Guidance

Safeguarding and promoting the welfare of children affected by parental alcohol and drug use: a guide for local authorities

Published 4 December 2018

1. Summary

1.1 Parental alcohol and drug use

Parents’ dependent alcohol and drug use can negatively impact on children’s physical and emotional wellbeing, their development and their safety. The impacts on children include:

• physical maltreatment and neglect
• poor physical and mental health
• development of health harming behaviours in later life, for example using alcohol and drugs and at an early age, which predicts more entrenched future use
• poor school attendance due to inappropriate caring responsibilities
• low educational attainment
• involvement in anti-social or criminal behaviour

1.2 Government guidance on safeguarding

In July 2018, the government published an updated version of its statutory guidance on safeguarding and promoting the welfare of children, Working together to safeguard children. The guidance sets out 2 principles:

1. Safeguarding and promoting the welfare of children is everyone’s business.
2. The wide range of organisations and services which contribute to this agenda should have a child-centred approach.

Working together to safeguard children also details the changes brought about by the Children and Social Work Act 2017. The Act removes the statutory responsibility for creating local safeguarding children’s boards (LSCBs) and directs local authorities to make the transition from LSCBs to locally determined multi- agency safeguarding arrangements by September 2019. It also directs them to set up new arrangements for child practice safeguarding reviews (where children have suffered serious injury or death as a result of child abuse or neglect) and for all child death reviews.

1.3 Whole family approach

As we understand more about the impacts of parental problem alcohol and drug use on children, it becomes more important that all health, social care and support organisations take a whole family approach. This is where action to protect children, and enabling all children to have the best outcomes, becomes integral to organisations’ service delivery.

Increasingly, adult alcohol and drug treatment services are being commissioned with this approach, which places renewed emphasis on how these services work collectively and co-operatively with children’s and adults social care services, to improve outcomes for children affected by parental problem alcohol and drug use.

2. Introduction

2.1 Safeguarding the children of alcohol and drug-dependent parents

Working together to safeguard children defines safeguarding and promoting the welfare of children as:

• protecting children from maltreatment
• preventing impairment of children’s health or development
• ensuring that children grow up in circumstances consistent with the provision of safe and effective care
• taking action to enable all children to have the best outcomes

2.2 Numbers of parents who are dependent on drugs and alcohol

The PHE Parental alcohol and drug use toolkit provides local authority level estimates of the numbers of children affected by parental dependent use of opiates and alcohol. It details the numbers of parents and children already known to alcohol and drug treatment services, which allows local authorities to see if the needs of alcohol and opiate dependent parents are being met in their area.

The figures in the toolkit show that an estimated 21% of alcohol dependent parents, and 52% of opiate dependent parents, were in treatment for their dependence in 2016 to 2017.

The toolkit also summarises the main impacts on children of parents’ dependent alcohol and drug use.

2.3 How parents’ alcohol and drug use affects children

Parental problem alcohol and drug use affects children and their experiences of family life in a number of ways. And it’s not just parent’s dependent alcohol and drug use which is a problem. Parents who are using alcohol and drugs at higher risk levels can also have an impact on children.

Pregnant women with complex needs including problem alcohol and drug use can face barriers in accessing and maintaining contact with antenatal care and may require additional support, information and care. The National Institute for Health and Care Excellence (NICE) has published a clinical guideline on a model for service provision for pregnant women with complex social factors.

Analysis by Loughborough University suggests that 7% of young carers are looking after a parent or relative with drug or alcohol use problems. Of these, 28% had received an assessment and 40% were missing school, or had other indicators of educational difficulties.

The Department for Education’s (DfE’s) Characteristics of children in need showed that in 2016 to 2017, drug use was assessed as a factor (either parent or child-related) in 19.7% of cases and alcohol use was a factor in 18%. It also shows that all children in need have poor outcomes at every stage of education, they start behind other children in the early years and that gap widens throughout school.

Problem parental alcohol and drug use is a common feature in serious case reviews (local enquiries into the death of, or serious injury to, a child where neglect or abuse is known or suspected, including where drugs were ingested by the child). In a Department for Education analysis of these reviews, parental alcohol and drug use was present in over a third of reviews (37% and 38% respectively), with at least 1 of these present in 47% of cases.

The same DfE report pointed out that in many families, where there had been a sudden infant death of children aged 0 to 9 months (where maltreatment was not a direct cause of the death) they appeared to have led chaotic lives which included substance misuse.

Analysis by the Association of Directors of Children’s Services found that double the proportion of early help assessments were for ‘trigger trio’ reasons (substance misuse, domestic violence, and poor mental health) in 2017 to 18 than 2 years before.

2.4 Understanding more about parental alcohol and drug misuse

Further research shows there are more nuanced ways of understanding the full extent of impacts and risks according to age and gender of the child and co-existing health and social issues found in families where 1 or more parents use alcohol and drugs in a dependent or high risk way.

A report by The Children’s Commissioner found that children living with parental alcohol misuse come to the attention of services later than children living with parental drug misuse. Boys are less likely than girls to seek help and are more likely to come to the attention of services because of their behaviour, such as through youth offending services, than for the harm they are experiencing.

Young parents in children and young people’s alcohol and drug treatment services are likely to have a range of other vulnerabilities alongside their alcohol and drug use including their own experiences of abuse and neglect, offending and antisocial behaviour.

The DfE serious case review analysis found that the youngest infants and older children (adolescents) stand out as being particularly at risk for different reasons. Babies and young children are inherently vulnerable and dependent, and more so where they require special care because of issues like low birth weight, illness or the impact of maternal drug misuse. These issues can be real challenges to parents over and above the demands of any new-born infant.

In adolescence, the effects of long-standing abuse or neglect may become apparent in mental health problems, or behaviour which puts the young person at increased risk of harm such as drug and alcohol misuse and offending. Disabled children are a particularly vulnerable group, where signs of abuse and neglect can be misinterpreted as physical impairments.

There is a gap in research which has explored the experiences and needs of specific groups of children affected by parental alcohol and drug use. This includes:

• young carers
• children from Black, Asian and Minority Ethnic (BAME) groups
• children who experience a substance misuse related bereavement
• children of prisoners
• children who are cared for by others (such as a grandparent or other kin carers)
• foster carers or adoptive families
• children with foetal alcohol spectrum disorders (FASD)
• young homeless people

2.5 How local authorities can prevent harm

Local alcohol and drug treatment services can do some things to help prevent later harmful consequences for both parents and children, including:

• screening for problematic alcohol and drug use in parents who attend their services
• assessing the impact their current use has on their children
• assessing the risks to their children if their alcohol or drug use escalates
• providing help and support at an early stage

3. Complex factors associated with children in need and those at risk of harm

Most children and families referred to children’s services for assessment will have more than 1 factor identified and reported at end of assessment, with domestic violence being the most prevalent issue (a factor in 49.6% of all assessments) followed by mental health (36.6%). Drug use is a factor in 19.3% of assessments and alcohol in 18.4%.

In 2018 the Children’s Commissioner’s annual study of childhood vulnerability in England estimated there are around 471,000 children in families where 2 of domestic violence, parental mental ill health and alcohol or drug abuse are present, and 103,000 children in families where all 3 factors are present.

From the DfE serious case review analysis, the factors which could raise potential risks of serious harm to the child were:

• domestic abuse
• parental mental health problems
• drug and alcohol misuse
• adverse childhood experiences
• a history of criminality, particularly violent crime
• patterns of multiple, consecutive partners
• acrimonious separation

The analysis found that these factors appear to interact with each other; creating cumulative levels of risk the more factors are present.

Families’ social and economic situations, such as low family income, problem debt and poor housing, can also be associated with poor outcomes for children. School-aged children in need are more likely to live in income-deprived families than any other children.

A national evaluation of the Troubled Families programme found looked after children and families with children on a child protection plan were more likely to claim Employment and Support Allowance. It also found that:

• over one-third of children in need and children on child protection plans were persistently absent from school
• nearly a fifth of families with a child on a child protection plan also had someone dependent on drugs or alcohol
• 16.9% of families in the Troubled Families programme have at least 1 person with alcohol or drug dependence

Adult and family services should be alert to potential problem alcohol and drug use by parents who they are providing help and support to. Staff in these services should understand the potential impact of problem alcohol and drug use on children and how that combines with other risk factors. Staff should also be clear what support their own service might be able to offer as well as what local pathways exist, so they can identify, assess and refer parents and affected children.

4. Commissioner’s and practitioner’s perceptions of joint working

PHE commissioned a consultation in early 2018 to find out about commissioners’ and practitioners’ experiences of effective joint working between alcohol and drug treatment and children and family services.

The majority of respondents thought their joint working was “effective, though with some difficulties” or “adequate”. However, they clearly had a desire to move “beyond the basics” of a system which identifies and refers children affected by parental alcohol and drug use into social care services and refers adults known to children’s services into alcohol and drug treatment services. They wanted to move towards a system where services work together in a coordinated way and focus on problems which affect the whole family.

4.1 Main themes of the consultation

This is a summary of the views of the people who responded to the consultation, about how they thought that joint working could be improved.

They wanted more protocols, guidance and sharing best practice, locally and nationally.

They thought that there needs to be more emphasis on joint working at the ‘early help’ end of the safeguarding spectrum, and that that their work should be more preventative than reactive.

They were keen to have single points of contact that could help people access different local services, and improving day to day contact with people who need help. They thought that these single points of contacts (which could be a person or an organisation) could also help with information sharing and decision-making for referrals, particularly for ‘grey area’ cases where the risks to the child were less clear.

They believed that getting together in person can help all local partners to implement ‘whole family’ practice. Specifically, they proposed some actions that could help this to happen, including:

• joint training for substance misuse and social care staff
• these staff carrying out joint assessments and care planning with families who have alcohol and drug problems
• locating substance misuse and social care services in the same buildings
• embedding substance misuse workers in social care teams
• embedding social care workers in substance misuse teams

They thought that local strategies should clearly set out who is responsible for leading on parental alcohol and drug use and that the strategies should emphasise how safeguarding and promoting children’s welfare is everyone’s business.

They also thought that they should have stronger governance structures to promote, monitor and evaluate the effectiveness of their joint working.

These themes were consistent with the findings of a survey done by Adfam in 2013.

5. Working together to safeguard children: implications for alcohol and drug treatment services

The Children and Social Work Act 2017 builds on previous legislation and directives from government and places new duties on police, clinical commissioning groups and local authorities (known as the local safeguarding partners) to work together with other partners to safeguard and promote the welfare of all children in their area.

The Working together to safeguard children guidance sets out these new statutory requirements and provides a framework for the new local safeguarding partners to develop multi-agency arrangements to replace existing LSCBs. It also sets out requirements for local safeguarding partners to identify and review serious child safeguarding cases, working with the National Child Safeguarding Practice Review Panel.

Local authorities need to make the transition from their former LSCB arrangements to local multi-agency safeguarding arrangements and child practice safeguarding reviews by September 2019.

Working together to safeguard children emphasises the importance of early identification of parents and children affected by drug and alcohol misuse. It also states that directors of public health should ensure that the needs of children are an important part of the joint strategic needs assessment developed by their health and wellbeing board.

Directors of public health, commissioners and the services they commission are important players in local multi-agency safeguarding arrangements, because child welfare statistics show the wide-ranging effects of parental alcohol and drug misuse on children.

Outcomes for children affected by parental alcohol and drug use can be improved by:

• developing closer links with, or being integrated into, local programmes such as troubled families
• having closer links with the types of programmes set out in Improving lives: Helping Workless Families
• providing support for children living with alcohol dependent parents
• learning from good and emerging practice

6. Joint protocols between alcohol and drug treatment services and adult and children’s social care services

6.1 The purpose of a joint protocol

Alcohol and drug treatment commissioners can review or develop a local joint protocol between alcohol and drug treatment and children and family services to support transition to the new multi-agency safeguarding arrangements.

The purpose of having a local protocol is to safeguard and promote the welfare of children and young people, including young carers, whose lives are affected by substance misusing parents or carers. It should also promote effective communication between adult drug and alcohol services and adult, children and family social care services, and set out good working practice for the services involved.

6.2 Why joint protocols are important

In the consultation, 55% of respondents did not have, or were unsure whether a formal local protocol for joint working was in place in their area. Where formal protocols were in place it was significantly more likely that these areas had:

• an implementation plan for joint working
• a steering group in place
• information sharing arrangements clearly outlined
• mapped out services and referral pathways
• set up arrangements to support pregnant substance misusers
• children and family leads in substance misuse services and substance misuse leads in children and family services

7. What to include in joint protocols

7.1 A clear statement of how alcohol and drug treatment services can be part of local safeguarding arrangements

The statement should reflect local arrangements for multi-agency safeguarding and should specify the roles of both adult and young people’s alcohol and drug treatment services in the arrangements. It should give assurances that duties and responsibilities for child safeguarding are set out in individual service contracts and say how they will be monitored.

What local partners should consider

Commissioners should have a clear sense of how alcohol and drug treatment services can be commissioned using the ‘whole family approach’ to fit in with local safeguarding and child welfare strategies and what this might mean for how services are delivered.

Alcohol and drug treatment services should have a lead practitioner, supported by a designated contact in children’s services. There should be a full explanation of the training and support needed for this role.

It would be good practice for alcohol and drug treatment services (for adults and young people) should have a designated professional lead or named professional to clarify the process for reporting and dealing with safeguarding concerns.

7.2 A clear statement about data and information sharing arrangements

The statement should include the processes and principles for how alcohol and drug treatment services should share data and information with others including the safeguarding partners, LSCBs (while they continue to exist) and multi-agency safeguarding hubs.

Information sharing arrangements should be supported by protocols which assist:

• local assessment of child need
• early identification of problem alcohol and drug use in parents and children
• identifying and assessing children affected by parental substance misuse
• promoting children’s welfare and protection

What local partners should consider

Local information sharing arrangements should be included in alcohol and drugs services’ internal policies on how they share information.

Commissioners should promote a culture of appropriate information sharing in alcohol and drug treatment services, supported by multi-agency training.

7.3 A focus on early help and prevention for families affected by parental alcohol and drug use

Early help means providing support as soon as signs of a problem emerge, at any point in a child’s life. This relies on organisations working together to identify children and families who might benefit from early help, undertaking an assessment of need and providing targeted early help services to children and their families with a focus on improving outcomes for children. Support can come from a wide range of statutory, health and community services according to the level of need assessed.

What local partners should consider

Where there is a low level of assessed need, alcohol and drug treatment services should be encouraged to agree referral pathways to local agencies and organisations which provide universal and targeted help to parents with alcohol and drug problems, and their children.

A range of support services that are appropriate to age, gender and ethnicity should be compiled and commissioners could facilitate this process by ensuring alcohol and treatment services are linked into any provider networks of services for families and children which exist in the local area.

Commissioners and practitioners should also be aware of the work their local authority is doing using the Ministry of Housing, Communities and Local Government’s Troubled Families: early help service transformation maturity model and work out if this will change the process for referrals into the Troubled Families programme and early help services.

Alcohol and drugs treatment services could make important contributions to the threshold document (which sets out the local criteria for action to safeguard children, see glossary for more information) to make sure that the needs of children affected by parental alcohol and drug use are recognised and provided for.

All alcohol and drug treatment and recovery services need to make sure they understand the Working Together to safeguard children guidance and the local threshold document.

The referral process should be simple and responsive, and the assessment should be focused on the needs of the child and the family. Local areas should have referral pathways from social care and support services into alcohol and drug treatment services and they should make clear:

• the criteria for referral
• the referral and assessment process
• the type of support treatment services can offer

When alcohol and drug treatment and children and family services are considering the impact of parental alcohol and drug use on a child, they should jointly assess families using tools and guidance which factor in all the relevant information. Commissioners should ensure there is multi-agency training in the use of assessment tools and the principles and practice of joint working.

7.4 A clear process for reporting and dealing with safeguarding concerns

The local threshold document should set out the procedures for cases relating to:

• abuse
• neglect
• contextual safeguarding risks
• child management within the secure estate
• disabled children

What local partners should consider

All children and young people’s alcohol and drugs services should have a ‘designated practitioner’ or ‘dedicated and named practitioner’ (a role to support organisations to recognise the needs of children, for more information see the glossary for safeguarding and it would be good practice for adult services to have a similar post.

The designated practitioner role will be important for generally promoting the welfare of children, but it’s likely to have a specific responsibility for when there is a child with complex needs who is being referred to children’s social care, or where there are safeguarding concerns. The job description should be described within the service staffing arrangements and might include attending child protection conferences, making local multi-agency safeguarding arrangements and doing child safeguarding practice reviews or child death reviews as part of the role.

Children’s social care should be the main contact point for child safeguarding concerns. All alcohol and drug treatment services should have a documented referral process into social care for where there are safeguarding concerns, informed by Working Together principles and in line with the local threshold document.

7.5 A commitment to joint training between substance misuse and social services

Working together to safeguard children stresses the importance of multi-agency training to support a collective understanding of local need and identifying children and families who would benefit from early help.

Local safeguarding partners will be expected to report on how inter-agency training will be commissioned, delivered and monitored for impact. They will also need to be clear about how they will do multi-agency and inter-agency audits once their local safeguarding arrangements have been published.

An Ofsted report on joint working found that senior managers in adult and children’s services and the majority of children’s services practitioners knew how to learn from serious case reviews involving parent or carer mental ill health and drug and alcohol misuse. However, this was less well understood by adult services practitioners.

What local partners should consider

Alcohol and drug services should be important participants in local multi-agency training arrangements both as recipients and providers of specialist training in identifying and responding to parents and children affected by problem alcohol and drug use.

Local authorities should share learning from local and national child safeguarding practice reviews with alcohol and drug treatment service managers and practitioners, to help them improve services and their responses to children in need.

7.6 A commitment to information–sharing by practitioners

Effective safeguarding work between practitioners depends on collaborative working between all relevant local agencies, and that they recognise that no single professional has all of the required knowledge or skills for this work.

The Department for Education has published guidance on information sharing for people who provide safeguarding services to children, young people, parents and carers.

What local partners should consider

Alcohol and drug treatment services and children and family services should work out how best to help their practitioners to understand what works best in information sharing, and how to overcome real and perceived barriers. Resources like The Centre of Excellence for Information Sharing will be useful.

Alcohol and drug treatment services should develop a coherent approach to making decisions about the balance of risk when sharing information about vulnerable children and families with children and family services.

7.7 A commitment to helping services to evaluate their practice and share good practice

The Ofsted report on joint working found that most local safeguarding children’s boards and senior managers did not systematically evaluate the quality of joint working taking place.

What local partners should consider

Alcohol and drug treatment services should regularly analyse referrals of children and families into social care and support services. They should also have a system of file audits, where possible using a peer review process for cases where there are children in the family.

Alcohol and drug treatment services need to consider how they assess and work with pregnant women particularly where they have co-occurring mental health conditions and where there is domestic violence and abuse.

All local partners should have ways to capture and share good practice across all relevant organisations.

8. Glossary

Whole family approach

An approach developed for adult services as a result of the Care Act 2014. A Local Government Association guide characterised this approach as having the following 4 steps:

1. Think family.
2. Get the whole picture.
3. Make a plan that works for everyone.
4. Check it’s working for the whole family.

Lead practitioner

In cases where a child and family would benefit from coordinated early support from more than 1 organisation (such as education, health, housing, police), a lead practitioner should undertake the assessment, provide help to the child and family, act as an advocate on their behalf and co-ordinate the delivery of support services. A GP, family support worker, school nurse, teacher, health visitor or special educational needs co-ordinator could take the lead practitioner role. Decisions about who should be the lead practitioner should be taken on a case-by-case basis and should be informed by the child and their family.

Once the referral has been accepted by local authority children’s social care, the lead practitioner role would usually fall to a social worker.

Designated practitioner or for health organisations, designated and named practitioner

Section 11 of the Children Act 2004 places a duty on services for children and young people to have in place a designated practitioner for child safeguarding. This role is to support other practitioners in their organisations to recognise the needs of children, including protection from possible abuse or neglect.

Designated practitioner roles should always be explicitly defined in job descriptions. Practitioners should be given enough time, funding, supervision and support to fulfil their child welfare and safeguarding responsibilities effectively.

Threshold document

Safeguarding partners should publish a threshold document, which sets out the local criteria for action in a way that is transparent, accessible and easily understood. This should include:

• the process for the early help assessment and the type and level of early help services to be provided
• the criteria, including the level of need, for when a case should be referred to local authority children’s social care for assessment and for statutory services under:
• section 17 of the Children Act 1989 (children in need)
• section 47 of the Children Act 1989 (reasonable cause to suspect a child is suffering or likely to suffer significant harm)

Contextual safeguarding

Some children may be vulnerable to abuse or exploitation from outside their families. These threats might arise at school and other educational establishments, from within peer groups, or more widely from within the wider community and online. Threats can take a variety of different forms and children can be vulnerable to multiple threats, including exploitation by criminal gangs and organised crime groups such as county lines, trafficking, online abuse, sexual exploitation and the influences of extremism leading to radicalisation.