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1.4.4 Guidelines for the Assessment of Parental Substance Misuse

SCOPE OF THIS CHAPTER

The use of alcohol, drugs and other substances by parents and others caring for children is frequently encountered by all agencies working with children and families. Children should not be routinely viewed as being at risk of abuse solely because their parent uses substances. Many parents who use substances are "good enough" parents and do not neglect or abuse their children.

This chapter should be read in conjunction with the see chapters in the West Yorkshire Consortium Procedures Manual:

This chapter was introduced to the manual in June 2010.


Contents

  1. Introduction
  2. Specialist Assessment
  3. Undertaking the Assessment
  4. Areas to be Covered


1. Introduction

Parents who misuse substances should be treated in the same way as other parents whose personal difficulties interfere with or lessen their ability to produce good parenting. They may be in need of services from Social Care in their own right, or it may be appropriate to offer services to any child in the family as a "Child in Need".

However, the degree and context of parental substance misuse may on occasion in itself pose a threat to the welfare of the child, or may in combination with other factors lead to a decision that a Section 47 Enquiry needs to be undertaken. In these circumstances the range of Child Protection procedures, including the possible need for a Family Support Meeting or Child Protection Conference and the need for legal proceedings will be considered.

The high incidence of parental substance misuse in child protection cases is well documented by research both nationally and locally. All agencies working with children in general, and in particular abused or neglected children should therefore be alert to the possibility that one of the contributory factors to abuse or neglect may be parental substance misuse. All child protection assessments should include consideration as to whether substance misuse is an element in the situation.

Staff at the Leeds Teaching Hospitals Trust have developed specific arrangements for the care of pregnant women who misuse substances, including child protection guidelines. It will not be assumed that because a pregnant woman has a history of substance misuse there will automatically be child protection concerns, but where child protection concerns become apparent referral will be made to Leeds Children's Service.


2. Specialist Assessment

The lead responsibility for undertaking a Child and Family Assessment is with the Children's Service social worker. However, drug or alcohol agencies may provide information for the purpose of the Child and Family Assessment, or may when appropriate be asked to undertake a specialist assessment.

The focus of the drug/alcohol agency worker will be on the adult who is misusing substances. The agency may provide an assessment of substance dependency, prognosis for change and an opinion on the possible effects of substance misuse on parenting performance. However, the agency worker will not be working with the parent in their parenting situation and their assessment should not be viewed as comprising an assessment of parenting ability or of overall risk to the child(ren).

The "Assessment Framework" cautions that "When commissioning a specialist assessment. It is important to ask questions which are within the remit of the particular professional to answer. For example, when a parent is being treated for alcohol addiction it is appropriate for a social services practitioner to ask for an adult psychiatric opinion on the likelihood of the parent being able to stop or reduce his or her drinking, and the impact of the parent's addiction on behaviour, but not necessarily to ask whether that parent is capable of responding appropriately to the child's needs". (Para 6.20)

Leeds Children's Service has a protocol for the involvement of Leeds Drug Project and Community Alcohol Services in the assessment of families where there is substance misuse.


3. Undertaking the Assessment

The following guidance re areas to be considered in assessing parental substance misuse is intended to supplement and not to replace the guidelines provided in the "Framework for the Assessment of Children in Needs and their Families". Indeed, all the questions posed here can be subsumed within the three domains of patenting capacity, child's developmental needs and family and environmental factors identified in the "Assessment Framework", and should be recorded as such.

Given the nature of substance misuse it is sometimes difficult to obtain accurate information, to verify information that is given by users themselves, or to rely on that information. Every effort should therefore be made to validate parental information from other sources.

The worker undertaking the assessment should routinely check parental descriptions against his/her own, and other workers' observations. Statements about effects, and cost of substances should be checked with workers from specialist agencies if the worker undertaking the assessment is not fully conversant with them. Statements about the impact on health, and the use of substitute prescriptions, e.g. methadone, should be checked with primary health workers.


4. Areas to be Covered

3.1 Substance Use

  • What are the substance(s) being used, and in what quantity
  • How are they taken?
  • Is alcohol used in combination with other substances?
  • Is the pattern of use experimental, recreational, chaotic, dependent?
  • Does the use move between these categories?
  • Does the use fluctuate between periods of chaotic use followed by periods of abstinence?
  • Does this then lead to problems of withdrawal?
  • Is there a substance free parent or partner?
  • Is there any evidence of co-existence of mental health problems alongside the substance use or have the mental health problems led to the substance use?

3.2 Procurement of Substances

  • Are the substances prescribed?
  • Are they bought illegally?
  • Are they used in combination? i.e. illegal/prescribed?
  • How are they procured?
  • Are the children left alone whilst their parents are procuring?
  • Are the children taken to places where they could be at risk whilst their parents are procuring?
  • How is the money obtained?
  • Is this causing financial problems?
  • Is this placing the parent at risk of arrest, e.g. prostitution, shoplifting?

3.3 Health Risks

  • If substances and/or equipment are kept in the house, are they kept securely?
  • Are the children aware of where they are kept?
  • Are the parents aware of the dangers to children of ingestion?
  • Do they take adequate precautions to ensure that this does not happen?
  • If parents are intravenous users:
    • do they share injecting equipment?
    • do they use a needle exchange?
    • how do they dispose of syringes?
    • are they aware of the health risks, e.g. hepatitis, HIV, etc?
    • are the children protected from exposure to needles?
    • Are parents aware of, and in touch with, appropriate health agencies? How regular is their contact?

3.4 Parental Perception of the Situation

  • Do the parents see their substance use as harmful to themselves?
  • Do the parents see their substance use as posing a risk to their children?
  • Do the parents place their own needs before the needs of their children?
  • Are the parents aware of the possible range of statutory interventions re themselves and their children, e.g. Child Protection Conference, civil proceedings, criminal proceedings?
  • Are the parents motivated to make changes to their substance use?
  • Have they previously attempted to address their substance use, and with what effect?

3.5 Accommodation and the Home Environment

  • Is the accommodation adequate for children?
  • Does the family move frequently? If so why?
  • Are household bills paid?
  • Are household possessions sold to fund substance use?
  • Is the family part of substance using community?
  • Are other substance users sharing the accommodation? If so, are relationships conflicting or harmonious?
  • Do the parents use the house/allow the house to be used to sell substances?
  • Do the parents allow the house to be used by other substance users?
  • When the parents are using substances, are they aware of/able to monitor who else is using the house, or their involvement with the children?
  • Could other aspects of the substance use constitute a risk to children, e.g. conflict with dealers, exposure to criminal activity related to substance use?
  • Has there been violence in the house related to substance use/debts? If so, have the children observed this?

3.6 Family, Social Network & Support Systems

  • Do the parents associate primarily with other substance users, or with non users?
  • Do the parents maintain contact with their own families?
  • If so, are relatives aware of the substance use?
  • What levels of support are relatives currently offering, and willing to offer?
  • Are the parents willing to accept help from family members?
  • Are the parents willing to engage with statutory agencies?
  • Are the parents willing to engage with voluntary agencies?
  • Are the parents socially isolated, or stigmatised within the community?

3.7 The Child(ren)

  • Are the children aware of parental substance use?
  • Do the children witness parental substance use?
  • Are the children provided adequate care when parents are using substances
  • Are the children exposed to violence linked to substance use/debts?
  • Are the children socially isolated, or stigmatised because of parental substance use?
  • Is there adequate food, clothing and warmth for children?
  • If the parents allow other substance users to use/stay in the house, do they ensure that the children's bedrooms are not used by these people?
  • Are the children's possessions sold to fund substance use?
  • Are the children taking on inappropriate parental roles within the family, linked to parental substance use, e.g. childcare, household responsibilities?
  • Are any other aspects of the children's developmental needs directly impaired by parental substance use?

End