parental substance misuse and the impact on children · parental substance misuse will often be a...

North Tyneside Safeguarding Children Board Safeguarding and Child Protection Procedures January 2014

Parental Substance Misuse and the

Impact on Children


Contents 1. Introduction 2. Key themes underpinning this Guidance 3. Confidentiality and Consent 4. Effects on individuals of Substance Misuse 5. Parental Substances Misuse and the effects on children

Neglect Emotional wellbeing Protective factors Focussing on the Child 6. Substance Misuse in Pregnancy 7. The Child Protection Threshold 8. Responsibilities of Agencies

i. Responsibilities Of all Professionals ii. Information gathering iii. Recognition and Response iv. Action for services

a) Early Help Assessment (EHA) b) Immediate Protection c) Parental Substance Misuse: The Effects on Children Risk Assessment

Tool d) Referral e) Multi-Agency Assessment f) Strategy discussion g) Decision to initiate section 47 enquiries h) Pre-birth assessment

9. TRAINING Appendix 1 Assessment Tool


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1. Introduction This procedure has been developed for practitioners in North Tyneside working with children and families and/or adults who have care of children where problematic drug and alcohol use affects their lives. It aims to provide practitioners with information about the issue of substance misuse and how this and associate factors, may impact upon an individual’s ability to care for a child. The guidance should be read in conjunction with the North Tyneside LSCB multi agency Safeguarding and Child Protection Procedures and “Working Together to Safeguard Children” (2015) It is acknowledged that not all substance users have problems with parenting. Families where parents/carers drink problematically, use illicit drugs or misuse prescribed medication can still provide a safe, secure and supportive family environment for children. However for some families, drug and/or alcohol misuse can become the central focus of the adult’s lives, feelings and social behaviour, and has the potential to impact on a child at every age from conception to adulthood. It is therefore essential that the implications for each child in the family are carefully assessed (Hidden Harm 2003). Adults who misuse drugs and/or alcohol may be faced with multiple problems including homelessness, accommodation or financial problems, difficult relationships, mental health issues, lack of effective social support systems, issues relating to criminal activities and poor health. Assessment of the impact of these stresses on the child is as important as the drug and/or alcohol itself. However, in many cases it will be necessary to undertake an assessment. This includes the substance use and behaviour of the parents, and any impact from this upon their parenting, before deciding what help and support, if any, is required. Comprehensive and up to date information on drugs and associated issues is available on Drugscope http://drugscope.org.uk/ 2. Key themes underpinning this guidance Professionals need to assess the effects of problematic drug/alcohol use upon an individual’s ability to maintain consistent and adequate care for a child and look at the parent’s substance misuse from the perspective of each individual child to understand the impact this has on the child’s life and development.

When working with families affected by drugs and/or alcohol, the welfare of children is paramount. All agencies in contact with families affected by substance misuse should consider the safety and welfare of the children of those families.

The need to recognise that many parents who use drugs and/or alcohol can be good parents.

Every child has a right to be treated as an individual and parental substance misuse should not be seen in isolation, but needs to be placed in a wider context of each family and its circumstances.

http://drugscope.org.uk/

North Tyneside Local Safeguarding Children Board September 2011

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Children should be considered and consulted when parents and professionals make important decisions about things that affect them, including where, and with whom, they should live, their schooling, their relationships and lifestyle. Their rights should be respected.

All agencies need to work in partnership with parents or carers and the child or young person.

Parental substance misuse will often be a cause for concern, but agencies should assess the child and family's circumstances and offer help and support to enable substance-misusing parents to provide the necessary care for their children at home.

3. Information Sharing, Confidentiality and Consent

Detailed guidance about information sharing, confidentiality and consent are provided in:

Information Sharing: Guidance for practitioners and managers (2008), https://www.gov.uk/government/publications/information-sharing-for-practitioners-and-managers

Section F of the North Tyneside LSCB multi agency Safeguarding and Child Protection Procedures

What To Do If you are Worried that a Child is Being Abused (Dfes2006) https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused

Confidentiality is a major factor in developing trust and in building and sustaining relationships between families and professionals. As no agency can guarantee absolute confidentiality, it is good practice for professionals to explain their agency’s policy on information sharing with parents who misuse substances, particularly in relation to safeguarding issues. Those providing services to adults and children will be concerned about the need to balance their duties to protect children from harm and their general duty towards their service user. Some professionals face the added dimension of being involved in caring for, or supporting, more than one family member, which may be the abused child, siblings or an alleged abuser. Where there are concerns that a child is, or may be at risk of significant harm the needs of that child must come first and the overriding objective must be to safeguard and promote the child's welfare. If a professional identifies a concern regarding a child’s welfare, they should inform the service user of the concern and discuss with them the reasons for this, except where telling the client may result in harm to a child or themselves. Wherever possible, the referrer should seek to obtain consent to share information with other agencies. If in doubt, practitioners should discuss concerns with a senior colleague, designated professional, or, if appropriate, the Caldicott Guardian.

https://www.gov.uk/government/publications/information-sharing-for-practitioners-and-managers

https://www.gov.uk/government/publications/information-sharing-for-practitioners-and-managers

https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused

https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused


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7. EFFECTS ON INDIVIDUALS OF SUBSTANCE MISUSE All substance use is potentially harmful and most types of use carry health risks. The use of drugs, alcohol and solvents can result in accidents, anti-social behaviour, crime and health problems including poisoning or overdose. Use of certain substances, for example, heroin and crack is associated with a greater potential to cause harm due to both greater health risks and greater social risks, such as acquisitive crime. Some methods of use are more harmful than others, for example, intravenous use, as this can lead to the transmission of blood born disease such as HIV and Hepatitis. Furthermore, some patterns of use are more harmful than others, these include:

Dependent use – A compulsion to continue to use a substance in order to feel good or avoid feeling bad. When this is done to avoid physical discomfort it is known as physical dependence, when it is used to avoid anxiety or mental stress or promote stimulation or pleasure, it is known as psychological dependence.

Combination use – The use of more than one substance, for example, use of drugs and alcohol or the use of more than one drug.

Chaotic and unrestrained use – Linked with combination use or bingeing on a single drug until the supply runs out or exhaustion or heavy intoxication prevents further use.

Substance misuse can affect an individual and consequently their families, in very different ways. The effects of the substance misuse will vary according to:

The individual.

The physical and psychological state – including whether the individual is on prescribed drugs for mental health problems.

The substance used and the methods of use.

The circumstances in which the substance is used.

Where use takes place and the presence of other people at these times. Information on the effects of different substances on users is available on the website FRANK http://www.talktofrank.com/ or Drugscope http://www.drugscope.org.uk/ . 5. Parental Substance Misuse and the effects on Children Agencies working with substance misusing parents should recognise that children are not necessarily at risk just solely because a parent uses substances. Many children of substance misusing parents receive good parenting, stability and have all their needs fully met. However, agencies working with children should be alert to the possibility that substance misuse by a parent may lead to a child being considered as a child in need and may prevent a child from receiving the level and quality of care that they need.

http://www.talktofrank.com/


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‘There is a reasonable basis in research to suggest that a child whose parent is misusing substances is at increased risk. Substance misuse can demand a significant proportion of a parent’s time, money and energy, which will unavoidably reduce resources available to the child. Substance misuse may also put the child at an increased risk of neglect and emotional, physical or sexual abuse, either by the parent or because the child becomes more vulnerable to abuse by others’ (V Lewis 1997)

Children’s physical, emotional, social, intellectual and developmental needs can be adversely affected by their parents’ misuse of substances. These effects may be through acts of omission or commission, which have an impact on the child’s welfare and protection. Children in need are likely to include children of parents who have problems associated with their use of either drugs or alcohol or both, and young people who provide care or support for parents who misuse drugs or alcohol, often termed “young carers”. On occasions substance misuse by a parent may prevent a child from receiving the level and quality of care that they need and the parents want them to have. These children should be considered children in need as defined by the 1989 Children Act. Children can be affected by their parents’ substance misuse due to:

Access to drugs or drugs paraphernalia within the home, for example tablets, needles etc.

Use of alcohol and/or some drugs can act as a disinhibitor that allows violence to surface or lowers tolerance levels.

Exposure to a number of strangers within the home who may be potentially dangerous to the child. Where families are entrenched in the drug culture, this may include, for example, threats of violence or demanding money within the home.

Substance use during pregnancy which may result in chemical dependence for the child when she/he is born and/or other associated health risk factors.

Lack of supervision due to the intoxication of the parent. Parental substance misuse is associated with a range of potential risks to children, which may include:

harmful physical effects on unborn and new-born babies

Unsafe sleeping arrangements. Parents may sleep with their baby in the bed or on a settee or chair when they are under the influence of substances

impaired patterns of parental care with a higher risk of emotional and physical neglect or abuse

chaotic lifestyles, which disrupt children's routines and relationships, leading to early behavioural and emotional problems

family income may be diverted to buy alcohol or drugs, leading to poverty, debt and material deprivation

unstable accommodation or homelessness as a consequence of anti-social behaviour orders, rent arrears or conviction for alcohol or drugs related offences

children having inappropriately high levels of responsibility for social or personal care of parents with problem substance use, or care of younger siblings

isolation of children and inability to confide in others for fear of the consequences

threat of domestic abuse


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disrupted schooling

children's early exposure to, and socialisation into, illegal substance misuse and other criminal activity

parents' reduced awareness or loss of consciousness may place children at physical risk in the absence of another adult who is able to supervise and care for them

careless storage of medication and disposal of needles and syringes may cause accident or overdose

repeated separation from parents when parents attend detoxification or rehabilitation facilities, or are in prison, or leave children looked after by multiple or unsuitable carers

multiple episodes of substitute care with extended family or foster carers.

Neglect Children of substance misusing parents may be at risk of having their needs neglected, as dependency on the substance may become the central organising influence of the family, overpowering many parents’ strengths and competencies. Therefore, for some parents who use alcohol, drugs and/or solvents, their ability to meet some or all of their children’s needs may be diminished. Some concerning factors may be:

The child’s basic physical needs not being adequately met.

The child receives inadequate supervision for their age.

Health appointments for the child are not kept or appropriate advice is not sought for any health problems the child may be experiencing.

Disruption to the child’s education or poor school attendance.

Child’s own needs are not being acknowledged or are ignored by their caregiver.

Child becomes the carer.

Unrealistic expectations of a child’s abilities.

No clear boundaries between family roles with the child assuming a parental role.

Lack of boundaries and routines for the child.

Emotional wellbeing Substance misuse may have an impact on a child’s emotional wellbeing as a result of their emotional needs not being met, however, there are other factors which can also affect a child’s emotional well-being, for example, it may be that parents under the influence of substances are emotionally unavailable to their child. Parents under the influence of alcohol and/or drugs can be very frightening to a child. The child may be emotionally affected by living with a parent who has:

Severe mood swings

Hallucinations

Withdrawal symptoms

Parental absence Where parental substance misuse in a home affects a child, the child is likely to be in tune with their parents’ need for drugs and/or alcohol and respond by removing itself from potentially volatile or abuse situations.


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In addition, the child’s daily life may involve a great deal of emotional stress in terms of:

Fearing they may be abandoned

Fearing that their parent(s) may die

Being afraid their parent(s) do not love them

Being afraid other people may find out about their parents’ substance misuse

Feeling responsible for their parent(s) misuse Children who live with these daily stresses may present as sad, unhappy and withdrawn. Their own self-esteem may well be affected as they feel they have no control over events within their own lives. Research cited in Dore, Doris and Wright (1995) suggests that children who live with substance misusing parents as part of their everyday life, may run a higher risk of having mental health problems themselves, a greater rate of drug and alcohol use in adolescence, impaired intellectual and academic functioning, higher levels of anxiety and depression and lower self-esteem. These children may feel different from other children and may worry that their friends may find out about their parents’ substance misuse. Therefore, they may miss out on aspects of childhood many children take for granted, for example, having friends visit them at home. Protective factors Some children and young people are extremely resilient and literature on the children of drug users does not support an assumption that child abuse and neglect automatically follow when a parent uses drugs (Hogan, 1998). It does highlight the importance of well informed, comprehensive assessments of substance misuse in a family and its effect on all its members, and effective support to promote children’s resilience and repair harm caused by damaging substance misuse. Risks associated with parental drug use can be mitigated by other, protective factors (Cleaver, Unell and Aldgate 1999). These include:

sufficient income and good physical standards in the home

a consistent and caring adult, who will provide for the child’s needs and give emotional support

regular monitoring and help from health and social work professionals, including

respite care and accommodation

an alternative, safe residence for mothers and children subject to violence and the threat of violence

regular attendance at nursery or school

sympathetic and vigilant teachers

belonging to organised out-of-school activities, including homework clubs Focussing on the Child In undertaking an assessment of the impact of substance misuse on parenting capacity, it is crucial to maintain the focus on:

the individual needs and welfare of the child/ren and

the standard of care provided to the child and the parents’ ability to fully meet the child’s needs.


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It is important to consider the parental substances misuse from the perspective of the child and the impact it has on the child’s life and development. It is necessary to separate the effects of substance use on the family from the effects on each individual child in the family. Professionals need to identify services that can reduce any adverse effects on the child of parental substance misuse. For some children, parental substance misuse will affect their lives to such an extent that they become children who are in need of protection. 6. Substance Misuse in Pregnancy There are increasing numbers of women using illicit drugs being notified to midwifery and obstetric services. Substance misuse in pregnancy may lead to an increased risk of the following, (although these can also be associated with other social factors):

Premature birth

Low birth weight of baby

Newborn developing withdrawal symptoms and requiring medication or other treatment

Death of the baby before or shortly after birth

Sudden infant Death syndrome It should be noted that the babies of alcohol or drug using mothers might be ill for reasons unconnected with their substance misuse. If the newborn baby is sick it may further strain the mother’s already compromised parenting skills. Women taking substances especially those taking opiates, can have reduced fertility and irregular or absent periods. Many of these women believe that they cannot become pregnant and consequently may not use contraception. It is often a shock for them to discover they are pregnant. A number of women do not seek antenatal care until late in the pregnancy or when they are in labour, as some will not seek appropriate care for themselves or their unborn child due to an anxiety regarding the response of professionals to their substance misuse and fear the attitudes of professionals and the involvement particularly of Children’s Services. Women who are attending substance abuse treatment services usually use antenatal services more appropriately and have better general health than substance misusers who are not in treatment, even if they are still using drugs. It is important to note that the risks involved in stopping suddenly can be high and cause problems to both the mother and baby. Therefore, it is essential that pregnant women seek medical advice before they stop taking any substance. (Refer also to Safeguarding the Unborn Baby procedure contained within the North Tyneside LSCB multi agency Safeguarding and Child Protection Procedures, Section C).


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7. The Child Protection Threshold In considering whether the child protection threshold is crossed, professionals should give consideration to the following factors as they arise throughout any assessment process.

Is the child receiving adequate and consistent care?

Are the parent(s) meeting the child(s) physical, emotional, social, intellectual and developmental needs?

Does the parent/carer usually know where the child is?

Is the child’s home a safe place?

Are there a lot of strangers in the house as a result of illicit drug use?

Is appropriate medical care sought for the child when required?

Does the parent(s) substance misuse involve them in other activities, for example selling drugs, prostitution and/or offending?

Are sufficient finances available to ensure the child’s needs are met?

Does the child attend Nursery/School regularly?

Do the child and parent have a positive relationship?

What is the composition of the household? Are there other substance using adults in the household? Are there other adults that are not involved in substance misuse?

Is there an absence of supportive family members or other support networks?

Are the parent(s) placing their own needs above those of the child?

Is there a history of poor parenting?

Are there other factors, which may increase the risk, for example, domestic violence, parental mental ill health? It is important practitioners understand how toxic the combination of substance misuse, domestic violence and parental mental health can be.

For unborn babies, has appropriate antenatal care been sought?

Is the child given inappropriate responsibilities in the home, for example, self care, parental children, looking after siblings, managing household chores etc?

Are the children frightened of their parent(s) or witnessing or experiencing frightening things within the home, for example severe mood swings by their parent(s)’, hallucinations etc?

Do the parent(s) deny that substance use is a problem for themselves and their children?

Are there clear and appropriate boundaries within the home?

What are the effects of the substance misuse on the parents(s) i.e. any evidence of thought disorder, paranoia, hallucinations or bizarre behaviour?

These factors in isolation are not indicative of abuse and/or neglect and the list is not exhaustive. However, consideration of these factors ensures that the focus of the professionals is on the impact of substance misuse upon childcare rather than the parent(s)’ use itself. 8. Responsibilities of Agencies Agencies have a collective responsibility to protect children, which demands effective communication and coordination of services. Working with parents who misuse substances requires close collaboration between Adults and Services to ensure that


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services to vulnerable children meet the needs of the child, as outlined in Working Together to Safeguard Children (2013) and ‘Supporting information for developing local joint protocols between drug and alcohol partnerships and children and family services’ (2013) available at: www.gov.uk/phe . The Adult Treatment Service responsibilities to support their adult clients as parents and maintain a focus on child welfare do not end after referral on to Children’s Services. Parents will need support from familiar professionals with whom they have established relationships. It is crucial that the Adult Treatment Services and Children’s Services work together closely to help families make best use of the help available. Children’s Services workers are experienced in respect of childcare/child protection issues and Adult Treatment Services workers are experienced in assessing problematic drug/alcohol use. Skills and knowledge from both fields contribute to an integrated assessment. The main focus should always be about working together to ensure that both the child and adults are supported. i. Responsibilities Of all Professionals Many professionals are likely to come across substance misuse within families and it is important that any areas of risk are recognised at an early stage so that intervention and services can be offered to support the family and improve the life chances of the children within the household. When working with parents who misuse substances, agencies should consider the impact on children, be alert to their needs and welfare and respond to any emerging problems. Professionals need to be open and honest with the parents and carers they work with but remain focused on the needs of the child where their welfare or safety may be compromised. ii Information gathering All Adult Workers should:

Gather basic information about the family and household circumstances of substance misusers, as a matter of routine.

Ask service users whether or not they have children in the family or in the household, at the earliest possible stage.

Be aware of potential risks to children in the care of those adults.

Be equipped to provide information and advice to parents about the possible impact of their substance misuse on dependent children, alongside other information and advice about alcohol/drugs and their effects.

Always explore how substance misuse may affect their responsibilities for child care.

Be alert to changes in families' circumstances and whether children appear to be well cared for and thriving.

Consider the potential long and short term effects of the substance misuse.

Make contact with the Front Door service and undertake an Early Help Assessment if there are children in the family (refer to Early Help Assessment procedures).

Liaise with Children’s Services if there is any concern about the welfare of a child.


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Children’s Services should liaise with Adult Treatment Services when working with children in a family with a drug abusing parent/carer in the household to access specialist advice and support as required. This can contribute to an informed assessment of the impact of the substance misuse on parenting capacity and the potential impact on a child(ren). iii Assessing Risk Professionals working with parents or carers who misuse substances need to identify whether the parent or carer's substance misuse is having a detrimental effect upon their capacity and ability to safely and effectively parent their child/ren. Where a worker from Adult Treatment Services is involved in undertaking an assessment/care plan with a parent, there may be a need to do a joint assessment with Children’s Services. The purpose of this joint work is to ensure that both the children’s needs and the parents’ needs are met via a care package, which includes individual plans for both the child and the parent. If there are any concerns about the safety or development of a child in a household or family, individual professionals have a responsibility to undertake a Risk Assessment in respect of the children of substance abusing carers and gather sufficient information to decide if further action needs to be taken in respect of the children involved. a. Early Help Assessment An EHA can be undertaken by a professional from any agency and is designed to promote more effective, earlier identification of additional needs, particularly in universal services. It is intended to provide a simple process for a holistic assessment of a child's needs and strengths, taking account of the role of parents, carers and environmental factors on their development. Practitioners will then be better placed to agree, with the child and family, about what support is appropriate. The EHA may indicate that a child’s needs can be met without a referral to Children’s Social Care. Once consent has been given, a EHA should be undertaken if there are children in the household of an adult who is misusing substances to identify whether children have additional needs. b. Immediate Protection If any suspicions are raised that a child or young person is suffering, or at risk of suffering significant harm, due to substance misuse of a parent(s), and immediate action to safeguard the child or young person is required, a referral should be made to the Front Door Service, according to the procedure outlined in Section D of the North Tyneside LSCB Safeguarding and Child Protection Procedures. Planning of any action will be within a strategy discussion, coordinated by Children’s Services, for the immediate protection of the child and to address possible crimes having been committed. This will include Children’s Services and the police as a minimum.


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Emergency action addresses only the immediate circumstances of child/ren and should be followed with enquiries under Section 47 of the 1989 Children Act if this has not already been done. Where this is the case a multi agency strategy discussion must take place within one working day of the emergency action to plan the next steps and completion of the Section 47 enquiry. c. Parental Substance Misuse: The Effects on Children Risk Assessment Tool The Parental Substance Misuse: The Effects on Children Risk Assessment Tool should be used to explore further the impact of the substance misuse on the children, and is included in Appendix 1. The tool can be completed by the adult social worker in consultation with a Children’s Services social worker and must include analysis of the impact of the substance misuse on parenting capacity and the effects on the child(ren). If a referral has already been made to Children’s Services, the tool can be completed by the professional best placed to do so.

Practice Guidance When assessing risk, professionals should consider the following questions:

Are there any factors which make the child(ren) particularly vulnerable, for example a very young child, or other special needs such as physical illness, behavioural and emotional problems, psychological illness or learning disability?

Are there any protective factors that may reduce the risks to the child?

How does the child’s health and development compare to that of other children of the same age in similar situations?

Are children usually present at home visits, clinic or office appointments during normal school or nursery hours? If so, does the parent need help getting children to school?

How much money does the family spend on alcohol/drug use? Is the income from all sources presently sufficient to feed, clothe and provide for children, in addition to obtaining alcohol/drugs?

What kind of help do you think the child needs?

Do the parents perceive any difficulties and how willing are they to accept help and work with professionals?

What arrangements are for the child(ren) when the parent goes to get illegal drugs or attends for supervised dispensing of prescription drug(s)?

What do you think might happen to the child? What would make this likely or less

likely?

Is there evidence of neglect, injury or abuse, now or in the past? What happened?

What effect did/does that have on the child? Is it likely to recur?

Is the concern the result of a ingle incident, a series of events, or accumulation of concerns over a period of time?

Do parent(s) think that their child knows about their problem alcohol or drug use? How do they know?

What does the child think? What do other family members think? How do you

know?

Is there a failure on the parent(s) part to maintain contact with helping agencies?

Who will look after the child(ren) if the parent is arrested or is in custody?


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d. Referral If a practitioner has concerns about the child of a drug abusing parent/carer(s) being at risk of significant harm at any stage, they should contact the Front Door Service . The procedure is outlined in North Tyneside LSCB Safeguarding and Child Protection Procedures Section D should be followed. The decision to make a referral to Children’s Services about a child in need should be made in consultation with parents or carers wherever possible. Parents or carers will have given the information needed for the decision and professionals will need to be open and honest about why they need to share the information. If unsure of whether to make a Child Protection referral professionals should seek advice from Child Protection professionals within their own agency or contact the Front Door Service to discuss their concerns and agree what action is to be taken. See below for factors which may indicate that the child protection threshold has been crossed. The receiving social worker should clarify with the referrer what his/her concerns are, why they made the referral and will request that they put their concerns in writing. The local authority should decide on a course of action within 24 hours. e. Multi-Agency Assessment A multi-agency assessment should be initiated within 24 hours of receipt of a referral and be carried out in a timely manner reflecting the needs of the individual child and the nature and level of any risk of harm faced by the child. This will require judgements to be made by the social worker in discussion with their manager on each individual case. The maximum timeframe for the assessment to conclude, such that it is possible to reach a decision on next steps, should be no longer than 45 working days from the point of referral into Children’s Services (in accordance with Working Together to Safeguard Children 2013). This can incorporate information gathered in the Risk Assessment tool if this has been completed. The Assessment takes into account the additional factors of parental substance misuse and be carried out on all relevant children in the family and/or the accommodation for whom there may be health or welfare implications. This assessment will where possible involve the participation of the parents or carers, and the child or young person if appropriate as well as the collection of information from all the agencies and professionals involved with the family. If this has not previously been completed by the referrer, it should also involve the use of the “Parental Substance Misuse: The Effects on Children Risk Assessment Tool” that accompanies this guidance. An interpreter should be used if required, rather than relying on family members. f Strategy discussion Whenever there is reasonable cause to suspect that a child is suffering, or likely to suffer, significant harm, following a referral or at any other time after this, a strategy discussion should be held with all relevant professionals, including the police.


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The Social worker will arrange a strategy discussion, within 3 working days, according to Section D of the North Tyneside LSCB multi agency Safeguarding and Child Protection Procedures. The adult social worker will be invited to contribute to this. The strategy discussion will agree:

an immediate action plan with the emphasis on assessing the risks to the child. Whilst the immediate protection of the child is paramount, appropriate consideration should be given to the planning of any subsequent enquiries and assessment.

the individual roles of professionals

how to ensure the child, and any other children, are currently safe if an immediate response is required .

g. Decision to initiate section 47 enquiries When the relevant information has been gathered, the social worker in consultation with a team manager and the police should decide whether to undertake Section 47 enquiries. The enquires should consider what further information is needed about the child and how it should be obtained. The identified Social Worker will commence Section 47 enquiries in accordance with the North Tyneside LSCB multi agency Safeguarding and Child Protection Procedures and actions identified at the strategy discussion. On completion of the section 47 enquiries, a further strategy discussion should be held to decide on future action. i. Pre-birth assessment Where agencies or individuals anticipate that prospective parents may require support services to care for their baby or that the baby may be at risk of significant harm, a referral to Children’s Services should be made as soon as the concerns are recognised. An early referral to Children’s Services will allow assessments to be undertaken and Family Support services provided at the earliest opportunity. Many of these services can be provided under the 'Child In Need' at the early stages of pregnancy. Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain consent to refer to the Children’s Services, unless this action in itself may place the unborn child at risk, for example, the parent/s may move in order to avoid contact with Children’s Social Care. A pre-birth assessment should commence as soon as the referral is received, according to the North Tyneside LSCB Child Protection Procedures, Section C. If, through the pre-birth assessment there is reason to believe that the child may be at risk of significant harm, a Pre-birth Strategy Meeting should be held under Child Protection Procedures and a Child Protection Conference should this become necessary.


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If a Pre-birth assessment determines that a child may be at risk of significant harm or parents require support because of parental substance misuse then a pre-discharge meeting must be held prior to child leaving the hospital. 9. TRAINING This guidance should be underpinned by training for all staff who work both with drug/alcohol misusers and with Children’s Services. All staff who work with problematic drug/alcohol users should receive basic Child Protection Training which is regularly updated. Staff who work in Children’s Services with parents and families should receive training in respect of signs and symptoms of drug/alcohol use as well as how to assess risk to children.


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APPENDIX 1

PARENTAL SUBSTANCE MISUSE AND ALCOHOL MISUSE AND THE EFFECTS ON CHILDREN

ASSESSMENT TOOL


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PARENTAL ALCOHOL AND SUBSTANCE MISUSE ASSESSMENT TOOL This tool should be used alongside the Local Safeguarding Children Board Interagency Guidance: “Parental Substance Misuse & the Effects on Children”. It is essential that the assessment includes analysis of the information according to the guidance in “Parental Substance Misuse & the Effects on Children”. The findings of the assessment should be shared with other professionals and used as contributory information when gathering information for assessments in accordance with Working Together to Safeguard Children (2013).

Names of Children in the household:

D.O.B.

D.O.B.

D.O.B.

D.O.B.

D.O.B.

D.O.B.

Names of Parents / Carers:

D.O.B.

D.O.B.

D.O.B.

G.P: (Name & Contact Details)

Family Address: (Including Postcode)

Any other professionals involved: Details

Assessment Completed by:

Date:

Designation:

Contact Number: e-mail:


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1 What drugs are being used by parents / partners?

Parent Prescribed

Un- prescribed

Partner Prescribed Un- prescribed

Amphetamine

Benzodiazepines

Diazepam

Lorazepam

Nitrazepam

Temazepam

Cannabis

Cocaine

Crack Cocaine

Ecstasy

Heroin

LSD

Methadone

Solvents

Steroids

Alcohol

Other

2 How are the drugs taken?

3 Is the drug use? (Refer to page 2 of the guidance for definitions)

Parent Partner Any other household member

Experimental

Recreational

Chaotic

Dependent

4 What is the frequency of use/pattern of use?

5 What is the cost per day of drug use?


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6 What negative effect does the drug use have on the parent’s behaviour/ability

to parent?

7 Does the drug use combined with alcohol?

Yes No

8 Give details of current or previous detoxification, including dates, type,

frequency and amount. Type(s)

Parent Partner

Methadone

Subutex

Alcohol

Other

Type

Frequency

Amount

9 Is there a history of mental health issues, including self-harm? (parent/partner)

If so, does the drug use affect the parent/carer’s mental health?


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10 Is there a drug/alcohol free parent or partner who can support the child? Are

they aware of the drug/alcohol use?

11 Do parents present during contacts by professionals as having taken

drugs/alcohol? If so, how?

Family Home 12 What is the family home type and condition? Is the home safe and suitable for

children? If not please describe, including state of repair/adequate warmth/hygiene/adequate sleeping arrangements or any other issues.


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Basic Amenities: Basic Amenities:

Bed & Bedding for each child

Yes No

Safety Gate Yes No

Fireguards Yes No

Smoke Alarms Yes No

13 Are the parents maintaining the payment of financial commitments eg bills

amenities? Do they have debts/ arrears associated with drug use?

14 How long have the family lived at the present address? Do the parents move

frequently? List previous addresses and length of occupation – ascertain reason for moves.

15 Are there any other drug/alcohol users sharing the accommodation?

If so, what are the relationships, are they harmonious, how do they impact on the family/children?

Gas Yes No

Electric Yes No

Water Yes No

Yes No


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16 Are there other drug/alcohol users visiting the home? If so, what are the

relationships, are they harmonious, how do they impact on the family/children?

17 Could other aspects of drug use constitute a risk to the children (eg conflict

with others or exposure to criminal activities)?


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Basic Needs 18 Do the children have adequate food?

Yes No

19 Do the children have adequate clothing?

Yes No

20 If appropriate do the children have school uniform?

Yes No

21 Are the children’s health needs met?

Yes No

Have they current health problems for which they are receiving treatment? If so, please give details: -

Are they registered with a GP?

Yes No

Are they registered with a dentist?

Yes No

Are there immunisations up to date?

Yes No

22 Are the children attending school regularly and on time? If not, please give

details.


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23 What activities do the children do after school or during holiday Do the children do age appropriate activities?

24 Are there any concerns about the children’s behavioural/emotional needs?

How does the parent manage the child’s distress/behaviour or any other issues.

25 Does the family have reasonable routine for: -

Getting up: - Yes No

Mealtimes: - Yes No

Bedtime: - Yes No

Yes No

26 Are there toys appropriate to the age of the children in the house?

Yes No

27 Have possessions been sold to fund drug use?

Yes No

28 Is there a positive / warm relationship between parents and children?

Yes No


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29 Are there any indications that any of the children are taking on parenting role within the family or being given inappropriate responsibilities within the home?

Caring for other children: - Yes No

Excessive household tasks: - Yes No

Are parents insightful into this?

Yes No

30 Are there any other factors that may make a chid in the family more vulnerable,

eg very young child, physical or learning disability, health issue?

31 Have there been any reported incidents of domestic violence? If so, give

details.

32 Does either partner state that they are subjected to domestic violence? If so,

give details.


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33 Have the children witness incidents of domestic violence? If so, give details.


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Procurement of Drugs 34 Who procures the drugs?

35 Are the children taken with parents / carers to obtain drugs? If so, give details

36 Are the children left alone or left with inappropriate carers? If so, give details:

37 How is the money for drug/alcohol use obtained?


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38 Have parents or partner/household members a criminal record? If so give detail

39 Is criminal activity linked to drug/alcohol use? If so give details

40 Are the premises being used to sell drugs? If so give details

Health Risks 41 Where are the alcohol/ drugs/equipment stored?


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42 If the parents are intravenous drug user: Where is the injecting equipment stored, if used? Do they share injecting equipment?

43 Do they use needle exchange system? If no, how do they dispose of

syringes?

44 Are they aware of the health risks of injecting or using drugs? Would they

know what to do if someone took large amounts of the drugs?

45 Are the parents aware/in contact with specialist drugs agencies?


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46 Are parents aware of the dangers of children accessing their drugs/alcohol?

Yes No

47 Are children aware of their parents being drug users? Are they aware of where

drugs/alcohol are stored? Do children witness the taking of drugs/use of alcohol?

48 Do children have knowledge of drugs terms / rituals?

Yes No

49 Is there any evidence of children in the household using drugs/alcohol? (If so,

a referral to N2L should be considered.)

50 Are parents using contraception?

Yes No

51 Have parents had immunisation against hepatitis B?

Yes No

52 If pregnant:

Is mother receiving antenatal care? Are there any health issues regarding the unborn child?


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53 Are parents making preparation for the arrival of the new baby?

Equipment Yes No

Scans Yes No

Antenatal appointments

Yes No

54 Any other information/concerns regarding the pregnancy?


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Family Social Networks & Support 55 Do parents and children associate primarily with:

Other drug/alcohol users Yes No

Non-users Yes No

Both? Yes No

56 Are parents accepting of family/friends/agency support? If so, who do

parents access support from?

Relatives Yes No

Friends Yes No

GP Yes No

Midwife Yes No

HV Yes No

Sure Start Yes No

Children’s Services (SSD/ CESC)

Yes No

MIND Yes No

Other Yes No

Yes No

Yes No

57 Are the parents socially isolated in the community? If so how and how does

this affect them and their parenting?

58 Are the relatives involved in drug/alcohol misuse?


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59 Are non-using relatives aware of the drug/alcohol use and are they supportive?

60 Have parents had previous involvement with Children’s Services and was this

a positive or negative experience? Are parents aware of the role of Children’s Services, Education and other agencies in terms of Child Protection? Are they willing to engage with services?


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Parents Perception of the Situation 61 Do parents see their drug use as a problem for themselves? If so, do they wish

to address it?

62 Do parents see their drug/alcohol use as a problem for their children? Are the

parents able to understand the risks to the children, Are they able to place their children’s needs before their own?


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Analysis of Risk The guidance outlined in the North Tyneside LSCB document “Parental Substance Misuse and the Effects on Children” should underpin the analysis of the information gathered in this assessment tool. It should focus on the safety and wellbeing of the children in terms of their physical, emotional, social, intellectual and developmental needs and how they are affected by their parents’ misuse of substances. The worker should make a professional judgement on:

the ability of the parents to respond to the needs of the child(ren);

the presence of any concerns about their ability to safeguard and promote the child(ren)’s welfare, and:

whether any action needs to be taken to ensure the safety of the child(ren). If a child is assessed to be “in need” a referral should be made according to Section 11 of the “Parental Substance Misuse and the Effects on Children” and North Tyneside LSCB Safeguarding and Child Protection procedures, Section D. 63 Strengths and protective factors?

65 Areas of Concern?

66 Risks to Children?

67 Can risks be managed / diminished if so how and who should be involved?


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68 Recommended Action

Early Help Assessment

Referral to Children’s Services

Child in Need

Child Protection

Pre-birth Assessment

Immediate Protective Action

Young carer’s referral

No Children’s Services action

Other Action, please specify:

69 Parental consent If you give permission, information will be shared with relevant organisations, to assist the effective provision of family support, education or health services. This consent applies to information already held on the file or record and to information subsequently added.

I/we consent to this information being shared with other professionals

Signed Signed Date

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