Rights, respect and recovery: alcohol and drug treatment strategy

Chapter 6: Getting it Right for Children, Young People and Families

Outcome: Children and families affected by alcohol and drug use will be safe, healthy, included and supported

Commitments to achieve the outcome
Ensure family members will have access to support in their own right and, where appropriate, will be included in their loved one’s treatment and support.	C1
Ensure all families will have access to services (both statutory and third sector) provided through a whole family approach, in line with the values, principles and core components of GIRFEC.	C2
Involve children, parents and other family members in the planning, development and delivery of services at local, regional and national level.	C3

Introduction

1. Problem alcohol and drug use amongst family members can have a devastating impact on the lives of children and other adults in the family. This includes health and wellbeing impacts, financial worries and social isolation.

2. Alcohol and drug use by a loved one can also cause trauma and distress for their children and families^[2], often leading to relationship breakdown and increased caring responsibilities. The impact of parental alcohol and drug use is far-reaching, it can increase the risk of abuse and neglect and negatively influence wellbeing throughout life – from ante-natal development through to adulthood.

3. This is compounded by the associated stigma that families experience which can create very specific challenges. It can isolate families from their communities and act as a significant barrier to seeking help and support. In addition, stigma and fear present specific challenges to accessing treatment for parents and particularly mothers. It is vitally important that all those involved in providing support to families, including children and adult services, are sensitive to stigma and discrimination and the barriers it presents.

4. Many thousands of adults across Scotland have experienced parental/family alcohol and drug use in their childhood which is commonly recognised as a key Adverse Childhood Experience (ACE). Evidence shows that without intervention, people with ACEs are at increased risk of a range of negative health and life outcomes, including in some cases their own struggle with alcohol and drugs. Understanding and addressing this impact is crucial to safeguarding children’s current and future mental and physical health and wellbeing^[78].

5. Each family is unique and their experience and journeys are all different, however, they all require support, compassion and understanding. Effective, high quality treatment and a family-inclusive approach for people affected by drug and/or alcohol use is vital and can have significant benefits for those around them. Families and the wider community also play a vital role in recovery and have their own support needs on this journey which need to be factored into how treatment and support is designed and delivered.

6. Over the past 10 years progress has been made on supporting families. This includes promoting good practice in services, introducing information-sharing protocols and developing robust 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. Findings from Significant Case Reviews show there remains scope for improvement in relation to effective, consistent information sharing between adult and children’s services.

7. It is also extremely important to identify and support the positive contribution family members can make to a person’s recovery journey. Although family relationships are complex, they are more often than not one of the most important factors in supporting someone with drug or alcohol use. However, family members also need support to build their own resilience and recover themselves.

8. This strategy sets out a shift towards a whole family and family-inclusive approach to treatment and must be developed with lived and living experience at the heart.

Delivering the outcome

Family-inclusive approach

9. The definition of ‘family’ means anyone who is affected by a loved one’s alcohol or drug use, including family members, partners, carers, friends, neighbours, work colleagues or concerned significant others.

10. Support from family and friends can be a key component of recovery. The whole family can be an asset in someone’s recovery journey, even where family relationships are fragile or under strain. It is most often the families who are there 24/7 and are the first point of support, coping with sometimes very challenging situations, supporting and caring for a family member or loved one. Families go through a journey, along with those affected directly and it is vital to support families in their own right, at any stage of the journey.

11. Over the last 10 years there has been a growing and thriving recovery movement and part of this is ensuring that families recover too. In 2018 the Family Recovery Initiative Fund (FRIF) was established, which offers small grants of up to £1,500 to support the development of groups which aims to improve wellbeing for families affected by a loved one’s drug or alcohol use. This commitment will continue, ensuring the FRIF becomes a strong asset for families at a local and national level.

Family members will have access to support in their own right and, where appropriate, will be included in their loved one’s treatment and support. (C1)

Identified actions

• The Scottish Government will continue to investment in the Family Recovery Initiative Fund which will continue to strengthen the capacity of family support and its voice in Scotland.
• New and existing models of support for family members through the National Development Fund will be evaluated. These findings will help shape and set expectations for delivery across Scotland.
• The workforce development framework will set expectations and competencies for the treatment workforce in being more family inclusive.

Whole family approach

12. The whole family approach looks at tailored support for all that are affected: adults on their recovery journey and also the children. We want children and young people to remain in stable loving families wherever possible. For this to happen, services need to work together to support families and share concerns quickly and effectively to protect children and young people from harm.

• Children at risk are identified and appropriate action taken.
• Treatment and good parenting comes together.
• Children’s needs are met in their own right.

13. Alcohol and drug treatment and recovery for those with children, needs to be underpinned by a whole family approach which includes understanding the needs and impact of not only the person who requires treatment, but also the whole family that is affected. In line with the values and principles of GIRFEC, working constructively with whole families at an early stage can prevent the need for later crisis interventions.

14. Treatment professionals are critically placed to be aware of, and identify, children and young people who are adversely affected by parental and family drug or alcohol use. Ensuring access to support, that services are trauma-informed, and having effective joint-working arrangements in place between treatment services and children and family services (including statutory child protection services), can have significant benefits to all involved.

15. Work is under way across a wide range of policy areas to better understand and implement a more trauma-informed approach. Implementation of the National Trauma Training Framework^[79] developed by NHS Education for Scotland (NES) aims to help Scotland’s current and future workforce develop skills and services that respond appropriately to of ACEs and trauma.

All families will have access to services (both statutory and third sector) provided through a whole family approach. (C2)

Identified actions

• Effective multi-agency guidance will be in place to support professionals to work effectively together in line with GIRFEC values, principles and core components; this will be embedded into Service Level Agreements, contracts and other performance requirements.
• Improving joint-working at a strategic and service delivery level across Scotland, including through the delivery of the Child Protection Improvement Programme.
• Expectations will be set around the competencies of professionals in our Workforce Development Framework.
• Ensuring joined-up support across treatment and other community services for parents whose children are looked after and accommodated due to lack of parental care.

Lived experience

16. The lived and living experience of children and families affected by problematic alcohol and drug use is vital in the planning, development and delivery of services. It is important to continue to ensure that people are heard and listened to. This includes ensuring lived experience makes a direct contribution to national and local developments.

17. Listening to families affected requires targeted approaches to ensure that they can make their voice heard. Engaging and listening to children and young people requires a specific sensitivity. Research Initiatives such as ‘Everyone Has a Story’^[80] has allowed a better understanding of the impact alcohol and drug use and recovery has on children and young people. There is a need to build on this work to understand how children feel about living with parents in recovery and how they want to be supported.

Children, parents and other family members will be involved in the planning, development and delivery of services at local, regional and national level. (C3)

Identified actions

• We will continue to invest in approaches that give children and young people’s lived and living experience a clear place in improving support and help developing new and innovative approaches.
• Mechanisms will be developed for the voice of family members and parents to be represented at national and local policy-making level.

Protecting children and young people: frameworks and strategies

18. Meeting the needs of children, young people and families affected by a loved one’s alcohol and drug use can be complex and this is reflected in the breadth of the policy landscape which supports them.

The Getting it Right for Every Child (GIRFEC) approach

19. Getting it Right for Every Child (GIRFEC), is the national approach in Scotland to improving outcomes and supporting the wellbeing of our children and young people by offering the right help at the right time from the right people. GIRFEC is central to all Scottish Government policies which support children, young people and their families, including those affected by parental alcohol and drug use and is delivered through services and people who work with families.

20. The GIRFEC approach is:

• child-focused;
• based on an understanding of the wellbeing of the child in their current situation; and
• based on tackling needs early.

21. This approach requires joined-up working. There have been significant developments across policy areas which are underpinned by the GIRFEC national framework including child protection, looked after children, support for young carers, child poverty and maternity and early years, which together improve support for children affected by parental drug or alcohol use. These have been underpinned by extensive training and awareness-raising sessions for staff across services with areas adopting local protocols on the delivery of the three key frameworks: National Risk Framework to Support the Assessment of Children and Young People^[81] (2012); Getting Our Priorities Right^[82] (2013), and National Guidance for Child Protection in Scotland^[83] (2014).

22. Children living with a parent or guardian with alcohol and drug use are not always at risk of harm. Nevertheless, neglect and lack of parental care, however unintentional, can be a key issue faced by children and young people in these circumstances. Sometimes subtle changes in a child’s circumstances can be difficult to detect and often this can be linked to changes in parental alcohol and drug use. Treatment professionals are critically placed alongside universal services to understand these changes and take appropriate action when necessary to ensure a child’s safety.

23. The Child Protection Improvement Programme^[84] was launched in 2016 and included an independently-chaired Systems Review Group, which looked at the formal elements of the child protection system. The programme is taking forward a number of actions aimed at strengthening current practice and improving outcomes for children and young people. This includes:

• The role of treatment professionals in providing information and skilled assessments to multi-agency case discussions, care planning and review arrangements;
• The role of services in providing ongoing treatment, care and recovery support to parents;
• The awareness and skills of staff in contributing to reviewing the circumstances, risk and wellbeing of children;
• Increase the consistency and delivery of joint learning and training and joint working opportunities, around revised and updated Getting our Priorities Right (GOPR) Protocols;
• Improved understanding of reducing neglect through work with The Centre for Excellence for Looked After Children in Scotland (CELCIS);
• Consult on a Shared Dataset for Children’s Services in order to better plan and commission services and measure outcomes for children and young people.

24. Third sector organisations also have a critical role in supporting children, young people and families. They are often best placed to offer intensive, early intervention support and are also, in a lot of circumstances, the first service a family will reach out to in crisis.

Maternal and infant health

25. The Scottish Government is committed to ensuring that all children in Scotland get the best possible start in life, even before they are born. Maternity care plays a vital role in providing women, their partners and their babies with the care and support they need at this important time. We recognise that some babies need medical intervention at birth, including those who experience, for example, neonatal abstinence syndrome (NAS). All babies that require intervention will receive high quality care in neonatal units. The Refreshed Framework for Maternity Care in Scotland^[85] sets out service aims focused on improving access to maternity care for vulnerable groups, including women with alcohol and drug problems. In January 2017, the Best Start^[86] report was published, following a review of Maternity and Neonatal Services in Scotland. Recommendations were made which cover working with vulnerable women (including those with problematic alcohol and drug use) and work has begun to take this forward. We know from the evidence gathered for the Early Years Framework^[87] that maternal and parental circumstances and behaviour during pregnancy have an impact on children’s outcomes. High risk factors such as alcohol and drug use impact on health outcomes at birth, in infancy, and across the whole of the life course.

Carers and kinship carers

26. Carers must also be acknowledged and supported (both adults, children and young people) Young Carers can use the Carers’ Charter^[88] to find out about their new rights introduced by the Carers (Scotland) Act 2016 which took effect in 2018. Alongside this the Scottish Government will be co-ordinating development of a Carers Strategic Policy Statement to replace the previous carers and young carers strategies.

27. Kinship Carers are often grandparents looking after grandchildren as well as dealing with their own adult child’s alcohol or drug use. It is vital that we recognise and provide support within our communities for Kinship Carers.

Independent Care Review

28. The Independent Care Review^[89], currently under way, is examining support to children and their families on the ‘edge of care’, many of whom will be children and young people affected by parental/family alcohol and drugs use. The relevant recommendations from this review will inform our future action plans.

Parenting

29. The National Parenting Strategy^[90] highlighted the vital role of parents in improving the health and wellbeing and life chances of all our children and young people, and provided targeted support to families facing additional pressures that impact on day-to-day parenting. Six years on, significant progress has been made around commitments on extending the provision of early learning and childcare, improving access to coordinated family support, widening access to relationship support, developing the PlayTalkRead campaign, offering Family Nurse Partnership and Triple P (Positive Parenting Programme) on a wider basis – which all aim to make a real, practical difference for families. The publication was only just the start of the journey and work continues with delivery partners to further develop and implement a range of commitments set out in the strategy.

Bereavement

30. Part of the tragic consequence of alcohol and drug use can mean a child, young person or adult losing a close family member, having an devastating impact on their lives. While there is support for those that lose a loved one, further work is required. As part of this, The Programme for Government^[91] committed to appointing a childhood bereavement coordinator to advise on steps that can be taken to drive forward improvements in bereavement services. The Scottish Government also provides funding to Scottish Families Affected by Alcohol and Drugs (SFAD) who deliver a range of materials and services for those who are impacted by a loved one’s drug or alcohol use; including a Bereavement Support service.

Children and Young People Act (2014)

31. Children and young people are human rights holders in their own right. In addition, the UN Convention on the Rights of the Child (UNCRC)^[92] sets out rights that all children everywhere are entitled to and underpins Scotland’s key GIRFEC approach and the definition of wellbeing, as set out in the Children and Young People (Scotland) Act 2014. As part of this, Scottish Ministers have committed to undertaking a comprehensive audit on the most effective and practical way to further embed the principles of the UNCRC into policy and legislation.

Child and Adolescent Health and Wellbeing Action Plan

32. The Scottish Government plans to publish its Child and Adolescent Health and Wellbeing Action Plan^[93] which aims to take a cross-policy, rights-based approach to improving the physical, mental and emotional health and wellbeing of children and young people within Scotland. It considers health and wellbeing across the life course and will take account of adverse childhood experiences throughout. The Action Plan will have broad ownership by those implementing the actions and will be directed, co-produced and overseen by children, young people, families and communities.

Mental health

33. The Mental Health Strategy^[94] highlights the importance of prevention and early intervention in reducing the severity and life impact that mental ill health can cause. Part of this includes the impact parental/family alcohol and drug use can have. Within the strategy, there are a number of actions aimed at ensuring mental health care for children and young people continues to improve. The Mental Health Strategy recognises the interdependence of ACEs and its children and young people actions, support prevention and early intervention to break cycles of adversity.

Child poverty

34. Every Child, Every Chance^[95] (2018), the Scottish Government’s Tackling Child Poverty Delivery Plan for 2018-2022, outlines the next crucial steps to delivering on our ambition to end child poverty, as laid out in the Child Poverty (Scotland) Act^[96] (2017). The Plan, backed by a range of investment, including a £50 million Tackling Child Poverty Fund, sets out a range of actions to increase household incomes, reduce costs, and support children and families to have a better quality of life.