Drug and alcohol services - improving holistic family support

3. Context for developing Whole Family Approach and Family Inclusive Practice – GIRFEC and The Promise

"For each family member it is important to see the whole person, their psychological – emotional, physical, social and intellectual development, as well as the context of their relationships, family systems, wider ecology and the power differentials within these.'^[10]

(CIRCLE 2019)

This section describes:

• The Independent Care Review, the Promise, which has a specific focus on families affected by substance use.
• Getting It Right For Every Child (GIRFEC) – policies, principles and national practice model.
• National Guidance for Child Protection in Scotland 2021
• United Nations Convention on the Rights of the Child (UNCRC).

3.1 The Scottish Government's ambition is to make Scotland the best place to grow up. Through GIRFEC everyone in Scotland can work together to help children grow up loved, safe and respected so that they realise their full potential. GIRFEC provides Scotland with a consistent framework and shared language for promoting, supporting, and safeguarding the wellbeing of children and young people. This helps children to grow up safe, healthy, achieving, nurtured, active, respected, responsible and included so that they can become confident individuals, effective contributors, successful learners and responsible citizens. GIRFEC was developed based on evidence, is internationally recognised, locally embedded and positively embraced by practitioners across children's services, changing culture, systems and practice for the benefit of children, young people and their families.

3.2 GIRFEC is founded on an integrated, relationship-based, co-ordinated approach that emphasises if extra support is required then it is much more effective when drawing on and working with the strengths of individuals, parents, family and wider community, working alongside support professionals in an open, respectful and collaborative way. As a strengths-based approach, GIRFEC seeks to realise children's rights on a day to day basis and is therefore underpinned by key principles. The following refreshed GIRFEC values and principles are currently in draft form subject to consultation. The Scottish Government's GIRFEC webpage on values and principles, will be updated following agreement post consultation.

• Placing the child, young person and family at the centre, and promoting choice, with full participation of children, young people and families in decision-making;
• Working in partnership with families to enable a rights-respecting, strengths-based, inclusive approach;
• Understanding wellbeing as holistic and interconnected, with a child or young person's developmental experiences understood within the wider context and influences of family, community and society;

"Kids have really connected with their worker and feel it's a safe space to talk about their feelings, worries and concerns. They always look forward to their time with her."

Parent who receives support and her children

• Valuing diversity and ensuring non-discrimination;
• Equitably tackling multiple and intersecting forms of inequality;
• An early offer of support, shifting resources and support towards providing and improving outcomes for children, young people and families; and,
• Joint working in a culture of co-operation and communication between practitioners and services, both locally and nationally across Scotland.

3.3 RRR recognises that over the past decade progress has been made in Scotland on supporting families. This includes promoting good practice in services, introducing and embedding information-sharing protocols^[11], use of the GIRFEC national practice model, and developing robust children's plan and child protection measures to ensure that all services working with children and families are equipped to meet their needs. It is important to ensure this improvement continues.

3.4 The GIRFEC national practice model is based on an approach which understands families have resilience, strengths and capabilities that need to be maximised to ensure both children and adults can thrive and prosper. GIRFEC provides a shared framework to provide initial advice and support, to consider and assess wellbeing holistically, and to plan and co-ordinate support across services.

3.5 The GIRFEC approach places significant emphasis on universal services such as education and health, working alongside families in a way that respects and builds on family assets and individual worth, and involves targeted, higher threshold services where a child, parent or family has specific needs. A Child's Plan coordinates support provided by those working with a child and family as "The Team Around The Child" and should involve relevant adult service practitioners providing to support to parents/carers.

3.6 Children's Services Planning arrangements should consider how GIRFEC is being locally implemented, and this will often include development of local practice guidance and protocols which supports the aims of ensuring support is experienced by families affected by substance use in as joined-up a manner as possible, including, critically across continued improvement and joint approach between adult and children's services.

3.7 National Guidance for Child Protection in Scotland (2021) describes the responsibilities and expectations of everyone who works with, or comes into contact with children and young people, families and carers in Scotland. It sets out how agencies should work together with children and young people, families, carers and communities to protect children and young people from abuse, neglect and exploitation and replaces the 2014 National Child Protection Guidance.

3.8 The guidance is part of a wider child protection improvement programme and provides an opportunity to reinforce that the protection of children and support for their wellbeing starts from the earliest stages of community-based family support and should be incorporated into broader, community planning frameworks. It informs the development of local multi-agency child protection procedures, processes and training and will support the care and protection of children across Scotland, including those children harmed by alcohol and drug use.

3.9 Parental alcohol and drug use overlaps and intersects with domestic abuse, neglect, emotional abuse and parental mental ill health, as a dominant reason for child protection registration and the need for children to be Looked After^[12]. There is a strong link between problem drug and alcohol use, deprivation, and trauma. In this context compassion, understanding and workforce resilience are essential within effective child protection.

3.10 In February 2020 Scotland concluded a root-and-branch review of services, support and lived experience of infants, children and young people growing up in the country's care system. The final report of the Independent Care Review, 'The Promise'^[13], is a powerful call for change and transformation in the way that Scotland looks after its children, particularly those with the need for significant support and protection.

3.11 The Promise has a specific focus on the rapid expansion of family-based support in Scotland, recognises that these supports are not consistently available across Scotland and that through their increased future expansion they must be able to support families early with a focus on prevention – but be as enduring and long-standing in their approach as necessary:

'Where children are safe in their families and feel loved they must stay – and families must be given support together, to nurture that love and overcome the difficulties which get in the way….Scotland already has a clear commitment to early intervention and prevention. That commitment is best realised through proper, holistic support for families. There must be a significant upscale in universal family support services.' (p.46)

3.12 The clear driving principles within the Promise relate to significant and wholesale change in the way that services work with children, their parents and their families, with a focus of valuing families, promoting supports, trusting relationships and a constant focus on trying to find ways of keeping families together wherever possible. This needs to be achieved by providing levels of support and active resonant help that are currently exceptional in Scotland at present, rather than the norm.

"Scotland must have a collective acceptance that there will be some families who will require long-term support that goes beyond what is current normative practice. Scotland must ensure holistic family support and individualised planning with the principles of 'one family one plan' wraparound support for all families in and on the 'edges' of care….

…The explicit aims of intensive family support must be to:

• keep families together and avoid children going into care.
• interrupt and address intergenerational cycles of trauma.
• sustain meaningful and loving relationships." (p.52)

3.13 The Promise sets out some very specific challenges for families affected by substance use issues, which includes, the need to recognise relapse as a common part of the recovery process and the requirement for services to move beyond a narrow risk-based approach to supporting children and their families, to one actively based on addressing the challenges they face in order to promote recovery within families. The Promise calls for alcohol and drug services supporting parents and statutory children's services to 'compassionately collaborate' for the best interests of children and their families, recognising the frequent and longstanding tensions that can and do emerge in supporting families affected by substance use, recognising both the needs and safety of children alongside those of parents and other adult relations.^[14]

"The Care Review has heard that children living with parents with problematic substance use have complex, conflicting feelings about their parents' difficulties. With more flexibility in how services are provided including a flexible, whole family approach to support and management of problematic substance use, there is the potential for families to stay safely together…..Services supporting parental substance use and statutory children's services need to compassionately collaborate with each other to ensure supports are in place that holistically assesses children within their families and support them to stay with families whenever this is safe to do so." (p.54)

3.14 The Promise has identified ten key principles that must underpin intensive family-based support services. These are:

Ten Principles of Intensive Family Support ^[15]

• Community-based
• Responsive and timely
• Work with family assets
• Empowerment and agency
• Flexible
• Holistic and relational
• Therapeutic
• Non stigmatising
• Patient and persistent
• Underpinned by children's rights

3.15 The adoption within RRR of a whole family approach and family inclusive practice resonates and aligns well with the commitments articulated in The Promise. All services with a concern for children, young people and their families including alcohol and drug services are core to this – the need and desire to work together in developing and redesigning services to better support families to nurture and protect children, and to support those who are affected by substance use in a respectful, trauma-informed, rights-based environment, pooling our resources together in doing so is key to meeting the aspirations of Rights, Respect and Recovery both at a national and local level.

"Thank you for making me feel that it is ok to have these thoughts and am able to talk about how I feel."

Young person

3.16 The wellbeing needs of children, young people and families are considered through local joint strategic needs assessments which inform the development and delivery of the Children's Services Plan for each area of Scotland. Collaborative leadership through Children's Services Planning partnerships therefore remains central to the delivery of RRR through a cohesive and joined up approach at the strategic, operational and frontline practice level.

United Nations Convention on the Rights of the Child (UNCRC)

3.17 In 2021/22 Scotland will likely be the first part of the UK to fully incorporate the United Nations Convention on the Rights of the Child (UNCRC)^[16]. The UNCRC will enshrine the rights of children into Scottish law. Key to UNCRC articles is the rights of all children to:

• Article 3 (best interests of the child) The best interests of the child must be a top priority in all decisions and actions that affect children.
• Article 5 (parental guidance and a child's evolving capacities) Governments must respect the rights and responsibilities of parents and carers to provide guidance and direction to their child as they grow up.
• Article 6 (life, survival and development) Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential.
• Article 9 (separation from parents) Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child).
• Article 18 (parental responsibilities and state assistance) Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children.
• Article 33 (drug abuse) Governments must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs.
• Article 39 (recovery from trauma and reintegration) Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support to help them recover their health, dignity, self-respect and social life.

3.18 An extensive array of help and support for children, their parents, family and wider community is recognised as key and necessary to ensuring that children's rights are given practical, meaningful and full effect^[17]. The importance of safeguarding and promoting the right to family life, to enjoy relationships with parents, brothers and sisters and wider family members and providing the right help for families affected by substance use at the right time is key to successful delivery of a whole family approach/family inclusive practice.