7.3 Children of Parents who Misuse Substances
1. Scope and Purpose
This chapter relates to the children of parents who misuse substances.
The term ‘substance’ is used to refer to psychotropic substances including illegal drugs, alcohol, illicitly used prescription drugs, new psychoactive substances (legal highs) and volatile substances (solvents and gases).
Substance misuse is defined as use of a substance, or combination of substances, that harms health or social functioning.
Parent is defined as a person acting as a father, mother or guardian to a child. This role may be played by a variety of individuals including the child’s natural mother or father, a step-parent, a natural parent’s partner, a foster or adoptive parent, or a relative or other person acting as a guardian or Carer.
Parental substance misuse has the potential to cause serious harm to children at every age from conception to adulthood .
The purpose of this chapter is to safeguard and promote the welfare of children and young people in circumstances where a parent or carer has substance misuse problems which may impact on a child/children and/or young person/people, by promoting partnership working, inter-agency collaboration and providing a framework for identification, Assessment and Care Planning.
 Hidden Harm – Responding to the needs of children of drug users (Advisory Council on the Misuse of Drugs: 2003)
The impact of parental substance misuse on child development  summarises the key messages from research as follows:
- In utero exposure to drugs and alcohol may affect bonding, health and development (short and long term);
- Parental substance misuse adversely affects attachment, family dynamics and relationships;
- Parental substance misuse significantly increases the risk of physical and emotional neglect;
- Parental substance misuse can lead to children and young people providing physical or emotional care or support which is inappropriate, excessive or harmful to their health, education or overall development.
- Parental substance misuse is implicated in behavioural and mental health problems in children and young people;
- Parental substance misuse often undermines school performance and academic attainment;
- Parental substance misuse can erode self-esteem, self-worth and confidence;
- Parental substance misuse reduces levels of safety and oversight – inside and outside the home;
- Parental substance misuse can provide a problematic model for problem-solving;
- There are a range of protective factors that can promote resilience and reduce risk.
In some cases substance misuse may be one factor which, when linked to Domestic Violence or mental illness, may increase the risks to the child. See also:
- Children at Risk Where A Parent Has A Mental Health Problem Procedure;
- Domestic Violence and Abuse Procedure.
An appropriate response to the needs of the children of parents who misuse substances is likely to require the close collaboration of a number of agencies e.g. substance misuse services, health and maternity services, Adult Social Care, Children’s Services, courts, prisons and Probation.
Any practitioner who believes that a child may be suffering or likely to suffer Significant Harm must always and immediately share this with Norfolk Children’s Services. See Referrals Procedure.
 Frontline briefing: The impact of parental substance misuse on child development. (Dartington: 2013) The full resource is available at: www.rip.org.uk/frontline
Where a professional is working with an adult they should consider whether the adult’s substance use is a concern and, if so, whether they have responsibility for caring for a child and/or extended contact with a child.
All professionals should be proactive in identifying when children or young people could be providing practical or emotional care and support to a family member or friend who is disabled or ill.
Where a professional is working with a child, the possibility that her parents or carers may misuse substances should always be explored.
4. Assessment of Need
The presence of substance misuse in a parent does not automatically mean a child will be exposed to serious harm but it is likely to have an impact on the extent to which a child’s needs are met. Careful assessment is essential to establishing the needs of children and families and ensuring that the right type and level of support is provided.
Assessment should consider the needs of the child and the needs of the adult as a parent.
The assessment process should consider the home environment. This may be via liaison with other services or home visits.
The assessment process should consider domestic violence and abuse, and any possible adult exploitation related to the substance use.
The assessment process should consider if there is a child or young person living in or visiting the household regularly. If so, professionals should consider if the child or young person is involved in providing physical or emotional care or support to anyone in the household.
Family Support Process
The Family Support Process should be used to assess the needs of the child and the parenting capacity of the adult(s). Consideration will be needed to identify who is the most appropriate person to undertake the Family Support Process with the family. See Family Support Process and Forms (Previously Common Assessment Framework) Procedure.
Pre-birth Risk Assessment
Where an agency is involved with a person who misuses substances and becomes pregnant, particular attention should be paid to the need for a pre-birth risk assessment. It is important for agencies to recognise that prospective parents may be at risk in their own right and that their needs should be assessed in conjunction with those of the unborn child. See Pre-Birth Protocol.
Social Work Assessment
Norfolk Children’s Services will undertake a social work Assessment where there is concern that a child is a Child in Need or is suffering or likely to suffer Significant Harm.
5. Risk and Protective Factors
The following risk and protective factors should be considered when assessing the needs of children and the needs of adults as parents.
|Protective Factor||Risk Factor|
|Parenting Capacity||Adequate food in house.||No food in house.|
|Child’s clothing clean and correct for time of year.||Child wearing inadequate clothing.|
|Child care arrangements are made for when parents are taking substances.||Child is with parents whilst they are taking substances.|
|There is a non-drug using adult member of the family.||Both parents are substance misusers.|
|Children are not left unattended.||Child left alone for long periods of time or taken to places where they are at risk.|
|Substances and related equipment are stored safely within the home.||Parents leave their substances and equipment within easy reach of the child.|
|Injecting substance misusing parents are accessing needle exchange. They are aware of the health risks associated with their drug use.||Parent shares injecting equipment with other substance misusers. Not in contacts with needle exchanges and are not aware of the health risks associated with their drug use.|
|Good quality of parenting, with good control of home environment.||Parenting capabilities are poor and household is chaotic.|
|Parent substance use is experimental or stable.||Parent substance use is problematic and or chaotic.|
|No indications of mental health problems.||Identified mental health problems.|
|Parent in touch with GP and/or specialist substance misuse agency. Treatment programme in place.||Parent no contact with GP and/or specialist substance misuse agency. No treatment programme in place.|
|Parent not pregnant.||Parent pregnant.|
|Family and Environmental Factors||Local community services are available nearby e.g. community centre, childcare facilities.||No access to community services in local area.|
|Parent has non-substance misusing friends in local community.||Family are isolated within the local community.|
|Children have contact with friends, other family members and the wider community.||Children have no or limited contact with friends, other family members and the wider community.|
|Household bills are paid.||Parents are behind in rent/mortgage payments.|
|Parent is employed.||Parent is not in employment.|
|The accommodation is safe, clean and adequate.||There is damp on the walls in the house, there is no secure lock, the carpets, and surfaces are dirty.|
|There are no other substance misusers living in the home.||Other adult substance misusers live in the home.|
|Parent has support from non substance using friends and family.||Parent mainly only associates with other substance misusers.|
|Family have lived in the home for a significant period and the accommodation is stable.||Family have only lived in the home for a short period and are potentially moving again soon.|
|Child in the family has not witnessed his/her parent taking substances or purchasing substances.||Child regularly witnesses parent taking substances and/or purchasing substances.|
|No evidence of violence or exposure to criminality within the home (including drug dealing, prostitution and/or sexual exploitation).||Identified violence and criminality in the home (including drug dealing, prostitution and/or sexual exploitation).|
|Parents do not drive (with children) whilst intoxicated.||Parents drive (with children) when intoxicated.|
|Child’s Developmental Needs||Child is registered with a GP and has all necessary vaccinations.||Family are not registered with a GP, no record of vaccinations.|
|Child attends nursery/school regularly.||Attendance at school is sporadic; child has not attended school/nursery for the last two weeks.|
|Child is achieving well in class, he/she enjoys going to school/nursery and joins in well.||Child has fallen behind in school, they find it hard to concentrate are regularly tired and not cooperative.|
|Child does not present any behavioural problems.||Child is aggressive, unusually quiet, extremely shy, or over familiar with new people. There is evidence of bed wetting, nightmares, or a reluctance to leave their parent(s).|
|Child talks about their parent in a positive way.||Child appears frightened by their parent.|
|Parent perceives their relationship with child as positive.||Parent has concerns about their relationship with their child.|
|Child is engaged in age appropriate activities.||Child is not engaged in age appropriate activities.|
|No evidence that child is taking on board a parenting role within the family.||Child takes on board parenting role within the family.|
6. Care Planning
Wherever possible, care planning should involve the active participation of children and adults in families where substance misuse is a concern.
The first step in the development of a care plan should be the identification of desired outcomes for the child. All interventions proposed should relate clearly to outcomes identified.
Where more than one agency is involved in meeting the needs of a young person, all services providing interventions should be involved in an overall care planning process coordinated by the Lead Professional in line with Family Support Processes; or by Norfolk Children’s Services in line with statutory care or Pathway Planning processes.
7. Access to Substance Misuse Services
Substance misuse services in Norfolk include:
- Change, Grow, Live (CGL) – Norfolk’s Alcohol and Drug Behaviour Change Service, behaviour change for adults aged 18 and above, with priority access for pregnant women and those with parenting responsibilities.
- The Matthew Project: Unity – support for children and young people affected by the substance misuse of others. The Matthew Project: Unity also provides services for young people who misuse or are at risk of misusing substances.