Substance Misuse and Child Welfare Special Interest Group To become a member To facilitate practitioners, policy makers and researchers to: share and discuss the implications of research findings disseminate developments in policy and practice promote the evidence base informing policy and practice developments network and share resources Members will receive regular updates through a listserv and seminars will be organised to provide a forum for disseminating developments in research, policy and practice

Michael Murphy University of Salford

 The attempt to make a bridge between two systems  System one – substance treatment systems – primarily focussed on individual adult patient health outcomes  System two – child care systems – primarily focussed on parent/child dyad and social/health outcomes for children  Denial of mutual impact of systems

 In 2003, the Advisory Council for the Misuse of Drugs (ACMD) published Hidden Harm, a report on the impact of parental drug use on children.  We estimate there are between 250,000 and 350,000 children of problem drug users in the UK.  The key messages of the report were that:  There are significant numbers of children affected by parental problem drug use in the UK;  Parental problem drug use causes serious harm to children of all ages.

 Reducing this harm to children should be a main objective of policy and practice;  Effective treatment for the parent can have significant benefits for children;  Services should work together to take practical steps to protect the health and well-being of affected children; and  The number of children affected is unlikely to decrease until the number of problem drug users decreases.

 Structural separation  Different worldviews  Different practice pathways and systems (MC 1973)  Can lead to exaggerated differences in practice behaviour and priority.

 We need to include  Illicit Drugs  Legal Highs  Prescribed medication +  Alcohol  In any consideration of family impact  (and the greatest of these is always alcohol)

EarnobtainuseIntoxication/enjoyrecover

Trust Attachment Self-esteem Child experiences need High arousal Caretaker meets need relaxation

Low demand + low response High response+ Low demand High demand + low response High Demand + High Response authoritativeAuthoritarian NeglectfulPermissive

 Parental Availability  Parental Predictability  Parental inclusion in sequences of repetitive intra- or extra-family violence

 Some children described violent events in a matter of fact manner, expressing no shock, fear or understanding of the danger of the circumstances. For example, an older child described a particularly violent incident in explicit detail without any sign that this was extraordinary in his life. There were numerous other occasions where more than half of the children and young people described such incidents. This included the use of weapons, mostly knives and machetes, and occasionally firearms. Five children had witnessed stabbing.

 Northern Ireland  Scotland (Caleb Ness and Brandon Muir)  England  Wales  Some significant national social policy response from the low (England) to the high (Scotland) with Wales and NI hovering between

 Raising awareness from Government to agency to team and practitioner (parents + children?)  Hidden Harm has become a short cut to ‘Substance Misuse - Remember the Family’  Focussing on the need for cross system working and looking/working beyond my silo of interest  Hidden Harm launched a thousand initiatives – some of them influential

 The extent to which adult and children’s services worked effectively together to assess concerns and support and challenge parents and carers varied considerably. Overall, the quality of joint working was much stronger between children’s social care and drug and alcohol services than between children’s social care and adult mental health services.  An excellent testimony to the influence of Hidden Harm initiatives (or merely a comparative success when measured against the mental health/child care comparator)  Still some concern around alcohol vs drugs response issues

 2003 Hidden Harm ACMD  2006New Strategic Direction (Alcohol + Drugs)  2007 Hidden Harm Three years on  2008 HO Drugs Strategy (Family ‘strand’)  2008 DHSSPS Action Plan  2009 PHA/HSCB Action Plan  2011 DHSSPS New strategic direction for alcohol and drugs

 The welfare of the child should be the paramount consideration.; A shared commitment and response to the issue, led by Children’s and Addiction Services, will achieve the best outcomes for parents and children;  Provision to respond to the needs of children and families affected should be integrated within mainstream Children's and Adult services;  Not all families affected by substance misuse will experience difficulties ;  Parental substance misuse may have significant and damaging consequences for children and it is important that proper planning and service provision is in place to reflect this;  Services need to be based on:  What children say they need  What parents/carers say they need  Evaluation of effectiveness.

Complex Needs Safeguarding Family Support Early Intervention/ Prevention

 Government Level  Senior manager  Middle manager (+trainers and educators)  Practitioners  Missing Level (Parents and children)  The importance of response across all levels of agency interaction

 We plan, commission, work and evaluate together  We routinely plan and work together  We routinely talk and consult together  We inform each other if we have clients in common  We talk to each other sometimes (When we have to)  We go our own way

 Find a stranger  Introduce yourself  If you have to ‘score’ the collaborative relationship between your team and staff from the ‘other system’ where would it be (see previous slide)  Why?

 Pathways for collaboration (at all managerial levels) Common goals/ languages/ performance indicators  Mutual prioritisation and shared and agreed thresholds  Interagency/intersystem education and training  Bridging posts/projects/services  Increasing interagency awareness, knowledge and skills

T.Morrison 2007 The everyday practice of leadership is central to meeting the challenge of establishing shared direction across increasingly complex systems and communities, whilst being rooted in an ethical commitment to children. Leadership is the nexus that enables people to take risks and go beyond their familiar practices. The Leadership Imperative: Reforming Childrens Services from the Ground Up. Lownsborough, H; O’Leary, D. (2005) Demos

 Different and complementary strengths  Substance practitioners have much more experience working with men singly and in groups on trauma, dependence, harm reduction and change  Child care practitioners have much more experience working with women as parents and their children in families that are struggling to cope.

 The reality of Family Life. Challenging the Private Domain (What systems can’t do!)  Can we really claim a whole family response?  Practitioner Confidence on both sides  Systems stubbornly separate – the valley is still very wide. Excellent initiatives have not caused the convergence of systems  Adolescent Misuse continues. A proportion of these adolescents will inevitably bring substance problems into their parenting style/capacity  The abstinence conundrum

 Increasing collaboration at all 4 levels of interaction  L4 Linking all govt agencies + DHSSPS with coordinated family substance services  L3Establishing protocols and procedures in each area  L2Really inviting and including staff from the other system in all meetings/training  L1 Encouraging all positive front line staff contact  L0 Taking the substance message into families

 How well do you collaborate outside your practice group/system?  Willingness to collaborate with adult or child oriented staff?  Inter-system Collaboration as a mind-set?  Knowledge of your’s and other system’s roles (and where they fit together)?  How well do you represent the other system to your own team (atrocity stories)

 Remember Bob the Alien (Louise and Luke Devlin) launched next week  