PG34. Parents who Misuse Substances

1.1

Although there are some parents who are able to care for and safeguard their child/ren despite their dependence on drugs or alcohol, parental substance misuse can cause significant harm to children at all stages of development. A thorough assessment is required to determine the extent of need and level of risk of harm for each child in the family.

1.2

Where a parent has enduring and / or severe substance misuse problems, children in the household are likely to suffer significant harm primarily through emotional abuse and neglect. The child/ren may also not be well protected from physical or sexual abuse. See Recognising Abuse and Neglect Procedure.

Significant harm is defined in Responding to Concerns of Abuse and Neglect Procedure, Concept of significant harm as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

2.1

Maternal substance misuse in pregnancy can have serious effects on the health and development of the child before and after birth. Many factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutrition, domestic abuse and mental health. Assessing the impact of parental substance misuse must take account of such factors. Pregnant women (and their partners) must be encouraged to seek early antenatal care and treatment to minimise the risks to themselves and their unborn child. See Referral and Assessment Procedure, Pre-birth referral and assessment.

3.1

Newborn babies may experience withdrawal symptoms (e.g. high pitched crying and difficulties feeding), which may interfere with the parent / child bonding process. Babies may also experience a lack of basic health care, poor stimulation and be at risk of accidental injury.

3.2

The risk to child/ren may arise from:

• Substance misuse affecting their parent/s' practical caring skills: perceptions, attention to basic physical needs and supervision which may place the child in danger (e.g. getting out of the home unsupervised);
• Substance misuse may also affect control of emotion, judgement and quality of attachment to, or separation from, the child;
• Parents experiencing mental states or behaviour that put children at risk of injury, psychological distress (e.g. absence of consistent emotional and physical availability), inappropriate sexual and / or aggressive behaviour, or neglect (e.g. no stability and routine, lack of medical treatment or irregular school attendance);
• Children are particularly vulnerable when parents are withdrawing from drugs;
• The risk is also greater where there is evidence of mental ill health, domestic abuse and when both parents are misusing substances;
• There being reduced money available to the household to meet basic needs (e.g. inadequate food, heat and clothing, problems with paying rent [that may lead to household instability and mobility of the family from one temporary home to another]);
• Exposing children to unsuitable friends, customers or dealers;
• Normalising substance use and offending behaviour, including children being introduced to using substances themselves;
• Unsafe storage of injecting equipment, drugs and alcohol (e.g. methadone stored in a fridge or in an infant feeding bottle). Where a child has been exposed to contaminated needles and syringes;
• Children having caring responsibilities inappropriate to their years placed upon them (see Young Carers Procedure);
• Parents becoming involved in criminal activities, and children at possible risk of separation (e.g. parents receiving custodial sentences);
• Children experiencing loss and bereavement associated with parental ill health and death, parents attending inpatient hospital treatment and rehab programmes;
• Children being socially isolated (e.g. impact on friendships), and at risk of increased social exclusion (e.g. living in a drug using community);
• Children may be in danger if they are a passenger in a car whilst a drug / alcohol misusing carer is driving.

3.3

Children whose parent/s are misusing substances may suffer impaired growth and development or problems in terms of behaviour and / or mental / physical health, including alcohol / substance misuse and self-harming behaviour.

3.4

See the National Patient Safety Alert (November 2009) Preventing harm to children from parents with mental health needs (The National Archives).

4.1

Substance misuse professionals must identify those adults who are parents, or who have regular care giving access to children, and share the information with local authority children's social care as early as possible.

4.2

Local authority children's social care, substance misuse services and other agency services must undertake a multi-disciplinary assessment using the Assessment Framework (see Referral and assessment Procedure) including specialist substance misuse and other assessments, to determine whether or not parents with substance misuse problems can care adequately for their child/ren. Such assessment should include whether they are willing and able to lower or cease their substance misuse, and what support they need to achieve this.

4.3

Professionals in all agencies must recognise that their primary duty is to safeguard and promote the welfare of the child/ren.

4.4

All care programme meetings for adults who are a parent must include ongoing assessment of the needs or risk factors for the child/ren concerned. Local authority children's social care should be invited to such meetings if appropriate and contribute.

4.5

Strategy meetings / discussions, child protection conferences and core group meetings, must include professionals from any drug and alcohol service involved with the subject child and their family.

4.6

Local Safeguarding Children Partnerships are responsible for taking full account of the challenges and complexities of work in this area by ensuring that inter-disciplinary / agency protocols and training are in place for the co-ordination of assessment and support and for close collaboration between all local children's and adult's services.

Useful further information

Dual Diagnosis - A Good Practice Handbook

NHS Choices Care Programme Approach

Hidden Harm - Responding to the Needs of Children of Problem Drug Users

Foetal alcohol spectrum disorder: health needs assessment

Parents with alcohol and drug problems: support resources

Parents with alcohol and drug problems: adult treatment and children and family services

NSPCC Learning from Case Reviews

Think Child, Think Parent, Think Family

NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder