What social workers should consider when risk assessing parents who misuse drugs and alcohol
Sue Smith, families and children regional manager for London and eastern areas, Crime Reduction Initiatives
Emma Pawson, national families and young people manager, National Treatment Agency
Emma Burr, former substance misuser and recovery champion with Addaction
- All three of our experts will be speaking at Community Care’s conference on Whole Family Support for Drug and Alcohol Misusing Parents, taking place in London on Tuesday September 11
1. Are the parents motivated to change?
Parents are rarely able to recover unless they can see how their substance misuse is impacting on their ability to care for their child or keep them safe, Smith says, adding that parents who are stable on methodone are able to care for their children. “It’s no longer a case of abstain or we’ll take your children away from you,” she says. A willingness to engage with professionals is also key, according to Pawson, as is the conviction that treatment does and will work. “There are brief interventions social workers can do, such as motivational interviewing to help start that process and assess the willingness to change,” she says.
2. Are there multiple problems?
Substance misuse is rarely the only risk factor in any case. “Usually parents will have a number of problems including mental health problems, such as depression or anxiety, or housing issues that will also need to be resolved,” Pawson says. “I see a key role for a social worker as a co-ordinator of care for all these services. If someone stabilises their substance misuse but their other needs are not met then it won’t last.” For Burr, one of the most helpful interventions during her own recovery was the help she received to paint her house. “They didn’t do it for me but I was really struggling to do it on my own. Even though it was a small thing it made such a difference. My house went from being a place of chaos to suddenly feeling like a home.”
3. What is the root cause?
Drinking or substance misuse is often a symptom rather than a cause, “a means of numbing the pain”, Smith says. She advises social workers to find out what the real problem is before they can assess the risk. Social workers must also remember that relapsing does not necessarily mean someone is a bad parent – it could be a sign that underlying issues have not been resolved. Burr agrees: “I felt guilty for letting my children down by drinking but I couldn’t cope with the guilt so I drank to escape it.”
4. Have previous children been taken into care because of substance misuse?
This is a difficult area, but social workers cannot afford to let past history influence the risk assessment, Pawson says. “Parents might now have completely different relationships or the root causes are different. Each case has to be assessed on the risk factors present. I wouldn’t want to see parents stigmatised as bad parents just because of substance misuse.” Smith also warns that falling pregnant with another child may well relive former feelings of loss for parents in recovery, which could risk a relapse.
5. What are the key resilience factors?
Social workers need to look at the risk or resilience factors of each family member and examine the professional network that surrounds the family, Smith says. “Who is visiting the house? How is the parent getting access to substances? Are they accessing treatment? Who else are they in contact with? Generally we are more concerned about children under five who may be in less contact with a professional network for example,” Smith says.
Families must be involved in both the risk assessment and the care plan, Burr says, because addiction affects everyone in a family. “Everyone needs to know what they can do to help and support. Each stage of recovery changes the addict which in turn changes the relationships they have and might put pressure on the family unit so they need support plans for every stage.”
1. Treatment time vs recovery time
All three experts agree that social workers need to be aware of the significant difference between treatment time and recovery time. Many treatments might only last four to six months, but recovery time will depend on the afflicted parent and the resilience factors around them. Burr’s own treatment time was four months. “It really helped me discover why I drank and what the problems that triggered it were. But I also knew at the end of it that I wasn’t recovered.” The end of treatment time is actually a high risk time, Smith says. “Most substance misusers will need a lot of support in place when they are discharged from treatment. They also need to know what to do if they feel themselves slipping, like someone they can talk to or touch base with.”
2. Important milestones
Most addiction programmes work in terms of milestones – a day, a month, a year. It’s important for social workers to be in regular contact with drug and alcohol workers to know what those milestones are for the parent involved, Pawson says. For Burr, the most significant milestone – and her personal ballpark figure for true recovery for an addict – is one year. “There’s something about having made it to a year that is a big thing for an addict,” she says. “It’s only when you do it for that long that you actually feel you can do it, that you can deal with life. It gives you such a massive spur of motivation to keep going with it.”
1. Joint care plans
If substance misuse is suspected while a woman is pregnant, joint protocols should be formed with maternity services to wrap support services around the mother, Smith says. Social workers need to be drawing up joint care plans with drug and alcohol workers so they are aware of the journey a parent needs to make and the services that are available, Pawson says. Burr agrees, saying she often sees cases where social workers simply tell parents what they need to do and then come back in a week to see if they’ve done it. “But if they haven’t already been able to do it on their own, they’re unlikely to be able to do it within a deadline. You need to give them some help,” she explains.
2. More referrals
This leads onto a second area of concern for Pawson who says a recent survey conducted by the National Treatment Agency found that some areas had very low levels of referrals from social workers. “Yet you would expect there to be a high number of referrals from social workers who will often be better placed to see an emerging problem with substance misuse in a family.”
3. Using volunteers
Burr is adamant that the only way to resolve the issues around the fear most addicted parents have when social services arrive on their doorstep is to use former addicts, trained in child protection, to act as an intermediary. “It would give social workers an insight into the journey these parents need to make. It would also improve their risk assessments,” she says. “We see it all the time at Addaction – a former addict is usually better able to tell if an addict really is motivated to change or if they’re just saying it. There is no excuse they can use that I haven’t used myself and I know why they are saying it.”
Volunteers also give addicted parents the comfort of knowing that someone else has been on the journey and made it to the other side, she says. And in a system where it is not uncommon for families to have five different social workers within a year, it would provide some stability. “In a perfect world, every social worker should spend six months in a rehab environment but I think this is a good second option to improve services,” she says. “I know places like Addaction are keen to enter into such partnerships and former addicts are usually highly motivated to give something back. I really hope it can happen.”
Questions for your continuing professional development (CPD)
1. Name one gap in your skills, experience, knowledge the conference or this feature has helped you identify.
2. What one thing in your assessments or visits do you intend to change as a result of information gathered from this feature or the conference?
3. Identify one case you would now do differently with any new knowledge or insight gained from this feature or conference?
The Health and Care Professions Council (HCPC) has outlined the main differences between CPD and PRTL for social workers and published a guide on how to complete your CPD profile and how it relates to registration.
Support for drug misusing parents to help the families stay together
Evidence Base: parental alcohol misuse