Support for drug misusing parents to help families stay together

Multi-agency working in Scotland and the efforts of the UK’s only Family Drug and Alcohol Court are challenging the notion that children must be removed from substance misusing parents. Molly Garboden and Camilla Pemberton report

Parental misuse of drugs and alcohol and the neglect that goes with it is one of the most common reasons for children to be taken into care. Yet a lack of joined-up working with adults’ services leaves some families falling through the net for support. On the one hand, as Dr Sarah Galvani, senior social work research fellow at the University of Bedfordshire, points out, children’s social workers often lack the skills to assess the impact of substance misuse on parenting.

“It’s about assessing the behaviour of the parents rather than jumping to judgement,” she says. “Just because a parent uses or even misuses drugs or alcohol doesn’t necessarily mean it’s affecting their parenting skills significantly. Some parents who drink or take drugs are still doing a good enough job.”

On the other hand, adults’ services are often dangerously unaware of the child protection issues that might be present when treating drug and alcohol misusers, as several serious case review conclusions have highlighted (See panel, above right).

However, progress is beginning to be made in this area. Here, we examine two approaches being trialled.

The multi-agency team

Hazel Robertson, service manager for social work and health at Angus Council in Scotland, says its Link-Up initiative was set up last year because Scotland is facing an increasing problem of parents misusing substances.

“We know that in Scotland between 40,000 and 60,000 children are living with parents with a drug problem,” she says. “We decided to try to establish how many of these children we were aware of from a child protection point of view.”

Of the children identified, few had had contact with more than one agency.

“Although we knew of the children, that didn’t mean they were receiving any support or that their parents’ issues were known or considered,” Robertson says.

Co-ordinated by the Alcohol and Drugs Partnership and the Child Protection Committee, Link-Up is headed by a multi-agency steering group that includes representatives from housing, police, health and education. It meets monthly to review all initial assessments that go through the council and provides the basis for formal liaison between different agencies and co-ordinated inter-agency responses.

It has so far focused on the town of Montrose, not because parental substance misuse was a particular problem there, but because its relatively small size and population made it a convenient testing ground.

Additionally, two family support workers offer families support on a short-term basis during times of difficulty. They tailor their services according to each family’s needs, and will help to establish routines and activities for their children. Support staff are available to spend evenings and weekends with families when pressures can increase in households.

Although it is too early to determine whether the scheme has been successful, in the first eight months of the initiative 60 children have been assessed. Thirty have been provided with short-term-support with half helped by Link-Up staff.

The Family Drug and Alcohol Court

Nicholas Crichton

The UK’s only Family Drug and Alcohol Court (FDAC) was the brainchild of Nicholas Crichton, a family judge of 18 years’ standing who heard about a similar programme in the US.

Crichton brought the courts to the UK – with the help of Camden, Islington and Westminster councils – to provide an alternative to care proceedings for families with complex parental substance abuse problems and to enable faster decision-making.

“For me, to remove a child for the sixth, seventh or eighth time from the same family because of parental drug and alcohol problems is pretty standard,” he says. “Substance misuse is a prominent feature in 60-70% of care cases, according to 2006 research, and I know a judge who has had to remove a parent’s 15th child.

“Substance misuse is a huge, intergenerational problem. I’ve had mothers say, ‘I’m going to keep having children until you let me keep one’. It’s all they know.

“I calculated the cost to the taxpayer of just one family, with eight children who were all in care or secure units. It was almost half a million pounds.”

The court is a partnership programme, run jointly by the Tavistock and Portman NHS Trust and the charity Coram. Three boroughs, the courts service and four government departments fund it to the tune of £1.3m over three years.

Families in need are referred to the courts – two judges sit on alternate Mondays – by one of the three boroughs if they are deemed to be serious about turning their lives around.

The team is multi-disciplinary, comprising housing officers, social workers, psychiatrists, drugs workers and parent mentors who have been able to keep their children as a result of the programme.

“We get an assessment of the family, their problems and needs and within three weeks develop an intervention plan,” says Crichton. “Parents come back to court and are asked if they’ll sign up to the programme, keep their appointments and come to court twice a week. We fill their week with treatments and appointments designed to tackle the full range of their problems.”

The team focuses largely on the substance misuse and health problems over the first three months. “We work intensively,” Crichton says. “For those families who are able to get through this, we can then start working on the parenting aspects.”

“We are careful not to be critical. For example, if they fall off the wagon but are honest with us about it, we can explore the reasons and applaud them for their honesty.”

There are generally two hearings a month, where progress is monitored. Parents’ lawyers come to the first two but after this are asked to step back unless there’s a legal problem. This enables the process to be less adversarial and lets parents to learn and develop freely.

“When parents agree to come without their lawyers it is remarkable,” says Crichton. “It shows courage and trust in what we can help them to achieve.”

On average, the programme takes one year. When parents complete it, a supervision order is made so the local authority can keep working with them less intensively.

The FDAC is funded until 2012. An evaluation, by Brunel University, due in December, already shows it may result in more family reunions and have more success in keeping parents off drugs than current models. Professor Eileen Munro has also pegged it as a model for further investigation in her review of child protection.

Crichton points out that, even when children are unable to return home, the advantage of the court’s specialist focus is speed. “Care proceedings can take one or two years in some cases,” he says. “We are able to make decisions more quickly, if parents are unable to address their problems or need longer than a child can wait. Every year a child spends in limbo is 6% of their childhood. That can’t be given back to them. We’re identifying the families that can’t sort out their problems rapidly enough and getting those children moved on more quickly.

“When parents are unable to keep their children, they have usually come to understand why – as distressing as that might be – so it is not such a hostile process as care proceedings. It has been moving to see mothers give up their babies for adoption voluntarily because they have realised their substance abuse problems are so serious and deep-rooted that it will take them years to become the good parent that their child needs. A child can’t wait that long.

“It is a very different way of working with people and we really value it. Given how entrenched these families’ problems are, the successes we have had are hugely positive.”

Communication failures

In spring 2008, a pre school-age child in Birmingham died after ingesting methadone.

The taste of the heroin substitute, which is high in sugar, appeals to some children. In this case, the parents had left an open bottle on the kitchen table. A sibling also ingested the drug but survived.

The serious case review concluded: “Agencies were working in isolation with poor information exchange between them and between professionals within agencies. The focus of agency involvement with the family was heavily weighted on the needs of the adults, particularly the father due to the known drug dependency and offending behaviour. The death of the child could have been prevented and the probability of harm being caused to the child and the siblings could have been predicted.”

A young single mother in Surrey died from a drugs overdose in 2007 while her 17-month-old daughter was in her care. It was estimated that the child was left unattended in her cot for more than 24 hours after the mother’s death.

The serious case review concluded: “While the drug and alcohol team did periodically address the child’s safety needs, this was not a consistent approach to their practice, primarily because their main role was to support and monitor the mother in managing her substance misuse problem. There appeared to be no judgement initially regarding what impact the mother’s detox programme would have upon her parenting capacity and for this purpose it would been helpful if there was greater involvement from children’s services.”

Community Care inform subscribers can access a guide to the impact of parental substance misuse on child development by Ruth McGovern of Newcastle University. More details at www.ccinform.co.uk or phone on 020 8652 4848

Case study: ‘Parents feel nurtured as well as supported’

Former statutory child protection social worker Sophie Kershaw now manages the Family Drug and Alcohol Court’s multi-disciplinary team. She says the team’s way of working has given her a chance to go back to doing “real social work” with children and families.

“In our team, the people with the most social work experience are still doing frontline work with children and families, as well as managerial work which we have found hugely beneficial,” she says.

“Local authority caseloads are so high that often social workers find themselves really stretched. We are able to do preventive work, rather than just reacting, and have the time and space for reflective work and proper analysis. This means families can get a really expert service.

“We start working with families on the first day of the court process which speeds up everything.

“The sooner you start, the more time you have to tackle problems. The fact the service is so comprehensive means parents feel nurtured and supported as well.

“It’s tough work but rewarding. We also have great partnerships all working towards the same goal and supporting each other so people feel like they are developing their skills and actually enjoy coming to work.”

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