In February 2023, a link was added in Further Information to NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder.
- Protection and Action to be Taken
- Further Information
- Local Information
Substance misuse refers to the abuse of drugs and/or alcohol. Whilst there may be different treatment methodologies for adults with these problems, they are considered together because the consequences for the child are quite similar. Substance misuse refers to both illicit drugs, alcohol, prescription drugs and solvents, the consumption of which is either dependent use, or use associated with having harmful effect on the individual, family or the community.
Many substance misusing adults also suffer from mental health problems, which is described as Dual Diagnosis and there may be several agencies, from both Adult and Children's social care and mental health services, who are working with the family.
National Serious Case Reviews and Domestic Homicide Reviews have identified domestic abuse, parental mental ill health and drug and alcohol misuse as significant factors in families where children have died or been seriously harmed. Where all three issues are present, they have been described as the 'toxic trio'.
Substance misuse can consume a great deal of time, money and emotional energy, which will unavoidably impact on the capacity to parent a child. The non-using parent will also be adversely affected by their partners substance misuse this will affect their ability to meet children's needs both mentally and physical. We need to start identifying that all adults in the family home including the non-user will be affected by another person's substance misuse this in turn will affect their ability to identify the risks to children in the home that are affected by another's substance misuse.
This behaviour also puts 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.' Children are at risk of social isolation, bullying and low self esteem which will hinder their development and ability to develop coping and life skills they will require.
Children's physical, emotional, social, intellectual and developmental needs can be adversely affected by their parent's or family members 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 may be introduced to drug and alcohol misuse at an early age by the behaviour of the parents or family members and the availability of the substances within the home. The risk of substance misuse becoming normalised increases.
The type, quantity and method of administration of drugs/alcohol are important but must be viewed in the context of the impact on the child.
All agencies need to work together in tackling the problems caused by substance misuse in families in order to safeguard children and promote their wellbeing. While keeping support person centered and age appropriate.
Parents who misuse drugs and/or alcohol may be good enough parents who do not abuse or neglect their children. It is important not to generalise or make assumptions about the impact on a child of parental/carer drug and/or alcohol use. It is, however, important that the implications for the child are properly assessed having full regard to the parents/carers ability to maintain consistent and adequate care. While keeping the children's needs to the fore front and ensuring that they have adulate coping skills to carry them forward with to help stop the inter-generational family history of substance misuse.
Equal regard should be given to each and every child's level of dependence, vulnerability and any special needs. Where there is more than one child in a family each will be affected in a different way.
Where there is concern that a parent or significant other is involved in substance misuse, the impact on the child needs to be considered, including:
- The child's physical safety when the parent is under the influence of drugs and/or alcohol or suffering the after effects;
- Is there a drug/alcohol free parent/carer, supportive partner or relative?
- What part does this person play? Could he/she be encouraged to do more?
- Children can suffer chronic neglect, from before birth and throughout childhood;
- Possible trauma to the child resulting from changes in the parent's or significant others mood or behaviour, including exposure to violence and lower tolerance levels in the parent;
- The impact of the parent's or significant others behaviour on the child's development including the emotional and psychological well-being, education and friendships and social development along with being unable to fit in with their community due to the lack of social skills and a limited understanding of appropriate boundaries;
- The impact on newborn babies who may experience foetal alcohol syndrome or other drug withdrawal symptoms;
- The extent to which the parent's or significant others substance misuse disrupts the child's normal daily routines and prejudices the child's physical and emotional development impacted by the lack of continuity and boundaries in their life;
- The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing and the children may come in to contact with risky adults. The risk of sexual exploitation heightens both in the home and community as people become aware that children are vulnerable;
- Is the child left alone while the parents/carers are procuring drugs/alcohol?
- How safely the parent's or significant others alcohol and/or drugs and equipment are stored as children can be at risk of ingesting substances or injuring themselves on drug paraphernalia;
- Children are particularly vulnerable when parents are withdrawing from drugs;
- Dangerously inadequate supervision and other inappropriate parenting or significant others practices;
- Intermittent and permanent separation;
- Inadequate accommodation and frequent changes in residence;
- Children being forced to take on a caring role and feeling they have the responsibility to solve their parent's, alcohol and drug problems. Also fear of authority figures in their life as they try to keep all siblings together.
The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare, for example, drug and / or alcohol use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.
There are many reasons why adults take drugs or drink alcohol. If doing so has negative consequences then it may be regarded as misuse. Parents or significant others may or may not be aware that their behaviour has a negative impact on their child; there is a real risk in focusing on the adult's difficulty and in supporting their attempts to control their behaviour. The real impact on the child can be overlooked or seen as a secondary consideration.
To be healthy and to develop normally, children must have their basic needs met. If a parent is more concerned with funding an addiction, or is under the influence of drugs or alcohol, they are unlikely to be able to achieve this consistently. A disorganised lifestyle is a frequent consequence of substance misuse. Parents may fail to shop, cook, wash, clean, pay bills, attend appointments etc. Schools are often best placed to notice indicators that young people or children in their school have parents who may be misusing substances due to the disorganised lifestyle. This may be around non parental engagement with the school, signs of neglect, being consistently late for school. Children may have lots of knowledge around substances beyond their years and may be very secretive. They may also be very tired due to being up late in the evening worrying about or looking after parents.
Substance misuse may affect a parent's ability to engage with their child. It may also affect a parent's ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions. Such parents may even become dependent on their own child for support. This can put stress on a child and mean they miss out on the experiences of a normal childhood.
Other consequences of substance misuse – lost jobs, unsafe homes, broken marriages, severed family ties and friendships, and disruption of efforts made by a local authority to help, going from school to school where it is hard for authorities to keep track of the child, poor school attendance impacting on both emotional and educational needs leading to isolation – are also likely to negatively affect a child.
Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug / alcohol-misusing environment must ask themselves "What is it like for a child in this environment?"
4. Protection and Action to be Taken
Where there are concerns by practitioners involved with a family about a child living in the environment of substance misuse an assessment of the parent's or significant others capacity to meet the child's needs including talking to the child should take place to establish the impact on the child of the parent's lifestyle and capacity to place the child's needs before those of their own. A referral to Children's social care in line with the Referrals Procedure should be made, checked it has been processed and the practitioners from adult services, or other relevant agencies, should work in collaboration by the use of contact details with Children's social care.
Children may be introduced to drug and alcohol misuse at an early age by the behaviour of the parents and the availability of the substances within the home. When there are concerns about a young person living in an environment of substance misuse a referral can be made to Aquarius young people team to determine the risk and offer support to the young person about making positive choices with regards to misusing substances.
Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children's social care.
The majority of pregnant substance misusing women will have been identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach / Care Co-ordination Approach will apply including input from the link midwives and a social worker from Children's social care, who will be invited to any meetings taking place in respect of the child/ren.
Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral and checking it has been processed to Children's social care in line with the Referrals Procedure before the child is discharged home.
Specialist Substance misuse services and any other agencies giving support to the family should be invited to and should attend and provide information to any meeting concerning the implications of the parent/carer's substance misuse problems for the child, including Child Protection Conferences and Child in Need meetings.
There is a clear need to assess the impact of the behaviour on the child as well as the wider family and community context. Some adult services may be reluctant to share information because of concern about confidentiality. However, the needs to safeguard children should be paramount and agencies with information regarding the parent will have a valuable contribution to make. In these circumstances, practitioners should seek advice from the Safeguarding leads in their organisation, if they are unsure as to what information should be shared, or what action should be taken.
When practitioners make a decision to end their involvement with a parent/carer with substance misuse problems, or a child who is living with a parent/carer with substance misuse problems, they should always discuss their plans with the other services who are working with the family and an exit plan discussed and produced with all in the family before the case is closed. This is to ensure that any on-going needs can be addressed.
Parents' or significant others own needs will need to be addressed and supported. Sometimes access to appropriate treatment resources is limited which may cause delays in providing services however the child's needs must not be put on hold without a contingency plan. The earlier the support can be given to the child the more beneficial the support will be to both the child and substance user.
Confidentiality is important in developing trust between drug using parents or significant others and staff in agencies working with them in relation to their substance misuse, however, practitioners must always act in the best interests of the child and not prioritise their therapeutic relationship with the adult. This should be enhanced by improved partnership inter-agency working.
When a woman with a substance misuse and/or problem attends for antenatal care, she should be encouraged to contact the Substance Misuse Team for assessment and advice on the treatment options available to her.
Adfam - support to families affected by drugs and alcohol.
Dual Diagnosis - A Good Practice Handbook
NHS Choices Care Programme Approach
Hidden Harm - Responding to the Needs of Children of Problem Drug Users
NSPCC Learning from Serious Case Reviews
Think Child, Think Parent, Think Family
Guidance: Parents with Alcohol and Drug Problems: Support Resources (GOV.UK)
Guidance: Foetal Alcohol Spectrum Disorder: Health Needs Assessment
Guidance: Parents with Alcohol and Drug Problems – Adult Treatment and Children and Family Services
NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder
Northamptonshire Protocol for Raising Concerns About Vulnerable Adults and Children
Family Support Link – Support for families affected by another's substance misuse from 5yrs in Northamptonshire
S2S Northamptonshire – support for adults with substance misuse issues
Aquarius Young People Service – support for young people aged 10 – 18