Independent report

Evaluation of the Children of Alcohol Dependent Parents programme innovation fund: executive summary

Published 1 June 2023

Applies to England

Introduction

This report presents the findings from the national evaluation of the Children of Alcohol Dependent Parents (CADeP) innovation fund (IF) programme in England. The programme was evaluated by the Tavistock Institute of Human Relations (TIHR), in partnership with IFF Research, between October 2018 and March 2022.

It is estimated that there are around 120,552 alcohol dependent adults living with children in England, based on data from 2018 to 2019. Of these, around 21% were in treatment in 2020, indicating an unmet need of 79%. Meanwhile, around 478,000 children are living with an alcohol or drug dependent parent, which equates to a rate of 40 children per 1,000 parents.

Parental alcohol misuse (PAM) has a multifaceted impact on children. It also often co-exists with other problems including parental conflict. Parental conflict is defined as conflict between parents that is frequent, intense and poorly resolved. It is not domestic abuse because there is not an imbalance of power, neither parent seeks to control the other, and neither parent is fearful of the other.

Families affected by both PAM and parental conflict can experience a range of related issues, including physical and mental illness, and intergenerational patterns of substance misuse. Evidence suggests that children affected by both parental substance misuse and conflict often have complex needs. Such needs are often associated with anxiety, depression, conduct problems, academic failure, substance misuse, criminal behaviour, homelessness, self-harming behaviours and suicidality in both the short and longer term^{[footnote 1][footnote 2][footnote 3]}.

The CADeP IF programme provided funding of £5.7 million between November 2018 and March 2022 to 9 areas to support them in innovating and improving systems and practices to enhance the identification of, and outcomes for, children of alcohol dependent parents (ADPs) and their families. It also aimed to increase awareness of parental conflict among services and explore ways of addressing it among such families.

The 9 project areas comprised:

• Brighton and Hove City Council
• Haringey Council
• Knowsley Council
• North Tyneside Local Authority
• Portsmouth City Council
• Rochdale Borough Council (including also Bolton, Bury, Salford and Trafford)
• St Helens Council
• Swindon Borough Council
• West Sussex County Council

Funding for the programme came from the Department of Health and Social Care (DHSC) and the Department for Work and Pensions (DWP), while Public Health England, which later merged into the Office for Health Improvement and Disparities (OHID), had responsibility for managing the fund.

Evaluation methodology

The national evaluation of the CADeP IF explored the effectiveness of the programme in supporting changes to systems and interventions aimed at families affected by alcohol dependency and parental conflict. At the same time, it facilitated the continuous learning of key stakeholders in DHSC, DWP and OHID, as well as in the 9 local project areas.

This was done through a range of qualitative methods between October 2018 and March 2022, including a telephone survey, case study interviews and the construction of vignettes to illustrate innovative practice and outcomes. It also included an analysis of data on adults receiving treatment for alcohol and drug misuse to identify trends in the number of families accessing treatment in the IF programme areas.

Running alongside these approaches was a programme of 6-monthly learning events organised and facilitated by the Tavistock research team, in conjunction with OHID.

Key findings

How the innovation fund led to improvements in the timely identification of ADPs and children of ADPs

The evaluation has shown that this was achieved through the ways outlined below.

Co-location of adult treatment staff with social care

This helped identify families most likely to benefit from support. Using the funding to place staff at key locations in the system led to earlier identification of alcohol dependent adults who were parents, and children of these ADPs in need of support.

Strategic leadership to facilitate closer collaboration and communication between adult and children’s services teams and other services

This:

• encouraged and enabled families to access support below the threshold of statutory intervention
• raised awareness of support available locally
• encouraged different services to learn from each other

This included, for example, learning how to identify the signs of parental conflict or alcohol dependency and how to start conversations about it.

Workforce development targeted at children’s services staff and substance misuse practitioners

Increasing knowledge and awareness of the impact of PAM and parental conflict gave them more confidence to start conversations with ADPs, and increased awareness of what tools to use to help assessment of need.

The impact of workforce development interventions was weakened in some cases, however, by factors such as:

• staff turnover
• other competing priorities
• capacity issues
• lack of integration of learning with practice

How the programme contributed to improvements and innovation in the local system for supporting parents and children of ADPs

The evaluation has shown that the programme has done this in several ways.

Hiring new staff to reduce the caseload of treatment providers, giving them the opportunity to engage and support families in more flexible ways

Families were more likely to stay engaged and achieve successful outcomes if the support provided was flexible in both location and length. IF funding was also used to enable the engagement of wider family members, kinship carers and friends through peer support networks.

Increasing capacity for the delivery of more whole-family interventions

Whole-family interventions were typically offered to reduce, or avoid, the risk of statutory intervention for children of ADPs. They often comprised weekly sessions and drew in other family members through building trust with them. They covered, for example:

• integrated restorative systemic family work
• parental conflict management
• specific therapeutic inputs for young people

Integrating parental conflict work into the support provided to parents, children and families

Support on parental conflict was seen as most effective when included as part of a holistic offer to tackle the combined effects and causes of alcohol dependency and parental conflict, rather than as a standalone intervention.

Expanding capacity or introducing new services specifically targeted at children and young people

IF funding was used to enable services to provide a greater focus on the therapeutic, mental health and support needs of children and young people affected by PAM, including young carers.

This included providing safe spaces and using creative activities to capture children’s voices to shape dialogue and work with parents. Also evident were relationship-based, child-centred interventions aimed at restoring and strengthening positive family relationships in the face of intergenerational conflict, trauma, domestic abuse, and alcohol and substance misuse.

Impacts that the interventions supported by the programme had on the children and families identified

The evaluation has shown 3 main impacts:

Increased participation rates

Analysis of data on adults receiving treatment for alcohol and drug misuse showed a noticeable increase in the number of parents accessing treatment (in the 8 areas that included this as a target). In particular, the number of parents accessing treatment increased by 42% between 2017 to 2018 (prior to the start of the pandemic) and 2019 to 2020, while nationally it was just 6% over this period.

It is worth noting that the measured change up until the start of the pandemic could have been influenced by other external factors, including other funding aimed at increasing participation rates provided to these areas.

Positive impact on parents accessing treatment

Several of the IF projects highlighted statistically significant positive impacts on parents who received whole-family support, including improvements in their wellbeing, parenting, relationship quality and self-reported health outcomes.

These findings were supported by qualitative evidence, which showed that parents valued the way whole-family support often enabled them to realise the impact their behaviour had on their children. In addition, parents reported that the support helped them to address parental conflict and relationship issues, while experiencing improved life satisfaction and general wellbeing as a result of changes in their behaviour.

Positive impact of whole-family support and therapeutic interventions on young people

The evaluation also included some examples of statistically significant impacts of services delivered as part of the CADeP IF projects on children and young people, relating to their life satisfaction and wellbeing. Qualitative interviews supported these findings and showed that individual or group interventions:

• helped to teach young people new coping strategies
• increased their understanding of their parents’ alcohol dependence and their relationship with them
• also often improved their wellbeing

Recommendations

The evaluation of the CADeP IF programme has highlighted several key messages relevant to the future development of policy and practice. As such, our recommendations are particularly pertinent for those co-ordinating delivery of such support - particularly commissioners and directors of public health and children’s social services, relevant service providers, and the government.

Recommendations for those co-ordinating delivery of support

Champion effective strategic system leadership and promote collaboration at all levels between children’s services, treatment providers and other relevant local agencies

Staff across children’s services, alcohol treatment providers and other relevant local agencies need to be encouraged to work together to bring about the best outcomes for families affected by alcohol dependency.

Ensure a more seamless transition when referring families between services

This includes finding effective ways to share data between providers so that:

• all have access to the same information
• assessments of families’ needs do not need to be duplicated

Promote co-location of adult treatment staff with social care teams

This supports the earlier identification of alcohol dependent adults as parents and children of ADPs in need of support to avoid escalation of need.

Include a strong focus on supporting children and families affected by parental substance misuse and work on reducing parental conflict in re-commissioning plans of substance misuse services

In recognition of the positive impact the approach had in the IF projects, several of the local authorities included a requirement to include whole-family working and a focus on children affected by alcohol dependence in their re-commissioning plans.

Embed or enhance workforce development plans into service provision that focus on increasing knowledge and awareness of PAM and parental conflict

This should be targeted at frontline children’s services staff, substance misuse practitioners and wider agencies that have contact with these families. This would give frontline staff the:

• confidence to start conversations with ADPs
• tools to assess need, provide support and make referrals

Workforce development would make a significant contribution to the increased, and earlier, identification and referral of children and families.

Recommendations for those delivering support

Place the voice of the child at the centre of service development

This is needed to ensure that provision is sensitive to their needs and preferences. Ensure that support is delivered to children and young people in a non-judgemental way, and adopts strength-based approaches.

Design services that are specifically targeted at children and young people affected by PAM

They should be provided with age-appropriate support that gives them a safe space in which to explore their feelings, such as:

• through creative activities
• with other young people with similar experiences
• through therapeutic interventions

Embed whole-family interventions into service delivery

Working with whole families helps to overcome family conflict and ensures that parents are aware of the impact of their behaviour on their children.

Provide support to families in community settings

Requiring families to attend substance misuse treatment centres can often be off-putting, given the stigma attached to addiction and not wanting to be seen to attend such a place by others locally.

Improve awareness in frontline staff of the impact of parental conflict and how it is different from domestic abuse

They also need to be aware of how parental conflict can contribute to, or be enabled by, PAM and poor mental health.

Improved awareness equips staff to combine support on parental conflict with other challenges parents and families might face, while ensuring that no parents are referred to parental conflict support where domestic abuse is a feature of the parental relationship.

Take every opportunity to give treatment provider staff the opportunity to engage and support families in more flexible ways

Flexibility in the timing, location and mode of services can encourage families to attend who might otherwise drop out or be reluctant to engage.

Recommendations for the government

Provide ongoing funding to deliver services

The evaluation has shown that delivering whole-family support work and therapeutic support for children is effective, but also very resource intensive, and often requires the support of specialist staff and services that can address the needs of parents, children and wider family members.

Evidence provided by CADeP projects demonstrates convincingly that earlier whole-family interventions can either avoid expensive higher-tier support or enable families to step down from it.

Overcome the often-siloed funding for children and adults’ services

The CADeP IF project has made a positive step in the right direction by funding the development of new approaches that combine a focus on alcohol dependency and parental conflict with the needs of children, parents and others affected by PAM. However, more needs to be done to ensure that providers can access more long-term funding sources to continue such work in an effective and sustainable way.

Work across government to embed the learning from this programme into other relevant government programmes

This will support a reduction in siloed working at all levels of the system.

Reflections

The CADeP IF project has provided many examples of good practice in identifying and supporting children and families impacted by PAM. Although much of the learning could be transferred to other areas, it would depend on the presence and strength of key contextual factors, such as:

• system leadership
• buy-in
• a strong, pre-existing level of inter-agency collaboration

Stronger evidence of what works could be developed in future by trialling some of the interventions shown to be effective by using experimental or quasi-experimental designs.

Overall, the CADeP IF project has proved to be a very effective mechanism for promoting change in the areas. One of its key strengths was the length of funding provided, which was extended to over 3 years as a result of the coronavirus (COVID-19) pandemic to allow projects ample opportunity to implement and refine changes in their systems for identifying and supporting families and children.

Next steps for the CADeP programme

The CADeP programme is moving into its second phase. This includes looking at ways to:

• roll out key learning to new areas
• maintain and enhance provision in existing areas
• expand support to include families affected by parental drug misuse

Through the £533 million drug strategy funding allocated to improving the treatment and recovery system in England, local authorities are now able to invest in interventions to improve their local treatment systems, which will be selected from a ‘menu of interventions’.

OHID is working with local authorities to encourage and support them to establish a new programme, and to enhance work in existing IF areas.

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2. Bernet W, Wamboldt MZ and Narrow WE. ‘Child affected by parental relationship distress.’ Journal of the American Academy of Child and Adolescent Psychiatry 206: volume 55, pages 571-579. ↩

3. Ferguson, KM. ‘Exploring the psychosocial and behavioural adjustment outcomes of multi-type abuse among homeless young adults.’ Social Work Research 2009: volume 33, issue 4, pages 219-230. ↩