Drug and alcohol services - improving holistic family support

4. What do we mean by Whole Family Approach?

"People with drug problems, however isolated, will have networks of families and friends who will feel the impact of the drug problems, whether they have become estranged or continue to provide vital support."^[18]

(UK Drug Policy Commission 2009)

This section describes:

• A range of whole family approach definitions, including the RRR definition
• Impact on the whole family, who may require individualised support
• Service silos

It also recognises:

• The fear and stigma families can feel in asking for help
• Particular needs for women
• The need for a trauma-informed and skilled workforce
• The need for inclusive, rights-respecting services

In Rights, Respect and Recovery we mean family to include – anyone that is affected by a loved one's alcohol and drug use (they don't have to be related).

And: We mean a whole family approach to include co-ordinated, holistic services aimed at children, young people, their parents/carers and their wider family, all of whom are likely to have been affected by substance use as well as a range of other difficulties, working with families – as individuals and as a collective, planning alongside families in the same way – mindful of individual needs, the strengths and fragility of relationships, the need to intervene to protect where necessary – but all underpinned by a clear belief in the possibility of change in order for difficulties to be overcome and recovery attained.

4.1 Whilst there are a range of definitions available in relation to whole family approach, most share some consistent and common themes relating to issues such as working together to common goals with families and achieving long term, sustainable change such as that offered by the US whole family approach network:

"Although families are made up of individuals, each member's challenges and successes are interdependent. The Whole Family Approach is a family-led strategy which provides adults and children with the tools to set, plan for, and achieve their goals together. When the whole family works together to support each other's goals, long-term change, stability and well-being become a reality. The Whole Family Approach is preventive rather than crisis-driven."^[19]

4.2 Closer to home; the Carers Trust, Scotland describes the Whole Family Approach in the following way:

"Adopting a whole family approach involves practitioners supporting young carers in the context of their families. Identifying … needs and considering the impact of caring responsibilities on the whole family, and what personalised support is required ensures that inappropriate caring does not take place. This holistic approach ensures that appropriate support is provided and promotes open dialogue within families about the caring relationship."

4.3 Whilst others such as the Family Strengthening Network emphasise the need for improved integration of services to more adequately address the needs of and support for both adults and children within the context of family:

"The Whole Family Approach breaks down silos in existing social services. It puts equal priority on the needs of adults and children and enables seamless collaboration among multiple organizations to support a family's plans. It is prevention rather than crisis-driven."^[20]

"My worker helped my Mum but he also played fun games and had bike rides and walks in the park with me. Without his friendly ear who knows where I'd be."

Boy, aged 11, Clued Up Project, 2021

4.4 Poverty, inequality, fear of stigma and ability to exercise their rights to access holistic co-ordinated services can all be challenges particularly faced by families affected by substance use, particularly those with experience of trauma which can be multi-layered and complex.

4.5 Whole Family Approaches, whilst common in relation to addressing concerns such as substance use, mental health and familial poverty, also have a strong base in working across and within families in relation to domestic abuse. This example from Safe Lives focusses on interconnectivity of family members and the risk of fragmentation of our approach to and missed opportunities in supporting both individuals and families, adults and children, no matter the specific issues, risks or challenges being faced by some or all:-

"Just like children's safeguarding, domestic abuse is everyone's problem, and every agency has a role to play in supporting the whole family. Frequently, however, the response to parents is so separated from the response to their children, that we're not joining up and looking at the impact of domestic abuse on the whole family." ^[21]

4.6 The Social Care Institute for Excellence (SCIE) in 2010 further defined the importance of a whole family approach in the context of parental mental health

"SCIE …recommends that good services for families affected by parental mental ill health should:

• enable joined-up support at every point of entry – a 'no wrong door' approach
• look at the whole family and coordinate care
• intervene early to avoid crisis
• provide support that is tailored to need
• build on family strengths and promote resilience.

This means incorporating a whole-family approach at each stage of the care pathway. This may require changing organisational structures and processes, as well as the practice of managers and practitioners."^[22]

4.7 The Covid-19 Children and Families Collective Leadership Group, whose membership includes The Promise, have the following definition of family support in their vision and blueprint, as developed by the Family Support Delivery Group:

• It can encompass a broad continuum of preventative and early intervention approaches to help families to meet their individual needs to improve their wellbeing including advice, support, and specialist help.

"Whole family work should not 'just be' about who lives in the home, it can include other relatives, friends, community etc."

Clued Up Project, 2021

• It is broadly understood to refer to support provided by a range of organisations (agencies, professionals, the third sector, trusted partners) to families to build their capacity and resource.
• It is offered across a wide spectrum of family situations ranging from very early universal intervention (e.g. pre-birth) to intensive/acute requirements, which still play a preventative role.
• At the least intensive end of the spectrum support includes information, advice and practical support (universal interventions, emotional support, financial support and in kind support such as Baby Box).
• At the more intensive end of the spectrum this means support for families (including adult to adult) that may sit alongside statutory interventions, to enable them live together positively, obviating negative experiences for the child and providing support for families when they are not able to be together.
• Interventions can be offered to a broad range of families including families seeking to have children and families with children are not currently living, which may be of short duration or which may be envisaged for the years until a young person reaches 18, or (where they are care-experienced) 25. It can also be used to describe support for families where a child or children have been removed and where ongoing, relationship-based, holistic support is vital to address the trauma of that separation.
• Family support is a mechanism or an enabler which, where effective, will support us in achieving our intended outcome of improved child and family wellbeing.

4.8 Families with parenting responsibilities who are affected by substance use are vulnerable to significant stigma and exclusion. Parenting expectations of mothers can be higher than those expectations placed on fathers. A father's substance use is often not linked with their parenting role. Services will wish to be mindful of this to ensure their services are sufficiently confident, inclusive and trauma-informed.

4.9 The difficulties that many parents experience in asking for help, for fear of children being removed from their care, needs to be overcome in the design, delivery and leadership of our services. Similar issues may exist for children and young people in order to ensure they feel confident and safe enough to ask for help, this can include their own issues with substance use or other issues where they may need help on a preventative basis. These are key themes within National Guidance for Child Protection in Scotland.^[23] It serves no-one when the needs of parents, children and the wider family are hidden from view, for preventative opportunities to be lost, only to emerge later as acute concerns. This is reflected within the statutory aims of Children's Services Plans, to ensure "any action taken to meet needs is taken at the earliest opportunity and where appropriate, prevents needs arising."

4.10 Having a trauma-informed workforce and services is one of the ways that we can intervene early to mitigate the impact of trauma and reduce the need for crisis interventions. Being trauma-informed means creating environments that aim to increase feelings of safety and trust, and decrease feelings of threat, stress and harm. This can support people to engage with services and to support their healing and recovery through positive relationships and connections.

4.11 Services and support for these families need to be open, welcoming, inclusive, rights-based and driven by a set of values and a belief that with the right kind of support, guidance and advocacy, families can overcome their difficulties. Good quality, resonant, sensitively delivered, help at the right time and over a sustained period for families is one of the key ways we can help children thrive and develop. This is the cornerstone of a whole family approach, linked to genuinely family inclusive practice in Scotland. This builds on the relationship-based support at the core of the GIRFEC practice model and the collaborative team around the child.