Getting our priorities right: good practice guidance

Executive Summary

This document has been produced as an accompaniment to the 2012 updated Getting It Right for Every Child ( GIRFEC) ^[1] 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.

Introduction

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. It has been updated in the particular context of the national GIRFEC approach and the Recovery Agendas, both of which have a focus on 'whole family' recovery. Another key theme 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.

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, Child's Plan and any other associated plans - also the local channels to engage with these - are clearly described in locally agreed problematic alcohol or drug use protocols. All services should also be clear that they have a shared understanding of the eight indicators of a child's wellbeing ( SHANARRI).

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.

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

Possible barriers to recovery should 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 (Alcohol Drug Partnerships) 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 wellbeing 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 promote, support and safeguard the wellbeing of children and young people.

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/when withdrawal of services may be considered.

In these circumstances it is vitally important to keep the child's wellbeing at the centre of the professional community.

Chapter 1: Describing the Challenge

Problematic substance use is associated with a large variety of drugs: illegal, prescribed, over-the-counter and legal. Its effects on children and 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, or those around them.

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 harm to children and families.

Early identification of concerns should indicate the level of interventions required to promote, support and safeguard children and young people's wellbeing.

Examples of impacts

No safe level of alcohol use during pregnancy has been established. Ideally services should be looking for early signs where children's wellbeing may be adversely affected.

Guidance at these stages tends to highlight lower thresholds of adult problematic alcohol or drug use before services should consider these interventions to promote, support and safeguard children and young people's wellbeing.

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.

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

All services

All services have a part to play in helping to identify children that may be 'in need' or '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. 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.

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 wellbeing - 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 wellbeing 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 wellbeing 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. Using the SHANARRI framework will assist in highlighting key issues.

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 safety and wellbeing.

Where there are concerns about a child's wellbeing, adult services should notify and seek advice from the Named Person and then take appropriate action.

Each service working with parents with problematic 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.

Consideration should be given as to whether compulsory measures of supervision may be required and a referral made to the Reporter.

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 appropriate, proportionate and timely.

The default position here is that information should always be shared where there are concerns to the child's wellbeing.

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 or an adult's risk of causing harm to themselves or others.

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 there are concerns for the child's wellbeing.

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

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 can be met within universal services, it is likely that the Named Person who is in universal services will also act as Lead Professional to co-ordinate the help that is to be given.

Where a single agency assessment of a child/family's 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, by what service, when, and what the desired outcome is.

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

Services should ensure that these key elements of the GIRFEC 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 wellbeing - 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 to be met by individual services delivering supports to a family and the desired outcomes for the child.

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.

Consideration should be given as to whether compulsory measures of supervision might be required to ensure compliance.

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

Chapter 5: Working Together

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

The welfare of the child is always paramount.

All services should ensure that the key features of GIRFEC 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. Opportunities for joint visits should be explored.

Evidence shows that children affected by problematic 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 and 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. Effective collaboration is vital.

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 includes 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 ( ADPs) and the Child Protection Committees ( CPCs) as key bodies responsible for co-ordinating local children's 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.