Engaging with families affected by parental alcohol and drug misuse Jenny Carpenter CASA Family Service Manager CASA Family Service Sept 2010

Overview Adult - alcohol / drugs / parenting Child’s experience? Promoting change Good outcomes

UK Context 1 in 10 children living with parental alcohol or other drug misuse Hidden Harm Report ACMD , ,000 children of problem drug users Bottling It Up Report Turning Point 2006 Up to 1.3 million children ( 1 in 11) affected by parental alcohol problems 1/3 of domestic violence incidents linked to alcohol misuse

Contemplation Action Maintenance (Re)lapse Pre-contemplation The Cycle of Change Success Prochaska & DiClimente Preparation

Parental alcohol and drug problems develop within a complex context and need to be understood and responded to in a comprehensive, inclusive and holistic way Other risks / needs / strengths Multi-agency system of support

Different voices Children I want my parents to be there for me Parents I love my children I need my drugs / my alcohol Childcare professionals Safety for children now Substance misuse professionals Change takes time Social Work Task Support / Concern Family as client / Child as priority Understand impact of psm on family life Parenting changes now / Substance use changes over time

Impact on family life Roles – parent / child boundaries Rituals – special days kept? Routines – inconsistent daily care & attention Social Life – isolation, secrecy, feeling different Finances – less money for family / children’s needs Communication – ‘elephant in the room’… Conflict – tension, stress, unpredictable moods/actions Velleman 1993

Risks to children Exposure to chaotic parental behaviour Insecure attachment patterns Neglect of children’s physical needs & routines Associated health risks & physical dangers Children exposed to substance misusing environment & adults Inappropriate levels of responsibility afforded to children Isolation, secrecy, stigma, bullying Developmental stages - changing risks from pre-birth to adolescence

Child’s experience Emotionally stressed - high alert / cut off Unsafe - life as unpredictable Can’t rely on routines & promises Treated as ally, carer, protector ‘Don’t talk, Don’t trust, Don’t feel’ Blaming self, trying to make things better Witness / experience violence, physical, verbal, sexual abuse Worried, confused, lonely, uncertain, angry, guilty, afraid of loss...

Process of change Change is likely where there is both motivation to change and confidence to be able to change Identifying and building on strengths and positive changes Agreeing manageable and specific goals for change Change is cyclical process – match our response to current need

Focus for change Outcomes / Goals Parenting Move parental preoccupation from alcohol / drugs to care of children Children Resilience and consistency for children / young people Substance use Reduction in use, addressing relapse prevention / triggers to use, engagement in appropriate adult treatment Family life can be more secure even if substance use does not change immediately

Protective parenting Affection & positive attention / role of non-using carer Time specifically for children Children see parents / family as united & caring Family does things together & celebrates special days Routines & predictability Child engaged with other stable adults & external activities Parents planning deliberately for the future Velleman & Orford 1999, Robinson 2006

Resilience Capacity to minimise & overcome the effects of adversity Arises within key relationships Can be strengthened & promoted Intrinsic Good self-esteem Self-efficacy Extrinsic Secure attachment relationship Support of relationships outside family Positive nursery / school / community experiences Robinson 2006, Newman 2004

Factors that promote children’s resilience Understanding & expressing feelings Having belief in own abilities & having own interests Other people & activities - extended family, social, community support Being able to problem solve & to ask for help Seeing self as separate from family problems Having own plans for the future Age appropriate information about adult problems Velleman & Orford 1999, Robinson 2006

The Child’s Experience Exercise Considering each child in turn, what might Chantelle & Ryan value and enjoy in their family life? Again, considering each child in turn, what might Chantelle & Ryan feel scared by and worried about?

Useful references Advisory Council on the Misuse of Drugs 2003 Hidden Harm Report Advisory Council on the Misuse of Drugs 2007 Hidden Harm: Three Years On Report search/acmd/HiddenHarm1eaff.html?view=Standard&pubID= Cleaver H, Unell I, Aldgate J 1999 Children’s Needs - Parenting Capacity: The impact of parental mental illness, problem alcohol and drug use and domestic violence on children’s development London:The Stationery Office Dept of Health 2004 Every Child Matters DiClemente C 2003 Addiction and Change: How Addictions Develop and Addicted People Recover NY:Guildford Press Kroll B, Taylor A 2003 Parental Substance Misuse and Child Welfare London:Jessica Kingsley Mason B 1993 Towards positions of safe uncertainty Human Systems, 4: 189–200 Newman T 2004 What works in Building Resilience Ilford:Barnardo’s Prime Minister’s Strategy Unit 2004 Alcohol Harm Reduction Strategy for England Robinson W 2006 About Protective Parenting & Children’s Resilience within the context of Parental Alcohol Problems London:Alcohol Concern Turning Point 2006 Bottling It Up Report Velleman R, Orford J 1999 Risk and Resilience: Adults who were children of problem drinkers London:Harwood