Chapter 5: Working Together
116. Working with a child and their family requires a co-ordinated response by services that identifies and meets all of the needs of the child and the family. These needs might extend beyond the problematic alcohol and/or drug use. This chapter is divided into 2 main sections which specifically look at:
- multi-agency working - strengths and challenges/barriers; and
- individual roles and responsibilities of individual services.
Multi-agency working - strengths and challenges
117. It is not sufficient to protect children from the serious risks associated with parental alcohol and/or drug use. It is important to provide for the wider needs of the child and family for overall therapy, support and recovery. Co-ordinated interventions might include help for parents to develop their parenting skills and interventions aimed at reducing or stopping substance use. All staff should recognise that their efforts to assist their client are part of a complex set of interactions which will impact both on individual workers and also on the family as a whole. Not all problems can be solved, and often no single worker/service can solve them alone.
118. Working together means working across boundaries and with a range of partners including children, parents, families, communities and other professionals. Different services have different types of expertise that can benefit families, where this is shared. For example, a childcare professional may need assistance in recognising problematic substance use and understanding its impact(s) - whereas a drug and alcohol worker may need support to understand children's developmental needs and also to recognise those situations where they can be put at risk.
119. Effective partnership working is an underpinning principle of GIRFEC which has a focus on early, proactive intervention in order to create a supportive environment and identify any additional supports for a family that may be required.
120. To help ensure effective working, all agencies should embed the GIRFEC National Practice Model (in particular the shared understanding of a child's wellbeing, the role of the Named Person and also the Lead Professional) into local protocols for tackling substance use.
Practice Study: Joint Working
The Midlothian Family Support Service was established as a partnership with the ADAT (now ADP) and Children 1st and had 2 priorities: firstly, to establish the service in the same offices as the Midlothian Substance Misuse Service, so there was improved working with adult substance misuse professionals and secondly, to provide an early intervention support service for children who are affected by parental problematic alcohol or drug use.
All referrals into the MFSS are directed through the Midlothian Substance Misuse Screening Group, a multi-agency forum that aims to ensure that the needs of any child living with the impact of parental problematic alcohol or drug use are met.
Most referrals come from Community Psychiatric Nurses when patients in the substance misuse service indicate that they are struggling with some element of their parenting, or their child's behaviour is causing concern. Family members are made aware of the close working relationship between the Midlothian Family Support Service and substance misuse partners, who will work collaboratively to ensure the adult patient has the best support in terms of their substance use and in their parenting role. As lapse and relapse is symptomatic of the recovery process, there is an inevitable direct impact on how the family functions with intermittent levels of chaos and potential risks to children.
Midlothian Family Support Service is likely to be the primary support provider with access to the family at home during a crisis period and has a key role in ensuring that other agencies involved are working in unison, information is being shared and importantly, that appropriate action is taken to safeguard the wellbeing of children and young people in the family.
Practice Points (what has worked in relation to this joint working approach):
- co-location supports effective communication and information sharing;
- co-located partners compliment each other's role and responsibilities;
- shared knowledge base;
- consideration of service delivery across all elements of service provision;
- robust monitoring of the home environment - able to challenge discrepancies; and
- parents and children and better supported.
Local developments that supported the approach:
- Children 1st and adult social work services were co-located with NHS substance misuse service;
- establishment of multi-agency screening group;
- every child affected by parental problematic alcohol or drug use was to be referred through the screening group; and
- a child focus was to be part of all adult assessments.
"Not one service can provide everything for everyone - that's why it's important to be involved in joint working, sharing skills and opportunities to co-workers." Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010)
121. A perceived lack of communication between children's and adult services is frequently mentioned as a key concern in individual cases where problematic alcohol and/or drug use is a factor. This lack of effective communication can put children and families at risk of falling through the gaps. Other services, such as the police or schools, also come into contact with families affected by problematic alcohol and/or drug use. Communication between them is also vital to ensure that all vulnerable families in need of support are able to access it.
122. The table below summarises some of the barriers and enablers to effective partnership working.
|Practice Points: Enablers and Barriers to Joint Working|
Types of situations illustrating the importance of multi-agency working
123. A number of reports have highlighted situations in which professionals failed to identify children suffering neglect and poor parenting, when parents had refused entry to the family home and professionals did not persist in gaining access to the child. It can be very difficult for individual services either to establish or maintain regular contact with people who have problematic alcohol or drug use problems. Planned appointments or visits may not be kept and parents may not respond to letters or calls. Parents may go to great lengths to avoid contact and they may be evasive and/or aggressive or hostile. Also, in some circumstances, parents may have stronger incentives to keep in touch with treatment and support agencies. When keeping appointments with, or visiting their patients or clients, services should keep children in mind and alert child welfare agencies if families' problems intensify or conditions deteriorate to a level likely to present risks to children.
124. Services responsible for child welfare should include both planned and unplanned home visits in their contact with families, observe the child and his/her interaction with the parents, and gather information about daily routines and sleeping arrangements. Workers should persist in their efforts to contact the family or see the child until they are satisfied that the child is not at risk of significant harm.
125. Even though professionals gain access to a household, the child(ren) in the family may not be seen. Staff should record every unsuccessful attempt to see the child(ren) and follow up to make sure that the child has been seen by someone, either by checking with other professional colleagues or agencies, or by repeating the visit quickly.
126. Services should ensure that staff have access to advice from specialist colleagues or child protection services if they are persistently unable to see a child. Their expectations of staff in these circumstances should be clearly described in local policies and guidance. It is essential that every child in the family is seen and assessed. The Child's Plan must include a definite timescale within which children must be seen by a staff member from one of the services involved.
127. Where professionals responsible for children's welfare in health or social work services repeatedly fail to gain access to a child(ren), the local authority should consider whether there may be a need to apply for a Child Assessment Order, requiring parents to make the child available to professionals or refer to the Reporter for a decision as to whether compulsory measures of supervision are required. If there is any concern that a child may be in immediate danger the social work service or the police should be contacted promptly. Where the parent does not accept help or agree to a referral to another service - and worries about the child persist - practitioners should contact the social work service and the Reporter without delay.
128. Alcohol and drugs agencies' responsibilities - to both support their adult clients and also maintain a focus on child welfare - do not end after referral to the social work service or other child protection services. Parents will continue to need support from familiar professionals with whom they have established relationships. It is crucial that specialist alcohol and drugs-related professionals and children's support agencies continue to work closely together to help families make best use of the help available.
129. The key to making effective decisions in determining the degree of risk to the child is good inter-agency communication and collaboration at all stages - i.e. in assessment, planning and intervention. This demands open and honest communication between professionals in different agencies and sharing of information about progress and regression. For example, a parent's encouraging signs of progress in substance use recovery may be too late or too slow for a child whose early experience is one of deprivation, trauma and unpredictable parenting and also who has a strong attachment to substitute carers.
130. Services should consider first and foremost the current and potential effect of continuing adversity on the child, regardless of the parent's intentions. All services should always consider the child's welfare to be the paramount consideration. If support provided to the family does not improve the child's circumstances, other action, such as child protection enquiries or removal of a child from his/her parents' care may be needed. The threshold for this kind of action is reached when there is evidence or suspicion of a lack of parental care or supervision, or abuse or neglect which may cause a child to suffer significant harm. There need not be evidence of deliberate abuse or neglect to prompt action.
131. A referral to the Reporter, or a request for a review hearing if the child is already subject to a supervision requirement, will allow consideration of whether compulsory measure of supervision is necessary and whether these should include removal of the child.
Practice Study: Trying to Get through the Door
Mum was referred to Aberlour whole-family approach outreach support project by the local addiction service in Dumfries. Nine appointments were offered to mum before she engaged with the project. In the beginning, when visiting to undertake the initial appointment, outreach project staff had the door slammed on them and were told to go away. The initial support identified was in relation to parenting routines and boundaries and socialising for the 2 year old within the family. Mum also required emotional support and 1:1 practical support. The children were on the 'at-risk' register.
Partnership working with Cameron House was very helpful, as the parent was aware we were fully updated as to her current interventions/future plans re: reduction etc. Initially being persistent and not giving up on the family, when the family did not engage with the service, the service user later said she was testing our commitment to her and her family, previous services only offered 3 appointments then closed her referral. The most successful approach was adapting the support provided to meet the families needs both collectively and individually and providing support at an appropriate time to suit the family.
Mum was on a methadone prescription and not confident about engaging with the wider community therefore her children were isolated. Her 6 year old son only had contact outside the home whilst he was at school. Gradually the family were encouraged to participate in small activity sessions and then larger group activities within the wider community. As Mum's confidence grew the service supported her to attend 'baby group' with her 2 year old son to aid his social skills and speech. The 6 year old was supported to attend the project's homework club and received support in a variety of areas. Mum was supported to attend community activities and linked with Community Learning and Development.
Mum has now developed a good relationship with the project and other community agencies. She successfully completed a reduction of her methadone and is now completely drug free. Her mood changed initially as she was becoming withdrawn again. Staff worked with her to re-engage her with the community.
The younger boy eventually attended nursery 5 mornings a week and older child had very good attendance at school. He also attended a local drama group which staff helped Mum to find.
The children were de-registered but linked to children and families social work on a voluntary basis. The family's planned case closure was at the end of the year (December 2011), initially Mum did not wish her case closed and panicked about the family's future. The support worker for the family has worked with Mum to prepare her for the case closing and reinforced it is a good thing that her family does not require support and it was a huge achievement on Mum's part. Mum was advised if she required advice in the future she can contact the project and they would signpost as required.
Commitment to engagement and persistency in visiting to gain access to the family and family home.
Importance of visiting family at home, at different times.
Identifying quickly what support the family need as a way of engagement, which should help work through more detailed assessment of need.
Practical support and assistance can be a key step to helping parents engage and access more therapeutic supports.
Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010).
Supportive Material for Engagement
In the study all projects note the importance of first impressions for potential clients. One noted the importance of this against the backdrop of a client's previous experience of poor engagement with services. The first visit was seen as an information gathering exercise which should not be ' too full on'. A number of services discussed the importance of 'chance meetings' to encourage engagement. The impressions given by most of the projects surveyed was that staff go out of their way to help people engage with the service. Cards or hand-written notes were left if people were not in at an appointment time, or miss an appointment. It was important to all projects to show ' you are not giving up on them.' Extracts to support this from (Continuation Study of Practice Issues Evidenced in Projects Funded through PDI; STRADA (June 2010).
"What helped me to attend in the first place was the worker's persistence." (Service user feedback)
Looked after children
132. Evidence shows that children affected by parental problematic alcohol and/or drug use are more likely to experience repeated separation and multiple care placements. In these circumstances the local authority should make early contingency plans to reduce the length of time that children may drift in substitute care under uncertain plans. This requires effective communication between services.
If assessment indicates that a child is at risk in the care of a parent using alcohol and/or drugs, the child's social worker should consider the following:
- The needs of the child and how these might best be met. This should include an assessment of family ties and support for the child and while family members may be the most appropriate carers for the child, either alone or in partnership with others such as foster or respite carers.
- In consultation with specialist alcohol or drugs agencies supporting the parents, the local authority should determine a realistic timescale in which problematic alcohol or drug using parents should stabilise and reduce alcohol intake or drug misuse, agreed wherever possible with parent(s).
- If the parent(s) fails to make demonstrable progress within this period the services should consider referring to the Reporter or requesting a review hearing if the child is already subject to a supervision requirement.
- If a child is placed in substitute care more than twice in one year because parents' problematic alcohol or drug use makes them unable to look after that child safely the local authority should refer to the Reporter or request a review hearing if the child is already subject to a supervision requirement.
133. Optimum care for children is not only a matter of finding the right placement and ensuring safety and stability. Children, parents and other family members will need help to come to terms with trauma and parenting failure, and to repair relationships, whatever the eventual outcome.
134. The local authority, or where a child is subject to a supervision requirement a Children's Hearing, must make decisions, with the parent(s) and others, about family members' continuing contact with children placed away from home - with whom, at what frequency and where this should take place. This will depend on:
- the child's age and stage of development;
- the stage of placement and the care plan for the child;
- the degree of stability in the parents' circumstances;
- the parents' capacity to maintain reliable and supportive contact;
- the child's and parents' views and wishes, and those of any other relevant person;
- any order by a court or Children's Hearing; and
- the views of the child's carers.
135. Where the Child's Plan indicates a planned return home, contact should be frequent and regular, with minimal restriction.
136. Parents may need help in managing periods when the child is in care, for example, in forming positive relationships with foster carers, or help in adjusting to the child's return home and taking up the primary parenting role once more. When parents' problems do not improve, contact may be difficult for both child and parent to keep up, and it may become a source of disappointment and perceived failure for both.
137. The child's social worker should explore honestly and carefully with parents what they feel able to undertake, and help, both parents and children to repair relationships and/or relinquish contact as gently as possible. The parent(s) may need help to present their views and wishes to the local authority, and may look to trusted workers in their alcohol or drugs related services for additional support.
138. When a parent is not able to resume care of their child they will need help and counselling to come to terms with this. The local authority responsible for the placement of the child should provide or arrange this through the social work service or another agency.
139. The loss of their child, whether to foster or adoptive carers or extended family (kinship care), may exacerbate or intensify a parent's problematic alcohol or drug use. Family services should continue to work with the parent in these circumstances even where a child is removed. This is because the removal of a child can often be a precursor for relapse by parents.
140. Some parents may quickly have another child, exposing themselves and their new baby to the possibility of further trauma and harm. These parents will need careful assessment and intensive help if they are not to repeat their pattern.
141. All alcohol, drugs, children's services and childcare agencies have an ongoing part to play in their support.
142. A single incident may seem insignificant but when considered cumulatively with others may indicate the likelihood of damage to the child's development in the longer term. An assessment of whether or not harm to a child is 'significant' is a matter initially for professional judgement and subsequently for determination in individual cases by the courts and Children's Hearings.
Practice Points: When Enough is Enough
When a parent consistently places procurement and use of alcohol or drugs over their child's welfare and fails to meet a child's physical or emotional needs, the outlook for the child's health and development is poor. Problematic alcohol or drug using parents themselves acknowledge this and it is the duty of professionals to act in the child's best interests when parents cannot.
Individual roles and responsibilities of services
143. All universal health services - General Practitioners, public health nurses and health visitors, school nurses, midwives, obstetricians, community pharmacists etc - have a crucial role in identifying and responding to the support needs of unborn babies, children and young people who have parents with problematic alcohol and/or drug useissues. These services have a unique role to play specifically around protection, intervention and care. This is because these are the only services that actively provide services to all pregnant women, children and families. Together with providing core services, universal services can ensure that pregnant women, children and families receive any additional supports that they require from other public services including the third sector.
144. The Universal Pathway of Care for Vulnerable Families (pre-conception to 3 years) highlights contact opportunities and also the approach that universal services should use to strengthen how they assess and respond to the needs of pregnant women, unborn babies and children. Additionally, 3 separate pathways have been developed as part of the Modernising Nursing in the Community Programme which outline what everyone needs to know about universal services. These pathways included pre-conception to 5 years, 5-11 years and 11-19 years.
145. Individual practitioners within universal health services have a pivotal role in assessing and responding to parents with problematic alcohol and/or drug use. These include the following.
- Midwives within maternity care services play a key role in promoting and enabling early access to antenatal care. They also promote the prevention or minimisation of harm to the fetus from maternal (and paternal) problematic alcohol and/or drug use. This involves providing information and advice about the impacts of substances on fetal development and the importance of maternal and infant bonding and attachment and the potential adverse impacts of problematic alcohol and/or drug use can have on infant mental health and wellbeing.
- The health visitor ( HV) provides a consistent, knowledgeable and skilled point of contact for families, assessing children's development and planning with parents and carers to ensure their needs are met. As a universal service, they are often the first to be aware that families are experiencing difficulties in looking after their children and can play a crucial role in providing support. The midwife's post-natal care usually ends 10 days following birth with the HV visiting the new baby and mother 11-14 days following the birth. In partnership with the family, they commence a comprehensive assessment using the GIRFEC Practice Model to assess the support required to meeting the needs of the baby and the family. This assessment may take up to 6 months to complete after which the HV will allocate a core or additional Health Plan Indicator. They will be the child's Named Person (and, in some cases, their Lead Professional), until the child starts full-time primary education. The role of the Named Person then becomes the responsibility of colleagues within education.
146. The Named Person for each child of school age will be a nominated member of staff within the child's school. This person, as well as having knowledge of the child's progress in relation to the school curriculum, will build a bigger picture of the child's needs in relation to the GIRFEC Wellbeing Indicators.
147. Well structured and dedicated joint support teams in all educational establishments have led to greater co-operation across professional boundaries for education, health and social work. Where criminal justice, housing and third sector officers engage in the process, success is greater for some families. All educational establishments should agree their child protection strategies and practices based on GIRFEC, producing specific guidance to all staff under the Wellbeing Indicators.
Social work services
148. Social work services can work with children and their families in a number of different ways - in either a voluntary capacity or as part of a supervision requirement. Specific practitioners have a pivotal role in assessing and supporting children and parents with problematic alcohol and/or drug use. These include the following:
- Children and families social work services. For children in need of care and protection, social workers will normally act as the Lead Professional, co-ordinating services and support as agreed in the Child's Plan. They might do this by identifying appropriate placements, assessing and supporting kinship carers and foster carers and supporting children within these placements. Social work has a duty to make enquiries where a child may be in need of compulsory measures of care and also have a key investigative and assessment role where concerns about child protection arise.
- Criminal justice social work services. Criminal justice staff have a responsibility for the supervision and management of adults where they have committed offences and are placed under some form of legislative order. They often work directly with the adult offender and are in a strong position to identify substance use problems and the potential impacts on any dependent children. They are also well placed to consider how the offending behaviour may specifically impact on a child.
- Adult support services. Adult services can include a range of specialist provisions for particular groups, including the elderly, those with mental health issues, people with disabilities and adults at risk and in need of support and/or protection. Given there are often links with problematic alcohol and/or drug useand mental health and domestic abuse, for example, the adult support worker can be pivotal in identifying any concerns that may impact on the child and also in identifying supports to promote the adult's recovery.
Alcohol and drug services
149. There are a number of different points where alcohol and drug services can offer prevention, treatment and support to adults, children and families. This can include early sexual health advice - before pregnancy - and signposting to other services. These services should be effective and responsive, ensuring people move through treatment into sustained recovery, where appropriate. It can also include advice about the dangers to a fetus of alcohol and drug use by expectant mothers, especially in the first trimester. Where an adult service user is pregnant, alcohol and drug services can support the assessment and identification of needs and risks and support and monitor their impacts.
150. Alcohol and drug services also play a vital role in educating adults about the risks of blood-borne virus infection ( HIV, hepatitis B, hepatitis C). Many offer testing on site and will support adults through diagnosis, referral to specialist clinical care for assessment and throughout any resultant anti-viral treatment. They can play a vital role in supporting families with children of all ages through family support groups. Family support services are able to support people affected by another's problem alcohol and/or drug use. These services allow families some respite and help to build their coping strategies.
151. Bespoke alcohol and drug services should also be available at local levels for young people who have begun/are at risk of an alcohol and/or drug use problem themselves. All steps should be taken to ensure that services offered to young people are separate from adult-focused alcohol and drug services.
Third sector services
152. Third sector providers can offer valuable links to families and individuals that are hard to engage with. This is often achieved through the trusting community based relationships that they can build. This might be where relationships between that family and the state have become difficult. The voluntary sector is therefore a vital partner in delivering interventions to families affected by problematic alcohol and/or drug use. These interventions can be targeted at young people and also adults who are reluctant to engage with statutory services. Intervention here may offer a young person or parent increased self confidence, skills development and also an awareness of the potential impact of parental alcohol and/or drug useon the health and development of a child.
153. Through community learning and development, and also community outreach work, the voluntary sector can work with parents and other adults to build awareness of the impacts of chaotic lifestyle factors on family life in the context of family planning.
154. Specific interventions here can offer additional employability and housing support - both of which are critical to help families tackle problematic alcohol and/or drug use.
155. Third sector providers should also play a vital role in linking up with other agencies around pregnancies where substance use is a factor. Voluntary providers can often be in a good position to take forward follow-up interventions beyond birth, through infancy and into early childhood. Positive relationships formed with mothers are often critical to successful and sustained engagement. The multi-disciplinary nature of some voluntary providers means that they can offer 'wrap-around' early years support for parents with young children attached to dependency services. These services can stimulate peer support networks, offer advice on active play and toddler development as well as offering support with housing and employability and signposting to other agencies and interventions.
156. Many third sector organisations also have years of experience engaging with hard to reach groups. This experience has equipped them with often unique workforce development expertise. There are many examples of third sector training programmes such as building parental capacity, attachment and resilience provided to a range of practitioners from all related agencies. A range of third sector support services are also available to assist young people of school age affected by parental problem alcohol and/or drug use. Third sector workers currently support children within the school setting on a 1:1 basis and also working with those who have been excluded.
Advocacy and welfare support services
157. Many individuals and families will often seek advice, support and advocacy on a range of topics. Often these issues emerge from families who may already be supported. A number though will not, and advocacy, advice and benefits agencies may still be the first point of contact for some families. These can often be local community groups that provide food banks or debt advice and be a place where families are seeking support to address specific crisis. Addressing such crisis for families is often a significant help in terms of practical steps before moving on to more therapeutic help. Guidance on advocacy can be obtained from the Scottish Independent Advocacy Alliance.
158. The security of a family's accommodation is important to enable universal services - such as GPs - to have the best input(s)/impact(s) with the family. If a family is in insecure accommodation (e.g. temporary accommodation provided by the local authority) if the household has become homeless, then this needs to be considered by services. If a family is homeless then services should be aware that the family is under additional stress at that time and that will likely impact on their ability to work through other issues - such as their problematic alcohol and/or drug use. A final outcome for that family might be that they are re-housed in another area.
159. Under the homelessness legislation (the Housing (Scotland) Act 1987 as amended) a homeless family is entitled to temporary, and then, provided that they have not made themselves homeless, settled accommodation. It is important that services - and across local authority areas - work effectively together to ensure that they know the location of families and that they are prepared for any changes in their accommodation. This is to ensure that - in turn - relevant services continue to be available to the family and to offer the strengthened supports that they will likely need.
160. Police officers play a critical role in the identification of need and risk for vulnerable children and young people. The police have a statutory responsibility to identify children or young people that might be in need of compulsory measures of care. In the past, the police have accounted for 88% of all referrals to the Children's Reporter. Patrol officers attending domestic violence incidents, or investigating drug use, should be aware of the impacts of adult behaviour on any children within the house.
161. Local screening arrangements for non-offence referrals have been an effective method of sharing concerns about vulnerable children and families in some parts of Scotland. Work is currently underway to provide a consistent approach to the management of police concerns across Scotland and embed the GIRFEC approach.
Children's Reporters ( SCRA)
162. The Children's Hearing System provides the legal framework for the care and protection of children in Scotland. Children's Hearings are decision-making tribunals who decide whether children require compulsory measures of supervision. Children and families have the right to attend, to be legally represented and to participate in the decision making of Children's Hearings. The decisions of Children's Hearings can be challenged in the courts.
163. Compulsory measures of supervision take the form of supervision requirements which are legally binding upon children, families and local authorities. Most children subject to compulsory measures of supervision continue to live with their parent or carer, although supervision requirements can authorise the removal of a child from home.
164. Children's Reporters assess children referred to them to decide whether they require compulsory measures of supervision and should be referred to a Children's Hearing. Children should be referred to the Reporter if they are considered to be in need of protection, guidance, treatment or control and compulsory measures of supervision might be necessary - it is for the Reporter to decide if such measures are in fact required.
165. It is important to note that the 'significant harm' threshold used for child protection referrals is not the threshold for referral to the Reporter, and that there is no need to seek consent before making a referral to the Reporter, or when responding to a request for information by a Reporter investigating a referral, as there is statutory authority to share this information.
166. Factors to consider when deciding whether compulsory measures of supervision might be required include:
- the seriousness of the concern/risk to the child;
- whether the family understand and accept the areas of concern;
- their motivation and capacity to address these areas of concern;
- their willingness and ability to engage and co-operate with supports; and
- whether supports provided on a voluntary basis have evidenced adequate improvements.
167. Early intervention and compulsory measures of supervision are not mutually exclusive. What is important is that the right intervention is provided at the right time. Compulsory measures of supervision at an early stage may help ensure compliance with interventions and thereby prevent problems from escalating. It is, therefore, important that all assessments include consideration of whether compulsory measures of supervision might be necessary.