London Safeguarding Children BoardSeminar 1

Specialist Substance Misuse Workers

and Children’s Social Care

Gill Watson – Parental Substance Misuse and Childcare Social WorkerISLINGTON

Alison Johnson – Senior Practitioner Substance Misuse CAMDEN

Suzanne Olsen – Substance Misuse Social WorkerLAMBETH

The problem in Islington

• Glasgow prevalence study (Hay et al, 2008): estimated 3575 problem drug users (heroin & crack) in Islington

• Second highest number of PDU’s in London

• Current numbers of PDU’s in treatment: 815

• 1806 adults in drug treatment in 2006/7

• Alcohol Needs Assessment Research Project: 5% alcohol

• dependent population (= 7178 Islington residents)

• 645 adults in alcohol treatment in 2005/6

A new approach

•Pre publication of Hidden HarmInterventions came too lateLack of coordination, poor links and mutual mistrustNon-systemic approach, concentrating on individual adult needs

•2 specialist substance misuse/ childcare posts paid for by adult pooled treatment budget (PCT)

•Overall aimsIncrease awareness of the needs of children amongst treatment workersImprove partnership working

•Location and designation of workers

Needs Assessment

• Audit of clients in treatment with Trust services with children (3 month snapshot 2005/6)

20% across NIDS, SIDS & AASCI 43% of those had current Children’s Social Care involvement

• Audit of Children’s Social Care cases - PSM 30% of children on CPR 45% of care proceedings cases

• Lack of consistent screening and recording in both sectors

Needs Assessment cont.

• Parental substance misuse, mental ill health and/ or domestic violence were a feature in over 80% of all child protection registrations in 2007

For drug & alcohol together, about 40% over 2007/8.

For the 3 month period June-August 08, in this period a total of 110 contributory factors were listed breaking down as follows:

Drugs 22 (20%) Alcohol 16 (14.5% ) D/V 34 (31% ) MH 20 (18%)

Interventions in Treatment Services

• Parental Substance Misuse Service: Social worker and health visitor based in adults’ drug & alcohol treatment services since late 2005

• Strategic, consultative and direct work focus

• Health visitor taking lead on antenatal and under 5s

• Social worker taking lead on over 5s

• Assessment of the family with the referring agency to ensure that children’s health and social care needs are being met

• 40 average monthly contacts during 2007-08

Interventions in Treatment Services 2

• Joint home visits with treatment keyworker to make assessment of children and family needs, home circumstances including safe storage of medication.

• Moving towards using the CAF

• Referring individual family members or whole family to services for ongoing support or further assessment, including:

• Young Carers IYPDAS CASA Family Service CASA FPF Chance UK Children’s Social Care

Interventions in Children’s Social Care

• Assessment of treatment needs and impact of use on children

• Parental drug & alcohol assessment and testing

• 59 referrals for testing 2007/8, of which 51 were engaged

• Positive outcomes (defined by children remaining at home with a child protection or children in need plan and children reunited with parents) have been achieved for 28 adults (47%) & 40 children including 1 unborn

• Referral onto and engagement with community based treatment: 43 (73%)

• Referral into residential rehab: 11 (19%)

Outcomes

• Good buy-in from adult alcohol and drug treatment services

• Multi-agency working: we are better together

• Changes in culture and practice

• Addressing the needs of children affected by parental substance misuse

• FAB group: partnership between Islington Young Peoples’ Drug & Alcohol Service, CASA Family Service and Family Action Young Carers Project

• Hidden Harm Steering Group

MALT and background to the post of Senior Practitioner Substance Misuse

• The post of Senior Practitioner Substance Misuse was commissioned in response to Hidden Harm (2003). The purpose is to reduce harm caused to children through parental drug and alcohol use.

• The post is located within a multi-agency team Camden MALT. This is a specialist CAMHS service managed jointly by Health and Safeguarding. The core task of the team is to provide a clinical service for children subject to Child Protection Plans, and for children and young people who are Looked After by Camden Local Authority.

• The team has an assertive approach, working with high need, hard to reach families. The team works within the Safeguarding Framework, to support Local Authority Care Plans and assist the Local Authority with their decision making about children and young people.

MALT and background to the post of Senior Practitioner Substance Misuse

• The post offers guidance concerning realistic expectations relating to abstinence, reduction, and safety in substance misuse in a timeframe that reflects the needs of children.

• A key message from the Hidden Harm report offers a different approach to themes, legislation, culture and beliefs normally undertaken around research and policy and one which represents the thinking behind this current post.

• The post will reflect ideas and responses that will improve outcomes for children and promote the recommendations of Every Child Matters.

• ‘Effective treatment of a parent can have major benefits for the child’ (Hidden Harm 2003)

Senior Practitioner Substance Misuse

• Specialist resource undertaking direct work with the family to consider the effect of substance misuse on children, parenting, emotional well being and relationships.

• Planned pieces of work with parents, carers and children over a series of sessions that supports care planning and decisions required of Social Work Teams.

• Assessments will aim to engage family members in appropriate treatment and offer insight into family history, functioning, lifestyle, identity, drug use, priorities, consistency and their ability to parent.

• Joint working with Adult Treatment Services and Forward (Young Person’s Drug Service).

Senior Practitioner Substance Misuse

• In 2007/08, 31 families accessed substance misuse advice and guidance via this post. 14 were in proceedings. 15 were CIN with a child protection plan and 3 were CIN only.

• The parents were offered individual work, support in engagement with the range of community treatment services, 1 community care assessment undertaken to support in patient and residential services.

• Motivational Interviewing, solution focused theory and systemic theory are the fields of practice used.

• Children were assessed and engaged in Psychotherapy, Psychology, Family Therapy and the FWD young person’s drug service.

Recent developments – Systemic Workshops

• Systemic Workshops• In January 2008 2 systemic workshops were dedicated to substance

misusing families. 6 substance misusing families have accessed this service so far. Completed sessions for each family carried an average of 8 sessions.

• Extended family members were invited to attend the systemic workshops, independently of the client where appropriate.

• The systemic workshops have been instrumental in working with substance misuse in a manner that was unavailable elsewhere. The clients received powerful feedback from family members about their substance misuse.

• The reflecting team consists of a Consultant Family Therapist, Psychologist, Senior Practitioners, Trainee Family Therapist, and Family Support Worker.

Recent developments – Family Support Worker

• Direct work with young people and their families around parental alcohol and substance misuse.

• Assist young people in developing positive relationships with their family and friends. Work will establish good communication skills and assist resilience for individuals and their families.

• Provide support to families affected by alcohol and substance misuse around harm reduction, signposting on support services available, support in attending appointments and parenting skills.

• To support parents to access treatment and for those in treatment to have access to parenting support.

• Develop closer integration between existing agencies that support families affected by alcohol and substance misuse. Raise concerning parenting, safety, children and issues outlined in the Hidden Harm Agenda.

• Working with FWD (Camden’s Young persons Substance Misuse Service) with training, group work and casework.

Recent Developments – Strengthening Families Programme

• Programme is an evidence-based family skills programme. Together, parents/carers and children learn to:

• Improve Family Relationships• Increase Communication and Understanding• Increase Coping Skills• Improve School Success• Reduce Harm and Promote Positive Change with Alcohol and

Substance Misuse.

• Parent Skills Training Group: Parents learn to increase positive time with children, manage stress, give clear directions, develop behavior change charts, hold family meetings, and use effective discipline.

• Young People’s Life Skills Training Group: Young people learn communication skills, “the magic rules of success,” peer resistance, recognizing feelings, consequences of substance use, anger management, problem solving, dealing with criticism, and other social skills.

• Family Skills Training Group: In the second hour parents and young people practice together new skills learnt in their separate groups such as communication, problem solving and discipline,

Specialist Substance Misuse Social Worker Lambeth Children and Young People’s Service

• The Specialist Substance Misuse Social Worker post was created initially on specific recommendations made by research undertaken in Lambeth which assessed the needs of women substance misusers in the borough.

• The post has evolved to also respond to the Advisory Council on the Misuse of Drugs (ACMD) publication: Hidden Harm – Responding to the needs of children of problem drug users (2003).

• The post reflects the commitment of Lambeth CYPS in partnership with the Lambeth DAAT to reduce harm to children as a result of parental drug and alcohol misuse.

• The Specialist Substance Misuse Social Worker was appointed in September 2005

• This is a permanent post, based and line managed within the Family Support and Child Protection (FSCP) team in CYPS. The post is jointly funded by Lambeth CYPS and Lambeth Young Persons Substance Misuse Grant.

• Specialist Substance Misuse Social Worker has regular clinical supervision meetings with the Head of Service, Lambeth Substance Misuse Team, Adult and Community Services.

• The Team Manager, Head of Service and Specialist Social Worker

meet quarterly to oversee development of the post.

• The Senior Commissioning Officer from Young People’s Substance Misuse attends the quarterly meetings.

• The management structure is an excellent example of partnership work.

Specialist Substance Misuse Social Worker Lambeth Children and Young People’s Service

Children in Need and Child Protection

• When parental substance use or misuse is an issue, the ongoing work of the Specialist Social Worker contributes to the allocated Social Worker’s assessment of parenting capacity, family and environmental factors and the child’s developmental needs. This includes both the direct work with the parent and consultations with the allocated Social Worker.

• Child Protection Plans and Child in Need Plans routinely include either i) referral to or consultation with the Specialist Substance Misuse Social Worker or, ii) ongoing work between parent/s and Specialist Social Worker. The Specialist Substance Misuse Social Worker attends Core Group meetings, CP Conferences and CiN meetings.

• The Specialist Substance Misuse Social Worker is embedded in the work of CYPS.

Parents who experience problematic

drug or alcohol use

• The Specialist Substance Misuse Social Worker works with parents that may not be ready, willing or able to engage with local drug and alcohol services. The Specialist Social Worker will meet with parents (usually at joint home visit in the first instance) to seek their views, to work motivationally with them in an attempt to support them to begin to access services in the community.

• The Specialist Social Worker will work with the parent’s readiness to change and, when appropriate, will link or refer the parent to appropriate local services.

• In some cases, the Specialist Social Worker will complete a Community Care Assessment (under the NHS and Community Care Act, 1990) and link the parent to the Adults and Community Services Substance Misuse Team for onward referral to abstinence based support and rehabilitation services.

• –Specialist Substance Misuse Social Worker co-facilitates a parenting skills course for service users of the Lambeth Drug and Alcohol Service (SLaM)

Specialist Substance Misuse Social Worker

• For 58% of families, the specialist social worker’s interventions played a significant role in safeguarding children

• 74% of these families had children on the children protection register/subject to child protection plan, all due to substance misuse and related issues 

• For 20% of families: family breakdown and local authority care were prevented or families were successfully reunited

• 55% of the families had problems related to parental alcohol use/misuse

• 43% of families had problems related to parental use/misuse of class A drugs

Intervention Outcomes – from a sampler of 60 families to June 2008:

Exercise

• What do you think are the challenges?

• Consideration may be given specifically to:• The practitioner• Treatment Services• Safeguarding and Social Care• Policies and guidance