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ANNEXES TO THE REPORT: Safeguarding Children of
Parents with Substance Misuse Problems and other
Vulnerabilities


List of Annexes

Annex 1 Practitioner Interview Tool
Annex 2 Bibliography
Annex 3 Glossary
Annex 4 FIP Safeguarding Protocol Exemplar
Annex 5 Evidence Based Practice Points
Annex 6 Summary of Strengthening Families Handbook
Annex 7 Evidence of What Works
Annex 8 Data Collection Tool for Pregnancy and Complex Social
Factors
Annex 9 Evidence base behind suggested principles
Annex 10 Case Study
Annex 11 Data Analysis Tables
Annex 12 Local Good Practice Examples
Annex 13 Parents and Young People Interview Tool
Annex 14 Project Methodology
Annex 15 Relevant Government Policy Documents
Annex 16 Essex Children Looked After Data Analysis
Annex 17 Analysis of What Works

Annex 1 Interview Tool

Interviewee Details:
Name: Role: Team: Department: Organisation: Reports to: Team
Size (FTE):

A. PROBLEM ANALYSIS
1. Scale of the problem: Snapshot tool Roughly how many of your clients
misuse drugs or alcohol, have MH problems, Learning Disabilities or
offending/Domestic violence?
Do you have any costings work?
2. Presenting problems: What vulnerabilities do the adults (or parents of
the children you work with) you see normally present with? How does this
impact on their children?
3. Definitions: Can you define the terms child protection, child in need
and safeguarding as they are used/understood in Essex?
4. Self rating: How would you rate your services knowledge, attitude &
behaviours re safeguarding
Are you aware of SET procedures? Are you allowed sufficient time
to do effective safeguarding? Do you have supervision/governance
in place to discuss these issues?

B. PRACTICE & POLICY
1. What safeguarding policies do you have in place (Request copy)?
Do you have any joint safeguarding protocols in place with other
agencies?
How good is the use of CAF by various agencies?
Are the local thresholds for safeguarding right? Too high/Too low?
Why?
Do you know of any joint working protocols that work well?
(Request copy)
2. Describe the safeguarding pathway?
Pathway: How does your agency, upon discovering an issue of
parental vulnerability that may impact on a child, inform the relevant
agencies or make a decision on what to do next?
How do you identify problems? What triggers are there? What do
you do when the problem is identified? Who do you ask for
guidance?
What flags do you use to inform other agencies who might need to
know of a specific child protection risk?
3. How do you assess parenting status and capacity/impact of vulnerable
parent on children?
What tensions exist from working with your adult client and ensure
safeguarding?
What is your policy on safeguarding adults?
How do you involve the whole family (Think Family)? Do you bring
in other agencies?
How do you support kinship care e.g. grandparent carers?
4. Governance
Escalation: Where would you go if you identified a problem family
and were unhappy with the level of support that they were
receiving?
Do you (are you given time to) regularly attend s47 enquiries and/or
child protection case conferences?

C. TRAINING & COMMUNICATION
1. How do you ensure that your staff are equipped to safeguard / how do
you check performance?
2. What training has been available and how did you rate it?
3. How should staff learn about safeguarding in future (training and
communications)?
4. Are findings from serious case reviews and SUIs routinely shared and
learnt from?

D. DATA
1. What database do you use? Does this talk to other databases used by
partner agencies?
2. What data do you collect that may give insight into the issue? (individual
level & strategic)
3. Do you regularly share this data with partners? Could you?

E. SWOT ANALYSIS
1. What works well in safeguarding for your organisation? What are the keys
to success?
2. What is missing / gaps?
3. What does not work well?
4. Can you identify any risks in the current system and suggest how to
manage them?
5. Can you give us a case study where things went well and/or badly? [get
in writing]
6. What frustrations do you experience when working with either a child or
parent in isolation?
7. Is there any duplication in the system?

F. STRATEGY
1. Who is the champion for safeguarding in your team/organisation and the
wider partnership?
2. What other areas of work should substance misusing parents also cross
over with?
What services currently work with complex families in a whole
family approach - in Essex? Are there any opportunities or
developments that this work should link in with?
3. What are the key strategic drivers for change in practice in Essex?
4. Where does this fit into your current strategic priorities?
5. In a new strategy, what would your top 3 changes be?
6. What are the barriers to change?

Annex 2 Bibliography

Working Together to Safeguard Children (DCSF, 2010)

Barnard M, McKeganey N: The impact of parental problem drug use on
children: what is the problem and what can be done to help? Addiction 2004,
99:552-559.

Bays, J. (1990) Substance Abuse and Child Abuse: Impact of Addiction on
the Child, in Paediatric Clinics of North America 37(4), pp.881-904.

Brookoff, D., OBrien, K.K., Cook, C.S., Thompson, T.D. & Williams, C. (1997)
Characteristics of participants in domestic violence assessment at the scene
of domestic assault. Journal of the American Medical Association, 277, 1369
1373.

Christensen H.B.,.Bilenberg N. (2000). Behavior and emotional problems in
children of alcoholic mothers and fathers. European Child and Adolescent
Psychiatry, 9 (3), 219-226.

De Micheli D, Formigoni (2002). Are reasons for the first use of drugs and
family circumstances predictors of future use patterns. Addictive
Behaviours;27(1):87 100.

Dunn M.G., Tarter R.E., Mezzich A.C., Vanyukov M., Kirisci L., Kirillova G.
(2002). Origins and consequences of child neglect insubstance abuse
families. Clinical Psychology Review, 22 (7), 1063- 1090.

Forrester, D. (2000) Parental substance misuse and child protection in a
British sample: a survey of children on the child protection register in an inner
London district office. Child Abuse Review, 9, 235246

Forrester D, Harwin J (2006) Parental substance misuse and child care social
work: findings from the first stage of a study of 100 families. Child and Family
Social Work, 11:323-355.

Glynn TJ (1981). From family to peer: A review of transitions of influence
among drug-using youth. Journal of Youth and Adolescence;10:363 383.

Harbin, F. (2000) Therapeutic work with children of substance misusing
parents. In: Substance Misuse and Child Care: How to Understand, Assist
and Intervene when Drugs Affect Parenting (eds F. Harbin & M. Murphy), pp.
7994. Russell House Publishing, Lyme Regis.

Hay G, Gannon M, MacDougall J, Millar T, Williams K, Eastwood C,
McKeganey N (2008): National and regional estimates of the prevalence of
opiate use and/or crack cocaine use 2006/07: a summary of key findings.
London: Home Office; 2008.

Jaudes, P. K. & Ekwo, E. (1995) Association of drug use and child abuse.
Child Abuse and Neglect, 19, 10651075

Johnson JL, Leff M: Children of substance abusers: overview of research
findings. Pediatrics 1999:1085-1099.

Kroll B, Taylor A: Parental substance misuse and child welfare. London:
Jessica Kingsley Publishers; 2003.

Annex 3 Glossary

BASW British Association of Social Workers
CAMHS Child and Adolescent Mental Health Services
CLA Children Looked After
CYPP Children and Young Peoples Plan
DfE Department for Education
DIR Drug Intervention Requirement
DIP Drug Intervention Programme
DV Domestic Violence, now referred to as Domestic Abuse
EARP Essex Access to Resources Panel
ECC Essex County Council
EDAP Essex Drug and Alcohol Partnership
EDAAT Essex Drug and Alcohol Action Team
ESAB Essex Safeguarding Adults Board
ESCB Essex Safeguarding Children Board
EYPDAS Essex Young Peoples Drug and Alcohol Service
FAS Foetal Alcohol Syndrome
FGC Family Group Conferencing
FIP Family Intervention Projects
FRP Family Recovery Project (Westminster)
IDACI Income Deprivation Affecting Children Index
JAP Joint Agency Panel
JAR Joint Area Review
LSCB Local Safeguarding Children Board
MAAG Multi-Agency Allocation Group
MH Mental Health
M-PACT Moving Parents and Children Together (Action on Addiction)
NDTMS National Drug Treatment Monitoring System
NFP Nurse Family Partnership
NICE National Institute of Health and Clinical Excellence
NTA National Treatment Agency for Substance Misuse
PDU Problem Drug User (Crack and/or heroin use)
SAMC Safeguarding Essex Management Committee
SCR Serious Case Reviews
SDQ Strengths and Deifficulties Questionnaire
SET Southend, Essex and Thurrock
TOP Treatment Outcomes Profile

Annex 4 FIP & Safeguarding Protocols

FAMILY INTERVENTION PROJECTS AND SAFEGUARDING
Working with childrens social care
Model Protocols for Practice


Below is a set of model protocols for FIPs covering joint work with
childrens social care. This is suggested best practice that we would
like you to review in order to adapt this protocol to reflect your local
circumstances and to have this signed off by your FIP strategic lead
who is also a member of your Local Safeguarding Children Board.


1. Introduction
Family Intervention Projects (FIPs) provide intensive support to
vulnerable families. Utilising multi-agency, whole-family support plans
alongside assertive working methods FIPs help families avoid negative
sanctions they may be facing and help families to address their
problems in a way that sustains positive change across social,
environmental and economic areas.

We know that the complex nature of problems experienced by families
supported by FIPs mean that there is a strong likelihood that children in
these families may be suffering, or be likely to suffer, harm. Where a
FIP is involved with a child who becomes the subject of a section 47
enquiry it should contribute to the enquiries and where appropriate
deliver elements of a child protection plan. Evidence shows that FIPs
can make a significant contribution to improving family functioning and
reducing the likelihood that a child will become looked after or the
subject of care proceedings.

Because of the nature of FIPs work with families and the significant
role FIP keyworkers have in families lives during the course of their
FIP experience; Local Authorities need to ensure they have effective
protocols in place between childrens social care and FIPs to establish
effective safeguarding practice.

2. Ensuring effective safeguarding practice
Protecting children from harm and promoting their welfare depends on
effective joint working between different agencies. The LSCB is
responsible for the development of policies and procedures for
safeguarding and promoting the welfare of children in the local area.
These procedures should include the work of Family Intervention
Projects. For example, the FIP should have a designated person for
safeguarding with clear lines of accountability through their manager to
the Head of Quality and Safeguarding in their relevant service and
through them to the DCS/Chief Executive for ensuring the
implementation of effective practice with regard to safeguarding and
promoting the welfare of children.


It is important that joint local protocols between childrens social care
and FIPs cover the following areas in order to ensure, at a local level,
that the welfare of children is safeguarded and promoted:-

Ensuring a joint understanding between childrens social care and FIPs
on their respective roles and responsibilities
a) That an understanding of the FIP team and model of work with
families is shared across Local Authority agencies and services,
b) childrens social care will provide representation on any existing
FIP and think family strategic groups and ensure safeguarding is
discussed as a standing agenda item,

Best practice in individual cases
c) That FIPs and childrens social care have agreed procedures
and protocols for joint work in relevant children in need,
including where children are the subject of a child protection
plan,
d) Where the FIP Team has concerns about the safety or welfare
of a child a referral should be made to childrens social care in
accordance with the local safeguarding children board
safeguarding procedures. There should also be a clear
escalation process or protocol (in line with that of the Local
Safeguarding Children Board) for resolving professional
differences of view, for example, if following referral to childrens
social care the FIP concerns continue. This might involve
consultation with the designated officer responsible for reporting
on joint working between FIPs and childrens social care, about
how best to take concerns or differences of view forward.
e) Where a FIP team is involved with a family there should be clear
and defined protocols outlining the respective roles and
responsibilities of the social worker and FIP keyworker as
appropriate, in any assessments, section 47 enquiries and
subsequent work led by childrens social care.
f) FIP Keyworkers will be given access to and will attend locally
provided childrens social care /multi-agency training in relation
to safeguarding and promoting the welfare of children. The
provision of this training in line with LSCB protocols is a
condition of the Think Family grant and FIP commissioners and
managers are responsible for ensuring it is available for all FIP
key workers.

FIP Keyworkers
3. FIPs and Childrens Social Care
The following guidelines should inform the development of local
protocols for joint work between childrens social care and FIPs.
These should be adapted for local use by childrens social care
and FIPs in accordance with the Local Safeguarding Children
Board safeguarding procedures.

FIP Roles and Responsibilities in Safeguarding

a) Staff in FIPs include persons and bodies listed in section 11 of
the Children Act 2004. These persons and bodies must ensure
that their functions are discharged having regard to the need to
safeguard and promote the welfare of children; the focus on the
childs safety and welfare should not be lost in the wider work
with the family.
b) FIP work, where appropriate, can support the goals of a child
protection plan through the provision of timely, intensive and
targeted interventions,
c) The FIPs role and ongoing contribution to the delivery of a child
protection plan will be subject to review as part of the multi-
agency child protection conference
d) FIP Reviews will take into account the existing child protection
plan and work to support its goals and objectives, combining FIP
reviews with statutory child protection meetings wherever
possible,
e) That the FIP has agreed processes for storing and sharing
information that are consistent with Government guidance on
information sharing, data protection legislation and the human
and other rights of the individuals concerned (e.g.
confidentiality).
f) Where a child is the subject of a child protection plan, the FIP
manager should ensure the Keyworker has access to specialist
advice and consultation from an appropriate officer able to
provide regular formal safeguarding supervision or consultation
to FIPs.
g) The FIP manager will provide a nominated person within
childrens social care with regular information detailing cases
held jointly with childrens social care, and which includes
named FIP Keyworker, Lead Professional and Case Managers.
h) FIPs will have safeguarding as a standing agenda item for team
meetings.

FIP and childrens social care Shared Responsibilities
a) Where a case open to FIP is also open to childrens social care
the allocated Social Worker is always the Lead Professional for
the child(ren), whether the case be child in need or the child is
the subject of a child protection plan,
b) Where the child is the subject of a child protection plan, this plan
takes priority and any concurrent FIP Family agreement/contract
will work to support the child protection plan objectives and will
not detract from them,
c) The core group and child protection review conference should
be kept informed of the progress and developments in the FIP
intervention with the family and where appropriate the FIP family
contract should be part of the child protection plan
d) Referrals by FIPs into childrens social care where concerns
about a childs safety have been highlighted will be responded to
and assessed in accordance with the local safeguarding children
board safeguarding procedures and decisions communicated
promptly to the FIP manager-
e) Subject to local information sharing protocols, Government
guidance on information sharing, data protection legislation and
the human and other rights of the individuals concerned (e.g.
confidentiality), the FIP Keyworker and the Social Worker will
Share information and actively contribute to each others
work as appropriate.
The allocated childrens social care manager will provide
copies of any records which include decisions relating to
families worked with by the FIP.

FIP Keyworker responsibilities working with childrens social care
a) The FIP Keyworker should attend child protection conferences
(both initial and review) and core groups when invited by
childrens social care,
b) The FIP Keyworker will look to combine FIP reviews with
statutory meetings required by child protection procedures
wherever possible,
c) The FIP Keyworker will be familiar with the statutory guidance
Working Together to Safeguard Children, (2010) and What to
Do If Youre Worried About a Child Being Abused,
d) The FIP Keyworker will not duplicate or accept any of the
statutory responsibilities held by the Social Worker.

Social Worker responsibilities working with FIPs
a) The Social Worker should contribute to FIP Reviews and other
team around the family meetings when childrens social care
and the FIP Team are involved with the same family.
b) The Social Worker will ensure the FIP Keyworker is a member
of the core group if the FIP is supporting a family where a child
is the subject of a child protection plan.
c) The Social Worker will not delegate any statutory responsibilities
to the FIP Keyworker.


Annex 5 Evidence Based Practice

1.
Identification
(i) there needs to be a clear referral process for getting help
Looking Beyond Risk Parental Substance Misuse:
Scoping Study Lorna Templeton, Sarah Zohhad, Sarah
Galvani, Richard Velleman 2006

(ii) Intervention at the crisis point. Families are considered to
be in crisis with this crisis generally being linked to the
possibility of their child entering public care. The response is
broadly shaped by crisis intervention theory and focuses on
immediate, intensive and short-lived intervention. Client
families are seen within 24 hours of referral. Final Report on
the Evaluation of Option 2 Prepared for the Welsh
Assembly Government University of Bedfordshire,
Brunel University and Birmingham University 2007

(iii) Of particular significance were creative responses to
initial contact procedures. For example, in initial meetings,
there was a conscious effort to normalize the difficulties the
family may be experiencing and stressing the ways in which
the FAS might help with these. There would also be a focus
on different family members fears or anxieties. Referral
protocols, how families are first seen, how and when the
children are included, and how and when missed
appointments may be followed up were also crucial aspects.
Parental Alcohol Misuse in Complex Families: The
Implications for Engagement Andy Taylor, Paul Toner,
Lorna Templeton and Richard Velleman 2008

iv) No wrong door Contact for vulnerable families with the
service should open the door to a broader network of support.
Public services should not seek to deflect individual issues as
they arise but, instead, aim to deliver long term solutions that
might be complex and involve several services and agencies
but, if ignored, mean that the family will continue to present.
Social Exclusion Taskforce (Key Recommended
Principles)
2.
Engagement

(i) Engagement, of both substance misusers and their
families (including children) is paramount. Looking Beyond
Risk Parental Substance Misuse: Scoping Study Lorna
Templeton, Sarah Zohhad, Sarah Galvani, Richard
Velleman 2006

(ii) Engagement was a significant factor for the service which
developed approaches and strategies to work with families
with whom it has traditionally been hard to maintain contact.
These included encouraging all family members, including
grandparents and other significant relatives or carers, in
addition to the childs biological parents, to attend, placing a
premium on establishing sufficient rapport in the initial
sessions and using creative and appropriate age-related
materials with children to explore and build on family
strengths and values. Parental Alcohol Misuse in Complex
Families: The Implications for Engagement Andy Taylor,
Paul Toner, Lorna Templeton and Richard Velleman 2008

3.
Assessment

(i) Parents believed services to help families like their own
could be improved if practitioners:
paid greater attention to ensuring families
understood what was happening;
consulted them throughout the process of
assessment, planning and intervention
adopted a more honest, open and respectful
approach; provided longer-term service provision;
co-ordinated better with other service providers.
The response of child protection practices and procedure
to children exposed to domestic violence or parental
substance misuse, Hedy Cleaver, don Nicholson, Sukey
Tarr & Deborah Cleaver, (2006)

4.
Intervention /
Support

(i) home visits are useful. Looking Beyond Risk
Parental Substance Misuse: Scoping Study Lorna
Templeton, Sarah Zohhad, Sarah Galvani, Richard
Velleman 2006

(ii) support groups must accept that attendance will fluctuate
thus emphasising the need for flexibility (ibid)

(iii) Where family preservation is not possible, it is seen to be
of critical importance to utilise strategies to keep families
involved in the treatment process, to reinforce contact
between parents and children. (Ibid)

(iv) One important factor to be highlighted here is the
benefits of combining clinical, therapeutic work, with home
visits. (Ibid)

(v) Copello, Velleman & Templetons review of family
interventions (2005), summarise (adult) family focused
interventions as:
1) acting as a mechanism for the entry and engagement of
substance misusers into the treatment system;
2) working jointly with substance misusers and (usually, adult)
family members; and
3) responding to the needs of family members in their own
right.
All three areas demonstrate evidence of effectiveness. (Ibid)

(vi) Joint work with substance misusers and (usually adult)
family members is based on the demonstration that, attention
to the persons social context and support system is
prominent among several of the most supported approaches
(Miller & Wilbourne, 2002 p276) (Ibid)

(vii) Behavioural, couples and marital work, social skills
training and the community reinforcement approach are all
good examples. (Ibid)

(viii) Intervention seemed to be most successful and
effective during pregnancy and the postnatal period, where
motivation was also likely to be high. (Ibid)

(ix) In relation to working together practices, parents felt this
was most effective when there was a lead professional with
specialist knowledge of drug misuse such as a health visitor,
midwife or family support workers who were twin trained and
who orchestrated the network, reducing the need for
repeating information. The main difficulties were caused by
failure to communicate either with one another or with the
parent concerned, as well as being included in meetings but
not addressed directly. Interventions for children and
families where there is parental drug misuse. Brynna
Kroll and Andy Taylor 2006

5. Relapse
Prevention
i) Follow up meetings, concrete support in times of crisis,
rapid access to substance misuse treatment services etc
(Review Evidence / Practice / Interview/s)
6. Support for
Children and
young people

(i) Barnard (2001) reviewed interventions for drug dependent
parents and their children, concluding that working in families
where there are younger children brings higher rates of
success, and that homebased interventions, peer support,
work through schools, community based schemes and play
based schemes all have potential. Looking Beyond Risk
Parental Substance Misuse: Scoping Study Lorna
Templeton, Sarah Zohhad, Sarah Galvani, Richard
Velleman 2006

(ii) a range of interventions is beneficial, including school-
based programs, play therapy, social support development
and group therapy. Emshoff & Price (1999) suggest that
information, coping skills (emotion focused and problem-
solving) and support (social and emotional) are key
components for working with children of parents with alcohol
or drug problems. Looking Beyond Risk Parental
Substance Misuse: Scoping Study Lorna Templeton,
Sarah Zohhad, Sarah Galvani, Richard Velleman 2006

(iii) Emshoff & Jacobus (2001) report that play therapy can
be both a relief for children and can also reduce risk. A main
element of the experience of having a parent with an alcohol
or drug problem, reported in the general literature, is loss of
childhood, demonstrated by children who miss out on
opportunities to play, either because of a lack of positive
parenting or because the child has to look after parents or
siblings (parentification). (ibid)

(iv) Banwell, Denton & Bammer (2002) [summarised in
Copello, Velleman & Templeton, 2005], summarise six
challenges to be overcome when working with children:
1) getting the balance right between intervention and trust;
2) location;
3) staff support;
4) multi-agency collaboration;
5) funding (including for evaluation); and
6) the need for flexibility. (Ibid)

(v) Protective factors and resilience have been identified in
a number of studies, both general and specific to parental
substance misuse (e.g. Werner, 1993; Velleman & Orford,
1999; Beinart et al, 2002; Bancroft et al, 2004). For example,
Bancroft et al (2004) interviewed 37 young people aged 15
27 who were children of substance-misusing parents, and
found that a number of protective factors could lead to
more resilient outcomes. These included support from
school, immediate and extended family, and individuals and
services outside of the family. Understanding and
modifying the impact of parents substance misuse on
children. Richard Velleman & Lorna Templeton Advances
in Psychiatric Treatment (2007), vol. 13, 7989

(vi) The practitioner needs to work directly with the children
involved, enabling them to:
maintain positive family rituals
remove themselves from the disruptive
behaviour of the problem parent or parents
disengage from the disruptive elements of
family life
engage with stabilising people outside the family
develop confidants outside the family
engage in stabilising activities (school, clubs,
sports, culture, religion) within which the child can
develop a sense of self and self-esteem
develop a desire to be, and pride in being, a
survivor.
Understanding and modifying the impact of parents
substance misuse on children. Richard Velleman & Lorna
Templeton Advances in Psychiatric Treatment (2007), vol.
13, 7989

(vii) All of these major risk factors are amenable to
intervention, even if the parental substance misuse is not at
the time. This means that practitioners working with families
in which parents have substance misuse problems should
not necessarily focus their risk-reduction efforts on
enabling the substance misuser to change (although, of
course, if this is a possibility it should be encouraged).
Instead, they need to work on:
family disharmony, in particular
violence (including physical, verbal or sexual
abuse)
parental conflict
parental separation and loss
inconsistent, neglectful and ambivalent parenting.
Understanding and modifying the impact of parents
substance misuse on children. Richard Velleman & Lorna
Templeton Advances in Psychiatric Treatment (2007), vol.
13, 7989

(viii) It has been suggested that pregnant substance users
could benefit from being managed using a shared care
approach, involving obstetric services in conjunction with a
substance misuse agency. Obstetric goals need to take
account of pharmacological treatments, but should also shift
towards a public health perspective, characterised by treating
pregnant and postpartum substance misusers, protecting at-
risk foetuses and children, and strengthening broken families.
There is a need to educate pregnant women around alcohol,
and the involvement of important people in mothers social
networks may be key to reducing substance misuse during
pregnancy. Many studies have concluded that there need to
be both women-specific and parenting components in existing
treatment programs, where pregnant women who are
substance misusers can benefit from comprehensive, family-
centred treatment services and receive useful parenting
advice. Looking Beyond Risk Parental Substance
Misuse: Scoping Study. Templeton, Velleman, Galvani,
Zohhadi 2006


6. Supporting
Families
i) Supporting mothers and fathers and key carers can be a
sustainable way of securing better outcomes for children.
Research suggests that using evidence-based parenting and
family support programmes, for example, through the
Parenting Early Intervention Programme, can have lasting
effects in improving behaviour even in cases where they are
initially reluctant to accept help. Providing help with parenting
impacts upon a range of outcomes for children and young
people. A meta-analysis of over 40 studies conducted in 2003
showed Family Based Interventions had substantial desirable
effects Farrington and Welsch (2007) Saving children
from a life of crime; Farrington and Welsh (2003). Meta
analysis in ANZJC.

ii) Parenting interventions tend to work best when both
parents are included in the intervention (or separate partner-
support is provided). The ability of workers to engage parents
effectively and consistently and to achieve buy in to what is
often a demanding and rigorous change management
programme, is crucial to the success of any intervention.
There is considerable skill, tenacity, determination and
tolerance required by parenting practitioners and key workers
who will need to identify the appropriate drivers for change in
their clients. They need to understand the underlying reasons
for the behaviours displayed by families and agencies, be
solution focused in their approach and be able to draw on the
necessary support themselves to enable them to set and
sustain realistic goals. 10.23 Working Together to
Safeguard Children. DCSF March 2010

iii) The Family Nurse Partnership is an evidence based,
intensive preventive programme for vulnerable, young first
time mothers that is being tested across England. The
programme is voluntary and family nurses visit from early
pregnancy until the child is two years old. The family nurses
build close relationships with clients and use the programme
methods and materials to improve antenatal health, child
health and development and parents economic self-
sufficiency. 10.27 Working Together to Safeguard
Children. DCSF March 2010

7.
Support/Train
ing for
professionals
(i) staff training and good links with others are important
Looking Beyond Risk Parental Substance Misuse:
Scoping Study Lorna Templeton, Sarah Zohhad, Sarah
Galvani, Richard Velleman 2006

(ii) GPs are often the first point of contact for many family
members but GPs often do not feel well enough equipped to
be able to respond. (Ibid)

(iii) Training on safeguarding and promoting the welfare of
children can only be fully effective if it is embedded within a
wider framework of commitment to inter- and multi- agency
working, underpinned by shared goals, planning processes
and values.
Whilst the detailed content of training at each level of the
framework should be specified locally, programmes should
usually include the following:
recognising and responding to safeguarding and
child protection concerns;
working together;
completing child in need assessments;
safeguarding disabled children;
safeguarding children when there are concerns
about domestic violence,
parental mental health; and
substance misuse.
Working Together to Safeguard Children: A guide to
inter-agency working to safeguard and promote the
welfare of children (DCSF 2010)
8. Service
Development

(i) Drug prevention with children of drug using parents must
consider the need for specialist skills / knowledge, have clear
protocols for the work, both within the organisation but also
with other agencies, understand the fear of social services
held by many children and parents, offer help with transport
where possible, and generally consider less structured work
(i.e. work responsively and proactively) with clear boundaries
and reassurance for parents on issues of safety and
confidentiality. Looking Beyond Risk Parental
Substance Misuse: Scoping Study Lorna Templeton,
Sarah Zohhad, Sarah Galvani, Richard Velleman 2006

(ii) One of the most widely known, and well evaluated,
programmes is the Strengthening Families Programme
(SFP). A systematic review of primary prevention
programmes for alcohol misuse in young people (Foxcroft et
al., 2003), concluded that this was the only programme that
could demonstrate effectiveness, maintained longer-term.
(Ibid)

9. Best
Practice
[Services]
(i) The Family Alcohol Service, a joint initiative between the
NSPCC and the London-wide Alcohol Recovery Project, is a
multi-disciplinary team that combines alcohol and family work.
The service works centrally with the children but also with
whomever else in the family wishes to engage (including the
misuser). A report of the evaluation of the pilot year of this
service discusses the projects success, but also some of the
key challenges to have emerged when working in this way
(Velleman et al., 2003). Looking Beyond Risk Parental
Substance Misuse: Scoping Study Lorna Templeton,
Sarah Zohhad, Sarah Galvani, Richard Velleman 2006

(ii) Option 2 is a short-term but intensive programme of work
that engages with a family at a point of crisis, usually when a
child is at serious risk of being removed from the family (see
Hamer, 2005 for a detailed description of the Option 2 way of
working) (Ibid)

Both Option 2 and the Family Alcohol Service have the
development and maintenance of resilience as a
theoretical foundation to their practice.

(iii) The London based Stella Project has been specifically
established to provide services with training and policy
guidance on the overlap between substance misuse and
domestic violence. There are no known examples of services
that cater specifically for children and families affected by
both substance misuse and domestic violence, though some
separate services (substance misuse or domestic violence)
are developing joint-working protocols and providing mutual
support to improve their service delivery, for example, the
Family Alcohol Service in London and the Nia Project in
London (formerly Hackney Womens Aid). (Ibid)

(iii) A recent review of programmes found that integrating a
course on parenting skills into longer-term intervention
programmes for substance misusing parents can improve the
quality of mother-child interactions and the self esteem of
mothers. Programmes based on home visiting either by
health workers or trained volunteers are considered a
successful model for families with babies and younger
children, but relatively few such programmes target drug
users specifically. One programme for high-risk drug and
alcohol using mothers using home visits by paraprofessional
advocates (trained positive role models experienced in
similar adverse life events) found that the mothers
participating in the programme were more likely to enter drug
and alcohol treatment, and to use health and social services
for their children. The review also identified a successful
home intervention programme for children of substance
misusing parents aged 6-12 years, which showed a long-term
positive impact on outcomes such as childrens problem
behaviours, emotional status and pro-social skills, as well as
parents parenting skills and family environment and
functioning. (Hidden Harm: Next Steps Supporting Children
Working with Parents. Scottish Executive 2006)

(iv) Breaking the Cycle Project Addaction Drug and
Alcohol Services
This project is a four-year (2005-2009) pilot initiative being
carried out by Addaction adult drug and alcohol services. This
pilot involves a shift in emphasis towards family-focussed
interventions which support parents in treatment as well as
working with the child and family to minimise risk of harm.
Families referred to the project receive a range of support
interventions, depending on the needs of the family. This can
include advice and support, one-to-one family support, family
therapy and art therapy. All intervention packages are based
on an in-depth family assessment process and care planning
overseen by a co-ordinator. Pilot projects have been set up in
Cumbria, Derby City and the London Borough of Tower
Hamlets and are subject to ongoing and final evaluation by
the Avon and Wiltshire Mental Health Research and
Development Unit based at Bath University. (Ibid)

v) The Substance Misusing Parents (SMP) Project
The SMP project is a Kent-based partnership project between
KCA (a local treatment agency) and Kent County Council that
has been running since 2003. Developed against a backdrop
of growing evidence that a significant proportion of child
protection cases involve families of substance misusing
parents, the project offers fast-track, quality interventions and
care packages. KCA provides assessment, drug testing,
home visits and ongoing support to clients. Through rapid
assessment, sensitive joint working practices and information
sharing, good outcomes for the children have been achieved
in a number of cases. Two independent evaluations suggest
the service improves engagement, produces benefits to the
families, is valued by practitioners, improves care decisions,
reduces the number of children who become looked after and
offers value for money. Clients can remain in core treatment
services, such as prescribing or counselling, after their SMP
case is closed. Drug treatment staff have enhanced their
understanding of child protection issues and how drug use
impacts on the user and their family. Also, social workers
have developed greater awareness of substance misuse and
how to work effectively with substance misusing parents to
improve parenting skills. (Ibid)

Annex 6 Summary of Strengthening Families Handbook

Note:
a) This preventative approach had been developed for all families and
childrens services. However, for the purposes developing an evidence-based
response for substance misusing parents, the highlights described below are
selected to create a model to fit the cohort.
b) Also, extracts below originate from the GUIDE.

Overview

i) It begins with shifting the focus of child abuse and neglect prevention efforts
from family risks and deficits to family strengths and resiliency. The reluctance
of families to participate in programs that identify them as at risk is well
documented and amounts to a significant barrier in interventions designed to
reduce abuse and neglect. A more universal, evidence-based model built on
promoting resilience is much more attractive to parents and, therefore, could
be an effective way of reaching many more families long before a risk of child
abuse or neglect emerges

ii) Strengthening Families second goal is to create a widespread
understanding of what all kinds of programs and providers can doand in
some cases already doto promote healthy child development and reduce
the incidence of child abuse and neglect.

iii) When these factors are present, child maltreatment appears to be less
likely to occur.
Protective factors related to families include:
Parental resilience
An array of social connections
Adequate knowledge of parenting and child development
Concrete support in times of need, including access to necessary
services, such as mental health

The protective factor related to children is:
Healthy social and emotional development

Protective Factors Approach

i) A focus on protective factors does not ignore the relevance of risk factors in
identifying families at risk of abuse and neglect. Early care and education
programs should be well aware of the risk factors correlated with abuse and
neglect. Focusing on protective factors, however, is more consistent with a
universal, early intervention approach to child abuse and neglect prevention
because:

Protective factors are positive attributes that strengthen all families,
not just those at risk; thus, programming based on protective factors
can reach families who are at risk without making them feel singled
out or judged.

Working with families based on risk generally requires risk
assessment, which is beyond the scope of most early care and
education programs. It also sets up a relationship with families
dominated by stigma and a sense of failure.

By focusing on protective factors which are attributes that families
themselves often want to build programs develop a partnership with
parents that encourages them to seek out program staff if they are
in need of extra support. This can be an important way to help
parents change or prevent behaviors or circumstances that may
place their families at risk that they otherwise might be reluctant to
disclose.

When programs work with families to build protective factors, they
also help families build and draw on their natural support networks
which will be critical to their long-term success.
ii)


iii) Parental Resilience - The single factor most commonly identified in the
child abuse and neglect prevention literature is development of empathy for
the self and others through caring relationships with friends, intimate partners,
family members, or professional therapists or counselors (Steele 1997;
Higgins 1994).
Parents who are emotionally resilient are able to maintain a positive attitude,
creatively solve problems, and effectively rise to challenges in their lives and
are less likely to abuse or neglect their children.

iv) Social Connections - Extensive evidence links social isolation and child
maltreatment. While the causal link between the two are unclear, fewer adults
in the household and fewer interactions with kin, along with little respite from
the stress of parenting, are related to child maltreatment (Guterman 2000).

Researchers who study social connections point to how poor, dangerous
neighborhoods characterized by low social trust and cohesion produce high
degrees of family isolation and stress; families who live in these
neighborhoods, consequently, experience high risk of child maltreatment.

Research also shows that social networks creat common norms about
childrearing. Parents who have positive social ties to the parents of their
childrens friends are able to discuss childrearing issues with them and
establish a consensus on shared standards, as well as sanctions for violating
those norms.

It is not the simple fact of social connectedness, then, that protects against
child abuse and neglect, but rather relationships that are positive, trusting,
reciprocal, and flexible, and that embody pro-social, child-friendly values.

v) Knowledge of Parenting and Child Development - Mental health
professionals who work with maltreating parents have observed that child
abuse and neglect are often related to a lack of understanding of basic child
development. In particular, parents who abuse their children commonly have
inappropriate expectations of childrens abilities and respond to childrens
behaviors in excessively negative ways.
A program structure that offers long-term relationships between
parents and program staff (two years or more), connects parents to
additional support services, and creates support groups of parents
with similar life experiences whose children are close to the same
age
Staffing patterns that feature dynamic leadership, peer facilitators
(such as parents who have experienced life situations similar to
those of group members), and ongoing staff training and
supervision
Interpersonal values that recognize the importance of developing
trust between and among parents and staff, and of respecting
individual and cultural differences
An educational approach that consistently focuses on parents
strengths, emphasizes consistent decision making over time rather
than quick fixes, and recognizes that the quality of interpersonal
relationships is critical to any learning that may take place (Carter &
Harvey 1996; Daro 2002; Hoelting et al. 1996; Reppucci et al. 1997)

Childrens Healthy Social and Emotional Development

i) Early childhood programs impact on childrens social and emotional
development happens in two ways: through social and emotional
development activities with children in the classroom and by working with
parents to help them build positive relationships with their children. Research
shows very positive relationship between childrens participation in quality
early childhood programs and virtually every social/emotional outcome that
has been assessed, including selfregulatory behavior, cooperation with and
attachment to adults, positive peer relations, social skills, and reduced
conduct problems. Notably, the strongest effects of high-quality care are
found among children from families with the fewest resources and under the
greatest stress (Shonkoff and Phillips 2000).

Implementing the Strengthening Families Approach

i) Build Connections with Other Community Service Providers
The relationships and daily contact early childhood program staff have with
children and families can help identify issues that may need to be addressed
and can open the door for families getting the support they need. The most
stressed and at-risk families, however, will likely have needs beyond what the
program can provide.

ii) By developing a strong relationship with community service providers, early
childhood programs can effectively connect families with what they need.
Some first steps to take are:
Learn from the families in the program about which providers in the
community provide good services, and which do not.
Identify a family support center or other community based program
that specializes in connecting families to needed resources and
services, one that has a good reputation with families. Contact staff
in that program. Find out if the program has a resource directory,
and, if so, ask permission to use the directory. Invite the programs
staff to come in and talk with staff about the resource and referral
process and how they work with families.
Regularly bring in staff from community programs that provide
various services and supports to talk with parents and/or staff. As
these relationships
develop, some providers may offer to provide onsite services to
children and families. This can be an important first step in building
families comfort with pursuing services themselves.
Seek opportunities to get to know other service providers. Go to
their events or offer help to them.

Note: The above is quite basic, but this could be easily developed to use
SureStart/Childrens Centres as the Hub, with health and social care
accessing families in a non-stigmatising way.

Moving from protective factors to strategies

i) The program self-assessment materials in this section are applicable to
early childhood programs of any size, budget, or structure, and most of the
strategies described can be implemented without creating new staff positions,
making significant changes to existing facilities, or raising additional financial
resources.

ii) Programme Strategy 1: Facilitate Friendships & Mutual Support
Having a young child can be a profoundly isolating experience or it can open
up opportunities to connect with others. On one hand, new parents suddenly
face changes in their lives that limit their free time, may prevent them from
participating in activities they previously enjoyed, and make it more difficult for
them to spend time with friends. On the other hand, parenting can also spur
the development of new friendships and connections. Because parenting can
be overwhelming, new parents are often eager to make new friends especially
parents going through similar experiences and whose children can be their
childs playmates. Early childhood programs can be conduits for parents to
connect with others.

iii) Programme Strategy 2: Strengthen Parenting
Early care and education programs are a natural place for parents to turn for
parenting information and support. Parents know that staff see their children
every day and will thus have some context for issues they want to ask about.
Their day-to-day interaction with teachers and other program staff makes the
program a convenient place for them to turn when they have questions or
concerns. Finally, parents know that teachers work every day to help children
develop and learn they view teachers as knowledgeable experts.

iv) Programme Strategy 3: Respond to family crisis
In addition to their day-to-day contact between teachers and parents, the
exemplary programs in this study offer extra support to families when they
face illnesses, job loss, substance abuse, financial problems, and other
issues. Staff are available to speak to family members that need help and, in
some of the smaller programs, directors maintain an opendoor policy so that
anyone can come to them for help. Larger, more complex programs employ
family support workers to respond to families in need.

Staff at these exemplary programs are knowledgeable about community
resources and available to help families get the services they need. They
maintain strong collaborative relationships with other service providers within
the community, so that they can make referrals to agencies they themselves
know and trust. When they refer parents to services, they follow up with the
parents to see whether or not they accessed the services suggested and, if
not, to continue to help them resolve their problems.

Staff work together to identify when a family is in crisis and to make sure that
the family does not fall through the cracks. They convene regular meetings in
which they share information and review class lists to make sure there are no
red flags that indicate a particular child or family might be in trouble. They
monitor unexplained absences, failures to make payments, or signs of
parental or child stress, and reach out to families about which they are
concerned.

v) Programme Strategy 4: Link families to services and opportunities
Exemplary early childhood programs recognize that a childs well-being is
grounded in the well-being of his or her family. Working with families to help
them meet their health, social, psychological, economic, and career goals is
an important part of the work they do.
Because early care and education programs are places parents visit
regularly, staff at these programs are in a good position to help families
identify and access services.

Connecting parents with services like mental health counseling also helps
overcome the stigma that might otherwise keep them from accessing the
service.

vi) Programme Strategy 5: Facilitate childrens social and emotional
development
Promoting childrens social and emotional development has long been
considered central to early care and education programs. Most programs in
this study used Second Step, I Can Problem Solve, or another curriculum
focused on helping children to articulate their feelings and get along with
others.

In focus groups for this study, parents were asked, How has your childs
participation in this program affected you and the way you parent? One of the
most common first responses was that the childs ability to articulate his/her
feelings a skill commonly taught through social and emotional development
curricula had changed how the parent viewed the child. Parents began to see
their children as independent people with feelings, needs, and rights.

vii) Programme Strategy 6: Observe and respond to early warning signs
of child abuse and neglect
Day-to-day interactions between staff, children, and parents provide an
important opportunity for program staff to identify concerns early and
intervene immediately. Rather than focusing simply on mandated reporting,
the exemplary programs in this study all train and support staff to observe
children carefully and respond at the first sign of any difficulty. They use such
indicators as frequent absences, missing payments, late pick-ups, or signs of
parental stress as opportunities to proactively reach out to families and
connect them with family support or other services.

When issues are identified, their response is immediate and helpful with staff
expressing concern for families and offering to help them solve any problems
they may be experiencing.

When staff see signs of possible neglect, they intervene proactively with
parents, explaining the legal definitions of child abuse and neglect, helping to
connect them to resources, explaining the impact that the issue could have on
their childrens development, and stressing that the issue needs to be
addressed. They follow up regularly with these parents to send the message
that the issue is important and needs to be addressed and continue to be
available to help and support them as they resolve the problem.

When staff have serious concerns, they follow protocols for reporting child
abuse or neglect to provide continuity and support for families who are the
subject of reports. Parents at several of the programs in this study told
personal stories of how the programs had helped them alter situations that
were dangerous for their children. That these parents continue to be involved
with the programs demonstrates the effectiveness of this approach.

viii) Programme Strategy 7: Value and Support Parents
Positive relationships with parents are the foundation of program efforts to
prevent child abuse and neglect. Quality early childhood programs treat
parents respectfully and partner with them on their childrens education. Staff
make parents feel welcome by:
Reaching out individually to each and every parent
Connecting parents who need supports with others
who can provide help
Involving parents in decisions about their children
and about the program
Setting aside space and time for parents in the program

When parents know and trust staff, they are more likely to reveal problems,
such as feelings of frustration or domestic violence, and ask for assistance.

While early childhood program staff cannot be expected to provide individual
or family psychotherapy, they can connect families to the services they need
and offer caring supportive relationships that promote parental resiliency.

Building program capacity to strengthen families

The most important factor in implementing the Strengthening Families
approach in early care and education programs is to send the clear and
consistent message that the program cares about whole families, not just
children. The supportive relationships their staff form with parents stem from a
common interest in the childrens well-being, are nurtured by a genuine
interest and concern for all family members, and are strengthened by their
responsiveness and ability to offer parents help when they need it.

In addition to employing the strategies described in the self assessment in the
previous section, exemplary early childhood programs:
Build a respectful staff culture
Support parents as leaders
Customize their physical space
Engage men and
Form relationships with child welfare personnel

This study also found several programming components in exemplary
programs that may not be feasible for all programs:
Family support services
Mental health consultation
Support for families with children with special needs

i) Build a respectful staff culture
A supportive and flexible atmosphere can have a profound effect on
strengthening bonds between parents and children and providing social
support for families. Creating a culture that is inclusive, respectful, nonviolent,
supportive, and empowering is the foundation for other programmatic efforts.

ii) Create Flexible Staff Roles
At the heart of programs work to strengthen families are relationship and the
most important one is between parents and staff members. One of the keys to
the effectiveness of the Strengthening Families approach is parents ability to
turn to staff members they know and trust with questions, problems, or
frustrations. Often that staff member is the childs teacher, but sometimes it is
another teacher, the centers director, the bus driver, the cook, the
receptionist, or the janitor. At exemplary programs, parents are encouraged to
develop relationships with multiple staff members. Lines of power and
authority are flexible enough that every staff member feels she has the
authority to be there for parents as needed.

Tips for Programs
Provide cross training to ensure that all staff members from
educators to family support workers are comfortable and capable of
responding to family members in crisis who come to them for
support.
Use substitute teachers, teachers aides, and staff teams to ensure
that staff members respond to families in a timely manner.
Encourage staff to try different roles within the program. This way
parents can see staff in a variety of different contexts. This is
especially important in building parent relationships with staff
members who provide services that are more likely to be viewed as
stigmatizing such as mental health consultation.

iii) Team-up to Support Information Flow
Because multiple staff members can and will interact with a single family, staff
at exemplary programs work together and share information.

Tips for Programs
Create cross-disciplinary teams (including early childhood
educators, family support staff, and specialists) that regularly
discuss the children and families within the program and identify
concerns.
When staff are particularly concerned about a family, use a team-
staffing model to provide assistance. All staff members who work
with the family should meet to discuss their impressions and
coordinate strategies for reaching out to the family.
If a family has multiple or serious challenges, offer to partner with
them to seek solutions and invite them to include others who they
think can help. This creates an open, supportive, respectful
atmosphere and can help families resolve sensitive issues in a way
that does not make them feel judged or blamed

iv) Offer Supportive Supervision
Supportive supervisory relationships are key to staff confidence and comfort
in their role with families. Staff need to feel supported and trusted and they
need to be able to get help when they need it.


v) Build Staff Relationships
Staff credibility with parents rests on the ability of all center staff to trust and
communicate with one another. Exemplary centers consciously work to
develop a team spirit with their staff, including good communication,
camaraderie, joint problem-solving skills, and understanding protocols and
procedures.

vi) Hire from the Community
Parents who have had good experiences with early childhood programs and
who have developed their leadership skills with the centers support can be
excellent ambassadors for the program and can become highly reliable,
effective staff members. Hiring staff from the within the community enhances
a programs knowledge and awareness of local issues and events and is a
concrete way of walking the talk.

Note: Service User Involvement

vii) Support Parents as Leaders
Center directors and other administrative leaders at exemplary programs are
committed to sharing power with parents and staff. Their leadership styles and
organizational structures are inclusive, respectful, and honor different
perspectives, ideas, and points of view.

Note: Service User Involvement

viii) Support Parents as Leaders within Their Families
A very clear way to support parents as leaders is to recognize and
acknowledge their leadership within their own families.

ix) Support Parents as Leaders within the Programme
Good programs also create structured ways for parents to take leadership
roles within the program and its community of parents.

x) Support Parents as Leaders within the Community
Effective programs also play a role in encouraging parents to take leadership
in the broader community.

xi) Customize the physical space
In exemplary early care and education centers, the physical layout and interior
design of the space contributes to the effort to reduce child abuse and
neglect.
What all had in common was their use of physical space to communicate to
parents and other visitors the importance of keeping children safe and
nurturing their development.

xii) Create a Welcoming, Safe Space for Parents
One of the key features of the centers profiled in this study is that they actively
and intentionally foster relationships between program staff and the parents of
children who attend their programs. Their ambiance contributes to the
relationship-building process in concrete ways. For example, they typically
include space for parents to:
Attend classes or workshops
Sit and talk with one another and/or with staff
Share food
Attend social events
Drop in and visit with staff or with their children
Observe their children playing with other children or learning in a
classroom

xiii) Use Observation Spaces
All of the exemplary programs profiled in this study have configured their
space so that staff and parents can observe children in class

xiv) Create a Flexible Space for a Range of Activities
Exemplary programs strive to make their space as flexible as possible,
allowing for a full range of activities to support children and families.

xv) Engage men
Childcare centers are not typically places where men feel welcome, included,
and part of the community.

xvi) Recruit Male Staff Members
The programs in this study find, hire, and retain male staff members. They
conduct extensive outreach in the community and spread the message within
the program both to staff and parents about the positive impact of hiring men
as program staff. Program leaders outwardly support male staff members an
especially important approach when there are only a few male staff members
or no history of having men on staff. Involving men in a number of different
roles at these centers increases the opportunity for children to communicate
their needs to different people in their lives. Some children do not have
positive, consistent relationships with men in their day-to-day lives.

xvii) Include Fathers and Male Nurturers
Exemplary programs make specific efforts to reach out to and engage fathers
and other male family members, whether they are a childs primary caretaker
or not. These programs play a pivotal role in enhancing communication
between parents by bringing developmental and safety issues to the attention
of both parents.

xviii) Support Male Nurturing
Research has shown that one of the attributes of a successful, non-violent
family is role flexibility especially gender roles. This means that family
members expect to share responsibilities when necessary, even if they are
not consistent with traditional gender roles.

xix) Form relationships with child welfare agencies
Early childhood centers are required by law to report suspected incidents of
child abuse and neglect to the state agency responsible for investigating such
claims. Making a report of abuse or neglect can result in a potentially
adversarial and inherently difficult situation for all involved. Program staff often
fear that reporting problems will drive the family away from the program,
which may make things worse at home by increasing isolation and reducing
available resources. Many staff are also concerned that the child welfare
agency will not be able to provide services and support that will help the
family adequately resolve the issue. These concerns can put staff in a triple
bind, being mandated to report incidents, wanting to protect the child, but
anxious not to exacerbate the situation by leaving parents and children
without support.

xx) Build Parent and Staff Awareness of Child Welfare Issues
Exemplary early childhood programs create a common understanding and
awareness of child welfare issues and the impact of different types of abuse
and neglect on childrens growth and development. They work with child
welfare agencies to create a common community of caring for children,
ensuring that staff and parents understand the continuum of behaviors that
might adversely affect a child including which behaviors carry a significant risk
of harm and require program staff to make a child welfare report.

xxi) Build Relationships with Child Welfare Staff
Early childhood programs are part of the web of services available to young
children and their families, as is the child welfare agency. Developing and
using relationships with the child welfare agency can help staff learn about the
resources available to local children and families and gain greater comfort in
dealing with child abuse and neglect.

xxii) Report Suspected Abuse and Neglect
Contrary to popular mythology, early childhood programs can maintain
positive relationships with families after making a report of abuse or neglect
depending on how they handle the situation. While reporting protocols vary
from program to program, a common thread among exemplary programs is a
commitment to reporting with versus reporting on families.

Note: The above is very important:

xxiii) Advocate for Parents with the Child Welfare System
Because exemplary early childhood programs value their relationships with
parents and families, their goal when a family becomes involved with the child
welfare system is to work with both the family and the child welfare system to
ensure the childs safety and emotional stability. Being the subject of a child
welfare report is extremely traumatic for a family even when a child is not
removed from the home, the process of being investigated and the stigma
attached to allegations of abuse and neglect cause extreme stress. When
children are removed, this stress is compounded by the disruption created in
families lives and the emotional stress on both parents and children.
Whenever possible, the programs in this study try to act as advocates for
parents with the system.

xxiv) Family Assessments
A number of programs use a structured family assessment process when
children enter the program. This assessment helps staff and families define
both educational goals for children and goals for families and parents. In
some cases, the process is in-depth and lasts for several hours, sometimes at
families homes. The service helps staff understand families goals and ways
the program can support them in meeting these goals.

xxv) Family Support Staff
A number of programs also have staff whose primary responsibility is to work
with parents on family issues. These family support workers connect families
to such resources and services as health care, employment training,
government subsidies (such as food stamps), supplemental resources for
their children, and transportation; offer one-on-one support and informal
counseling when families ask for it; and provide information about parenting,
family life, and child development.

xxvi) Support Groups
Most of the programs in this study offer multiple support group opportunities,
which encourage networking and mutual support among parents by creating a
safe space for parents to talk about common concerns, share ideas, and learn
from each other.

xxvii) Parent Education Classes
While parenting education and child development information can be
integrated in informal ways into the day-to-day work of any childcare program,
many exemplary programs also offer parenting education classes varying in
structure from single lectures that parents can attend as they see fit to multi-
session classes.

xxviii) Home Visiting
All of the programs in this study offer educational home visiting at the
beginning and end of each school year at a minimum. This allows educators
to meet with parents in their homes and to plan a childs educational goals
together.

xxix) Mental Health Consultation
The importance of childrens health and mental health has been extensively
researched and documented, and educators, clinicians, families,
policymakers, and advocates have made great strides in increasing childrens
and parents access to mental health services.

xxx) Consultation with Parents
The most important relationship for fostering mental health for children in any
early care and education program is between teachers and parents. When
trusting relationships between parents and teachers are already established,
introducing mental health consultation to parents is much easier.

xxxi) Help with Childrens Challenging Behaviors
Mental health consultation is becoming an increasingly important component
of childcare. Over the past three decades, the number of children in childcare
has jumped by 50 percent. Each day, five million children under the age of
three are cared for by adults other than their parents. The number of children
and families entering childcare with behavioral and learning difficulties and
family challenges has also increased.

xxxii) Consultation with Programs
Mental health consultants often play an important role in building the quality of
programs and contributing to their infrastructure plans. Their aim when
consulting with programs is to improve the quality of care for all children by
improving the quality of relationships within a childcare centers community.

xxxiii) Support for families with children with special needs
Children with special needs are at increased risk of abuse and neglect. Their
parents often become frustrated by the extra care and attention they require
and may not fully understand or have unrealistic expectations of their special
needs.

xxxiv) Support for Parents at the Time Special Needs Are Identified
When their children are identified as having special needs, parents often
experience a high degree of stress and can exhibit symptoms of denial, guilt,
anger, and confusion.

xxxv) Access to Resources that Help Parents
Support Special Needs Children Staff at early childhood programs play an
important advocacy role in helping parents with special needs children who
often feel overwhelmed by their day-to-day care access the supports they
need.

xxxvi) Care for Special Needs Children
A few of the programs in this study have the resources to integrate special
needs children into their standard classrooms, either on a full- or part-time
basis.

Concluding Comments
According to Kagan, strengthening the early childhood system to implement
the Strengthening Families approach will involve bolstering eight key
infrastructure components:
quality programs;
a child- and family-based, results-driven system;
parent, community, and public engagement;
individual licensing for staff;
improved professional preparation;
program licensing;
adequate funding and finance; and
governance, planning, and program accountability.

Ultimately, building a strong infrastructure for an early childhood system will
require societal commitment, advocacy and support.
Annex 7 Evidence of What Works

M-PACT Programme (Essex)
The Moving Parents and Children Together (M-PACT) programme, developed
by Families Plus at Action on Addiction, is a good example of a family focused
service. The M-PACT programme is a structured ten week group programme
(including a comprehensive assessment and a review session), which
involves several families where at least one parent has a serious alcohol or
drug problem (but is in treatment or recovery) and where there is at least one
child/young person aged 8-17 years who attends the programme. Supported
by the DAAT the M-PACT Team in Essex consists of four facilitators from two
services in different parts of the County (Open Road and Essex Young People
Drug and Alcohol Service). The focus is on delivering M-PACT programmes in
the North East of the County.

The first M-PACT programme ran between January and March 2010. Seven
families (19 individuals) were accepted on to the programme. This included
eight parents (a mix of users and non users), one grandmother and 10 young
people aged between 8 and 14. Six families completed the programme,
including 7 parents and 8 young people. This makes it one of the largest M-
PACT programme which has run to date.

The key benefits from attending an M-PACT programme appear to be
improving communication with the family, understanding and talking about
addiction, and meeting and talking to other people living in similar situations.
This is an emerging area of good practice work for M-PACT and is an area
which would benefit from specific attention in terms of the evaluation over the
rest of the M- PACT license period. Focusing M-PACT delivery within Essex
towards families who are currently involved with social services is clearly
benefiting the work which has been done so far. However, it will be necessary
to consider how to develop equally strong partnerships with other agencies so
that M-PACT reaches out to a much wider demographic of families and, within
this, can perhaps target families who fall under the remit of hidden harm
because they do not easily come to the attention of services or have the
opportunity to benefit from something like M-PACT
1
.


Westminster Family Recovery Project (FRP)
Westminster has a multi agency co -ocated team called the Family Recovery
Project (FRP) that aims to support and intervene with families who are at risk
of losing their children, home and/or liberty. The FRP works in a targeted and
phased way to support a familys capacity for change and to embed and
sustain changes.

The Family Recovery Project is a 3 year funded pilot project, funded through a
combination of DCSF Pathfinder funding, Westminster One City funding as
well as contributions from key stakeholder agencies. It is one of 15 pathfinder
pilot projects across the country and has been ambitious in terms of the range
and scope of the project. The FRP is a multi-agency whole-family approach to
a range of family and social problems.

Family focused work and multi-agency work are not new, but the FRP is
ground- breaking because:
Agencies who normally only work with adults will be part of the core
team around the family working alongside agencies who normally
focus on children
There will be identified lead workers for each family to coordinate
the range of services involved and ensure interventions are
appropriately phased, reducing the volume of concurrent work with
the family.
The work will be based on individual packages of intervention and
support, but with clearer consequences for families who do not
engage - contracts with consequences
The service will be intensive with several contacts/sessions per

1
Evaluation of the M-PACT Programme in Essex Progress Report, August 2010.
Lorna Templeton Mental Health Research & Development Unit (MHRDU)
Cost Savings: [to add latest data]
week when families need this
Each family (children and adults) will have one care plan based on
one assessment and care pathway, shared with the family
themselves.

The overall aims are:
To improve outcomes for children
To reduce disorder and crime in our communities
To strengthen families and improve outcomes for adults
To improve integrated work practice and reduce duplication of
resources
To reduce the longer term costs to public services.

A set of 20 priority outcomes has been established covering all partners
targets and including increased protection of children from abuse and neglect,
improved access for families at risk to all services, improved school
attendance and attainment, improved immunisation rates, movement off
benefits and into work, and fewer incidences of domestic violence.

The biggest change for the services involved has been that adult and
childrens services now work together in order to help the whole family. The
professionals involved are based in the same office and all report directly to
the same manager, the Head of Family Recovery.

Information is now easily shared across different services and this has been
greatly facilitated through the Information Desk. Co-ordination between
different services is now much easier as reviews of the families involved take
place every three weeks.

The professionals involved have better access to resources and, as they are
now all part of the same team, less duplication of work occurs meaning better
use of peoples time. Having one care plan for the whole family means less
duplication of work by different departments and agencies. The development
of the Information Desk to collect, analyse and present data on families for
use by practitioners. The information is then used to develop a number of
reports which present a wide range of information in an easy to read package
which identifies reasons for referral, presenting issues, intelligence gaps and
recommendations. All practitioners who are members of the TAF can access
these reports via SharePoint.

Family Recovery consists of a multi-agency team who work with and support
families who are most at risk of losing their homes, liberty or children into
care. The programme is centred on the work of the Team Around the Family
(TAF) which consists of professionals with expertise in areas such as adult
mental health, domestic violence, education, the police, housing, intensive
outreach work, and childrens social work.

The TAF devises a single care plan that takes into account the varying needs
and problems of each family member. Typically, the TAF works with families
for 6 to 12 months and support and services are phased to avoid overloading
the family. The care plan uses intensive outreach work to create a possibility
of change. In the initial phase of the care plan, several visits each week are
often required before becoming less intensive as capacity is built within the
family to change behaviour. The family is involved with the process
throughout.

The FRP is groundbreaking because agencies who usually only work with
adults are part of the core team around the family working alongside agencies
who usually focus on children. There are two lead workers for each family:
one for the adults and one for the children to co-ordinate services involved.
Work is based on individual packages of intervention and support with clear
consequences for families who do not engage (Contracts with
Consequences). They found that the project helped to speed up decision
making about child protection, going into care and adoption.

Westminster City Councils Family Recovery Programme is not just another
pilot project or isolated example of good practice that is easy to praise but
difficult to replicate. We believe the programme offers a blueprint for a
mainstream service that can tackle some of societys most damaging
problems whilst making substantial savings to the public purse. Cllr Brian
Connell, Cabinet Member for Economic Development and Family Policy,
Westminster City Council

Of the first 40 families who have participated in the FRP we have a number of
indicators of progress:

- 83% of families have had their benefits checked and corrected where
necessary and two mothers are in training for work following long
periods of time without any employment.
- 78% of parents who have been through the FRP process are now
engaged in parenting courses
- Since becoming part of the FRP, 39% of families with a history of anti-
social behaviour have reduced their anti-social behaviour and 20%
of the families have stopped anti-social behaviour
- 50% of children have shown an improvement in their school
attendance.
- 47% report family functioning improving
- 32% of families are now engaged with domestic violence practitioners
- 32% more of the families are now registered with GPs
- 32% of the families are having their housing arrears cleared or plans in
place.
- 21% are seeking or attending training or further education
- 21% assessed for mental health and substance misuse or receiving
interventions
- 16% have received full immunisations this will be a focus of work in
the new year in order to get a much greater increase coverage.

Cost Savings:












Domain Example costs Total cost avoided
for 60 families in
Year 1
Whose budget?
Housing Temp
accommodation, rent
arrears, evictions and
dealing with noise.
243k Evictions cost to landlords.
Noise and nuisance to WCC
and RSLs.
Housing benefit - DWP.
Ant i-social
behaviour,
criminality

Police and court
costs, imprisonment.
650k A small amount of the cost is
incurred by WCC for
responding to ASB, but the
majority is to the criminal
justice system - Police, Home
Office, Ministry of Justice.
Educational
failure
Young people without
employment.
80k Dept of Work & Pensions
(DWP)
Worklessness Benefits dependence
of adults in family.
150k DWP - based on 5 adults who
have started work following
FRP intervention.
Poor
parenting (inc
domestic
violence)
Social work
investigation,
assessment,
interventions and
cost of care for a
child.
503k WCC Children Services costs
based on preventing 8 children
coming into care, domestic
violence interventions and
other social care costs.
Health - adult
and child
Long term impact of
mental ill -health,
physical ill health,
substance misuse.
407k NHS and WCC - further work is
planned with NHS to obtain
more robust data.
Potential further saving to DWP
if adult is unable to work.
TOTAL 2,033,000
Less costs of
FRP ser vice
1,200,000
Year 1 Net 833,000




Nurse Family Partnerships (NFP)
Parents who empathise with their infants and sensitively read and respond to
their babies communicative signals are less likely to abuse or neglect their
children and more likely to read their childrens developmental competencies
accurately, leading to fewer unintentional injuries (Peterson & Gable, 1998).
While it makes sense to target these proximal behaviors, it is helpful to
understand and address the general sets of influences that affect parents
abilities to care for their children. We have hypothesized that these influences
on parenting skills can be moderated with targeted intervention strategies.
Parents caregiving skills are affected by ontogenetic and contextual factors.
Parents who grew up in households with punitive, rejecting, abusive, or
neglectful caregiving are more likely to abuse or neglect their own children
(Egeland, Jacobvitz & Sroufe, 1988; Quinton & Rutter, 1984b; Rutter, 1989).
Parents psychological immaturity and mental health problems can reduce
their ability to care for their infants (Newberger & White, 1990; Sameroff,
1983). While it is impossible to change parents personal histories and very
difficult to reduce personal immaturity and mental illness, as indicated later,
the program has sought to mitigate the effect of these influences on parents
caregiving. In addition, unemployment!(Gil, 1970), poor housing and
household conditions (Gil, 1970), marital discord (Belsky, 1981), and isolation
from supportive family members and friends (Garbarino, 1981) are all
associated with higher rates of abuse and neglect, perhaps because they
create stressful conditions in the household that interfere with parents ability
to care for their children (Bakan, 1971; Kempe, 1973). As noted later, the
program is designed to improve parents economic self-sufficiency, help
parents find safe housing, improve partner communication and commitment,
and reduce social isolation.
2



2
THE NURSEFAMILY PARTNERSHIP: AN EVIDENCE-BASED PREVENTIVE
INTERVENTION (DAVID OLDS, University of Colorado)

The programme is an evidence-based nurse home visiting programme
developed in the USA (where it is called the Nurse Family Partnership) and
designed to improve the health, well-being and self-sufficiency of young first-
time parents and their children (Olds, 2006). The programme is offered to
first-time young mothers early in pregnancy (ideally before 17 weeks
gestation) and continues until their child is 24 months old. There are three
main aims, to improve maternal and child pregnancy outcomes, to improve
child health and developmental outcomes, and to improve parents economic
self-sufficiency.
Clients and FNs indicated that they believed good progress had been made in
parenting and in other life skills.
Case studies illustrate substantial gains in mothers developing
relationships with infants and improving difficult relationships with fathers,
often in the face of initial low engagement or risk factors such as having
been in care. These generally involved much multi-agency working and
were facilitated by the strong Family Nurse-client relationship.
Almost three quarters of all enrolled clients (943/1304; 72%) had been
referred to other services by their Family Nurse, most often for financial
assistance (39%), maternal health (35%), housing (27%) or infant health
(23%).
There was a relative reduction in smoking of 20% from early in pregnancy
(40%) to 36 weeks gestation (32%); however this average masks
substantial differences between sites.
Site variation is affected both by the proportion of clients who report
smoking at intake (very low in some areas) and by whether all the
necessary health habits forms were completed at both time points during
pregnancy.
Breast feeding initiation was 63%, with more than a third (36%) of these
clients still breastfeeding at 6 weeks, which is promising in relation to the
rates identified in national surveys for socio-economically disadvantaged
mothers.
There was a wide range in breastfeeding initiation rates between sites,
from 38% to 86%.
The 1003 (singleton) infants were born on average at 39 weeks gestation,
with 7.4% premature; their average birth weight was 3221 grams, with
9.2% LBW.
Just under one quarter (23%) of clients reported experiencing some
physical or emotional abuse since their infants birth, which might reduce
the likelihood of FNP having an impact
3
.


Option 2
Option2 is a service funded by the Welsh Assembly that works with families
in which parents have drug or alcohol problems and there are children at risk
of harm. A particular focus of the service is reducing the need for children to
come into public care. It has a Cardiff and a Vale of Glamorgan service. The
intervention is short (4 to 6 weeks) and intensive (workers are available 24
hours a day). Workers use a combination of Motivational Interviewing and
Solution-Focused counselling styles, as well as a range of other therapeutic
and practical interventions. Option2 did not reduce the proportion of children
who entered care Option2 significantly reduced the time children spent in
care, because: Option2 children take longer to enter care; If they do enter
care, they tend to stay there for a shorter time A higher proportion of Option
2 children return home from care. As a result a quarter of Option2children
were in care at the end of the study, compared to a third of children in the
comparison group

3
Nurse-Family Partnership Programme (Professor Jacqueline Barnes, Mog Ball, Pamela Meadows,
Professor Jay Belsky, University of London)
Cost Savings: The Rand Corporation calculates that every dollar invested
in providing the program to the families at greatest risk returns $5.70, and
every dollar spent on the average participating family returns $2.88, most of
this in reduced government expenditures on health care, educational and
social services, and criminal justice. According to the Washington State
Institute for Pubic Policy, the program produces $18,000 in net benefits per
family served.



Families First
Families First was established in April 2006 by Middlesbrough Council as a
family focused crisis intervention service working with families where there are
serious child protection concerns directly related to parental substance
misuse. It is based on the Option 2 model developed in Cardiff in 2000.The
service receives referrals from mainstream childrens services (locality) teams
and aims to:

keep children with their families where it is safe and possible to do so
help families during times of crisis
support parents/carers to recognise their drug issues and help them to
change

This is achieved by providing an intensive intervention and support package
(for up to 8 weeks) to children and their parents/carers, delivering parenting
programmes/advice and linking with other local agencies and services. To do
this effectively, the team deploys both adult and childrens workers flexibly to
establish clear goals with the family and address whole-family issues in a
structured manner.

After the initial period of intensive support, the team will continue to work with
a family for a further 8-12 weeks on a less intensive basis to reinforce and
Cost Savings: For Cardiff, the cost of Option2 was 2194.67 per child.
Option2 on average saved 3372.77 per child in the cost of placements.
Thus, on average each appropriate referral saved the local authority
1178.10 per child.
The total cost for running Option 2 in Cardiff from 2000-2006 was 410,403
in this time Option 2 worked with 187 children. This gives an average cost
per child referred to Option 2 of: 2194.67
On average each child receiving the service cost 13558.36 while each child
in the comparison group cost 16931.13. This was a net saving in the cost of
care of 3372.77.
When the cost of Option 2 is set against the cost of care each child saves
the reduced cost of care minus the cost of Option 2 (3372.77 - 2194.67 =
1178.10). Each child referred to Option 2 in Cardiff therefore results in a net
saving of 1178.10.

consolidate new patterns of behaviour, at the end of which they will devise a
long term support plan to help families maintain the progress and changes
they have made. This involves transferring case-responsibility back to locality
teams and mobilising mainstream services. As part of this maintenance
phase, Families First provides short follow-up/booster sessions at 3, 6 & 12
months to all families. An independent evaluation of the project from the
Centre of Public Health at Liverpool John Moores University is available
below. The reports conclusion states: Evaluation findings suggest that the
Families First model prevents the need for permanent placement of children
into care and reduces the time spent in temporary care placements by helping
parents to provide a safe home environment or by finding an alternative
kinship care placement. These findings are limited by a small sample size and
no comparison group and therefore implementation in other areas should be
accompanied by an imbedded evaluation from the projects inception, based
upon the current research model.


Family Intervention Projects (FIPs)
Providing intensive support for families with multiple problems often succeeds
when everything else has failed, whilst delivering impressive savings in local
service costs.

Independent research by NatCen shows improved outcomes across various
sectors, including:-

Reduction in housing enforcement actions from 50% to 14%
Drop in ASB by almost two-thirds
Truancy, exclusion and bad behaviour at school reduced by more than
50%
Domestic violence incidents declined from 32% to 17%
Child Protection concerns declined from 24% to 14%
Cost Savings: Families First had positive impact on care status during 12
month observation period. Cost effective approach to reducing the need for
care. child 6,555. Mean cost per family 12,642. Families First Giving
Families a Chance to Change, Suzy Kitching - Middlesbrough Council

Parenting support programmes lead to an improvement in the
behaviour of children

The support received will increase the likelihood of positive outcomes for the
children of the family, the adults and of the family as a whole. It may also
improve the experience of life for the community in which they live.

Independent evaluation for the first 1,000 families to complete family
intervention projects shows significant improvements at the end of an
intervention for a number of factors. Families affected by a mental health
problem declined from 38% to 27%; families in which domestic violence was a
concern more than halved from 22% to 9%; and families with drug & alcohol
problems declined from 32% to 17%.

The Coda Consultants evaluation of the Harlow FIP states: Structured
feedback from families who have been involved with the Harlow Family
Intervention Project (the FIP), and professionals who have worked in
partnership with the FIP suggests that the project has had a significant impact
within the Harlow locality.



Family Pathfinders
Early findings from independent evaluation of 15 local authorities developing
new and innovative approaches to supporting families with multiple problems,
shows (from the first 43 families who have completed a support plan and
exited a whole family support project) that the no wrong door whole family
way of working is reducing families and practitioners concerns on a range
issues and helping parents to assume back control of their lives and those of
their children.

Cost Savings: The average saving per family per year is 81,624 (NatCen).
However, in a recent evaluation by Sheffield Hallam University and Action
for Children found they can save the taxpayer over 200,000 per family per
year.
There are a number of common practices that characterise the approach in
these areas such as; having a multi-disciplinary team, often co-located, to
form a Team Around the Family who coordinate tailored packages of support,
with the families engagement and based on a Whole Family Assessment, so
that all the needs of the family are identified and met. Each member of the
multi-disciplinary team has a small case-load to reflect the high intensity
support that is necessary to influence the behavioural change needed. These
operational practices are underpinned by strategic buy-in from adults and
childrens services.

All 15 local authorities surveyed a number of practitioners and managers to
find out what different services views were in relation to the whole family
approach the authority was adopting.

The feedback overwhelming endorsed the approach with nearly 100% of
those surveyed expressing that they thought the multi-disciplinary team was
filling a gap in service delivery. Three quarters of those surveyed thought that
the intensity of support would not otherwise have been provided but for the
whole family support project.

The Southend Family Pathfinder has a dedicated multi-agency team that
works with families with complex needs. The team uses a whole family
assessment that identifies the needs of the family and enables tailored
support packages to be designed for the families.

Based upon 45 families:

The need for Child Protection Plans has almost halved
Over 75% of the childrens school attendance has improved
The majority of families have one Integrated Family Plan
Parents are being supported to access voluntary, education and
training opportunities
Of families where domestic violence was an issue, 80% have seen a
reduction in domestic violence reports to the police



Family Group Conferencing
FGC is a system of family led decision-making. It draws on the resources of
the extended family and empowers those involved to negotiate their own
solutions to a problem, rather than imposing external remedies.
The approach of contingency planning involves the preparation of plans to
minimise the disruption caused to families if the family situation deteriorates,
for example if a parent is temporarily unable to continue with their parental
responsibilities owing to a mental health problem.
Evidence clearly demonstrates a range of excellent outcomes:
Plans that are viewed as safe by families and workers in over 90% of
conferences
Significantly improved communication and understanding between
social services and families
A reduction in the number of children who are accommodated and
increased contact with their friends and family network.
Every family is unique, with its own culture, personalities, personal dynamics
and history. All families come up against problems from time to time. Some
more difficult situations involving children can be sorted out more easily with
help from relatives and friends, and some may also need help from the health
services, the education department, social services, or other agencies.

Family group conferences are a way of giving families the chance to get
together to try and make the best plan possible for children.
The decision makers at a family group conference are the family members,
and not the professionals. It is here that the mother or father or aunt or
Cost Savings: This cannot be determined yet due to differing pathfinder
approaches. However a further report is expected in December 2010.
grandfather gets together with the child or young person and the rest of the
family to talk, make plans and decide how to resolve the situation
4
.

Kent Substance Misusing Parents Project
KCA's Substance Misusing Parents' Service is a joint initiative with Thanet
and Dover Social Services Children and Families teams. The project works
with families in which there are substance misuse issues which put the
children at risk of harm, so that the risk can be reduced and the families be
kept together with the benefit of reducing the number of Looked After children
and the numbers of children on the child protection register.
The project is targeted at four main groups of parents:

Parents with a child or children on the Child Protection Register where
parental substance misuse is a factor
Parents with a child at risk of becoming looked after, again where
substance misuse is a characteristic
Parents who are using drugs or alcohol in a way that is affecting their ability
to parent adequately
Women who are pregnant and whose substance use may be harmfully
affecting their baby

4
Barnardos
Cost Savings: Coordinators are paid 19 per hour and FGCs take on
average 25 hours of work. Therefore without taking on board other project
costs, each conference costs approximately 475. Where the process leads
to avoidance of the local authority entering into care proceedings this can
add savings of 25,000 per child.

Similarly the Loughborough University cost calculator has estimated that the
average unit cost of a child in residential care was 4.5 times that of a child in
an independent living arrangement; eight times that of a child in foster care;
9.5 times that of a placement with family or friends; and more than 12.5
times the cost of a placement with the child's own parents. This evidence
points to the cost savings that could result if the FGC leads to a reduction in
placements out of the family.
(Using the family group conference as a mechanism to enable the family to respond to safeguarding
concerns about their children, North Somerset)

The benefits of SMPP involvement in cases of children in need and child
protection included:

Parental admission of the impact of the drug use on children.
Fast track referrals to methadone prescription service.
Engagement with methadone programme and abstinence from street
opiates.
Consent to work alongside SMPP and to undergo random drug testing in
accordance with child protection plans/and or court agreement
Decision by a mother to remove herself and children to an environment
where they could be better safeguarded.
The controlled use of methadone by pregnant woman and engagement
with SMPP and midwifery services by pregnant women who have had
histories of previous babies becoming adopted Outcomes for KCC

KCC staff reported that SMPP led to the following outcomes:

More accurate assessment of children and parents needs.
Awareness raising for social workers who use SMPP workers as a
resource to advise them on drug issues.
Information sharing.
Successful interagency working.

The key mechanisms of the SMPP that produced these benefits were
considered to be:

The speed of the SMPP worker response.
SMPP workers expert knowledge.
Home visiting by SMPP workers.
Drug testing.
The sharing of information by KCA and KCC



Family Drug and Alcohol Courts (FDAC)
FDAC attempts to improve outcomes for children subject to care proceedings
by offering parents with substance misusing problems: Intensive assessment
and support from the specialist court; Help from parent mentors; Quicker
access to community services; and Better co-ordination between child and
adult services.

FDAC is based on a model widely used in the United States. The national US
evaluation found that outcomes for parents and children were better when
families took part in specialist drug and alcohol courts. Key findings were:

More children were reunited with their parents
Quicker decisions were made for out of home care if reunification was
not possible
There were financial savings on foster care.

FDAC is being evaluated by Brunel University.
The main purpose of FDAC is to see whether it can improve outcomes for
children subject to care proceedings by offering parents with substance
misusing problems:

Intensive assessment and support from the specialist court
Help from parent mentors
Quicker access to community services
Better co-ordination between child and adult services

The results were attributed to the fact that more parents took up and
completed substance misuse treatments than in traditional courts and
Cost Savings: The monthly cost-benefit associated with these outcomes
was between 15,094 and 90,940, depending on whether children returned
to their families from foster care or residential care (and assuming that these
returns were directly attributable to the SMPP service).

services. In order to provide a preliminary picture of the pattern of
engagement with the FDAC process we present an update of the cases at 30
April 2009. At this point 23 families had left FDAC and 14 were still in the
programme. Families who had entered FDAC in late 2008 were still at a
relatively early stage in the process. In summary:

27 families had remained in FDAC for 12 weeks or more.
A period of six to eight months was the minimum time it took parents to
deal with their substance misuse and provide suitable parenting for their
child (3 families).
Most families who exited FDAC did so within the first five months, and nine
left within the first two months.
The maximum length of stay in FDAC to date has been 9 to 12 months (4
families).

Several points need to be made in relation to the picture of families exiting
and remaining in FDAC. First, FDAC was able to meet the NHS National
Treatment Agency for Substance Misuse (NTA) standard for retention in
treatment of twelve weeks for 27 families
5
.




5
Family Drug and Alcohol Court (FDAC) - Evaluation Research Study 2009
Brunel University
Cost Savings: To be determined. However, interim findings there were cost
savings, particularly on foster care services, because children spent less
time in out-of-home care.

GENERAL APPROACHES

Multi-Systemic Therapy (MST)
Multi-systemic therapy works with young people and their families to increase
parenting capacity, engagement with education and training, family cohesion
and promote pro-social activities for parent and child as well as to tackle
underlying health or mental health problems in the young person or parent,
including substance misuse and reduce young peoples offending behaviour.
Positive outcomes are being reported from 10 UK trial sites: 84% of families
worked with have completed the programme and 86% of young people are
still living at home at the end of the programme. (Unit cost 8,000 for six
months).
Evidence based on a systematic review of interventions in the US has shown,
amongst other things, that family-based therapy reduced re-offending by 12
per cent. Providing family therapy for young people who had offended cost an
average of just over 2,000 per participant but saved tax-payers and victims
of crime an estimated 52,000 per participant in the longer term.
6


Multi-Agency Training
An evaluation of training on working with substance misusing parents and
their children provided in 2009 for a range of agencies in Essex found that of
244 participants, 94% felt better able to support the client group after
completing the training and 98% felt the quality of instruction was of a high
standard. The evaluation also found that there was a perceived lack of
knowledge before the training by large numbers of participants, that there was
a clear need for higher level training for certain professionals e.g. drug and
alcohol workers and police and that training should be rolled out further.
7


Parenting Programmes
There are two broad groupings of parenting programmes:

6
Drake K, Aos S and Miller MG (2009) Evidence-Based Public Policy Options to Reduce Crime and
Criminal Justice Costs: Implications in Washington State. Victims and Offenders 4: 17096 (available
at www.wsipp.wa.gov/rptfiles/09-00-1201.pdf).
7
Evaluation of Hidden Harm Training in Essex (Mark Bowles, 2010)

i) Evidenced Based Programmes that have been developed over a number
of years and have undergone extensive academic evaluation and are based
on sound theoretical knowledge e.g. Triple P and Webster Stratton. These
can only be delivered by suitably qualified and supervised facilitator and are
provided over an extended timeframe.

ii) Knowledge Based Programmes - These are often programmes that have
been developed locally by practitioners based upon their professional
knowledge and experience. Initial evaluation has shown impact but this has
not been tested through academic rigour over an extended period of time.
Again they would need to be delivered by a suitably qualified and supervised
facilitator.


The 5-step intervention for family members (Templeton & Velleman)
The intervention is based on a theoretical understanding of how family
members can be affected by substance misuse, a model that was developed
from research with family members about what its like to live with substance
misuse. The stress-strain-coping- support model (Velleman & Templeton,
2003) states that living with a substance misuser is stressful and that this
stress leads to strain that is often exhibited through physical and
psychological ill health, but also by the presence of other problems and
indicators, for example, relationship problems, family disharmony and
disruption, financial difficulties, and problems with work or education
attendance/performance. The amount of strain is influenced by two key
factors: coping and social support. Family members will try all manner of
things to try and cope with, or respond to, their situation, with the three broad
categories of tolerant coping, engaged coping and withdrawal coping having
been identified as capturing the range of response (Orford, Natera, Davies,
Nava, Mora, Rigby, Bradbury, Bowie, Copello, & Velleman, 1998b). Some
forms of coping, for example tolerant inactive coping, are more likely to
increase strain, whereas others, particularly withdrawal coping are more likely
to reduce it (Orford, Natera, Velleman, Copello, Bowie, Bradbury, Davies,
Mora, Nava, Rigby, & Tiburcio, 2001; Orford, Templeton, Velleman, &
Copello, 2005b). Similarly, family members will also have differing levels and
quality of social support; higher levels of social support and support that is
more helpful to a family member can lead A group intervention with families of
substance misusers to reduced strain at any given level of stress. The model
indicates that there are two ways of reducing strain; either by reducing stress
and/or by altering one or both of the mediating factors of coping and support.
Because the level of strain is a result of either the amount of stress, or the
amount and style of coping and support, then, over time, expected change in
symptoms would occur if there were changes in these other areas first.

Annex 8 Data collection Tool for Pregnancy and Complex
Social Factors
Complete one form for each woman
No
.
Dat
a
item
no.
Data item Yes No
1
If yes, which complex social factors does the woman
have?

1.1 Poverty*
1.2 Homelessness*
1.3 Substance misuse *
1.4 Recent arrival as a migrant*
1.5 Asylum seeker or refugee status*
1.6 Difficulty speaking or understanding English
1.7 Age under 20*
1.8 Domestic abuse*
1.9 Other (specify)
2 Did the woman attend for booking by:
2.1 10 weeks? *
2.2 12
+6
weeks?*
2.3 20 weeks?*
2.4 Later than 20 weeks?*
3 3.1
How many antenatal appointments should the woman
have attended according to CG62 Antenatal care?
8

7 / 10
3.2
How many antenatal appointments were scheduled for
the woman?

3.3
How many antenatal appointments did the woman
attend?

3.4 How many antenatal appointments did the woman miss?
4
Did the woman or her baby (or babies) experience
mortality or significant morbidity?

Woman

8
A schedule of antenatal appointments should be determined by the function of the appointments. For a
woman who is nulliparous with an uncomplicated pregnancy, a schedule of 10 appointments should be
adequate. For a woman who is parous with an uncomplicated pregnancy, a schedule of 7 appointments
should be adequate.
No
.
Dat
a
item
no.
Data item Yes No
4.1 Mortality (detail)
4.2 Morbidity (detail)
Baby
4.3 Mortality (detail)
4.4 Morbidity (detail)
4.5
If mortality, was the death reported to the Confidential
Enquiry?


Annex 9 Children of Substance Misusing Parents Principles

Overarching Principles
Principle Source Evidence Them
e
i) All those who come into
contact with children,
parents and families in their
everyday work, including
practitioners who do not
have a specific role in
relation to child protection,
have a duty to safeguard
and promote the welfare of
the child.
ii) Local authorities, health
services, housing
agencies, courts and
childrens Hearings, and
other agencies in contact
with families have a range
of responsibilities to
promote the welfare of
children and protect them
from danger.
i) Croydons
protocol to meet
the needs of
children and the
unborn, whose
parents or carers
have problems,
substance misuse
problems, or a
learning disability.
Croydon
Safeguarding
Children Board
2008
ia) Hidden Harm
Three Years On:
Realities,
Challenges and
Opportunities
ACMD 2007
ii) Getting our
priorities right:
Good Practice
Guidance for
working with
Children and
Families affected
by Substance
Misuse. Scottish
Executive 2001
Government Guidance is clear that
safeguarding and promoting the welfare
of children and young people is
everyones responsibility and that all
agencies and professionals should share
and help to analyse information so that
an assessment can be made of the
childs needs and circumstances
(Government 2006a, p.34, 1.16).
The response of child protection
practices and procedure to children
exposed to domestic violence or
parental substance misuse, Hedy
Cleaver, don Nicholson, Sukey Tarr &
Deborah Cleaver, (2006)
Even when practitioners have the skills,
many feel that it is not their role to work
with children, or families or parents with
substance misuse problems. We take
the view that we all have both
clinical and moral responsibilities to
think about the wider systems and not
solely about our identified and referred
patients.
Understanding and modifying the
impact of parents substance misuse
on children. Richard Velleman &
Lorna Templeton Advances in
Psychiatric Treatment (2007), vol. 13,
7989
Respo
nsibilit
y
i) The rights of the child are
paramount. The rights of
parents, carers and
pregnant women for
support in fulfilling their
parental roles and
responsibilities do not
override the rights of a
child to be protected and
be treated as an individual.
ii) Childrens welfare is a
more important
consideration than
confidentiality
i) ii) Hidden Harm
Three Years On:
Realities,
Challenges and
Opportunities
ACMD 2007

Mental health professionals appeared to
avoid asking their adult patients or
clients crucial questions concerning their
children, even when there was a clear
need, given the circumstances of the
carers situation. The majority also felt
that specialist drug workers were too
exclusively focused on the needs of their
adult clients and that concerns about
sustaining trust and not breaching
confidentiality appeared at times to
override the principle that the childs
welfare was the paramount
consideration.
Rights
Although it was generally acknowledged
that the childs welfare was the
paramount consideration in law (1989
Children Act), how and when information
was communicated across agencies was
a key issue for many professionals. This
was seen to significantly affect the
quality of assessment and the timeliness
of intervention, particularly in cases of
high risk
Working with Parental Substance
Misuse: Dilemmas for Practice Andy
Taylor & Brynna Kroll 2004
i) A parents drug/alcohol
use should not
automatically lead to child
protection inquiries or other
forms of compulsory
intervention unless there is
evidence that this is
necessary to prevent the
child coming to harm.
There is a requirement on
all agencies to properly
assess the impact of such
substance misuse on the
care and development of
the children of any
substance misuser with
whom they are working.
Parental drug misuse
should not be seen in
isolation, but needs to be
placed in a wider context.
ii) Whilst not condoning the
use of drugs and / or
alcohol, it is recognised
that such use in itself may
not affect a parents
capacity to look after their
child well.
i) Protocol to
Promote Inter-
Agency Working
With Children &
Families Affected
by Substance
Misuse Joint
Strategic Planning
Group on Family
Support & Child
Protection Pilot
April September
2008
ia) Solihull - Joint
Services Protocol:
Families and
Children affected
by Parental
drug/alcohol use
2008 (Page 2)
ii) i)
Nottinghamshire
Safeguarding
Children with Drug
and Alcohol Using
Parents: Practice
Guidance for all
Agencies 2009

Assumptions that drug misuse
necessarily led to inadequate parenting
were seen as particularly unhelpful, while
approaches which did not dictate to them
and were nonjudgmental, combined with
openness about use of power and
authority, facilitated communication and
sustained engagement.
A FAS intervention potentially has two
stages. A first-stage intervention with
each family normally consists of five
sessions, usually with two workers co-
working and seeing some family
members individually, including the
children. In these sessions, information
is gathered from the whole family about
all aspects of their life, with the emphasis
on what the family feel that they do well,
rather
than just focusing on the presenting
problem. This positive reframing helps
families become motivated to change by
focusing on their values and what is
important to them as a family. Parental
Alcohol Misuse in Complex Families:
The Implications for Engagement
Andy Taylor, Paul Toner, Lorna
Templeton and Richard Velleman
2008
Good
enoug
h
Parent
ing
All services are required to
a shared view of parental
substance misuse and
negative impacts on their
children and what are the
shared thresholds for
action (Tonic)
Tonic From the professionals point of view,
the main difficulties were caused by
varying thresholds for intervention
between services, confusion about
confidentiality, the interpretation of both
protocols and the definition of significant
harm and insufficient assessments of
the impact on children.
Thres
hold
(Share
d)
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
Families experiencing drug
and alcohol related harm
are subject to multiple
vulnerabilities and could be
experiencing problems like
poor mental health,
poverty, domestic violence
etc. It is critical all services
respond in a holistic way
and provide interventions
that are timely, appropriate
and ultimately strengthen
the family. (Tonic)
Tonic As can be seen, problems of mental
health, domestic violence, severe
relationship difficulties and bereavement
all featured in the families under
discussionsix out of seven of these
families (often single mothers), there
were at least two, sometimes three, and,
in one instance, four, problem
characteristics occurring. This,
compounded by continued alcohol
misuse, underscores the difficulties of
gaining a foothold in families in chaos.
For a number of parents in this sample,
alcohol use was linked to coping with
distressing aspects of past relationships
and their emotional and physical impact,
as has been reflected in other research
(see, e.g. Humphreys et al.,
2005).Parental Alcohol Misuse in
Complex Families: Implications for
Engagement Andy Taylor et al 2008

Although the amount of research
focusing on family members is small in
relation to the whole substance-misuse
literature, there is ample documentation
of the multiple and often chronic stresses
to which family members are exposed
(e.g. Asher, 1992; Barnard, 2007;
Corrigan, 1980; Dorn, Ribbens, & South,
1987; Jackson, 1954; Orford et al., 2005;
Velleman et al., 1993; Yang, 1997); the
strain in the form of physical and mental
ill health for which family members are at
high risk (e.g. Bailey, 1967; Moos,
Finney, & Cronkite, 1990; Orford et al.,
2005; Student & Matova, 1969;
Wiseman, 1991;
Yang, 1997); the dilemmas that family
members face in trying to cope (e.g.
Ahuja, Orford, & Copello, 2003; Asher,
1992; Dorn et al., 1987; Orford et al.,
2001; Wiseman, 1991); and the
limitations on the social support that
family members receive (e.g. Orford et
al., 1998, 2005; Wiseman, 1991).
Increasing the involvement of family
Multipl
e
Vulner
abilitie
s

Families experiencing drug
and alcohol related harm
are subject to multiple
vulnerabilities and could be
experiencing problems like
poor mental health,
poverty, domestic violence
etc. It is critical all services
respond in a holistic way
and provide interventions
that are timely, appropriate
and ultimately strengthen
the family. (Tonic)
Tonic As can be seen, problems of mental
health, domestic violence, severe
relationship difficulties and bereavement
all featured in the families under
discussionsix out of seven of these
families (often single mothers), there
were at least two, sometimes three, and,
in one instance, four, problem
characteristics occurring. This,
compounded by continued alcohol
misuse, underscores the difficulties of
gaining a foothold in families in chaos.
For a number of parents in this sample,
alcohol use was linked to coping with
distressing aspects of past relationships
and their emotional and physical impact,
as has been reflected in other research
(see, e.g. Humphreys et al.,
2005).Parental Alcohol Misuse in
Complex Families: Implications for
Engagement Andy Taylor et al 2008

Although the amount of research
focusing on family members is small in
relation to the whole substance-misuse
literature, there is ample documentation
of the multiple and often chronic stresses
to which family members are exposed
(e.g. Asher, 1992; Barnard, 2007;
Corrigan, 1980; Dorn, Ribbens, & South,
1987; Jackson, 1954; Orford et al., 2005;
Velleman et al., 1993; Yang, 1997); the
strain in the form of physical and mental
ill health for which family members are at
high risk (e.g. Bailey, 1967; Moos,
Finney, & Cronkite, 1990; Orford et al.,
2005; Student & Matova, 1969;
Wiseman, 1991;
Yang, 1997); the dilemmas that family
members face in trying to cope (e.g.
Ahuja, Orford, & Copello, 2003; Asher,
1992; Dorn et al., 1987; Orford et al.,
2001; Wiseman, 1991); and the
limitations on the social support that
family members receive (e.g. Orford et
al., 1998, 2005; Wiseman, 1991).
Increasing the involvement of family
members in alcohol and drug
treatment services: The results of an
action research project in two
specialist agencies
JIM ORFORD, LORNA TEMPLETON,
ALEX COPELLO, RICHARD
VELLEMAN, AKAN IBANGA,
& CHARLOTTE BINNIE 2009
Multipl
e
Vulner
abilitie
s
Families experiencing drug
and alcohol related harm
Tonic The type of families discussed here
require particular approaches,
Hard
to
Strategic

Principle Source Evidence Theme
i) Parents should
normally be responsible
for the upbringing of their
children and should
share that responsibility.
So far as is consistent
with safeguarding and
promoting the childs
welfare, local authorities
should promote the
upbringing of children by
their families
i) Getting our
priorities right:
Good Practice
Guidance for
working with
Children and
Families affected
by Substance
Misuse. Scottish
Executive 2001
ii) Hidden Harm
Three Years On:
Realities,
Challenges and
Opportunities
ACMD 2007
Responsibility
i) Any intervention by a
public authority in the life
of a child must be
properly justified and
supported by services
from all relevant
agencies working in
collaboration
ii) Safeguarding and
promoting the welfare of
children in the context of
parental drug or alcohol
use, like safeguarding
more generally, is a
shared responsibility and
depends on effective joint
working between
agencies and
practitioners that work
with children and young
people. All agencies
should be alert to the
risks and be able to take
action, working jointly
where an issue is
identified
iii) The Children Act 1989
states that it is the duty of
every local authority: to
safeguard and protect
the welfare of children
i) Ibid
ii)
Nottinghamshire
Safeguarding
Children with
Drug and Alcohol
Using Parents:
Practice
Guidance for all
Agencies 2009
iii) Solihull -
Joint Services
Protocol:
Families and
Children affected
by Parental
drug/alcohol use
2008 (Page 2)
Given the potential problem of
concentrating on adults needs at the
cost of the childrens, how are these
apparently competing needs to be
reconciled? In
this study, a number of professionals
alluded to those agencies that had
managed to resolve these conflicts
successfully. Many talked about the
clarity
of communication and joint working
Interventions for children and
families where there is parental
drug misuse. Brynna Kroll and
Andy Taylor 2006
What were seen as effective were
not only timely responses, and the
sharing of information where families
had dropped out, but the sharing of
joint knowledge and expertise about
the reasons for this, and discussion
of strategies (i.e. the management of
alcohol relapses; issues of child-care
management) in such
circumstances. What was also re-
affirmed was that some multi-
problem, complex and conflictual
families could place terrific strain on
staff already burdened with large
caseloads, and, in such
circumstances, there was greater
Safeguarding
within their area who are
in need; and so far as is
consistent with that duty,
to promote the
upbringing of such
children by their families
by providing a range and
level of services
appropriate to those
childrens needs.
pressure placed on respective
responsibilities and roles. Without
robust and
constructive working-together
practices, this could lead to splits
between agencies, causing
particular tensions, particularly
where there were constant changes
in staff. Parental Alcohol Misuse
in Complex Families: The
Implications for Engagement
Andy Taylor, Paul Toner, Lorna
Templeton and Richard Velleman
2008
i) If there is a concern
that a child may be in
need due to living in an
environment where
drugs/alcohol is being
misused, all agencies,
subject to professional
codes of confidentiality,
have a duty to share this
information with
Education and Childrens
Services. Their
confidentiality codes
must reflect this duty.
i) Solihull - Joint
Services
Protocol:
Families and
Children affected
by Parental
drug/alcohol use
2008 (Page 2)
Women in particular are worried
about judgemental attitudes . . . and
fear losing their children . . . so that
you are trying to reassure them
about confidentiality which links to
trust . . . sometimes they can be
reserved
about telling you about child care
issueson the other hand
sometimes you are used as their
confidant which can be difficult
Interventions for children and
families where there is parental
drug misuse. Brynna Kroll and
Andy Taylor 2006

Confidentiality
i) Clear leadership and
cross sector co-
ordination produces the
most significant progress
in responding to the
needs of children born to
and living with parental
substance misuse.
ii) Greatest progress is
being made where the
needs of children of
problem drug and alcohol
users are identified and
addressed by a shared
strategic approach, which
is embedded within joint
commissioning
arrangements for both
adult and childrens
services.
i) Hidden Harm
Three Years On:
Realities,
Challenges and
Opportunities
ACMD 2007
iii) Working
Together to
Safeguard
Children: A guide
to inter-agency
working to
safeguard and
promote the
welfare of
children (DCSF
2010)
Strategic
Approach
i) Interagency training is
not an end in itself but
should be seen as a
necessary and vital
component of the
safeguarding children
process
ii) There is a need for a
sensitive response by
workers. All workers
likely to come into
contact with substance
misusing parents should
have relevant training
and opportunities to
develop skills relating to
the impact of drug and
alcohol use on family
members.
i) Outcomes of
Interagency
Training to
Safeguard
Children: Final
Report to the
Department for
Children, Schools
and Families and
the Department
of Health 2010
ii) What works in
promoting good
outcomes for
children in need
where there is
parental
substance
misuse? Social
Services
Improvement
Agency Welsh
Assembly 2008
Training on safeguarding and
promoting the welfare of children
can only be fully effective if it is
embedded within a wider framework
of commitment to inter- and multi-
agency working, underpinned by
shared goals, planning processes
and values.
Whilst the detailed content of
training at each level of the
framework should be specified
locally, programmes should usually
include the following:
recognising and responding to
safeguarding and child protection
concerns;
working together;
completing child in need
assessments;
safeguarding disabled children;
safeguarding children when there
are concerns about domestic
violence,
parental mental health; and
substance misuse.
Working Together to Safeguard
Children: A guide to inter-agency
working to safeguard and
promote the welfare of children
(DCSF 2010)
Improve qualifying and post
qualifying social work training to
ensure that it includes training on
alcohol and drug use and how this
relates to working with children and
families.Looking Beyond Risk
Parental Substance Misuse:
Scoping Study. Templeton,
Velleman, Galvani, Zohhadi 2006
For many professionals, working
with children and families of
substance misusers will be a new
area of work, and as such progress
in this area must consider the
knowledge, training and support
needs of staff, whether they work in
specialist or generic services. Often,
confidence in working with
substance misuse, and other co-
existing issues, is the main barrier to
Training
progress. How to respond to co-
existing issues, for example,
domestic violence or parental
mental health problems, can bring
additional challenges and training
and supervision needs.
Looking Beyond Risk Parental
Substance Misuse: Scoping
Study. Templeton, Velleman,
Galvani, 2006
Service Provision

Principle Source Evidence
i) When working with
parents who misuse
substances, agencies
should consider the impact
on children, be alert to
their needs and welfare
and respond to any
emerging problems.
i) Getting our priorities
right: Good Practice
Guidance for working
with Children and
Families affected by
Substance Misuse.
Scottish Executive 2001
ii) Solihull - Joint
Services Protocol:
Families and Children
affected by Parental
drug/alcohol use 2008
(Page 2)
iii) Nottinghamshire
Safeguarding Children
with Drug and Alcohol
Using Parents: Practice
Guidance for all
Agencies 2009
Children whose parents drink too much can
suffer a range of physical, psychological and
behavioural problems as a result of living in
such an environment (Velleman, 2002).
Hidden Harm issues for professionals
working with parents who misuse
alcohol. The Parenting & Alcohol Project
Guidance 2006
i) While many parents,
carers and pregnant
women with, mental health
problems and/or substance
misuse problems and/or a
learning disability
safeguard their childrens
well-being, childrens life
chances may be limited or
threatened as a result of
those factors.
Professionals need to
consider this possibility for
all clients with children and
for all children whose
parents are experiencing
these problems
i) Croydons protocol to
meet the needs of
children and the unborn,
whose parents or carers
have problems,
substance misuse
problems, or a learning
disability. Croydon
Safeguarding Children
Board 2008
a) The response of child protection practices
and procedure to children exposed to
domestic violence or parental substance
misuse, Hedy Cleaver, don Nicholson,
Sukey Tarr & Deborah Cleaver, (2006)
b) Understanding and modifying the impact
of parents substance misuse on children.
Richard Velleman & Lorna Templeton
Advances in Psychiatric Treatment (2007),
vol. 13, 7989
It has been suggested that pregnant
substance users could benefit from being
managed using a shared care approach,
involving obstetric services in conjunction
with a substance misuse agency. Obstetric
goals need to take account of
pharmacological treatments, but should also
shift towards a public health perspective,
characterised by treating pregnant and
postpartum substance misusers, protecting
at-risk foetuses and children, and
strengthening broken families. There is a
need to educate pregnant women around
alcohol, and the involvement of important
people in mothers social networks may be
key to reducing substance misuse during
pregnancy. Many studies have concluded
that there need to be both women-specific
and parenting components in existing
treatment programs, where pregnant women
who are substance misusers can benefit
from comprehensive, family-centred
treatment services and receive useful
parenting advice.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
i) There is a requirement
that all agencies
adequately assess the
impact of mental health
problems and/or substance
misuse problems and/or
learning disability on the
care and development of
children
i) Ibid The majority of statutory drug workers
acknowledged limitations in their
assessment of children, due to their primary
focus on the adult. This was coupled with a
feeling that they had little sense of the
parents wider world, due
to the pattern of contact and only
occasionally saw them with their children. In
fact, in some cases, parents were
discouraged from bringing children to office
appointments due to inadequate facilities
and the fact that their presence might affect
open discussion with parents about their
drug use.
There were also marked differences in the
extent to which workers in both non-
statutory and adult services felt responsible
for making an assessment of risk to
children. Some identified a child protection
role, albeit of a different
nature to that of statutory child-care social
services, which involved making some
intuitive assessment about the ability to
parent, based on the workers knowledge of
the type of substance and the pattern of
use. Interventions for children and
families where there is parental drug
misuse. Brynna Kroll and Andy Taylor
2006

i) A child of substance
misusing parents will be
seen as potentially being in
need or at risk and
therefore the subject of at
least observation,
recording of relevant
information and/or
concerns and referral on
by any professionals in
i) Hidden Harm
Three Years On:
Realities, Challenges
and Opportunities
ACMD 2007

contact with the family.

ii) An inter-agency
assessment of the risks to
a child caused by
substance misuse is an
essential part of providing
assistance.
i) Ibid All the professionals interviewed
acknowledged that they were involved in
making some level of assessment of the
impact of substance use on parenting,
although in many cases, this may have been
intuitive or non-explicit. The
function of the agency was one fairly
obvious factor that influenced assessment.
Thus the primary focus of the agency, core
tasks, organizational pressures and
constraints impacted upon the breadth of
the assessment. As one person
commented: the lack of resources means
that you only do your bit of the work . . . the
gap is trying to fit it all together.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006

iii) We should help children
early and not wait for
crises or tragedies to
occur. This requires
periodic observation
involving home visits, in
order to have an
opportunity to see and
assess children in the
environment in which they
live.
i) Ibid Professionals almost universally
acknowledged that far more had to be done
for children both at the child in need stage
and before this point was reached. Whilst
the introduction of the Common Assessment
Framework (CAF) was seen by some to
encourage earlier identification of children,
many queried the extent to which this could
help provide a more robust system of
identification and intervention and reach this
particular group of children.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
i) Agencies and
professionals must work
together in the planning
and delivery of services, in
assessment and care
planning with families and
in multi-disciplinary
training.
ii) Effective working
practices including
information sharing
protocols should be in
place across both adult
and childrens services to
identify these children.
iii) Integrated in approach
i) Ibid
ii) Nottinghamshire
Safeguarding Children
with Drug and Alcohol
Using Parents: Practice
Guidance for all
Agencies 2009
iii) Working Together to
Safeguard Children: A
guide to inter-agency
working to safeguard
and promote the welfare
of children (DCSF 2010)
The co-morbidity of the difficulties facing
many families means that a number of
different agencies will need to work
together. The findings suggest that services
for domestic violence and alcohol and drug
misuse are not routinely involved at any
stage in the child protection process
When an initial child protection conference
was held services for domestic violence
were represented in only 5% of cases and
services for substance misuse in 18.2% of
cases, despite the fact that domestic
violence was an issue in 72.7% of cases
and parental substance misuse in 60.3% of
cases.
The response of child protection
From birth there will be a
variety of different
agencies and services in
the community involved
with children and their
development, particularly
in relation to their health
and education. Multi- and
inter-agency work to
safeguard and promote
childrens welfare starts as
soon as it has been
identified that the child or
the family members have
additional needs requiring
support/services beyond
universal services, not just
when there are questions
about possible harm.
practices and procedure to children
exposed to domestic violence or parental
substance misuse, Hedy Cleaver, don
Nicholson, Sukey Tarr & Deborah
Cleaver, (2006)
All of these major risk factors are
amenable to intervention, even if the
parental substance misuse is not at the
time. This means that practitioners working
with families in which parents have
substance misuse problems should not
necessarily focus their risk-reduction
efforts on enabling the substance
misuser to change (although, of course, if
this is a possibility it should be
encouraged). Instead, they need to work
on:
family disharmony, in particular
violence (including physical, verbal or
sexual abuse)
parental conflict
parental separation and loss
inconsistent, neglectful and ambivalent
parenting.
Understanding and modifying the impact
of parents substance misuse on
children. Richard Velleman & Lorna
Templeton Advances in Psychiatric
Treatment (2007), vol. 13, 7989
Ensure that services are provided more
holistically, focusing on all aspects of
parenting, substance misuse and co-existing
issues (such as domestic violence, mental
health problems, or women who are
pregnant and where children might have
been exposed to drugs or alcohol in utero).
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
In relation to working together practices,
parents felt this was most effective when
there was a lead professional with specialist
knowledge of drug misuse such as a health
visitor, midwife or family support workers
who were twin trained and who
orchestrated the network, reducing the need
for repeating information. The main
difficulties were caused by failure to
communicate either with one another or with
the parent concerned, as well as being
included in meetings but not addressed
directly.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
i) Some parents who
misuse drugs and / or
alcohol have poor
parenting skills for reasons
other than their drug and /
or alcohol use. Other
sources of stress may
combine to increase
difficulties with parenting
e.g. domestic abuse,
mental health issues.
ii) Services should be
accessible and acceptable
to parents. This might
include: practical help with
the stresses on parents;
helping to reduce social
isolation; building parental
motivation; building on
existing services beyond
treatment and
acknowledge the additional
responsibilities of some
parents (e.g. employment).
i) Ibid
ii) What works in
promoting good
outcomes for children in
need where there is
parental substance
misuse? Social Services
Improvement Agency
Welsh Assembly 2008
Establish a database and directory of
services that respond to the needs of
children and families
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
On an organisational level, information
sharing, joint-working, policies and
procedures, training, supervision and
monitoring are all areas that might need
attention. Offering a diversity of therapeutic
services beyond standard office hours,
providing home visits, child care and
transport are all important; and this again
has implications for staff, in terms of
training, contractual obligations and their
expectations of their role.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
The core dimensions (psychological,
physical, interpersonal, social behavioural)
of the experience of living with a parent with
substance misuse are believed, in certain
aspects, to be very similar (Orford et al.,
2005; Velleman, 2001) and research has
demonstrated that often it is the impact of
substance misuse on family harmony rather
than the substance misuse itself that causes
greater problems (Velleman and Orford,
1999). Parental Alcohol Misuse in
Complex Families: The Implications for
Engagement Andy Taylor, Paul Toner,
Lorna Templeton and Richard Velleman
2008
i) Interventions should be
available to fathers as well
as mothers.
ii) When working with
families it is important to
Think Fathers as well,
including where the father
i) Ibid
ii) Working Together to
Safeguard Children: A
guide to inter-agency
working to safeguard
and promote the welfare
of children (DCSF 2010)
The literature suggests a complex pathway
between paternal substance misuse and
unfavourable outcomes for children. Some
studies focussed on the negative impact of
substance misuse on various aspects of
fathering (Das Eiden et al., 2002; Das Eiden
& Leonard, 2000; Dumka & Roosa, 1995;
is himself a young person.
A childs father can have a
significant, positive impact
on the childs outcomes
but only where he is
causing no harm to the
child for example,
research shows that
children with highly
involved fathers do better
at school and are more
empathic in the way that
they behave. More and
more fathers want to be
involved within their family
and in their childrens
upbringing even if they are
no longer living with the
children and their mother.
Brooks et al, 1998), whilst others look at
mediating factors (e.g. family structure or
paternal warmth) that may reduce the
negative impact of (paternal) substance
misuse on children Finally a number of
studies focussed on the impact of substance
misuse not only on the children, but also the
(usually non substance-misusing) mothers
in these families (e.g. Frank et al, 2002;
Fisher, 1998; Das Eiden & Leonard, 1999),
and report negative psychological and
physical outcomes associated with the
fathers substance misuse. These are all
factors to take into account when
considering intervention and service
delivery.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
i) Support should be
available for the extended
family. Acknowledging the
value of exploring and
using family strengths
when planning for children
and avoiding the
assumption that parents
and children can cope
alone.
i) Ibid Despite the evidence that affected family
members have considerable needs in their
own right, service delivery remains on the
whole focused on the individual drinker or
drug user, with family members playing a
peripheral role if any. Family members are
often marginalised by alcohol and drug
treatment services and those that
commission them. There is little evidence of
dissemination into routine service provision
of those forms of family treatment that have
been developed (Fals-Stewart & Birchler,
2001). We have argued elsewhere that the
base of treatment needs to be broadened so
that the family is seen as a legitimate unit for
intervention, that services are dedicated to
family members in their own right, and that
commissioners and service providers
recognize that a full set of outcomes should
include those that relate to affected family
members and to the family as a whole
(Copello & Orford, 2002). Increasing the
involvement of family members in
alcohol and drug treatment services: The
results of an action research project in
two specialist agencies JIM ORFORD,
LORNA TEMPLETON, ALEX COPELLO,
RICHARD VELLEMAN, AKAN IBANGA &
CHARLOTTE BINNIE 2009

Practitioner

Principle Source Evidence
i) Every child who can form a
view on matters affecting him or
her has the right to express
those views if s/he wishes
Children should be considered
and consulted when parents and
professionals make important
decisions about things that
affect them, including where,
and with whom, they should live,
their schooling, their
relationships and lifestyle. Their
rights should be respected.
ii) His or her welfare should be
kept sharply in focus in all work
with the child and family. The
significance of seeing and
observing the child cannot be
overstated. The child should be
spoken and listened to, and their
wishes and feelings ascertained,
taken into account (having
regard to their age and
understanding) and recorded
when making decisions about
the provision of services.
i) Getting our
priorities right:
Good Practice
Guidance for
working with
Children and
Families affected
by Substance
Misuse. Scottish
Executive 2001
ii) Working
Together to
Safeguard
Children: A guide
to inter-agency
working to
safeguard and
promote the
welfare of children
(DCSF 2010)
A key finding with particularly relevant
implications for service provision relates to
barriers to help-seeking. Reference is
commonly made to childrens reluctance to
speak to people outside the family about the
problems they are facing within it. A number
of related reasons emerge, including loyalty,
fear (of nothing being done), the reactions of
others, shame and stigma. Interestingly, and
somewhat conversely, children have
reported feeling aggrieved that people have
not tried harder to break down this barrier
and uncover the truth (Kroll & Taylor, 2003).
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
Most young people said they rarely felt
supported, listened to or understood. At
times, they were invisible - in case records,
to some of the professionals they
encountered and to their parents.
Experiences of intervention, in the majority
of cases, suggested that, from their
perspective, too little was offered too late,
not enough was done to help families stay
together and, equally problematically, some
children were not rescued early enough.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
i) When there are concerns
about the parents ability to
provide adequate care, in such
circumstances the needs of the
child must be seen as
paramount.
i) Solihull - Joint
Services Protocol:
Families and
Children affected
by Parental
drug/alcohol use
2008 (Page 2)
(See Overarching Principles)
i) Intervention should be carried
out as far as possible in
partnership with the family, and
with the aim of helping them to
put their childs welfare first
i) Hidden Harm
Three Years On:
Realities,
Challenges and
Opportunities
ACMD 2007
Copello, Velleman & Templetons review of
family interventions (2005), summarise
(adult) family focused interventions as: 1)
acting as a mechanism for the entry and
engagement of substance misusers into the
treatment system; 2) working jointly with
substance misusers and (usually, adult)
family members; and 3) responding to the
needs of family members in their own right.
All three areas demonstrate evidence of
effectiveness though the authors (and
others, e.g. Barnard & McKeganey, 2004)
argue that further work is needed.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
i) Sometimes, practitioners can
be scared of opening up a can
of worms and parents are
fearful of social care
involvement. Early intervention,
support and involvement
however, can reduce the risk of
children becoming subject to
child protection processes.
i) Ibid As Werner (1993) argued, our examination
of the long-term effects of childhood
adversity and of protective factors and
processes in the lives of high- risk youths
has shown that some of the most critical
determinants of adult outcomes are present
in the first decade of life. Waiting for
problems to occur often makes offering help
more difficult.
Understanding and modifying the impact
of parents substance misuse on
children. Richard Velleman & Lorna
Templeton Advances in Psychiatric
Treatment (2007), vol. 13, 7989
Professionals highlighted a variety of
dilemmas in intervening with families for
whom drug misuse was but one difficulty
among many. These included the often
longstanding nature of the problems, the
chaotic nature of both the use and the
accompanying lifestyle and the tendency of
drug misusing communities in rural locations
to close ranks, contributing to the invisibility
of children. Engaging parents and working
with denial were also major obstacles to
effective working.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
i) Where there is parental drug
and / or alcohol use it is the
responsibility of practitioners to
consider how to build trusting
relationships with families and
consider how attitudes and
practice may act as barriers to
engagement.
i) Ibid Parents believed services to help families
like their own could be improved if
practitioners:
- paid greater attention to ensuring families
understood what was happening;
- consulted them throughout the process of
assessment, planning and intervention;
- adopted a more honest, open and
respectful approach;
- provided longer-term service provision;
and
- co-ordinated better with other service
providers.
The response of child protection
practices and procedure to children
exposed to domestic violence or parental
substance misuse, Hedy Cleaver, don
Nicholson, Sukey Tarr & Deborah
Cleaver, (2006)
some of the greatest barriers to intervention
were presented by the parents and young
people themselves, who often made it very
difficult for professionals to gain access to
them, albeit for what they saw as very good
reasons . These tended to be linked to
stigma and labelling, fears about the
consequences of disclosure and becoming
visible, particularly where social workers
were concerned, and to the values and
attitudes of some of the professionals they
encountered.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006
i) Those working with children
should have a detailed
understanding of child
development and how the
quality of the care they are
receiving can have an impact on
their health and development.
They should recognise that as
children grow, they continue to
develop their skills and abilities.
Each stage, from infancy
through middle years to
adolescence, lays the
foundation for more complex
development. Plans and
interventions to safeguard and
promote the childs welfare
should be based on a clear
assessment of the childs
developmental
progress and the difficulties the
child may be experiencing.
Planned action should also be
timely and appropriate for the
childs age and stage of
development.
i) Working
Together to
Safeguard
Children: A guide
to inter-agency
working to
safeguard and
promote the
welfare of children
(DCSF 2010)
Obviously, interventions should take into
account the age, gender and
developmental level of the child. For
example, it may be more difficult for younger
children to seek external support: there
may be problems with transportation,
money, parents permission, protection
and safety. Girls seem less affected by
parental problem-drinking in the short term
but if the situation continues then there is an
increased likelihood of problems developing
(Cleaver et al, 1999). Werner (1993) also
found that individual disposition was more
important for females, whereas external
support was more important for males.
Understanding and modifying the impact
of parents substance misuse on
children. Richard Velleman & Lorna
Templeton Advances in Psychiatric
Treatment (2007), vol. 13, 7989
The impact on boys tended to manifest
itself through externalised behaviours, such
as increased aggression, whereas girls
internalised the negative effects and were
more prone to withdrawal and mental ill
health.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
i) Having a holistic approach
means having an understanding
of a child within the context of
their family (parents or
caregivers and the wider family)
and of the educational setting,
community and culture in which
he or she is growing up. The
interaction between the
developmental needs of
children, the capacities of
parents or caregivers to respond
appropriately to those needs,
the impact of wider family and
environmental factors on
children and on parenting
capacity, requires careful
exploration during an
assessment. The ultimate aim is
to understand the childs
developmental needs and the
capacity of the parents or
caregivers to meet them and to
provide services to the child and
to the family members that
respond to these needs. The
childs context will be even more
complex when they are living
away from home and looked
after by adults who do not have
parental responsibility for them.
i) Ibid Very often practitioners need to intervene
in a more holistic and systemic way, and
not imagine that intervening with the child
in the absence of their problem parents,
or the adult in the absence of their
wider family, will lead to a successful
outcome: dealing with the impact of
parents substance (or mental health)
problems on their children is an issue
not just for child and adolescent mental
health services: it is the responsibility of
all healthcare practitioners.
Understanding and modifying the impact
of parents substance misuse on
children. Richard Velleman & Lorna
Templeton Advances in Psychiatric
Treatment (2007), vol. 13, 7989
i) Building on strengths as well
as identifying difficulties
Identifying both strengths
(including resilience and
protective factors) and
difficulties (including
vulnerabilities and risk factors)
within the child, his or her family
and the context in which they
are living is important, as is
considering how these factors
are having an impact on the
childs health and development.
Working with a child or familys
strengths becomes an important
part of a plan to resolve
difficulties.
i) Ibid
ii) North Tyneside
LSCB
Safeguarding and
Child Protection
Procedures 2009
Protective factors and resilience have been
identified in a number of studies, both
general and specific to parental substance
misuse (e.g. Werner, 1993; Velleman &
Orford, 1999; Beinart et al, 2002; Bancroft
et al, 2004). For example, Bancroft et al
(2004) interviewed 37 young people aged
1527 who were children of substance-
misusing parents, and found that a
number of protective factors could lead
to more resilient outcomes. These
included support from school, immediate
and extended family, and individuals and
services outside of the family.
Also;
The practitioner needs to work directly with
the children involved, enabling them to:
maintain positive family rituals
remove themselves from the disruptive
behaviour of the problem parent or parents
disengage from the disruptive elements
of family life
engage with stabilising people outside
the family
develop confidants outside the family
engage in stabilising activities (school,
clubs,
sports, culture, religion) within which the
child can develop a sense of self and self-
esteem
develop a desire to be, and pride in
being, a survivor.
Understanding and modifying the impact
of parents substance misuse on
children. Richard Velleman & Lorna
Templeton Advances in Psychiatric
Treatment (2007), vol. 13, 7989
Reflect the equal importance of promoting
resilience and reducing risk in the
development of interventions and services
for children affected by parental substance
misuse.
Looking Beyond Risk Parental
Substance Misuse: Scoping Study.
Templeton, Velleman, Galvani, Zohhadi
2006
For the parents, it was apparent that
intervention often failed to address the
complex roots of drug misuse, seeing only a
drug problem, generally interpreted by
professionals as the cause of current
difficulties rather than a symptom of those in
the past. Intervention seemed to be most
successful and effective during pregnancy
and the postnatal period, where motivation
was also likely to be high. For
many,however, interventions had a feast or
famine quality, with abrupt termination of
support once recovery or drug management
had been achieved leaving them (and their
children) very vulnerable and the problems
precipitating drug misuse unresolved.
Interventions for children and families
where there is parental drug misuse.
Brynna Kroll and Andy Taylor 2006

Annex 10 Case Study: Mother with Substance Misuse Problems in Essex

16 years ago I started using heroin. I was babysitting for a couple and they
introduced me to it, they were preparing to shoot up and I took it. There was
nothing like the first hit, finally I found something that could block out the years
of abuse at the hands of my father and brother, the pain of my childhood. I felt
like my life was now getting better, when in fact it was getting worse. I had to
steal to get money for drugs but I kept doing it and it wasnt fun anymore. I
used every day for 16 years. When I was 16 I had a baby, she is 13 now and
shes had to grow up faster than she should. Everyone knew that her parents
use drugs and now she gets bullied for it. She had to put up with a lot and
when I found out I was pregnant again and about a year ago I knew I had to
change for my daughter, for my baby and for myself. I knew in order to give
my children a better life, I had to get help.

It has been hard work but Im learning new things, like to be without drugs,
how to wake up without drugs and about how to accept myself for who I am. I
have bonded with my children, its a whole new life experience and Im getting
to know myself more as a person, to value myself and to believe that Im
worth more than the life I used to have.

Its great, I can have my baby with me and my daughter visits for weekends.
The last time I saw her she said you look brilliant Mum and that I sounded
better than I ever done. She also added that she is proud of me, which is
wonderful. I cant wait to be with her again when I leave treatment to rebuild
my family again. Finally, I think Im doing something right, I am achieving
something and I know with the right support I can stay off drugs for life.












Annex 11 Data Analysis Tables




Annex 12 EXAMPLE OF LOCAL PRACTICE: Catch 22 R-Life
Project
The target group of young people aged 12 18 years inclusive, with complex
and enduring needs. Issues include abuse, offending, behaviour disorders,
being on the Child Protection register, a family history of mental ill health,
violent behaviour, substance misuse, loss and bereavement, deliberate self
injury and family breakdown. This will include those who are at significant risk
of harming themselves or others.

To provide highly specialist Services to 60 young people a year with
complex and enduring needs.
To reduce family breakdown of the young people referred
To increase family support and capacity to cope
To ensure each young person referred is in appropriate education or
training
To ensure involvement of appropriate Services:
o Connexions
o CAMHS
o Youth and Leisure Activities
To improve multi-agency working within the 2 areas identified.
To develop models and extend good practice across Essex within the
length of the project.

The Project was commissioned by Essex County Council to deliver services in
Tendring and Basildon. In 2009-10 underspend from 2007-8 was used to set
up an additional outreach team to deliver services in Colchester as this was
identified as an area of high need. Of the 62 cases closed:

! 100% had been contacted within 24 hours
! Of the 146 problems identified at referral, 120 had improved and 19
partly improved
! 214 Actions were planned with families to meet the needs identified,
189 of these were fully met and 21 partly met.
! 57 of the 62 young people referred remained with their families; 1 was
supported into independence and four young people became looked
after, of these, two experienced the death of a parent during our
involvement, one was Autistic and was placed in a specialist provision
and one had a parent with mental health problems and was
experiencing neglect and emotional abuse.
! All young people except one was in suitable accommodation on
closure, this young person had been found accommodation but
declined, choosing to stay with a friend.
! Two young people were not in suitable education, training or
employment on closure.

Families are offered a 6-month intensive program of work. During the first 6-8
weeks an in-depth whole family assessment is undertaken. Change
objectives are agreed with the family and a multi agency action plan is put in
place.

EXAMPLE OF LOCAL PRACTICE: Positive Futures: Project
supporting women with addiction problems during pregnancy
and the early years
This project is called Positive Futures and has developed by the drive to:

1) Support parents at the earliest stage possible
2) To implement prevention interventions
3) Awareness of the need to support parents with addiction problems

The aim is to establish early contact with pregnant women and their partners
who have substance misuse problems and retain them in treatment, through
the creation of a non-judgmental, non-threatening system of support. Parents
are supported throughout their pregnancies and beyond. As a coordinated
and integrated team of multi-agency professionals and lay people, we will
work to create a positive pregnancy experience for the woman and their
partners, irrespective of risk and despite any difficulties that they may have.

This project aims to achieve a holistic, multi-agency approach to supporting
parents with addiction issues, and in doing so increase the proportion of
parents maintaining a healthy relationship with their children.

There are three outstanding achievements:
1) Maintaining regular contact with the parents: as the project numbers
are small it may be easy to judge the project as high maintenance for
such a small group. However, this client group is very difficult to
engage with and develop a trusting working relationship. The fact that
parents come voluntarily to the workshops is an achievement! They
have kept involved despite relapse, issues of contact with their
children, issues with their social workers or other professionals, family
conflicts, etc.
2) Fewer children in care or living with relatives.
3) Another major achievement of the project is the attitudinal change both
of agencies surrounding this client group and of the parents in their
relationships with these agencies, particularly Social Care. The multi-
agency nature of this project has led to improved understanding of the
roles of each group of agencies. Parents have become less
judgemental of their Social Workers and more accepting of their need
to be involved in their lives. Initially Social Care was seen as a very
negative agency, surrounded by mistrust and secrecy. This project has
worked to break down the barriers, establishing an air of
understanding, support and honesty.


Annex 13 Parents and Young People Interview Tool

1. What problems have you encountered growing up in a family with
problems around drugs and alcohol? (School / Peer Group /
Relationships etc)
2. Apart from drugs and alcohol, what other sort of problems did you
experience in your family? (DV, MH, Poverty)
3. At what stage did your family get support (if any)? What was it like?
4. If youve had involvement from social services, what was it like for you
and your family?
5. Have you ever been in care? If this was due to drug and alcohol
problems, was this ever explained to you?
6. Did you feel listened to and involved?
7. Is there anyone who has either helped you or your family, was it
positive and could we learn anything from the way they support
you/families?
8. How have services in the past either supported your family or caused
problems?
9. How could services find families earlier and provide help?
10. What would consider the best way to support a family experiencing
drug and alcohol problems
11. What would you consider the wrong way to support a family with drug
and alcohol problems
12. If you could design a service for families with drug and alcohol, what
would it look like and how would it help families
13. If you could go back in time, what could people do better
(professionals, Friends, Extended Family) to improve or strengthen
your family?
14. How could services build trust and have a better relationship with
families?
15. What messages would you like me to take back to Essex County
Council?
Annex 14 Project Methodology

Literature Summary
The objective of our review of academic and professional literature was to
locate, summarise and analyse research pertaining to the risks and outcomes
associated with children of vulnerable parents. The analysis and findings of
the review will be used to directly inform the development of the
recommendations for improving the childrens safeguarding protocols within
Essex County Council.

Although this project is concerned primarily with children of substance-
misusing parents, there is a range of antecedent, consequent and associated
vulnerabilities that are directly relevant to substance misuse. For the sake of
brevity, however, we have limited the literature review to include the following
vulnerabilities: substance misuse, alcohol misuse, domestic violence, mental
health problems, and involvement in offending. Naturally, any other relevant
vulnerabilities uncovered during the review will be highlighted for further
consideration in the project.

As with all social research, it is recognised that there are few distinct
categories of risk, outcomes, and vulnerabilities. Here these categories
(and others) are adopted for expediency, and should not be regarded as
discrete or immutable.

The data and literature captured in this review was accessed between
01/06/2010 and 30/09/2010.

To find the most relevant and robust policy, literature and evidence, several
search methods were employed: (I) all local and national policies, protocols
and procedures pertaining to child protection and substance misuse were
accessed via Government and local authority web portals, (ii) international
evidence and best practice was identified via published (and peer-reviewed)
meta reviews of professional practices and studies, (iii) pathfinding or pilot
projects enacting best practice principles were identified via professional and
academic journals, and (iv) academic articles and literature more broadly was
surveyed via the meta-search engine, the ISI web of knowledge.

Minimum quality standards
To acquire a minimum quality standard for research and literature, this
extensive survey of evidence includes only inputs from:

Nationally or internationally recognised government, professional or
third sector bodies.
Peer-reviewed articles published in national or international academic
journals.

In addition, all primary or secondary research within articles met requirements
that the full research methods are included within the publication and the full
outcomes data is available.

Accordingly, research that is unpublished is excluded from this review.
Nonetheless, emerging evidence from some family-based programmes will be
included in later sections of the project report (along with the caveats
associated with non peer-reviewed research).

Presentation of findings
To make this review as accessible as possible, the findings of the review are
presented thematically and concluded with an analytical summary.



Annex 15 Relevant Policy Documents

There has been a raft of policy documents over the last 10 years that support
a whole family approach to dealing with complex families, including:

Getting Our Priorities Right (2001): Good Practice Guidance for
working with children and families affected by substance misuse.
Tackling Drugs in Scotland. (Scottish Executive)
Hidden Harm: (2003) Responding to the needs of children of problem
drug users (Advisory Council on the Misuse of Drugs)
Government Response to Hidden Harm: the Report of an Inquiry by the
Advisory Council on the Misuse of Drugs (2005)
Hidden Harm (2007): Three Years On: Realities, Challenges and
Opportunities (Advisory Council on the Misuse of Drugs)
Think Family (2008): Improving the life chances of families at risk
Pathways to Problems (2009): A follow!up report on the
implementation of recommendations from Pathways to Problems
(Advisory Council on the Misuse of Drugs)
Every Child Matters (2003)
National Service Framework (NSF) for Children, Young People and
Maternity Services (2004), including the Healthy Child Programme 0-5
and 5-19
Maternity and Early Years - making a Good Start to Family Life (2010)
Care Matters: Time for Change White Paper (2007)
Every Parent Matters (2007).
Reaching Out: Think Family (2007).
The Children's Plan Building Brighter Futures (2007 and 2009).
Your child, your schools, our future: building a 21st century schools
system White Paper (2009)
The Families and Relationships Green Paper (2010)
Parenting and Family Support: Guidance for local Authorities in
England (2010)
Annex 16 Essex Children Looked After Data Analysis

Child Safeguarding Referrals (April to June 2010)
Child safeguarding referrals across Essex are presented in the charts below.
They use the same approach as above, comparing the proportion of
safeguarding referrals with the proportion of Essexs 0-15 year old population.

This data points to some areas with highly disproportionate numbers of
referrals. Colchester reports the highest, with 16 child safeguarding referrals
per month per 1,000 0-15 year olds (or 1.6% of the whole child population in
Colchester). This rate is nearly double that of the next highest proportion;
Basildon 8 referrals per 1,000 children (0.8% of child population), Rochford -
6.5 referrals per 1,000. Clearly, these are districts of pressing need.


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Colchester 15.96
Basildon 8.23
Epping 6.82
Rochford 6.47
Tendring 6.24
Harlow 6.10
Chelmsford 5.04
Castle Point 5.02
Braintree 4.80
Maldon 3.89
Uttlesford 2.61
Brentwood 2.24

Open cases
Basildon hosted the highest number of open child safeguarding cases per
month between April and June 2010 (1,284 on average). However, with an
average of 1,102 open cases, Colchester represents the highest proportion of
cases. Colchesters child population is just 16,000, thus there are 68.8 open
cases per 1,000 children (or 6.8%). The considerable gap between Colchester
at 68.8 and Basildon at 40.25 cases per 1,000 children illustrates the limitation
of simple data analysis: it may indicate either there is a concentration of at-
risk children in Colchester, or that services in Colchester have lower
thresholds for referral, or even that services are better at detecting children at
risk. These causal relationships, however, can be elucidated better via the
qualitative strand of our needs analysis.





District
Open cases per 1,000 children (0-15) per month
(monthly average taken from June April 2010)
Colchester 68.92
Basildon 40.25
Chelmsford 34.21
Tendring 32.61
Harlow 32.46
Epping 30.77
Maldon 19.37
Braintree 18.97
Brentwood 12.07
Rochford 7.49
Castle Point 6.85
Uttlesford 2.35

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Referral Sources
The data from the Essex Safeguarding Children Board between April and
June 2010 provides a useful depiction of the sources of child safeguarding
referrals. 48% of all referrals came from the police (35%) or schools (13%),
indicating that the role of these services, especially the police, in safeguarding
children is crucial.


Figure 1: Child Safeguarding Referral sources: Essex April 2010 to June
2010

Children Looked After (CLA) Data Analysis
There are around 1,475 looked after children in Essex (excluding those
accommodated under a series of short-term breaks). This number has been
trending upward since December 2007 (when there were 1,203 looked after
children). A growth rate of 9% per annum or 0.75% per month.

In addition to this, demand for adult safeguarding has also risen from around
500/600 referrals in 2005 to an anticipated 2,000 referrals in 2010.

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with a relative or friend.


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77% of all CLA are due to Abuse or Neglect or family dysfunction), there is
little further attention to the specific factors of abuse, neglect or dysfunction.



Performance of Essex Childrens Social Care

Status 2005/06

2006/07

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ECC has a consistently lower rate of referrals to social care than the national
average (2005-2008). Within ECC districts, Harlow, Basildon and Tendring all
have referral rates above the national average.

The number of repeat referrals per 10,000 children has generally increased,
and in 2007/08, ECC had higher rates than the England average.

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has increased. The performance of ECC remains below the England average
and all districts in ECC are below the national average.

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assessments carried out within 35 days is still below the England average for
ECC. Most of the districts in ECC also fall below this national figure.

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Child Protection Plan (CPP) or on the Child Protection Register than England.

ECC performed worse than the national figure on the percentage of children
who became the subject of a Child Protection Plan, or were registered during
the year, who had previously been the subject of a Child Protection Plan or
had been registered.



The rate of children looked after by ECC remains high in comparison with the
national average. Harlow, Southend, Basildon and Tendring have the highest
rates of looked after children pan-Essex.

In 2007/08 60.0% of children in ECC districts (aged under 16 who had been
looked after continuously for at least two and a half years) had lived in the
same placement for at least two years, or were placed for adoption. This
percentage has increased over the last five years both nationally and pan-
Essex. The ECC percentage is lower than that for England (66.5%)

In ECC districts just 9.6% of looked after children achieved 5+ A*-C grades at
GCSE in 2007 (compared to 60.7% of all pupils), below the England average
of 10.7% and considerably below the 15% target.

SDQs of CLA
It is well known that, broadly, looked after children have greater social,
emotional and behavioural difficulties than children not in care. In Essex, the
average SDQ score for a looked after child is more than double the average
national score for all children. More positively, Essexs looked after children
score at a similar level to the national average in prosocial behaviour.




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Annex 17 Analysis of What Works Evidence Based Approaches

Action Evidence Author/s
1.
Identification
(i) there needs to be a clear referral process for getting
help

(ii) Intervention at the crisis point. Families are
considered to be in crisis with this crisis generally
being linked to the possibility of their child entering public
care. The response is broadly shaped by crisis
intervention theory and focuses on immediate, intensive
and short-lived intervention. Client families are seen
within 24 hours of referral.

(iii) Of particular significance were creative responses to
initial contact procedures. For example, in initial
meetings, there was a conscious effort to normalize the
difficulties the family may be experiencing and stressing
the ways in which the FAS might help with these. There
would also be a focus on different family members fears
or anxieties. Referral protocols, how families are first
seen, how and when the children are included, and how
and when missed appointments may be followed up
were also crucial aspects.

i) Looking Beyond
Risk Parental
Substance Misuse:
Scoping Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006
ii) Final Report on the
Evaluation of Option
2 Prepared for the
Welsh Assembly
Government
University of
Bedfordshire, Brunel
University and
Birmingham
University 2007
iii) Parental Alcohol
Misuse in Complex
Families: The
Implications for
Engagement Andy
Taylor, Paul Toner,
Lorna Templeton and
Richard Velleman
2008
2.
Engagement

(i) Engagement, of both substance misusers and their
families (including children) is paramount.

(ii) Engagement was a significant factor for the service
which developed approaches and strategies to work with
families with whom it has traditionally been hard to
maintain contact. These included encouraging all family
members, including grandparents and other significant
relatives or carers, in addition to the childs biological
parents, to attend, placing a premium on establishing
sufficient rapport in the initial sessions and using creative
and appropriate age-related materials with children to
explore and build on family strengths and values.

i) Looking Beyond
Risk Parental
Substance Misuse:
Scoping Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006
ii) Parental Alcohol
Misuse in Complex
Families: The
Implications for
Engagement Andy
Taylor, Paul Toner,
Lorna Templeton and
Richard Velleman
2008

3.
Assessment
(i) Parents believed services to help families like their
own could be improved if practitioners:
paid greater attention to ensuring families
understood what was happening;
consulted them throughout the process of
assessment, planning and intervention
adopted a more honest, open and respectful
approach; provided longer-term service
provision;
co-ordinated better with other service
providers.

i) The response of
child protection
practices and
procedure to children
exposed to domestic
violence or parental
substance misuse,
Hedy Cleaver, don
Nicholson, Sukey
Tarr & Deborah
Cleaver, (2006)
4.
Intervention /
Support

(i) home visits are useful.

(ii) support groups must accept that attendance will
fluctuate thus emphasising the need for flexibility (ibid)

(iii) Where family preservation is not possible, it is seen
to be of critical importance to utilise strategies to keep
families involved in the treatment process, to reinforce
contact between parents and children. (Ibid)

(iv) One important factor to be highlighted here is the
benefits of combining clinical, therapeutic work, with
home visits. (Ibid)

(v) Copello, Velleman & Templetons review of family
interventions (2005), summarise (adult) family focused
interventions as:
1) acting as a mechanism for the entry and engagement
of substance misusers into the treatment system;
2) working jointly with substance misusers and (usually,
adult) family members; and
3) responding to the needs of family members in their
own right.
All three areas demonstrate evidence of effectiveness.
(Ibid)

(vi) Joint work with substance misusers and (usually
adult) family members is based on the demonstration
that, attention to the persons social context and support
system is prominent among several of the most
supported approaches (Miller & Wilbourne, 2002 p276)
(Ibid)

(vii) Behavioural, couples and marital work, social skills
training and the community reinforcement approach are
all good examples. (Ibid)

(viii) Intervention seemed to be most successful and
i-viii) Looking
Beyond Risk
Parental Substance
Misuse: Scoping
Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006
ix) Interventions for
children and families
where there is
parental drug misuse.
Brynna Kroll and
Andy Taylor 2006
effective during pregnancy and the postnatal period,
where motivation was also likely to be high. (Ibid)

(ix) In relation to working together practices, parents felt
this was most effective when there was a lead
professional with specialist knowledge of drug misuse
such as a health visitor, midwife or family support
workers who were twin trained and who orchestrated
the network, reducing the need for repeating information.
The main difficulties were caused by failure to
communicate either with one another or with the parent
concerned, as well as being included in meetings but not
addressed directly

5. Relapse
Prevention
Ongoing
6. Support
for Children
and young
people

(i) Barnard (2001) reviewed interventions for drug
dependent parents and their children, concluding that
working in families where there are younger children
brings higher rates of success, and that homebased
interventions, peer support, work through schools,
community based schemes and play based schemes all
have potential.
(ii) a range of interventions is beneficial, including
school-based programs, play therapy, social support
development and group therapy. Emshoff & Price (1999)
suggest that information, coping skills (emotion focused
and problem-solving) and support (social and emotional)
are key components for working with children of parents
with alcohol or drug problems.

(iii) Emshoff & Jacobus (2001) report that play therapy
can be both a relief for children and can also reduce risk.
A main element of the experience of having a parent with
an alcohol or drug problem, reported in the general
literature, is loss of childhood, demonstrated by children
who miss out on opportunities to play, either because of
a lack of positive parenting or because the child has to
look after parents or siblings (parentification). (ibid)

(iv) Banwell, Denton & Bammer (2002) [summarised in
Copello, Velleman & Templeton, 2005], summarise six
challenges to be overcome when working with children:
1) getting the balance right between intervention and
trust;
i-iv & viii) Looking
Beyond Risk
Parental Substance
Misuse: Scoping
Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006
vi & vii)
Understanding and
modifying the impact
of parents substance
misuse on children.
Richard Velleman &
Lorna Templeton
Advances in
Psychiatric Treatment
(2007), vol. 13, 7989

2) location;
3) staff support;
4) multi-agency collaboration;
5) funding (including for evaluation); and
6) the need for flexibility. (Ibid)

(v) Protective factors and resilience have been identified
in a number of studies, both general and specific to
parental substance misuse (e.g. Werner, 1993;
Velleman & Orford, 1999; Beinart et al, 2002; Bancroft et
al, 2004). For example, Bancroft et al (2004) interviewed
37 young people aged 1527 who were children of
substance-misusing parents, and found that a number
of protective factors could lead to more resilient
outcomes. These included support from school,
immediate and extended family, and individuals and
services outside of the family.

(vi) The practitioner needs to work directly with the
children involved, enabling them to:
maintain positive family rituals
remove themselves from the disruptive
behaviour of the problem parent or parents
disengage from the disruptive elements of
family life
engage with stabilising people outside the
family
develop confidants outside the family
engage in stabilising activities (school, clubs,
sports, culture, religion) within which the child
can develop a sense of self and self-esteem
develop a desire to be, and pride in being,
a survivor.
(vii) All of these major risk factors are amenable to
intervention, even if the parental substance misuse is
not at the time. This means that practitioners working
with families in which parents have substance misuse
problems should not necessarily focus their risk-
reduction efforts on enabling the substance misuser
to change (although, of course, if this is a possibility it
should be encouraged). Instead, they need to work on:
family disharmony, in particular
violence (including physical, verbal or
sexual abuse)
parental conflict
parental separation and loss
inconsistent, neglectful and ambivalent
parenting.

(viii) It has been suggested that pregnant substance
users could benefit from being managed using a shared
care approach, involving obstetric services in conjunction
with a substance misuse agency. Obstetric goals need to
take account of pharmacological treatments, but should
also shift towards a public health perspective,
characterised by treating pregnant and postpartum
substance misusers, protecting at-risk foetuses and
children, and strengthening broken families. There is a
need to educate pregnant women around alcohol, and
the involvement of important people in mothers social
networks may be key to reducing substance misuse
during pregnancy. Many studies have concluded that
there need to be both women-specific and parenting
components in existing treatment programs, where
pregnant women who are substance misusers can
benefit from comprehensive, family-centred treatment
services and receive useful parenting advice.
6. Supporting
Families
i) Supporting mothers and fathers and key carers can be
a sustainable way of securing better outcomes for
children. Research suggests that using evidence-based
parenting and family support programmes, for example,
through the Parenting Early Intervention Programme, can
have lasting effects in improving behaviour even in cases
where they are initially reluctant to accept help. Providing
help with parenting impacts upon a range of outcomes
for children and young people. A meta-analysis of over
40 studies conducted in 2003 showed Family Based
Interventions had substantial desirable effects

ii) Parenting interventions tend to work best when both
parents are included in the intervention (or separate
partner-support is provided). The ability of workers to
engage parents effectively and consistently and to
achieve buy in to what is often a demanding and
rigorous change management programme, is crucial to
the success of any intervention. There is considerable
skill, tenacity, determination and tolerance required by
parenting practitioners and key workers who will need to
identify the appropriate drivers for change in their clients.
They need to understand the underlying reasons for the
behaviours displayed by families and agencies, be
solution focused in their approach and be able to draw
on the necessary support themselves to enable them to
set and sustain realistic goals.

iii) The Family Nurse Partnership is an evidence based,
intensive preventive programme for vulnerable, young
first time mothers that is being tested across England.
The programme is voluntary and family nurses visit from
early pregnancy until the child is two years old. The
i) Farrington and
Welsch (2007)
Saving children from
a life of crime;
Farrington and Welsh
(2003). Meta analysis
in ANZJC.
ii) 10.23 Working
Together to
Safeguard Children.
DCSF March 2010
iii) 10.27 Working
Together to
Safeguard Children.
DCSF March 2010


family nurses build close relationships with clients and
use the programme methods and materials to improve
antenatal health, child health and development and
parents economic self-sufficiency.
7. Support /
Training for
professionals
(i) staff training and good links with others are important

(ii) GPs are often the first point of contact for many
family members but GPs often do not feel well enough
equipped to be able to respond. (Ibid)

(iii) Training on safeguarding and promoting the welfare
of children can only be fully effective if it is embedded
within a wider framework of commitment to inter- and
multi- agency working, underpinned by shared goals,
planning processes and values.
Whilst the detailed content of training at each level of the
framework should be specified locally, programmes
should usually include the following:
recognising and responding to safeguarding
and child protection concerns;
working together;
completing child in need assessments;
safeguarding disabled children;
safeguarding children when there are concerns
about domestic violence,
parental mental health; and
substance misuse.

I & ii) Looking
Beyond Risk
Parental Substance
Misuse: Scoping
Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006
iii) Working Together
to Safeguard
Children: A guide to
inter-agency working
to safeguard and
promote the welfare
of children (DCSF
2010)
8. Service
Development

(i) Drug prevention with children of drug using parents
must consider the need for specialist skills / knowledge,
have clear protocols for the work, both within the
organisation but also with other agencies, understand the
fear of social services held by many children and
parents, offer help with transport where possible, and
generally consider less structured work (i.e. work
responsively and proactively) with clear boundaries and
reassurance for parents on issues of safety and
confidentiality.

(ii) One of the most widely known, and well evaluated,
programmes is the Strengthening Families Programme
(SFP). A systematic review of primary prevention
programmes for alcohol misuse in young people
(Foxcroft et al., 2003), concluded that this was the only
programme that could demonstrate effectiveness,
maintained longer-term. (Ibid)
I & ii) Looking
Beyond Risk
Parental Substance
Misuse: Scoping
Study Lorna
Templeton, Sarah
Zohhad, Sarah
Galvani, Richard
Velleman 2006