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Safeguarding Children of Parents
with Substance Misuse Problems
and Other Vulnerabilities in Essex
Presentation to ESCB19 October 2010
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INTRODUCTION
PROJECT BACKGROUND Responding to issues raised in JAR, by NTA
and in SCRs
Project funded by EDAAT, overseen by aSteering Group, to: Raise awareness
Develop better understanding and improvepractice
Build a case for changing the approach tocomplex families
Methodology Interview programme frontline
practitioners, team leaders and seniormanagers across the partnership
Listening to parents and children affected bythese issues in Essex
Online survey for practitioners
Data analysis
Literature review
Visiting evidence based programmes
POLITICAL CONTEXTGovernment Commitment
Coalition agreement to investigate a new approachto families with multiple problemsfocusing on50,000 high need families e.g. 400 mostchallenging families in each authority
Government Priorities Strip away obstacles that stop disadvantaged
children succeeding
Safeguarding children at risk
Improving the cost effectiveness of childrensservices
Building capacity and resilience within families andcommunities
Local policy commitments
Ensure that all children thrive Parents are supported
Families affected by substance misuse receive moreintegrated help
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DRIVERS FOR CHANGE
(from DfE)
Challenge
Find a more sustainable approach to funding for familyintervention/support services using evidence and costeffectiveness
Solution DfE/ADCS cost-effective childrens services project
focus on family intervention to reduce entrants ofolder children into the care system
Financial Context Decisions about investment (and achieving savings) will
be made locally. BUT there is a strong case forcontinued investment in family intervention
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WHAT IS THE PROBLEM? Key parental vulnerabilities were identified as
Drug & Alcohol misuse
Domestic violence
Offending
Mental health problems
These parental vulnerabilities have been shown to be
Intergenerational
Overlapping, Mutually reinforcing & Long-term
Impact not just on individual but also whole family and wider community
They often impact negatively on children
Immediate safety, with clear links to child protection Long-term outcomes
Parents with multiple vulnerabilities can create complex families, which
Cost society a lot of money (250k-350k per year)
Are a challenge to services
Evidence shows we do not do well in improving their outcomes
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LOCAL NEED
In Essex, we estimate that there are:
7,300 children (under 16) who have at least one parent who is
a dependent drug misuser
57,902 children who have at least one parent misusing alcohol 46,636 children with at least one parent with a mental health
problem
2,620 children who have at least one parent with drug misuse,
alcohol misuse AND mental health problems 26,200 children experiencing parental domestic violence
5,240 families with four or more vulnerabilities
732 births to substance misusing mothers per year
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CHILDREN LOOKED AFTER
Of the 1,465 children looked after in Essex, from
our study of cases, we conservatively estimate
that there are:
492 have a substance misusing parent
527 have parents involved in domestic violence
211 have alcohol misusing parents
421 have parents with mental health problems
386 have parents involved in offending
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Overlapping Parental Vulnerabilities (PVs)From case file audit of CLA
ALCOHOL14%
DRUGS33%
DV 36%CRIME
26%
MH 29%
Most CLA in Essex
have parents with more two
or more vulnerabilities
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Young Persons Substance
Misuse ServiceDRUGS: 13%ALCOHOL: 19%
DV: 8%MH: 15%
CRIME: 8%
Adult Substance MisuseServices
DRUGS: 50%ALCOHOL: 25%
DV: 9%MH: 8%
CRIME: 15%
Childrens Social CareDRUGS: 48%ALCOHOL: 33%
DV: 39%MH: 52%
CRIME: 0%
Family Services
ALCOHOL: 16%DV: 46%
MH: 52%
CRIME: 0%
Permanency
DRUGS / ALCOHOL: 58%
Children Looked After
DRUGS / ALCOHOL: 53%
DV: 36%
MH: 29%
CRIME: 26%
CAMHSDRUGS / ALCOHOL: 25%
MH: 50%
Adoption
DRUGS / ALCOHOL: 67%
Essex Prevalence Estimates by Team
As cases become more severe,we see a rising prevalence of parental substance misuse
AMinority
Half
AMajority
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PARENTS IN TREATMENT
Essex has an estimated 3,486 crack &/or heroin users
1,603 (46%) of these will be parents
Those in treatment had 2,990 children a minority were in care
Analysis of treatment data shows
Those parents outside of treatment were more likely to be chaotic
than non-parents
Those parents entering treatment were more likely to be stable
Parents were more likely to have dual diagnosis
Parents stay in treatment less than half the average duration
Parents were less likely to complete in a planned way
However, those parents that completed treatment had similarly
good outcomes
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0
20
40
60
80
100
120
1 2 3 4
%
ofTreatmentPop
ulationperstage
Treatment Progression
How do Parents and Non-Parents do in Treatment?
Male Parents
Female Parents
Male Non-Parents
Female Non-Parents
Parents
Non-Parents
Parents do not engage in treatment as well as non-parents
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ISSUES
We heard that services did not feel able / allowed to work with
whole families and many were clear that their priority was the
adult or child who was their client
Members of complex families are often dealt with as individuals
& their vulnerabilities often dealt with in isolation
Services often wait until a crisis has occurred before taking action
with complex families
Essex has not identified the priority, high-cost complex families
nor costed their impact
There are some excellent family & parenting projects across the
county, but these are not well enough joined up, many are short
term pilots or geographically limited, making it difficult to have a
consistent system across Essex
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GAPS & BARRIERS
Services do not habitually record these vulnerabilities
Subsequently we do not know actual numbers of children
affected
No system to flag families with multiple parental
vulnerabilities
No systematic approach to listening to and involving complex
families in designing and evaluating services
No clear, consistent strategy for complex families, so we tend to
deal with each family on an ad hoc basis
Failing to future proof families once a child is taken into care
Working with complex families as whole families is not a priority
for everyone
Some adult services are not set up to be family friendly
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WHAT WORKS
EFFECTIVE PRACTICE High quality key-workers with low caseloads
(e.g. 4-6 families per worker)
Ways of whole family working that areempowering and build on family strengths
Respectful, persistent working styles.Flexibility to use resources creatively.Incentives/rewards and focus onconsequences secure families engagement
Support that is not time-limited (average 12-18 months) and is available out of hours
Effective multi-agency relationships (co-ordination, clear arrangements for jointworking e.g. with CSC, adult services)
Parenting support through evidence-basedparenting programmes
EFFECTIVE PROGRAMMES Family Recovery Project (Westminster)
Average saving per family is 13,883
Family Intervention Project (Essex and otherareas) The average saving per family peryear is 81,624 some research estimates it
could be up to 200k per year Option 2 (Cardiff + other areas) on average
each appropriate referral saved the localauthority 1,178 per child
Families First (Middelsbrough) The meanaverage cost saving
Substance Misusing Parents Project (Kent)Cost-benefit associated with these
outcomes was between 15,094 and90,940
FDAC, M-PACT, Family Pathfinders
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THE CHALLENGE
The challenge in Essex is to Do better for complex families
Improve practice and public services
Save taxpayers money / cost avoidance
Improve family outcomes
Evidence tells us that it can be done, a number ofprogrammes show that by Working jointly with whole families
Taking an approach to build strengths & reduce risks
We can keep children safe, keep families together,improve long-term outcomes and avoid future costs
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NEXT STEPS
Report findings & recommendations to ESAB / ESCB
Identify & cost priority complex families across Essex
Introduce a staged model of improvement:
1. Joint working protocol
2. Training, Support and Co-location
3. Evidence-based Programme
Better join-up of safeguarding for adults & children
Activate senior level champions
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CONCLUSION
If we can see these families coming and knowthat they are not likely to do well in our
normal service responses, then we have a
duty to do something different with them in
future
Now is the right time to look again at families
with complex needs and use the evidence and
policy direction to change our approach forthe better