The road to recovery: a new approach to tackling Scotland's drug problem

Chapter 5: Getting it Right for Children in Substance Misusing Families

The children who live with parents who have drug and alcohol problems are among the most vulnerable in society. Building on the success of Getting Our Priorities Right and Hidden Harm, we must do more at a local level to:

• ensure the best possible start for every child through effective prevention and early intervention;
• build the capacity of universal and targeted services to improve the identification, assessment, recording and planning for children at risk;
• build capacity, availability and quality of support services for children and families affected by parental substance misuse;
• strengthen the consistency and effectiveness of the management of those children known to be at immediate risk; and
• support communities to protect children by encouraging the public to report concerns through, for example, the National Child Protection Line.

176. Current best estimates indicate that 40-60,000 children may be affected by parental drug misuse. ⁵³ The immediate effects of this can include children being at risk principally of neglect, but also of emotional and physical abuse. Long-term risks can also include poor physical and mental health. Growing up in a household where parents are using drugs and alcohol can affect the life chances of the child for the worse and exacerbate health inequalities.

177. Children and young people in this situation require particular support and care to ensure they share in the same high aspirations and outcomes we want for all of Scotland's children. Agencies have found it difficult in the past to identify situations where children might be at risk, and subsequently to work together to ensure interventions that most effectively put the child's interest first. The death of Caleb Ness in Edinburgh in 2001 and the subsequent inquiry highlighted the potential for serious failures in this regard.

178.Getting It Right For Every Child is the Government's policy for addressing the needs of all children - and it provides the framework within which public agencies can work better together with a focus on improving outcomes for children. ⁵⁴ Building the capacity of families and communities to engage in activities that support children is central to this approach. The Early Years and Early Intervention Framework being developed jointly by the Scottish Government and CoSLA will ensure a strong focus on what needs to be done to ensure that all children, including the most vulnerable, get the best start in life.

HIDDEN HARM

179. One of the first significant attempts to understand and tackle the problems of children and young people affected by parental abuse - the Hidden Harm report - was published in 2003 by the UK Government's Advisory Council on the Misuse of Drugs. This report significantly raised the profile of the issue and highlighted the challenges for public agencies to work together more effectively to address it.

180. Since then, the Government, local authorities and other partners have done considerable work in Scotland to turn policy recommendations into improvements on the ground. The previous administration's report, Hidden Harm - Next Steps (2006), set out a wide-ranging plan of action across numerous sectors (from social care, maternity services, early years and schools to drug and alcohol services and child protection) to make significant improvements to ways in which vulnerable children are identified and protected. ⁵⁵ Prior to this, Getting Our Priorities Right provided a useful framework for many joint Child Protection and local ADAT Committees to take forward action into their own areas in the form of local protocols to help identify and protect children.

CHANGING THE EMPHASIS

181. Addressing the needs of children of substance misusing parents under the 'Hidden Harm' banner has led to real improvements in the way that public agencies deal with this complex problem. However, the time is now right for a change of emphasis in order that:

• strengthened focus on prevention and early intervention reduces the impact on children of parental substance misuse;
• actions to address these issues are integrated with wider measures to promote the well-being of children and young people, particularly the Getting It Right For Every Child agenda;
• there is a proper balance of interventionist actions with a focus on intervening as early as possible to prevent harm (or further harm). Principally, we must avoid stigmatising children affected by their parents' substance misuse; and
• the needs of children affected by parental substance misuse are recognised and addressed, whether the substance is drugs, alcohol or both; or indeed anything else that puts children at risk.

182. The Government believes that addressing the needs of children in substance misusing families should be incorporated into part of wider work on Getting It Right For Every Child. This is the overarching framework intended to ensure that public agencies work to address each child's needs in a child-centred, timely, proportionate and effective way. The core components of Getting It Right For Every Child include:

• a focus on improving outcomes for children, young people and their families based on a shared understanding of well-being;
• an integral role for children, young people and families and those with a relevant interest in reaching the decisions that affect children's lives as part of assessment, planning and intervention;
• maximising the skills of the workforce within universal services to identify and address their concerns about children at an early stage and, where necessary, bring other expertise on board;
• a common approach to gaining consent and to sharing information where appropriate;
• a co-ordinated and unified approach to identifying concerns, assessing needs, agreeing actions and outcomes based on indicators of well-being;
• streamlined planning, assessment and decision making processes that lead to the right help at the right time for the child;
• consistent high standards of co-operation, joint working and communication, across Scotland, where more than one agency needs to be involved;
• a confident and competent workforce in the statutory universal and targeted services as well as the independent sector;
• a lead professional to co-ordinate and monitor multi-agency activity where necessary; and
• the capacity to share demographic, assessment, planning and outcome information electronically within and across agency boundaries through the national eCare programme where appropriate.

ACTIONS

183. To ensure this work leads to improvements on the ground, the Scottish Government has brought together internal and external expertise to develop an action plan focussed on the following key areas:

Improving identification, assessment, recording and planning and information sharing.

184. Many of the challenges in dealing with children affected by parental substance misuse are generic to all vulnerable children, though as Hidden Harm reflects, there is a particular risk of this group going unrecognised. The Scottish Government, working with COSLA, in the context of Getting It Right For Every Child, will:

• work with local authorities and NHS Boards to strengthen the role of practitioners in universal and specialist services who see children affected by their parents' substance misuse at first hand. This will involve providing ongoing multi-agency training to help them identify children in need of help at an early stage, to know when to pull in other specialist colleagues, and when to share the right information in a timely way. Work is already under way to identify when and how this training will be best carried out;
• build on the learning from the Getting It Right For Every Child pathfinders to support sharing and embedding of good practice around single and inter-agency assessment of and planning for children. This will include dissemination and training on tested tools and guidance;
• the current version of Care Framework, integrates existing systems to allow effective, secure, lawful data-sharing to support early and appropriate partnership intervention;
• the next version of eCare Framework will be developed with increased security and access controls appropriate for inter-agency sharing of information on the most vulnerable citizens, especially children. Work on this version is underway with an expectation that it will be available by the end of 2009 to support subsequent implementation in practice as agencies' own systems are adapted to work in the multi-agency environment;
• through developing data standards, determine what information is collected, how it can be shared and how it is recorded so that it can be brought together as required for those who need to see it; and
• work with partners to develop more accurate prevalence figures for children affected by substance misuse to support effective planning at a local level.

Build the capacity, availability and quality of support services.

185. There are many examples of effective services for children affected by parental substance misuse and the challenge is to develop integrated, effective and consistent provision across Scotland. Working in partnership with COSLA, the Scottish Government will:

• support the sharing of good practice around what works including lessons learned from the 270 innovative projects supported through the Lloyds TSB Foundation Partnership Drugs Initiative; ⁵⁶
• strengthen the focus of adult substance misuse services on the needs of children and families by including relevant outcomes in the commissioning framework;
• promote the creation of integrated services to provide equality of access to treatment for all drug users across Scotland; so that every child affected by their parents' substance misuse can be sure their parents will receive the treatment they feel will be effective for them. All parents, particularly where both parents with a drug problem are parenting a child together, should be offered treatment at the same time, to facilitate the best chance of recovery and increase their capacity to effectively care for their child;
• in the context of the Early Years Framework, work to improve parenting capacity, recognising the role of wider family and community networks in promoting resilience in children and their families. As part of the delivery of Recommendation 27 of the SWIA inspection of a Western Isles child protection case, we have recently funded a 3-year post for the Scottish Child Care and Protection network ( SCCPN) to support the learning of child protection front-line professionals based on evidence of best practice and from latest academic research. A specific objective of that post is likely to include the development of evidence and good practice around the effectiveness of a range of intensive family support measures which benefit children affected by their parents' substance misuse and which provide the most useful kinds of interventions into families at immediate risk from the parents' drug and/or alcohol misuse;
• ensure better support for kinship carers, such as grandparents and other family members who take responsibility for children affected by their parents' substance misuse. ⁵⁷ This includes the provision, through Citizen's Advice Scotland, of a specialist information service for all kinship carers, giving advice on benefits and maximising financial support, a commitment to pay allowances to approved kinship carers who care for looked after children, and strengthened training and support; and
• promote support for young carers, mindful that older children will continue to be affected by their parents' substance misuse and often take on the burden of care. This will include building on existing work, such as the development of a national young carers' festival and young carers' services self-evaluation toolkit to enable services to evaluate and improve the services they provide.

A Case Study - Partnership Drugs Initiative - Intensive support for families affected by substance misuse

The Brown* family (Mum, Dad and Nat and Lee aged 2 and 6 respectively). The family had no established routines (e.g. frequently missed school, no set bed times) and both parents were unable to put the needs of the children first due to their heroin use. There were also concerns that the parents were drug dealing. Due to these factors there were poor relationships between parents and children and very little time spent as a family.

The PDI project started to work with the family building up regular contact with Mum and Dad to discuss parenting skills and behaviour management. The project also supported the parents to access support in relation to their drug use. Alongside the work with the parents the project started offering one to one support with Nat and Lee, who also started to attend a group for children in similar situations. Advocacy support was also offered to help the family engage and access support from other professionals and mainstream services including housing.

Mum no longer uses heroin and Dad has reduced his use. The family have been re-housed to remove them from the threat posed by drug dealers.

Lee has also started to attend school regularly and Mum has improved her relationship with both Nat and Lee.

Mum and Dad are continue to receive parenting support and are slowly establishing boundaries and routines for the children.

* All names in this case study have been changed.

Strengthen the consistency and effectiveness of the management of immediate risk.

186. The safety of children is paramount. While risk can never be eliminated, important lessons have been learned in recent years about how to manage it effectively, focussed on early and proportionate intervention. The Scottish Government will continue to support this work as a priority by:

• working with a national stakeholder group to develop a risk assessment framework to support appropriate and consistent intervention;
• promote collaborative working between Child Protection Committees and ADATs in planning and meeting the needs of this group; and
• working with all relevant partners, to develop and disseminate effective strategies to engage parents, including compulsory measures as appropriate.

ALCOHOL

187. While this is a strategy about drugs, the needs of children affected by parental alcohol misuse are equally pressing, and arguably at even greater risk of being overlooked. Accordingly, the measures set out in this Chapter are designed to strengthen the response to children affected by any kind of parental substance misuse.

188. Ministers have committed to developing a long-term strategic approach to tackling alcohol misuse, to challenging the perception that being drunk is acceptable and to reducing the long-term harms caused by alcohol misuse. Children and family issues will form an important component of the developing alcohol strategy.

189. The Scottish Government is already making a record investment in alcohol services, providing an additional £85m over the next three years to increase access to early intervention and treatment for people with alcohol problems. We will work with ADATs to ensure that significant improvements in access to treatment for parents bring positive benefits for children.

MAKING IT HAPPEN

190. There is a great deal of expertise around the country on addressing the needs of children affected by parental substance misuse. In order to promote the development and dissemination of good practice, the Scottish Government will support a learning partnership dedicated to this agenda. Building on the model of the Getting It Right For Every Child domestic abuse pathfinders, the Scottish Government will support learning partners in strategic partnerships involving several agencies and services, to test how to apply Getting It Right For Every Child principles to addressing the needs of children affected by parental drug and/or parental alcohol misuse. The strategic and practical lessons emerging from this work will be invaluable in informing national and local improvements in this area. The learning partners will develop approaches over 2008/09 and the lessons learned, when available, will be disseminated through the Getting It Right For Every Child Learning Community.

A Case Study - The Angus Demonstration Project - Now A Getting It Right For Every Child Learning Partner

In 2003, Angus Drug and Alcohol Action Team ( DAAT) and the Angus Child Protection Committee ( CPC) developed a multi-agency protocol on working with children and families affected by substance misuse, to ensure priority was given to the safety and well-being of children. In summer 2006, a pioneering study was undertaken in Angus to quantify the number of children and young people affected by parental substance misuse who were known to a range of services. The study targeted specialist and universal adult and children's services, including schools.

Using a standardised template and a unique identifier to help prevent any double counting, a total of 698 children were identified, which constitutes 3.24% of Angus' under 16 population. Whilst this figure is likely to underestimate the number of children and young people who live in households where there is significant substance misuse, this is more definitive data than was previously available.

Consequently, Angus launched in January 2008 a 'demonstration' project involving key partnership staff to develop and promote a more robust and innovative response to meeting the needs of these children. This is the first phase of a process to strengthen improved inter-agency working and encouraging a more creative approach to sustaining families within their communities. It has reinforced the commitment of all key partners to working differently to identify and support children affected by parental substance misuse. Becoming a Getting It Right For Every Child 'Learning Partner' will ensure lessons learned in Angus are shared nationally.

191. It is possible that the ADAT national support body will have a role in engaging with the Getting It Right For Every Child Learning Community to promote examples of good practice around supporting children affected by parental substance misuse. The national support body may also encourage local Child Protection Committees and ADATs in their work to develop and implement local protocols ensuring effective multi-agency working in line with Getting It Right For Every Child.

ENGAGING THE COMMUNITY

192. Much of the work to improve the protection of children in substance-misusing families is necessarily focussed on the role and capacity of public agencies. However, the Government believes that communities also have a critical role to play in ensuring awareness and information at a local level about these situations, and other situations which suggest children may be at risk.

193. That is why, in February 2008, the Government launched a national marketing campaign for the 24-hour national gateway line to local child protection service providers - the Child Protection Line. The line - number 0888 022 3222 - and related website www.infoscotland/childprotection - is staffed by trained operators who will:

• transfer the call to the most relevant local child protection provider;
• provide information and a local number for the caller to use themselves, if preferred, at a later date; and
• provide information leaflets and materials about what to do if there are concerns about a child, for whatever reason.

The Government believes that communities must play their part in tackling these most difficult of issues and appeals once more to communities to make full use of the line and associated procedures - for individuals to be the 'eyes and ears of the community'.

HOW WILL WE KNOW WE'VE MADE AN IMPACT?

194. The National Performance Framework puts children at the centre of our aspiration for a more successful Scotland. In particular, the Government in Scotland is committed, collectively to ensuring:

• our children have the best start in life and are ready to succeed; and
• we have improved the life chances for children, young people and families at risk.

195. It is clear that addressing the issues of children affected by parental substance misuse will be a critical part of delivering on these goals, and the Scottish Government will work with local authorities and Community Planning Partnerships to support the integration of this agenda into national and local performance frameworks.

CONCLUSION

196. The Chapter has focussed on changing the emphasis to ensure that actions to address the way that public agencies deal with children in substance misusing families are integrated with wider measures to promote the well-being of children and young people, such as Getting It Right For Every Child. It sets in train actions to improve the identification of children at risk; build capacity and quality of services; strengthen the management of immediate risk; and improve the evidence base.