of progress in substance use recovery may be too late or too slow for a child whose early experience is one of deprivation, trauma and unpredictable parenting and also who has a strong attachment to substitute carers.

229. Services should consider first and foremost the current and potential effect of continuing adversity on the child, regardless of the parent's intentions. All services should always consider the child's welfare to be the paramount consideration.

230. If support provided to the family does not improve the child's circumstances, other action, such as child protection enquiries, compulsory measures of supervision or removal of a child from his/her parents' care may be needed. The threshold for this kind of action is reached when there is evidence or suspicion of a lack of parental care or supervision, or abuse or neglect which may cause a child to suffer significant harm. There need not be evidence of deliberate abuse or neglect to prompt action.

PRACTICE STUDY: TRYING TO GET THROUGH THE DOOR

Mum was referred to Aberlour whole-family approach outreach support project by the local addiction service in Dumfries. Nine appointments were offered to mum before she engaged with the project. In the beginning, when visiting to undertake the initial appointment, outreach project staff had the door slammed on them and were told to go away. The initial support identified was in relation to parenting routines and boundaries and socialising for the 2 year old within the family. Mum also required emotional support and 1:1 practical support. The children were on the at risk register.

Partnership working with Cameron House was very helpful, as the parent was aware we were fully updated as to her current interventions/future plans re: reduction etc. Initially being persistent and not giving up on the family, when the family didn't engage with the service, the service user later told us she was testing our commitment to her and her family, previous services only offered 3 appointments then closed her referral.

The most successful approach was adapting the support we provide to meet the families needs both collectively and individually .Also providing the support at an appropriate time to suit the family.

Mum was on a methadone prescription and not confident about engaging with the wider community therefore her children were isolated. Her 6 year old son only had contact outside the home whilst he was at school. Gradually the family were encouraged to participate in small activity sessions and then larger group activities within the wider community. As mum's confidence grew the service supported her to attend 'baby group' with her 2 year old son to aid his social skills and speech. The 6 year old was supported to attend the project's homework club and received support in a variety of areas. Mum was supported to attend community activities and linked with Community Learning and Development.

Mum has now developed a good relationship with the project and other community agencies. She successfully completed a reduction of her methadone and is now completely drug free. Her mood changed initially as she was becoming withdrawn again. Staff worked with her to re-engage her with the community.

The younger boy is now attending nursery five mornings a week and older child has very good attendance at school. He also attends a local drama group which staff helped mum to find.

The children have now been de-registered but are linked to children and families social work on a voluntary basis. The family's planned case closure was at the end of the year (Dec 2011), initially mum did not wish her case closed and panicked about the family's future. The support worker for the family has worked with mum to prepare her for the case closing and reinforced it is a good thing that her family does not require support and it is a huge achievement on mum's part. Mum was advised if she requires advice in the future she can contact the project and they will signpost as required.

PRACTICE POINTS TO CONSIDER FROM THIS CASE STUDY:

Commitment to engagement and persistency in visiting to gain access to the family and family home

Importance of visiting family at home, at different times

Identifying quickly what support the family need as a way of engagement, which should help work through more detailed assessment of need

Practical support and assistance can be a key step to helping parents engage and access more therapeutic supports

Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010))

SUPPORTIVE MATERIAL FOR ENGAGEMENT

In the study all projects note the importance of first impressions for potential clients. One notes the importance of this against the backdrop of a client's previous experience of poor engagement with services. The first visit is seen as an information gathering exercise which should not be 'too full on'. A number of services discuss the importance of 'chance meetings' to encourage engagement. The impressions given by most of the projects surveyed is that staff go out of their way to help people engage with the service. Cards or hand-written notes are left if people are not in at an appointment time, or miss an appointment. It is importance to all projects to show 'you are not giving up on them.' Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010))

QUOTE; "What helped me to attend in the first place was the worker's persistence". (Service user feedback)

LOOKED AFTER CHILDREN

231. Evidence shows that children affected by parental problem alcohol and/or drug use are more likely to experience repeated separation and multiple care placements. In these circumstances the local authority should make early contingency plans to reduce the length of time that children may drift in substitute care under uncertain plans. This requires effective communication between services.

232. When a child is looked after away from home, the local authority must prepare a written care plan describing the purpose of the placement, likely duration, and the services and support to be provided. This should set out:

KEY PRACTICE POINTS

If assessment indicates that a child is at risk in the care of a parent using alcohol and/or drugs, the child's social worker should consider the following:

• The needs of the child and how these might best be met. This should include an assessment of family ties and support for the child and while family members may be the most appropriate carers for the child, either alone or in partnership with others such as foster or respite carers.
• In consultation with specialist alcohol or drugs agencies supporting the parents, the local authority should determine a realistic timescale in which problem alcohol or drug using parents should stabilise and reduce alcohol intake or drug misuse, agreed wherever possible with parent(s).
• If the parent(s) fails to make demonstrable progress within this period, the social work service should consider advising the Reporter or Children's Hearing.
• If a child is placed in substitute care more than twice in one year, because parents' substance misuse makes them unable to look after the child safely, the local authority should seek advice from the Reporter or, if the child is under supervision, a review hearing; care away from home may have to be considered.

233. If extended family members are caring for a child on a long-term or permanent basis, the local authority should support them to obtain legal security for the child's placement, and appropriate legal responsibilities and rights under Part 1 of the Children (Scotland) Act 1995.

234. If grandparents are older carers, or there are concerns about their health, the local authority should help them to make contingency plans for the future care of their grandchild(ren).

235. As far as possible they should be enabled to make their own decisions about where the children in their family should live, unless this is not consistent with the children's welfare. Children and their carers should know what will happen, and be content with proposed arrangements, should the placement end suddenly.

MENDING RELATIONSHIPS

236. Optimum care for children is not only a matter of finding the right placement and ensuring safety and stability. Children, parents and other family members will need help to come to terms with trauma and parenting failure, and to repair relationships, whatever the eventual outcome.

237. The local authority must make decisions, with the parent(s) and others, about family members' continuing contact with children placed away from home - with whom, at what frequency and where this should take place. This will depend on:

• the child's age and stage of development;
• the stage of placement and the care plan for the child;
• the degree of stability in the parents' circumstances;
• parents' capacity to maintain reliable and supportive contact;
• the child's and parents' views and wishes, and those of any other relevant person;
• any order by a court or children's Hearing; and
• the views of the child's carers.

238. Where the child is deemed to be at little risk in the parents' care and the local authority plans a speedy return home, contact should be frequent and regular, with minimal restriction.

239. Parents may need help in managing periods when the child is in care, for example in forming positive relationships with foster carers, or help in adjusting to the child's return home and taking up the primary parenting role once more. When parents' problems do not improve, contact may be difficult for both child and parent to keep up, and it may become a source of disappointment and perceived failure for both.

240. The child's social worker should explore honestly and carefully with parents what they feel able to undertake, and help both parents and children to repair relationships and/or relinquish contact as gently as possible. The parent(s) may need help to present their views and wishes to the local authority, and may look to trusted workers in their alcohol or drugs related services for additional support.

241. When a parent is not able to resume care of their child they will need help and counselling to come to terms with this. The local authority responsible for the placement of the child should provide or arrange this through the social work service or another agency.

242. The loss of their child, whether to foster or adoptive carers or extended family, may exacerbate or intensify a parent's problem substance misuse. Family services should continue to work with the parent in these circumstances even where a child is removed. This is because the removal of a child can often be a precursor for relapse by parents.

243. Some parents may quickly have another child, exposing themselves and their new baby to the possibility of further trauma and harm. These parents will need careful assessment and intensive help if they are not to repeat their pattern.

244. All alcohol, drugs, children's services and childcare agencies have an ongoing part to play in their support.

245. A single incident may seem insignificant but when considered cumulatively with others may indicate the likelihood of damage to the child's development in the longer term. An assessment of whether or not harm to a child is 'significant' is a matter initially for professional judgement and subsequently for determination in individual cases by the courts and children's Hearings.

246. There may be times when an assessment is made that the level of problems caused by drug and /or alcohol use undermines capacity and necessitates the removal of children from their birth family, at the very least, on a temporary, respite basis. This is particularly important for younger children where neglect may inhibit secure attachment, and both physical and emotional difficulties may escalate. Interagency decision making is of particular importance in the assessment of such concerns.

When enough is enough

When a parent consistently places procurement and use of alcohol or drugs over their child's welfare and fails to meet a child's physical or emotional needs, the outlook for the child's health and development is poor. Problem alcohol or drug using parents themselves acknowledge this and it is the duty of professionals to act in the child's best interests when parents cannot.

INDIVIDUAL ROLES AND RESPONSIBILITIES OF SERVICES

247. Chapter One of this Guidance described some of the impacts of parental problem alcohol and/or drug use and stressed that these can vary - depending on the age, stage and needs of the child. Equally, families may experience periods of crisis as well as periods of stability.

248. As a result, levels of supports from individual services must also vary depending on the individual circumstances and needs of children and their families.

249. This part considers in more detail the specific contributions different services can make in supporting a child and their family. Whether acting as a Named Person/Lead Professional, or contributing to the Child's Plan and family support, all agencies will have a unique contribution to make.

UNIVERSAL HEALTH SERVICES

250. All universal health services - General Practitioners, Public Health Nurses - Health Visitor - School Nurses, Midwives, Obstetricians, Community Pharmacists etc - have a crucial role in identifying and responding to the support needs of unborn babies, children and young people who have parents with problem alcohol and/or drug use issues.

251. These services have a unique role to play specifically around protection, intervention and care. This is because these are the only services that actively provide services to all pregnant women, children and families.

252. Together with providing core services, universal services can ensure that pregnant women, children and families receive any additional supports that they require from other public services including the Third Sector.

253. The Universal Pathway of Care for Vulnerable Families (pre-conception to 3 years) highlights contact opportunities and also the approach that universal services should use to strengthen how they assess and respond to the needs of pregnant women, unborn babies and children.

254. Additionally, three separate pathways have been developed as part of the Modernising Nursing in the Community Programme which outline what everyone needs to know about Universal Services. These pathways included pre-conception to 5 years, 5-11 years and 11-19 years.

255. Individual practitioners within universal health services have a pivotal role in assessing and responding to parents with problem alcohol and/or drug use. These include:

• Midwives within maternity care services - Midwives play a key role in promoting and enabling early access to antenatal care. They also promote the prevention or minimisation of harm to the fetus from maternal (and paternal) problematic alcohol and/or drug use. Care of high risk pregnancies is generally the responsibility of the obstetrician.
• This involves providing information and advice about the impacts of substances on foetal development. It also involves providing information and advice about the importance of maternal and infant bonding and attachment and the potential adverse impacts of problematic alcohol and/or drug use can have on infant mental health and well-being as well as the promotion of a healthy pregnancy generally.
• The Public Health Nurse (PHN) - Health Visitor (HV) - provide a consistent, knowledgeable and skilled point of contact for families, assessing children's development and planning with parents and carers to ensure their needs are met.
• As a universal service, they are often the first to be aware that families are experiencing difficulties in looking after their children and can play a crucial role in providing support.
• The midwife's post-natal care usually ends ten days following birth with the PHN- HV visiting the new baby and mother eleven - fourteen days following the birth. This is a statutory visit. In partnership with the family, the commence a comprehensive assessment using the Getting it right for every child practice model to assess the support required to meeting the needs of the baby and the family.
• This assessment may take up to six months to complete after which the PHN - HV will allocate a core or additional Health Plan Indicator. They will be the child's Named Person (and/or, in some cases, their Lead Professional), until the child starts full-time primary education. The role of the Named Person then becomes the responsibility of colleagues within education.

EDUCATION SERVICES

256. The Named Person for each child (of school or pre-school age - depending on local arrangements - see opening Policy Framework Chapter) will be a nominated member of staff within the child's school.

257. This person, as well as having a knowledge of the child's progress in relation to the school curriculum, will build a bigger picture of the child's needs in relation to the Getting it right for every child well-being indicators. (again see opening policy Framework Chapter).

258. Curriculum for Excellence gives a new focus to Health and Well-being for children and it is now spread right across the curriculum. The aim is to develop young people as successful learners, confident individuals, effective contributors and responsible citizens.

259. Young people develop at their own pace so learning is planned to suit their stage of development, maturity and ability - not age:

• Pre-school - In nursery and early primary children learn through play, exploration and investigation. They will learn about hygiene, how to take care of their teeth, how to choose and prepare foods and how to learn and play together.
• Primary - Children develop their knowledge and skills to higher levels. They will enjoy daily physical activity and learn more about how to keep themselves safe and healthy. Health and well-being will be woven into learning across a variety of subjects.
• Secondary - Health and well-being is taught through a range of courses and topics. All of these continue to plan for choices, learn about problematic substance use and other issues in line with their maturity and some will choose to specialise in PE or food and nutrition.
• Communication between schools and external supporting agencies is crucial. Schools can offer children additional support to try and limit the impact of home situations on educational attainment.

260. Education services work with a range of other agencies, including youth workers and Community Learning and Development. Education services can provide a range of services and support to meet the needs of a child or young person and education staff can support a child in ongoing planning and support for children, including participation in the Child and Family's Plan.

261. Well structured and dedicated Joint Support Teams in all educational establishments have led to greater co-operation across professional boundaries for education, Health and Social Work. Where Criminal Justice, Housing and Voluntary Sector Officers engage in the process, success is greater for some families.

262. All educational establishments should agree their child protection strategies and practices based on Getting it right for every child, producing specific guidance to all staff under the Well-being Indicators.

SOCIAL WORK SERVICES

263. Social work services can work with children and their families in a number of different ways - in either a voluntary capacity or as part of a supervision requirement. Specific practitioners have a pivotal role in assessing and supporting children and parents with problem alcohol and/or drug use. These include:

• Children and Families Social Work services - For children in need of care and protection, social workers will normally act as the Lead Professional, co-ordinating services and support as agreed in the Child's Plan. They also play a key role in helping to ensure that suitable care arrangements are in place.
• They might do this by identifying appropriate placements, assessing and supporting kinship carers and foster carers and supporting children within these placements.
• Social work has a duty to make enquiries where a child may be in need of compulsory measures of care and also have a key investigative and assessment role where concerns about child protection arise.
• Criminal Justice Social Work services - Criminal Justice staff have a responsibility for the supervision and management of adults where they have committed offences and are placed under some form of legislative order. They often work directly with the adult offender and are in a strong position to identify substance use problems and the potential impacts on any dependent children. They are also well placed to consider how the offending behaviour may specifically impact on a child.
• Adult Support Services - Adult services can include a range of specialist provisions for particular groups, including the elderly, those with mental health issues, people with disabilities and adults at risk and in need of support and/or protection.
• Given there are often links with problem alcohol and/or drug use and mental health and domestic abuse, for example, the adult support worker can be pivotal in identifying any concerns that may impact on the child and also in identifying supports to promote the adult's recovery.

ALCOHOL AND DRUG SERVICES

264. Responsibility is devolved to Alcohol and Drug Partnerships (ADPs) to commission (informed by robust needs assessment evidence-based, person-centred and recovery-focused treatment services to meet the needs of their resident populations.

265. There are a number of different points where alcohol and drug services can offer prevention, treatment and support to adults, children, and families. This can include early sexual health advice - before pregnancy - and signposting to other services. These services should be effective and responsive, ensuring people move through treatment into sustained recovery, where appropriate.

266. It can also include advice about the dangers to a fetus of alcohol and drug use by expectant mothers, especially in the first trimester. Alcohol and drug services can also actively raise awareness of Fetal Alcohol Spectrum Disorders and other consequences of using alcohol and/or drugs while pregnant through local awareness raising and training.

267. Where an adult service user is pregnant, alcohol and drug services can support the assessment and identification of needs and risks and support and monitor their impacts.

268. Alcohol and Drug services also play a vital role in educating adults about the risks of blood borne virus infection (HIV, hepatitis B, hepatitis C). Many offer testing on site and will support adults through diagnosis, referral to specialist clinical care for assessment and throughout any resultant anti-viral treatment. They can play a vital role in supporting families with children of all ages through family support groups.

269. Family Support services are able to support people affected by another's problem alcohol and/or drug use. These services allow families some respite and help to build their coping strategies.

270. Effective communication between services is also essential, as is acknowledgement of timelines. Sometimes parents are unable to make progress as quickly as children's services need them to for the purpose of protecting any vulnerable, dependent children. It is essential that alcohol and drug services communicate to other relevant services if there have been any changes for the family - either positive or negative - as these may have an impact on the other types of supports offered to the family.

271. Bespoke alcohol and drug services should also be available at local levels for young people who have begun/are at risk of a problem alcohol and/or drug use problem themselves. All steps should be taken to ensure that services offered to young people are separate from adult focused alcohol and drug services. This is because a different approach is required.

272. Local alcohol and drug services must also be alert to the needs of young carers. Links should be improved between these services and local young carers' services.

THIRD SECTOR SERVICES

273. Voluntary sector providers can offer valuable links to 'hard to reach' families and individuals. This is often achieved through the trusting community based relationships that they can build and that, in some cases, statutory partners may find difficult to foster.

274. This might be where relationships between that family and the state have become difficult. The voluntary sector is therefore a vital partner in delivering interventions to families affected by problem alcohol and/or drug use.

275. These interventions can be targeted at young people and also adults who are reluctant to engage with statutory services. Intervention here may offer a young person or parent increased self confidence, skills development and also an awareness of the potential impact of parental alcohol and/or drug use on the health and development of a child.

276. Through community learning and development, and also community outreach work, the voluntary sector can work with existing parents and other adults to build awareness of the impacts of chaotic lifestyle factors on family life in the context of family planning.

277. Specific interventions here can offer additional employability and housing support - both of which are critical to help families tackle problem alcohol and/or drug use.

278. Voluntary sector providers should also play a vital role in linking up with other agencies around pregnancies where substance use is a factor. Voluntary providers may often be in the best position to take forward follow-up interventions beyond birth, through infancy and into early childhood. Positive relationships formed with mothers are often critical to successful and sustained engagement.

279. Voluntary sector providers deliver services on both a residential and outreach basis to achieve a whole family approach to tackling dependency. They can work in a way that stabilises life-style factors - on the one hand - while also strengthening relationships within the family and supporting whole family development - on the other.

280. The multi-disciplinary nature of voluntary providers means that they can offer 'wrap-around' early years support for parents with young children attached to dependency services. These services stimulate peer support networks, offer advice on active play and toddler development as well as offering support with housing and employability and signposting to other agencies and interventions.

281. The third sector can complement statutory approaches. It can often adapt to fill any gaps that might exist in parenting support approaches. Third Sector partners are also flexible and can tailor their supports to meet the needs of those who do not engage with more mainstream services.

282. Many Voluntary Sector organisations also have years of experience engaging with hard to reach groups. This experience has equipped them with often unique workforce development expertise. There are many examples of Voluntary Sector training programmes such as: building parental capacity, attachment and resilience provided to a range of practitioners from all related agencies.

283. A range of Voluntary Sector support services are also available to assist young people of school age affected by parental problem alcohol and/or drug use. Voluntary Sector workers currently support children within the school setting on a 1:1 basis and also working with those who have been excluded. They often combine youth work with formal curriculum based learning. These services need to be flexible and built around the needs of the child or young person.

HOUSING SERVICES

284. The security of a family's accommodation is important to enable Universal Services - such as GPs - to have the best input(s)/impact(s) with the family.

285. If a family is in insecure accommodation (e.g. temporary accommodation provided by the local authority) if the household has become homeless, then this needs to be considered by services.

286. If a family is homeless then services should be aware that the family is under additional stress at that time and that will likely impact on their ability to work through other issues - such as their problem alcohol and/or drug use. A final outcome for that family might be that they are re-housed in another area.

287. Under the Homelessness Legislation (Housing (Scotland) Act 1987 as amended) a homeless family (provided that they did not make themselves homeless) containing children or a pregnant woman is entitled to temporary, and then, provided that they are not intentionally homeless, settled accommodation.

288. Services should note that any temporary accommodation offered to such families may last for a considerable period of time. During that time, a family may be moved to a number of different types of temporary accommodation. For example they might be moved from initial bed and breakfast accommodation to temporary furnished flats.

289. It is important that services - and across local authority areas - work effectively together to ensure that they know the location of families and that they are prepared for any changes in their accommodation. This is to ensure that - in turn - relevant services continue to be available to the family and to offer the strengthened supports that they will likely need.

POLICE

290. Police officers play a critical role in the identification of need and risk for vulnerable children and young people. The police have a statutory responsibility to identify children or young people that might be in need of compulsory measures of care. In the past, the Police have accounted for 88% of all referrals to the Children's Reporter

291. Patrol officers attending domestic violence incidents, or investigating drug use, should be aware of the impacts of adult behaviour on any children within the house.

292. Local screening arrangements for non-offence referrals have been an effective method of sharing concerns about vulnerable children and families in some parts of Scotland. Work is currently underway to provide a consistent approach to the management of police concerns across Scotland and that embed a Getting it right for every child approach.

293. The police have critically reformed their systems and processes to accommodate a growing identification of children in need, by doing so. They are key partners in multi-agency Getting it right for every child meetings where early intervention and prevention themes focus the assistance provided to children and families in need of support and help.

294. They are now more likely to share information about concerns with other services to make sure that the child gets any help needed. The Named Person is a key player here.