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EAST AYRSHIRE CHILD PROTECTION

COMMITTEE

Good Practice - Working with Pregnant Women with Parental Substance Misuse

Date Approved by CPC: 4 March 2014 Date due to be reviewed: March 2016

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1. PURPOSE OF GOOD PRACTICE DOCUMENT

1.1 To provide East Ayrshire Child Protection Committee (EACPC) and other relevant

individuals with a rationale relating to the effectiveness of interventions in improving outcomes for problematic substance use. To support practitioners in evidence based practice to inform work with women referred under the High Risk Pregnancy protocol due to substance misuse in pregnancy.

2. BACKGROUND 2.1 For many years much of the evidence for effective interventions in the field of

problematic substance use pertained to medical, pharmacological or clinical interventions.

2.2 For a particular intervention to be deemed effective, it was generally expected that

the intervention underwent a randomised controlled trial (RCT) in order that the intervention was scientifically valid and robust.

2.3 Following discussion with Scottish Government and the Institute for Research and Innovation in Social Services (IRISS), the Association of Directors Social Work (ADSW) substance misuse standing committee in partnership with IRISS and Scottish Government issued a tender for a review of the evidence base to determine the contribution made by social work and social care to supporting people with alcohol and/or other drug problems. The findings were to be set within the context of the recovery based approach to working with substance use that is at the core of Scotland’s national drugs strategy.

2.4 Published in March 2011, Social Work Services and Recovery from Substance

Misuse: A Review of the Evidence is a summary of the findings from a review of the research evidence, which looked at social work’s contribution to helping people with problem drug and/or alcohol use.

3. OVERALL FINDINGS 3.1 Twenty Five studies revealed that social workers are well placed to play an active

role in supporting people with alcohol and other drug problems because of the profession’s holistic and ecological approach. The literature also suggests that an ongoing and intensive involvement with service users may often be an appropriate role for them to fulfil rather than a shorter, time-limited involvement.

3.2 Forty eight studies considered workforce development issues for social workers.

Two key findings are pertinent to East Ayrshire:

training social workers can improve their attitudes, knowledge and work in this area. Additionally, where social workers feel it is a legitimate part of their job to address substance use, training has a greater impact;

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in social services with specialist substance use workers, both staff and service users report more positively about their knowledge, skills and the support available to them.

3.3 Common elements identified as supporting improved outcomes were:

the use of motivational interviewing and;

the quality of the individual case manager and their relationship with the service user.

3.4 Whilst social work case management approaches are effective in supporting and

encouraging recovery, some studies have suggested that integrating agencies at an organisational level may be necessary.

4. EVIDENCE OF EFFECTIVENESS 4.1 A relatively small study, Grant et al (2004), found that fairly intensive parent

assistance programmes may reduce alcohol and drug use as well as having other positive outcomes.

4.2 Comfort et al (2000) conclude that an emphasis on relationship building with

substance using women with children may increase their engagement with drug services.

4.3 Jansson et al (2005) found positive outcomes following a period of intensive case

management for mothers for the 4 months following the birth of a child. 4.4 Case managers who saw service users more often, were more active in coordinating

services and developed an empathic and respectful relationship with service users, seemed likely to be achieving more positive outcomes. (Rogers et al 2008, Morgenstern et al 2008, Hall et al 2009).

5. EARLY IDENTIFICATION 5.1 Social, emotional wellbeing and cognitive development provide the foundation for a

child’s future. A child’s experience in utero and in the early years of life can have a life-long impact on their relationships, educational attainment and employability.

5.2 Adverse and complex social factors experienced during pregnancy have the earliest

impact on the health of the infant and their mother. 5.3 Effective communications between pregnant women and their carers and in

particular continuity of care and carers, improves the antenatal experience of women with complex social needs.

5.4 A progressive universal model of care (a continuum of services planned and

delivered in response to identified need) is the mechanism by which families with additional needs/risks may be identified and appropriately supported.

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5.5 Women who have complex needs in pregnancy seldom attend for their first antenatal booking appointment, despite the fact that they may require greater support in order to establish and maintain contact with antenatal services.

5.6 Interventions which enhance maternal mental health and wellbeing and those that

promote positive parent infant relationships can have long term benefits. 6. EFFECTIVE INTERVENTIONS 6.1 Interventions that are aimed at reducing the impact of socially complex needs in

pregnancy focus on the role of maternity care services and specifically on improving a women’s access to and the maintenance of contact with services.

6.2 Effective communication and relationships with women early in pregnancy assists to

enhance their access and engagement with services. An ongoing relationship which includes both continuity of care and of carers enables effective communication and enhances the antenatal experience of women in the following way:

a named person/support worker with specialist knowledge/ability to engage the women improves the women’s engagement with services;

for women experiencing domestic violence (research indicates this can increase significantly in pregnancy) an ongoing relationship for a support worker can facilitate disclosure;

the support worker can assist the woman to engage with the baby in utero and focus her on the needs of the baby;

engagement of the woman and their partner helps them both to understand the pregnancy/support each other and encourages them to change together. This can also assist women to recognise their partner’s motivation to change and inform their decision regarding the relationship.

7. SUPPORT FOR WOMEN IN EAST AYRSHIRE 7.1 In recognition of the increase in parental substance misuse across the East Ayrshire

area, the Council and all partners have made a concerted effort via the Child Protection Committee and the Officer Locality Group (Children and Young People) to ensure a range of support services are available to women and their partners.

7.2 Practitioners require to be aware of the availability of resources, while also being

responsible for ensuring that resources are appropriately targeted and deployed at the earliest possible stage of pregnancy. This will maximise the potential for these supports having a positive impact on the well being of the child (pre and post birth).

7.3 The attached flow charts (Appendix 1 and 1 a) along with the High Risk Pregnancy

Protocol (Appendix 3) assists practitioners to understand the process for the early identification and support to women / families.

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“the relationships between parents and staff influences whether parents continue to use services, regular interaction enables parents to develop open, non-judgemental collaborative relationships..”

(Source: NHS Health Scotland)

Document prepared by: Janie Allen, Principal Officer (Early Education and Childcare) References: ADSW (2011) Social Work Services and Recovery from Substance Misuses: a Review of Evidence- a Practitioners Guide Comfort et al. (2010) Substance Abuse Volume 21, Issue 1, pp 33-45 Grant et al. (2004) Community Mental Health Journal Volume 40, Issue 6, pp 449-511 Jansson et al. (2005) Social Work in Mental Health Volume 3, Issue 4

Morgenstern, Rogers et al. (2008) Addiction Volume 103, Issue 3 pages 469-477

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EAST AYRSHIRE

ARRANGEMENTS FOR ENSURING THE IDENTIFICATION OF THE LEAD AGENCY, LEAD PROFESSIONAL, NAMED PERSON AND SUPPORT

RELATIONSHIP

Identification of Vulnerable Pregnancy

Midwifery Service Addiction Services

Refer to Social Work* *where the situation is high risk, complex and requires a lead professional to co-ordinate a multi-agency assessment and plan

OR Refer to Multi-Agency Referral Group (MARG)** **where multi-agency consideration is required to identify named person

Identify support relationship to work with pregnant woman through her

pregnancy

Questions/Issues to consider in Identification of

the Support Relationship 1. What is the right type of response at this time? 2. Is there already a support relationship in place? Can this person be asked to fulfil this role? 3. The lead professional arranges a meeting with the core group and agrees decisions and responsibilities.

Key Tasks of MARG 1. Share information – identify lead agency 2. Identify named person 3. If requiring lead professional allocation, identify Lead Professional (if named at that stage) 4. Identify support relationship which will engage immediately with the woman to support her throughout her pregnancy.

Options

Family Nurse Partnership (up to

age 19 years)

NSPCC Minding the Baby (up to 25

years)

Early Years Services (if already known due to other

children being supported)

SW Family Support Team (in all other circumstances)

Other key relationships, e.g. this could be Lead

Professional/Addiction Services

Appendix 1

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EAST AYRSHIRE

SUPPORT FOR PREGNANT WOMEN WITH SUBSTANCE MISUSE

Lead Professional Identified

Multi-agency meeting/Core Group around the pregnant

woman

Roles and responsibilities identified and expectation of feeding into the assessment

Lead Professional – holds meeting consider assessment

and recommendation

Sent to Team Leader/Service Manager for decision

Appendix 1a

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Appendix 2

Examples of Support Services:

Building a relationship, where emotional support is central, with reciprosity in

the relationship enabling advice and guidance to be positively received in

respect of preparing for the birth.

Building a relationship which seeks to empower and facilitates self

determination eg through informal learning opportunities such as involvement

in play; observation of nurturing care.

Linking families with group work which can be a source of information and

advice, but which offer opprunities for peer support and learning in a safe

context (eg Pre Birth Groupwork / A Baby is for Life)

Providing practical support in the context of a supportive relationship

eg accompanying parent to:

antenatal appointments;

addiction appointments.

Offer advice/support in respect of income maximisation.

Liaising with organisations such as Hillhouse Care to access

equipment/clothing/baby items to support preparation for baby arriving.

Liaising closely with Substance Misuse Workers/Social Workers conducting

the Pre Birth Assessment.

Post Birth Support

Jansson et al (2005) suggest that continued support post birth can potentially

increase positive outcomes for parents and children. Having the same worker offer

the support, offers the parent less emotional stress at having to change workers etc.

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It also offers those women who have experienced domestic abuse an opportunity for

disclosure and support, as is mentioned in 6.2.

Access to post-birth groupwork where the focus is the importance of

attachment, bonding and play such as Baby Massage, Tickle Giggle, Book

Bug, play@home, parent:child placements.

Support to identify and access community resources e.g toddler groups,

social groups within Early Childhood Centres etc.

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PRE-BIRTH SUPPORT: USEFUL CONTACTS AND SERVICES Service Description Contact Addaction Ayrshire Opening Times:

Mon – Fri 9.00 to 5.00pm

Tue: Group work 6.00pm to 8.00pm

1 The Cross Kilmarnock Ayrshire, KA1 1LR Scotland Tel: 01563 558777 Fax: 01563 545787

Addiction services

NHS Ayrshire & Arran Addiction Service is made up of North, South and East Ayrshire locality services, one residential service and two specialist teams. A range of comprehensive person-centred services are available which are individualised, stage-appropriate, needs led, and flexible throughout the duration of the intervention and recovery process. Specific clinical treatment interventions are delivered by a Community Addiction Team (CAT) and a Primary Care Addiction Team (PCAT) in each of the three localities.

East Locality 01563 574237 North Locality 01294 476162 South Locality 01292 559800

Primary Care Addiction Team (PCAT)

This service provides a comprehensive and equal service in each of the three locality areas across Ayrshire. It also provides a community-based specialist drug and alcohol recovery service to individuals experiencing issues with alcohol and or drug related problems.

East Locality 01563 574237 North Locality 01294 476162 South Locality 01292 559800

Buttle Trust

Small Grants provide a personal and fast response to families living in crisis, when there is no one

else that can help. By paying for basic items such as a cooker, fridge or bed, the grant can offer

relief from a critical situation. The trust also distributes grants through the BBC Children In Need

Emergency Essentials Programme. The Trust works with over 5000 voluntary sector or local

authority partners across the UK to provide far-reaching support for those most in need. These

agencies make applications for children and young people experiencing a wide range of issues

such as illness, disabilities, behavioural and psychological problems. Other social issues

surrounding their family life may include abuse, neglect, domestic violence, homelessness, drug

and alcohol dependency and living in severe poverty.

Scotland Buttle UK PO Box 5075 Glasgow G78 4WA scotland@buttleuk.org 01505 850437

www.buttleuk.org

Childcare and Recreation Information Service (CARIS)

The Childcare and Recreation Information Service (CARIS) is a shared service jointly funded between North , South and East Ayrshire Councils.

The service offers impartial and reliable information on childcare, recreation and family support

Helpline: 0845 351 3000 www.scottishfamilies.gov.uk

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services across Ayrshire. This includes information about parent and toddler groups, registered childminders, independent and voluntary sector nurseries, providers of pre-school education and out of school care services.

DIGS Scheme

The Rent Deposit Guarantee Scheme (DiGS) is now part of CHAP's portfolio of services, having taken over the management of the scheme in June 2005, on behalf of East Ayrshire Council. DiGS provides the 'guarantee' of a rent deposit, (which is normally in place for between 6 to 12 months) claimable by the landlord, at the end of the tenancy (if within the guaranteed term), if any loss or damage is incurred. The deposit enables those who are facing homelessness or are currently homeless, on a low income and unable to raise a deposit on their own, to access the private sector.

DiGS 24b Grange Street, Kilmarnock Monday to Thursday.

DIGS are operate an outreach service at Yipworld, Cumnock on a Friday

More information is available on the CHAP website : www.chap.org.uk

DWP

The DWP is responsible for the administration of a range of working age benefits; benefits which support to people with disabilities and their carers; and the administration of the Child Support Agency and Child Maintenance Service. (See also the Benefits/Money Advice (Financial Inclusion) section of this report for information about supporting people to ensure that they have claimed benefits to which they may be entitled).

DWP is responsible for: understanding and tackling the root causes of poverty rather than its symptoms encouraging people to work and making work pay encouraging disabled people and those with ill health to work and be independent providing a decent income for people of pension age and promoting saving for

retirement providing value for money and reducing levels of fraud and error reducing work-related death and serious injury in workplaces through the Health and

Safety Executive Priorities

welfare reform – simplifying the welfare system and ensuring work pays getting Britain working helping to reduce poverty and improve social justice

Jobcentre Plus

Telephone: 0845 6060 234 Textphone: 0845 6055 255 Monday to Friday, 8am to 6pm

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reforming pensions enabling disabled people to fulfil their potential improving service to the public

Early Childhood Centres,

East Ayrshire Council

The procedures for accessing 0-3 Services are set within the context of increasing demand for services for vulnerable children under 3 years and their families and the need to ensure that resources are allocated appropriately, proportionately and timeously. The wider context of the Early Years Framework and Getting it Right for Every Child recognise that the universal services of education and health can support children age 3-5 years and their families. However, resources for children aged 0-3 years are not universal, apart from health care and therefore services require to be targeted at those children and families in greatest need and allocated based on an integrated needs assessment. Services will be allocated according to Band 1 or Band 2 of the Council’s Early Education and Childcare Procedures for Accessing 0-3 Services. This may be a part- time nursery place, a parent and child placement in an early childhood centre, a placement with a Day Carer, access to a Family Care Worker or access to the Pre-School Home Visiting Teacher. The two primary pieces of legislation which support and determine eligibility for 0-3 Services for children are the Children (Scotland) Act 1995 and the Education (Additional Support for Learning) (Scotland) Act 2004 and 2009.

Bellsbank Primary School and Early Childhood Centre Craiglea Crescent Dalmellington East Ayrshire KA6 7UA Telephone: 01292 550305 Flowerbank Early Childhood Centre 39 Portland Road Kilmarnock KA1 2DJ Telephone: 01563 522 722 Hillbank Early Childhood Centre North West Kilmarnock Area Centre Western Road KA3 1NQ Telephone: 01563 521064 Netherthird Primary School and Early Childhood Centre Craigens Road Cumnock East Ayrshire KA18 3AN Telephone: 01290 421980 Shortlees Primary School and Early Childhood Centre Blacksyke Avenue

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Kilmarnock East Ayrshire KA1 4SR Telephone: 01563 523817

Fax: 01563 550047

Early Years Daycare Service,

East Ayrshire Council

The Ea The Early Years Day Care Co-ordinator will arrange the placement of children aged 0-3 years with the parents and Day Carers. Day Carers provide care to children in a home based setting. They are registered childminders who have had a further assessment undertaken by Social Work Services.

Early Education And Childcare Service

Crosshouse Campus

Playingfield Road

Crosshouse

Kilmarnock

East Ayrshire

KA2 0JJ

Telephone: 01563 554980

Family Nurse Partnership,

NHA Ayrshire and Arran

Family Nurse Partnership (FNP) is a preventive programme for vulnerable young first time mothers. It offers intensive and structured home visiting, delivered by specially trained nurses, from early pregnancy until the child is 2. FNP has 3 aims:

to improve pregnancy outcomes;

to improve child health and development; and

to improve parents' economic self-sufficiency. The methods are based on theories of human ecology, self-efficacy and attachment, with much of the work focused on building strong relationships between the client and Family Nurse to facilitate behaviour change and tackle the emotional problems that prevent some mothers and fathers caring well for their child.

FNP has brought a different way of working with the neediest families. It is strength based and focuses on an expectant mother's intrinsic motivation to do the best for their child. It consists of structured home visits using materials and activities that build self-efficacy, change health

Family Nurse Partnership Supervisor NHS Ayrshire & Arran Child Health Department Ayrshire Central Hospital Irvine North Ayrshire KA12 8SS Tel: 01294 323342 www.nursefamilypartnership.org

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behaviour, improve care giving and increase economic self-sufficiency. At the heart of the model is the relationship between the client and the nurse. A therapeutic alliance is built by specially trained nurses, which enables the most at risk families to make changes to their health behaviour and emotional development and form a positive relationship with their baby.

NHS Ayrshire and Arran have recruited a Family Nurse Supervisor and 7 Family Nurses. Each Family Nurse has a maximum of 25 clients and the Family Nurse Supervisor has 5. Clients are eligible for the programme if they are 19 years or under and live within Ayrshire and Arran. FNP in Ayrshire and Arran started recruiting clients on 4th February 2013.

Hillhouse Care Hillhouse is a unique social enterprise in Ayrshire working to support individuals and families experiencing financial hardship. We offer practical support by supplying good quality second hand children’s clothing, footwear and equipment. Our vision is to help alleviate hardship faced by individuals and families and make a positive difference in their lives.

Donations of baby, children’s clothes and equipment are essential to Hillhouse. These can be handed in to the Care and Collect Centre or the Charity Shop.

Care and Collect Centre,11 Hill Street, Kilmarnock KA3 1HA TEL No: 01563, 523362,

Charity Shop, 122 King Street, Kilmarnock KA1 1PG Tel No: 01563 258014

Housing Service, East Ayrshire Council

Council Housing The Council owns, manages and provides a range of services to approximately 13,000 homes within the East Ayrshire area. The Council housing section is responsible for:

allocations, tenancy and estate management homelessness services and temporary accommodation liaison with other landlords including housing associations and the private rented sector new social housing developments liaising with health and social services to support people to remain in their own homes

We aim to improve the quality of life in all communities by improving the quality of the housing stock, the range of housing options available, the quality of services available to tenants and the level of tenant involvement.

Housing: Kilmarnock Central and South Civic Centre North John Dickie Street Kilmarnock KA1 1HW Telephone: 01563 576618 Email: housing@east-ayrshire.gov.uk Housing: Kilmarnock North Northwest Area Centre Western Road Kilmarnock East Ayrshire KA3 1NQ Telephone: 01563 555670

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Email: housing@east-ayrshire.gov.uk Housing: Cumnock and Doon Valley 1 Greenholm Road Cumnock East Ayrshire KA18 1LH Telephone: 01290 427868 or 427867 Email: housing@east-ayrshire.gov.uk Housing: Irvine Valley and Ballochmyle 51 Academy Street Hurlford East Ayrshire KA1 5BU Telephone: 01563 554650 Email: housing@east-ayrshire.gov.uk

Homelessness, East Ayrshire Council

The Council has a legal duty to help homeless people. The Housing Options Team can provide for advice and assistance for people who are concerned about losing their home. An initial interview can be arranged along with provision of information and advice.

Outwith normal working hours, people who find themselves homeless should contact the Council's emergency helpline.

24 Hour Emergency Helpline Telephone: 0845 7240000 Housing Options 16 College Wynd Kilmarnock East Ayrshire KA1 1HN Telephone: 01563 554554 Email: homelessness@east-ayrshire.gov.uk

NSPCC – Minding the Baby

Minding the baby has a focus on the families who need the most help. It is offered to first-time mothers aged under 25, who are struggling with problems such as depression, homelessness, poverty and violent relationships. The mums may also have suffered trauma, poor parenting abuse or neglect in their own childhood. Home visits are made bi-weekly to provide an intensive level of support and ensure difficulties are effectively addressed. The teams work directly with mothers and across whole family systems, including fathers and other family members to prevent infants suffering abuse or neglect. Families are offered the

Scrutiny & Review Officer Social Work Officer 9 Balmoral Road Kilmarnock KA3 1HL Tel: 01563 503337

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service by their midwife, health visitor or social worker. The parents choose whether they wish to join. NSPCC staff work with other relevant partners e.g early childhood centres This service is designed to complement mainstream provision, delivering additional intensive services to those with the most complex needs. Practitioners from Minding the baby can be relied upon to collaborate closely with other agencies in the best interests of their clients Young women age 19 years and under and who meet the criteria of Family Nurse Partnership (FNP) will be referred to FNP. Those aged 19 years or under will only be referred to Minding the baby if FNP reach their recruitment capacity or the young woman has declined to participate in the FNP programme. Minding the baby support young woman aged 19 years to 25 years who are willing to engage with the programme and meet the eligibility criteria

Benefits and Money Advice (Financial Inclusion)

Approximately 1/5th of children in Scotland live in relative poverty (Scottish Government, 2013). Evidence shows that many people entitled to benefits do not claim them (DWP, 2012). There are potentially a large number of households which may benefit from information advice and support to ensure that they are claiming the welfare benefits to which they are entitled. Many of these households may also benefit from access to money advice and debt counselling. Benefits Advice: Information, advice and support in relation to welfare benefits is provided to the general population of East Ayrshire by East Ayrshire Citizens Advice Bureau. Information, advice and support in relation to welfare benefits is provided to vulnerable people by the Council’s Financial Inclusion Team. Money Advice: Specialist money advice and debt counselling is provided by East Ayrshire Citizens Advice Bureau.

Social Services (Cumnock) Rothesay House 1 Greenholm Road Cumnock East Ayrshire KA18 1LH Telephone: 01290 427720 Email: social.work@east-ayrshire.gov.uk Social Services (Dalmellington) 33 Main Street Dalmellington East Ayrshire KA6 7QL Telephone: 01292 552900 Email: social.work@east-ayrshire.gov.uk Social Services (Galston)

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For further information, please contact your local Social Work Services office (if a user of Social Work Services) or East Ayrshire Citizens Advice Bureau. N.B. East Ayrshire Citizens Advice Bureau also operates a range of outreach services in the south of East Ayrshire and further information can be obtained directly from the Bureau using the contact details provided or by visiting its web pages (link below). http://www.cas.org.uk/bureaux/east-ayrshire-citizens-advice-bureau

Ross Court Titchfield Street Galston East Ayrshire KA4 8AB Telephone: 01563 503400 Email: social.work@east-ayrshire.gov.uk Social Services (Kilmarnock) The Johnnie Walker Bond 15 Strand Street Kilmarnock East Ayrshire KA1 1HU Telephone: 01563 554200 Email: social.work@east-ayrshire.gov.uk Citizens Advice Bureau 3 John Dickie Street Kilmarnock East Ayrshire KA1 1HW Telephone: 01563 576000 Fax: 01563 571106

Women’s Aid East Ayrshire Women’s Aid offer information, support and refuge to women, children and young people who have experienced domestic abuse.

10 Croft Street Kilmarnock KA1 1JB Tel: 01563 536001 Fax: 01563 574917 30a Ayr Road (by appointment) Cumnock KA18 1DW Tel: 01290 423434

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Opening times Monday – Thursday 9am – 4pm Friday 9am – 1pm info@eastayrshirewomensaid.org.uk

www.womensaid.org.uk

Barnardos Axis Service

The service offers structured supports to 11-17 year olds living within the local authority area who are affected by alcohol misuse. Early intervention through fun and creative groups are also delivered to all secondary schools within East Ayrshire as part of the AXIS project. This project is funded by East Ayrshire Alcohol Drug Partnership.

Barnardos Axis 11 Grange Place Kilmarnock KA1 2AB 01563 530646 www.barnardos.org.uk

Lighthouse Foundation

The Lighthouse Foundation has a variety of projects which are available to families affected by drug / alcohol misuse living in Ayrshire. Further information can be found on their website.

The Lighthouse Foundation 40a Portland Road Kilmarnock KA1 2DJ 01563 521 343 lighthousekillie@aol.com www.lighthouse-foundation.co.uk

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The management of HIGH RISK PREGNANCIES

Version No: Number 1.0

Prepared By:

Effective From: 01/07/11

Review Date: July 2013

Lead Reviewer:

Dissemination Arrangements:

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1.0 Introduction In December 2010 the Scottish Government published National Guidance for Child Protection. The guidance made recommendation for changes in practice which were set in the context of Getting It Right for Every Child (GIRFEC). Maternity services play a key role in assessment and support of health and well being during pregnancy and the early postnatal period, which is aimed at improving the health and well being of the mum and her baby. This is particularly important where there are adversities in the women’s life, current or past, which may impact on her and/or her partner’s capacity to provide what the baby needs. The GIRFEC approach is primarily aimed at early identification of risks and needs and appropriate intervention at the earliest possible stage should offset the development and escalation of more complex needs and risks where the response is co-ordinated, appropriate and timely from all services. In 2.0 Who does the guidance apply to? This guidance applies to staff in all agencies that form East Ayrshire Child Protection Committee (EACPC) partnership. 3.0 Definition of High Risk Pregnancy A pregnancy may be considered high risk if one or more of the following circumstances exist within the household: substance abuse, alcohol misuse, learning disability, domestic abuse, serious mental health issues previous history of child abuse or neglect or any other adversity which may impact negatively on the parent’s capacity to care and prepare for a newborn baby. 4.0 Impact of Parental Behaviours of Unborn/Newborn Babies

Parents/carers with alcohol and/or drug misuse Substance misuse can involve alcohol and/or drugs (including prescription as well as illegal drugs).

Impact of parental alcohol and/or drug misuse on children and the parenting role The risks to and impact upon children of substance misusing parents/carers are known and well researched. Alcohol and/or drug misuse during pregnancy can have significant health impacts on the unborn child: o Parents/carers who misuse substances may lack the ability to provide

structure, routine and discipline within family life

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o Their capacity for providing consistent warm and responsive care to their children can be undermined.

o It is important that all practitioners working with alcohol and/or drug

misusing parents/carers know the potential impact of that misuse on children, both in terms of the care environment and of direct exposure to alcohol and/or drug misuse.

o Addiction staff need to know when and how to share information to

keep children safe, and should understand the contribution they can make to assessing risks and needs, and planning.

Parents/carers involved in offending behaviour Criminal behaviour has been identified as a common theme in several cases of child deaths and serious abuse in Scotland (Vincent, 2010). Many of the adults in the inquiry and review reports in Scotland had criminal convictions and police intelligence suggested that some of those who did not have criminal convictions had been involved in criminal activity.

Impact of offending behaviour on children and the parenting role Where parents/carers engage in offending behaviour, there may be a number of potential implications for children and young people within that household:

o Separation from a parent/carer due to custody – either short or long term. This may result in issues of loss of a parent/carer which can have long term implications for children’s emotional well being.

o If one parent/carer is imprisoned, the couple may separate and a new partner may join the household. Such loss and change has a significant impact on children.

o Police raids on a household may be frightening for children and

young people

o All professionals need to be aware of the link between domestic abuse and the risk of harm to children, and be alert to the risk that violent males pose to vulnerable women and children.

Parents/carer’s with mental health difficulties Mental health might usefully be viewed as a continuum of experience, from mental wellbeing to a severe and enduring mental illness. Everybody experiences changes in mental health and well being, influenced by social, personal, financial and other factors. Major events such as bereavement can impact on how people feel about themselves and can lead to depression and anxiety.

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A minority of people may experience mental health problems to such a degree that they are diagnosed with a defined mental illness, requiring the involvement of specialist services and support.

Mental illness refers to a diagnosable illness that significantly interferes with a person’s ability to conduct the tasks needed for day-to-day living. These tasks include the range of self care skills, the ability to regulate emotional arousal and the ability to appropriately interact with others. The more common mental illnesses include clinical depression, postnatal depression, severe anxiety, schizophrenia, bi-polar affective disorder, obsessive compulsive and eating disorders, personality disorder, dementia (including alcohol related brain damage). Mental illnesses are usually defined medically by using internationally recognised classifications.

Impact of Mental Illness on children and the parenting role Parental mental illness is likely to affect children. It can impact on parenting and the parent-child relationship. Parenthood itself can precipitate and influence mental illness. Children’s developmental needs and mental health can have an impact on parental mental health.

o The parent/carer may be unable to anticipate the needs of the child or put the needs of the child before their own. The child may become involved in the parent/carer’s delusional system or obsessive compulsive behaviour.

o The child may become the focus for the parent/carer’s aggression or rejection. The child may witness disturbing behaviour arising from the mental ill health.

o Providing physical care is more difficult when mental illness can

leave a parent lacking in energy, unable to concentrate or go out.

o Providing a secure emotional environment can be difficult if mental illness impairs the capacity to accept, tolerate and express feelings, or to have empathy and communicate effectively.

o Managing children’s behaviour requires emotional control, energy,

decisiveness and concentration.

o If the parent/carer is hospitalised, there is the impact of separation on the child.

o The child may take on caring responsibilities inappropriate for their

age and stage of development. Successful interventions both in the short term (to reduce stress and negative impacts on the children) and longer-term preventative strategies

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can potentially reduce the proportion of children who go on to require psychiatric services as adults. A better understanding of how children experience growing up with a mentally ill parent, and the impact on them of this experience, helps service planners and professionals to improve the effectiveness of interventions. Alcohol and drug usage should also be noted as significant impact factors. Mental health problems can frequently be significantly co-issues alongside substance misuse, where substance can sometimes be used as ‘self-medication’. One impact of this is that even if the substance misuse is addressed, life in the family may not feel significantly improved for the children. This highlights the importance of assessing change from the child-focussed perspective when addressing other presenting issues.

Parents/carer’s with learning disabilities Learning Disability is a lifelong experience with 3 components: 1. Reduced ability to understand new and complex information or to

understand new skills; 2. Reduced ability to cope independently; and 3. Onset before the age of 18 with a lasting effect on the person’s

development.

[The „Same As You‟, Scottish Executive, 2000] The level of disability ranges from mild to moderate to severe to profound. The person may also experience other things such as: physical disabilities; sensory impairment; mental illness; communication difficulties; epilepsy. Prevalence figures suggest that 2-3% of the general population have some degree of learning disability, which equates to some 120,000 people in Scotland.[Scottish Executive 2002] Compared to the general population, people with learning disabilities:

o Are 4 times more likely to die of a treatable illness; o 58 times more likely to die before aged 50 years; o May have 5 undiagnosed conditions at any time; o Are 20 times more likely to have epilepsy; o Have higher levels of mental ill-health.

Some of the challenges professionals face in meeting the needs of people with learning disabilities are:

o Diagnostic over-shadowing (symptoms hidden by other issues); o Multiple health needs; o Communication difficulties; o Non-engagement; and o Problem behaviours.

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Impact Of Learning Disabilities On Children And The Parenting Role Although the numbers of people with learning disabilities having children is relatively small (establishing numbers is difficult – varying widely from 23,000 to 250,000 across the UK) [Nursing Times, August 2007]. There are increasing numbers coming into contact with services. The learning disability has an impact on both the parent and the child:

Parents with learning disabilities have more chance of their children being taken into care [Community Care, June 2000]. Providing physical care and a secure, emotional environment can be difficult when the parent(s)’ abilities are impaired in any way;

Managing children’s behaviour requires focussed intervention from the parent(s);

Several factors have been demonstrated to have an adverse effect on parenting, such as: low socio-economic status; unemployment and social isolation. All of these factors make parenting difficult and parents with learning disabilities are at greater risk of experiencing one of more of these disadvantages;

Up to 90% of people with learning disabilities will have communication difficulties.Some of the common demonstrations of this are:

o Inability to articulate how they are feeling o Inability to make choices and consent to treatment/procedures. o Difficulty discussing their concerns/symptoms. o Someone else mis-interpretating/misunderstanding their

behaviour

Parents/carers displaying anti social behaviour Antisocial behaviour can mean different things to different people. The Antisocial Behaviour etc (Scotland) Act 2004, defines antisocial behaviour as:

Acting in a manner that causes or is likely to cause alarm or distress; or

Pursuing a course of conduct that causes or is likely to cause alarm or distress to at least one person not of the same household as the perpetrator.

Impact of anti social behaviour on children and the parenting role Anti social behaviour may have a range of impacts on children and young people. Behaviour that causes alarm or distress is likely to affect children within the household:

this can place children in a state of alarm or distress themselves;

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it may model inappropriate behaviour which children and young people may imitate and it may result in disruption for the child through changes of carer or house moves; and

Housing difficulties have been found to be common in families where children die or are seriously abused and victims families tend to move home more frequently than other families (Sanders et al., 1999; Wilczynski, 1995).

N=

4.0 Information Sharing

5.0 Response

The National Guidance for Child Protection in Scotland, published in December 2010, makes it explicit that “services and agencies who may have previously seen their role as being to „pass on‟ concerns are now expected to take a proactive approach to identifying and responding to potential risks, irrespective of whether the child in question is their „client‟, „patient‟, or „service user‟. “All agencies, professional bodies and services that deliver adult and/or child services and work with children and their families have a responsibility to recognise and actively consider potential risks to a child, irrespective of whether the child is the main focus of their involvement.” Part 2 of the National Guidance for Child Protection in Scotland sets out roles and responsibilities for child protection. This section explicitly includes responsibilities for a range of services and professional bodies including local authority adult support services and adult healthcare providers. There are certain circumstances which require the involvement of adult services and may be more likely to increase the need for effective information sharing in order to protect children. These circumstances, while not exhaustive, include:

Parents/carers with physical impairment or disability

Parents/carers with drug or alcohol misuse

Parents/carers involved in offending behaviour

Parents/carers with mental health difficulties

Parents/carers with learning disabilities

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Parents/carers displaying anti social behaviour

Parents/carers with learning disabilities Initial and ongoing assessment by those providing services to adults in the circumstances noted above, must always include consideration of how the service user’s condition, behaviour or lifestyle may impact on any child care responsibilities. Best practice also involves sharing information with regard to parents and carers whose actions or behaviour could result in ineffective partnership working between agencies to promote and protect the wellbeing of children. For instance, this would include parents/carers who display aggressive behaviour or who are known to employ a range of diversionary tactics to deflect attention from agencies concerns. Guiding Principles

The welfare of the child is of paramount consideration

Children have a right to be protected from abuse, harm and exploitation

Parents should normally be responsible for the upbringing of their children

Public services should support parents to bring up their children

Information held by services should be treated respectfully, recorded accurately and stored securely

Services should have in place a policy to explain to service users what information is held about them and in what circumstances it might be shared with others

Generally, consent should be sought before sharing information, except where this may place a child or adult in need of support and protection, at risk of harm

Where any service has information that may aid understanding of a child’s circumstances in respect of their needs and risks, this should be shared appropriately

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4.0 Flowchart – High Risk Pregnancy

High Risk Pregnancy Criteria Met?

Refer to Child Protection Health Team (Tripartite Discussion)

Submit for information sharing (only) @ Pre referral screening group

Child Protection Advisor/Midwife supervision and then discuss case again with social work

Health Professional to continue to

support and assess

Child Protection Initial Case Conference by 28th week of pregnancy or within 21 days for late presenting pregnancy

Support needs identified, multi agency planning

meeting convened by senior social worker, lead

professional identified

Refer to community midwife

Unborn child placed on child protection register

Child plan agreed Lead professional

identified

No Child Protection Referral

Child Protection Referral to Social Work

Pre Birth Assessment Document commenced by health

Child Protection Concerns

Child Protection concerns

No Child Protection Concerns

Health Professional to continue to support and

assess

Midwife & SW discuss case & progress completion of assessment

6.0 Appendix 1- Assessment Document

PRE-BIRTH ASSESSMENT Assessment Team Contributors Template

As a contributor to the integrated assessment for child/young person could you please provide your information in the relevant parts provided.

Name of Professional completing assessment

Contact Details

Date of Assessment

EDD & Gestation of pregnancy

Name Of Lead Professional Address and Contact Details (Where appropriate)

PARENTS DETAILS

Forename Surname Other Forenames Known as

Home Address Date of Birth Relationship

Forename Surname Other Forenames Known as

Home Address Date of Birth Relationship

Professionals involved

Name Profession / Agency Contact Details

Purpose of Assessment

Other Children/Significant Others

NAME DOB / CHI CURRENT ADDRESS SCHOOL/NURSERY

(if appropriate)

Unborn Baby Affected by parental: Yes No Self Others

Substance Misuse

Domestic Abuse

Mental Health

Learning Disability

Other

Further Details:

Family Circumstances Historical –

Current

Brief Description of Recent/Current Interventions

Substance Misuse- details of prescribed or illicit substances, including triggers for relapse where known (this information should be sought from addiction services, prescriber, GP)

Assessment of Parents/Unborn Baby – My World Triangle

WHAT I NEED FROM THE PEOPLE WHO LOOK AFTER ME

Details – can be based on past parenting experience:

Needs Met Y/N?

1. Every day care & help 2. Keeping me safe 3. Being there for me 4. Play, encouragement & fun 5. Guidance, supporting me to make the right choices

6. Knowing what is going to happen & when

7. Understanding my family’s background & beliefs

HOW I GROW AND DEVELOP

Details Needs Met Y/N?

1. Being healthy Include health of the mother

2. Learning & achieving 3. Being able to communicate 4. Confidence in who I am 5. Learning to be responsible 6. Becoming independent, looking after myself

7. Enjoying family & friends

MY WIDER WORLD

Details Needs Met Y/N?

1. Support from family, friends and other people

2. School 3. Local Resources 4. Enough Money 5. Comfortable & Safe Housing

6. Work opportunities for my family

7. Belonging

ASSESSMENT ANALYSIS

Safe

Healthy

Active

Nurtured

Achieving

Respected/Responsible

Included

RISKS

RESPONSE/COMMENT FROM PARENT/CARER

RECOMMENDATIONS

Report Completed by

Print Name

Designation

Signature

Page 33 of 34 Version 3.7 Phase 3 October 2010

Resilience Matrix

ADVERSITY PROTECTIVE

ENVIRONMENT

VULNERABILITY

RESILIENCE

Chronology of Significant Events Date of Entry

Date of event

Detail Entered By