Getting our priorities right: good practice guidance

Chapter 2: Deciding When Children Need Help

45. This chapter gives advice to all 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 problematic alcohol and/or drug use - often termed 'young carers'. It sets out guiding principles of intervention for services. The chapter is divided into 3 main sections:

• what services should look for when deciding whether children need help - gathering information and 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; and
• what to do once a concern about a child's wellbeing has been identified.

Gathering information

"There were so many things I 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)

46. When working with parents with problematic 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.

47. 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

48. Services, such as local authorities, health services, housing agencies, Courts and Children's Hearings, the Reporter, and other services in contact with families have a range of responsibilities to promote the wellbeing and protection of children. Relevant legislation, and key roles and responsibilities here, are described in the National Child Protection Guidance, which should be consulted as appropriate where there are child protection concerns.

49. 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 problematic alcohol and/or drug use is a factor.

• The welfare of the child is the paramount consideration.
• Every child has a right to be treated as an individual, parental problematic alcohol and/or drug use cannot be considered in isolation by services.
• 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. This might include decisions about with whom they should live, their schooling, their relationships and lifestyle.
• Every child has the right to protection from all forms of abuse, neglect or exploitation.
• 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.
• 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.

What services should look for

Children services

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

51. Although parental alcohol and/or drug usecan 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. 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.

52. 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 wellbeing, should be conveyed to the child's Named Person.

Adult services

53. 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 problematic alcohol and/or drug use.

54. Adult services should be equipped to provide information and advice to parents about the possible impacts of their problematic 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 problematic alcohol and/or drug use may affect an adult's responsibilities for child care.

55. Some vulnerable adults with alcohol and/or drug useissues 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).

Practice Points for Adult Services

Wider questions may be relevant - dependent on individual case circumstances - but all services supporting adults with problematic 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?
• Do you have any contact or care for a child?

56. The Scottish Drug Misuse Database ( SDMD) is an important and widely used national information source on the use of drugs in Scotland. The purpose of the SDMD is to help us understand the needs of people with drug problems presenting for specialist treatment. It will help inform recovery plans and over time, enable us to understand more about people's journey through treatment and the outcomes they achieve.

57. The enhanced SDMD is designed to collect information about people at the following points as they access and engage with services at the following stages:

• Initial Assessment
• 12 week Follow-up
• Annual Follow-up
• Discharge from Service
• Transfer from Service

58. Data for the SDMD is collected via the SMR25a (initial assessment) and SMR25b (follow-up) forms. In relation to children, at initial assessment stage, clients are asked if they have any dependent children, what their ages are and what their current living arrangements are:

• Living with own children
• Living with partner's children
• Own children living elsewhere

59. The follow-up process asks the same questions, as well as if there have been any childcare interventions since the last report:

• Direct work by drug/ addiction workers
• Nursery/crèche/after school care
• Respite care

60. It asks if the child(ren) are looked after

• At home with parent(s)
• With kinship carer(s)
• Child looked after and accommodated (local authority)

61. It then asks if there has been a statutory child protection intervention by social work services:

• Yes
• No
• Unknown

Practice Points for Children/Family 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

62. There are a range of other factors that can be associated with problematic alcohol or drug use and may exacerbate child protection concerns. These are described in detail in the National Child Protection Guidance, and include the following:

• Domestic abuse. 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. Traumatic experiences in childhood and adolescence (for example, sexual abuse) can be a major hindrance to recovery if not dealt with through support and advice.
• Mental health. Problematic 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. ^[11] Research shows problematic drug use may lead to, or exacerbate, psychiatric or psychological symptoms or syndromes. The most common associations for problematic alcohol and/or drug use are with anti-social personality disorders, depression and schizophrenia. ^[12]
• Young carers. 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 and other responsibilities around the children.
• Kinship care. 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. Care for children by extended family arrangements will need sensitive and effective support from local services.

"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)

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

Practice Points

At each stage of an intervention, practitioners should consider the GIRFEC values and principles and ask themselves the following questions:

• What is getting in the way of this child or young person's wellbeing?
• 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?

Practice Study: Early Intervention

Quarriers Carer Support Service (Moray) aims to deliver an approach to identify hidden young carers affected by parental problematic alcohol or drug use 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.

Recognising the barriers which young people affected by parental problematic alcohol or drug use 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.