Since 2003 a Kent project has worked successfully to reduce the number of children with substance misusing parents going into care, says Anne Nerva
The Substance Misusing Parents (SMP) project was set up in one Kent district in response to high numbers of children going into care whose parents were misusing substances.Specialised practitioners. A single referral route. Clear, open information sharing. Intensive contact with home visits. Regular drug testing. Care co-ordination across the drug and alcohol treatment system. A clear focus on the child's needs including informed, timely planning and decision-making.
The risks to children with substance misusing parents had been highlighted by the Advisory Council on The Misuse of Drugs in its report Hidden Harm.(1) In Kent this coincided with growing awareness of the role of substance misuse in work with children and families. A report in 1996 had revealed that parental drug or alcohol misuse was a significant factor in 66 per cent of cases where children were subject to care proceedings. Subsequent work suggested that parental substance misuse was implicated in 41 per cent of child protection cases in the east of the county.
Alongside the evidence of a high level of local need there was also a growing appreciation of the effectiveness of treatment, but there was a poor uptake of services among misusing parents.(2)
There were also weaknesses in the systems for supporting children locally. These included poor referral links between social services and substance misuse services, limited awareness of child protection issues among drug and alcohol workers, and limited awareness of drug and alcohol issues among child protection workers.
This weakness led to the development of the SMP project: a partnership project steered by social services, the local treatment agency (KCA) and Kent drug action team.
A specialist service was commissioned to help substance misusing parents stabilise their lifestyle, enhance the expertise of practitioners who work with them and, improve communications between social services and treatment services.
An annual budget of £65,000 allows 1.33 whole time equivalent staff to work with up to 20 cases at any one time. It was believed the investment was likely to be cost effective in terms of reductions in direct costs arising from children who become looked after.
Between April 2003 and March 2006 the service worked with 173 cases, of which 145 have since been closed. In practice, a whole time equivalent worker held an average case load of 15 people at any one time.
Despite particular concern about illicit drug use at the time of the project's inception, the balance of work has included a substantial proportion of people whose main problem is with alcohol (52 per cent illicit drugs, 41 per cent alcohol, 7 per cent illicit drugs/alcohol). Although the service works with more women than men, 22 per cent of cases include work with fathers.
The project has had two independent evaluations. The first of these focused on the project's operation in its first 14 months.(3)
During this period, 10 children ceased being looked after and 23 children came off the child protection register. Direct cost savings were estimated to be at least £15, 940 per month.
Procedurally, the evaluation usefully identified a number of early problems with record-keeping, care planning, information-sharing and interagency working, which were rapidly addressed. There seems a degree of inevitability to these problems when establishing any innovative service. In many respects, policies were being developed from scratch and without any ability to refer to custom and practice in similar services.
More recently, Stevens and Radcliffe conducted a process evaluation using interviews with social services and treatment staff.(4)
At this point the service had had three years to "bed down" and the investigators examined outcomes for children, outcomes for social services, the mechanisms by which
benefits were being achieved and how benefits might be maximised with further rolling out of the service.
The service improved outcomes for children and had improved social services' ability to work with families in which a parent had a substance misuse problem.
The most useful elements of the programme were the speed of the SMP workers' response and their expertise. The ability to conduct joint home visits was especially valued for its contribution to assessment and its compatibility with parents' needs and preferences as, for parents, the logistics of travelling to treatment services were problematic and treatment services were viewed as an unsuitable environment to take children.
Our experience has shown it is feasible to engage substance misusing parents in a way that can help improve their parenting.
Better interagency working has led to the sharing of skills and knowledge between social services and treatment practitioners and greatly improved risk management.
Crucially, the evidence to date suggests that the service reduces the incidence of children who need to be looked after - in line with its original aim.
Locally, the service is valued and has already been extended to another district in Kent and plans are being discussed for rolling the model out into other areas within the county.
Key features of the SMP project:
Outcomes so far Parents' readier acknowledgment of the impact of their drug use on their children. "Fast track" access to treatment. Abstinence from street drugs and engagement in methadone programmes. The successful use of drug testing in line with child protection plans. Social services staff especially valued the improved assessments and better information-sharing systems.
Anne Nerva is district manager in Thanet for Kent social services. Ave Price is a district manager in Kent with experience in child protection services and family support services. Anton Derkacz is a qualified social worker and head of substance misuse agency KCA. Vanessa Cropper is a service manager at KCA and Neil Hunt is KCA's director of research.
Training and learning
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Kent social services and treatment agency KCA have developed a specialised team targeting children with substance misusing parents. Independent evaluations suggest that the service improves engagement, produces benefits to families, is valued by practitioners, improves care decisions, reduces the number of children who become looked after and offers value for money.
(1) Advisory Council on the Misuse of Drugs, Hidden Harm, Home Office, 2003.
(2) A Brook, A Bonner, Thanet Substance Misusing Parents' Service: Evaluation, February 2003-March 2004. Kent Institute for Medicine and Health Sciences, University of Kent.
(3) M Gossop, J Marsden, D Stewart, A Rolfe, "Treatment retention and one year outcomes for residential programmes in England", Drug and Alcohol Dependence, 57,89-98
(4) A Stevens, P Radcliffe, Brief evaluation of the substance misusing parents project, European Institute of Social Services, University of Kent, 2006
Hidden Harm Next Steps: Scottish Executive, 2006.