Working effectively with families where there is parental substance misuse

Childhood Neglect: Improving Outcomes for Children

Presentation P23P23Childhood Neglect: Improving Outcomes for Children

Presentation

Working effectively with families where there is parental substance misuse

What I need people to do


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Learning outcomes• To address factors affecting parenting capacity

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Wider context• Prevention of substance misuse is key to

ensuring that fewer children experience neglect.• National strategic approaches to tackling

alcohol and drug misuse are key.• Local strategic partnerships provide the context

for multi-disciplinary responses to prevention and intervention.



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Guidance‘It is important that all practitioners working with alcohol and/or drug-misusing parents/carers know the potential impact of that misuse on children, both in terms of the impact on the care environment and of direct exposure to alcohol and/or drug misuse. Addiction staff also need to know when and how to share information to keep children safe, and should understand the contribution they can make to assessing risks and needs and planning. Planning is vital, particularly in the case of unborn children, and will often include input from agencies that do not have a frontline child care role. The best interests of the child should always be the principal concern.’

(Scottish Government 2010, p.109)



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Prognosis‘The task when planning for children is not only to examine the quality of the parenting now, but also to predict how it will develop in the future. This is a particular challenge when working with substance misusing parents, who may have intrinsically good parenting skills but be unable to exercise them consistently.’

(Hart 2004 p260)



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Impact of parental substance misuse on parenting capacity• The crisis in an adult’s life can often dominate.• Although adults who misuse substances may

have intrinsically good parenting skills – they may be unable to exercise them consistently.

• There can be difficulties in predicting the extent to which parenting can meet the needs of the child in the future especially the case for unborn/ new born babies.

(Hart 2004)



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A child living with substance misusing parents needs…A haven of safety Barnard (2007)

or

A safe haven Howe (2005)

or

A secure base Daniel et.al. (1999)

or

A base camp Gilligan (2009)



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The ante-natal periodPreparing parents to establish routines and practices that a newborn baby will need. Focus on:• increasing the ability of the parent to meet the

child’s needs;• developing the motivation of the parent to improve

parenting skills;• providing opportunity to practice caring for the baby.

(Horwath 2008)



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The challenge of changingPregnancy is a window of opportunity for parents to make changes and parents may experience a range of feelings:• empathic concerns for the developing foetus;• guilt as a response to not achieving change;• anxiety relating to realisation of limited coping skills;• fear of potential lapse or relapse;• increased difficulty in accessing mainstream services;• changing relationships between parents;• uncertainty about impact of birth upon other children within the

household.(Petersen & McBride 2002)



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Meeting the baby’s needsIt is the moment by moment meeting of the (baby’s) needs which promotes and gives a sense of security. This involves:• recognising their needs;• helping the child to communicate their needs;• meeting these needs.

(Howe 2005)



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School age children’s needsConsider development needs in relation to:

• home security and stability;

• secure attachments;

• positive school experiences;

• positive achievements – socially or academically;

• opportunities to play and socialise;

• whether the basics are in place – food, shelter, warmth and safety.

(Cleaver, Unell & Aldgate 2011)



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Young people’s needsConsider developmental needs in relation to:

• relationships and appropriate role models;

• risky behaviours – safe sex, injuries and risk taking behaviour related to drinking or substance misuse;

• emotional problems – self harm, suicide, self blame, guilt etc;

• isolation from friends and adults outside the home;

• young carers – compromising own needs in favour of responsibility for dependent parent/carer/sibling.

(Cleaver, Unell & Aldgate 2011)



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What children say they want• Don’t want to be ‘different’ from their peers.• Want consistency.• To keep attachment with their parents.• Stimulation that promotes their development.• Certainty about important aspects of their lives

– care givers, placements, school and so on.• Friendships.



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Listening to children‘It is only through hearing the voices of children and young people that the totality of their experience can be considered...We need to know and understand the reality of the lives they lead...’

(Kroll & Taylor 2003, p305)



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Approaches to working with families where there is parental substance misuse• Recognise issues of loss and low self-esteem.• Expect a detached engagement style.• Understand ambivalence as a response to loss

of control.• Be aware of complex motivational forces

involved in relinquishing, or controlling, long-standing dependent behaviour.



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Supporting parents to establish stability:• rituals• roles and responsibilities• routine• communication• social life• finances• relationships and interaction.



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Features of effective interventions to support parents that misuse substances• Sourcing and giving clear information. • Assertive action on behalf of children.• Establishing healthy, supportive networks.• A commitment to inclusion; based on realistic

expectations.• Recognising the potential for the parent to

recover, but also recognising what that might mean for the child.



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Barriers to engagement• Families close off contact with those outside the family .

• Family members view alcohol and/or drugs as a way of coping.

• Problematic types of attachment or dependence on substances develop.

• Defensive barriers protect the family from stigma and social exclusion.

• Same barriers keep professionals away.(Taylor, Toner, Templeton & Velleman 2008, p38)



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Multiple expectations• In practice, recovery will mean different things

at different times to each individual person with problem drug use.

• There is no right or wrong way to recover. Recovery is about helping an individual achieve their full potential – with the ultimate goal being what is important to the individual, rather than the means by which it is achieved.



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Recovery for the child‘Recovery is about restoring or establishing for the child a sense of self and a sense of control, to allow her or him to break free of the feeling of helplessness… Safety is critical to recovery.’

(Tomlinson & Philpot 2008, p114)



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Recovery

• What do children need?• recognition of their needs;• help with attachment to parents;• appropriate treatment for trauma.

(Cairns & Stanway 2005, p51)



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RecoveryThis means:

• taking a holistic approach;• appreciating the lived experience of the child;• appreciating what has become ‘normal’ for the child

because of parental substance misuse;• appreciating that children may have to re-learn how to

‘be’ themselves if parents stop taking drugs.



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Protective factors for the child• Presence of a stable adult figure and close positive bond with at least one adult

in a caring role (e.g. parents, older siblings, grandparents).

• A good support network beyond this.

• Little separation from the primary carer in the first year of life.

• Parents’ positive care style and characteristics.

• Being raised in a small family.

• Larger age gaps between siblings.

• Engagement in a range of activities.

• Individual temperament.

• Positive opportunities at times of life transition.

• Continuing family cohesion and harmony in the face of the misuse and its related effects.

(Velleman and Templeton 2007 )P23 Working effectively with families where there is parental substance misuse 23


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Resilience created by protective factors• Deliberate planning by the child that their adult life will be different.

• High self-esteem and confidence.

• Self-efficacy.

• An ability to deal with change.

• Skills and values that lead to good use of personal ability.

• A good range of problem-solving skills.

• Feeling that there are choices.

• Feeling in control of own life.

• Previous experience of success and achievement.



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Messages from research• Limited evidence about the efficacy of interventions that aim to

support families affected by parental substance misuse.

• The studies that have been undertaken indicate that some interventions have positive effects on knowledge, attitudes and behaviours of children and parents.

• Intensive, family focused interventions are proving to be effective in improving outcomes.

• Particularly, interventions that include a strong therapeutic alliance between practitioner and parent or child are helpful.

• Services targeting the child, parent and the family as a whole are needed.

(Mitchell and Burgess 2009)


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Working effectively with families where there is parental substance misuse

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