11.6 Joint Local Protocol between Drug and Alcohol Partnerships and Children and Family Services

 

Contents

1.	Introduction
2.	Purpose of the Document
3.	Background
	3.1	Outcomes
	3.2	Equalities
4.	Information Sharing
5.	Rights of Children and Young People
6.	Information for Drug and Alcohol Professionals
	6.1	Levels of Need
	6.2	Lower Threshold Concerns (level 2 & 3)
	6.3	Child Protection Concerns (level 4)
	6.4	Case Conference and Core Groups
7.	Information for CYPD Workers
	7.1	Drug Treatment Services
	7.2	Treatment Options
	7.3	Local Treatment Services
8.	Role of the Substance Misuse Worker
9.	Effective Joint Working Arrangements
10.	Differences of Opinion
11.	Training and Supervision
	Appendix 1: Information Sharing
	Appendix 2: Child Protection Concern Flowchart
	Appendix 3: Referral Pathway from Childrens Centres
	Appendix 4: Referral Pathway from Treatment Services
	Appendix 5: Children Centres Registration Form
	Appendix 6: Pre Assessment Checklist (Pre-CAF)
	Appendix 7: Social Care Referral Pathway to Treatment Services

1. Introduction

The current coalition government made a commitment to develop a new approach to supporting families with multiple problems, including those where substance misuse is a factor.

A third of the treatment UK population has childcare responsibilities (NTA, 2010). For some parents this will encourage them to enter treatment, stabilise their lives and seek support. For others, their children may be at risk of neglect taking inappropriate caring roles and, in some cases serious harm. Having a parent in drug or alcohol treatment is a protective factor for children. Parents enter, are retained and successfully complete treatment at a similar level or better than the whole treatment population.

Adult treatment services and children’s services need to work together to identify, assess, refer support and treat adults with the aim of protecting children and improving their outcomes.

The Munro Review (May 2011) of child protection highlighted that children are too often “invisible” to services, including substance misuse services, which tends to focus on the adult in front of them.

Joint working across service areas is paramount to safeguard children and this protocol must be adhered to by all practitioners in the childcare workforce and those employed by drug and alcohol services.

This protocol applies whenever there are concerns about the welfare of a child where the levels of drug and/or alcohol use being presented within a treatment setting, or as assessed by social care, compromise the ability of the parent or carer to care for their children effectively.

This area of work is most sensitive due to the stigma associated with drug and/or alcohol misuse can create. Therefore thorough and skilled interventions across both service areas are required to ensure the child’s needs are being met and that services are working in partnership to support the needs of the whole family. In addition, interventions should also take into account other issues e.g. domestic violence, mental health and learning difficulties.

2. Purpose of the Document

A core aim of this protocol is to enable practitioners to feel more confident and have a greater understanding and awareness of thresholds of intervention in order to identify families and access support at the earliest opportunity, assess risk factors and have clarity on referral pathways. This will fully embrace multi agency working and its key principles.

This Protocol seeks to define a framework for how all organisations work together, to promote and safeguard the welfare of children and young people within Wirral, including unborn babies of pregnant mothers.

The overarching purpose of the protocol has to be agreed by all key partners. The protocol will apply to unborn babies, children and young people who have additional or acute needs due to substance misusing parents or carers.

• Strengthening the relationship between drug and alcohol services and children and family services;
• Identification, assessment and referral of drug or alcohol using parents;
• Identification, assessment and referral of children who need to be safeguarded;
• Referral thresholds and pathways into children and family services;
• Referral thresholds and pathways into drug and alcohol treatment services;
• Effective joint working arrangements, including sharing of information and data;
• Staff competencies and training.

Particular emphasis should be placed on those children and young people who are suffering, or are likely to suffer, Significant Harm as a result of parental substance misuse. Practitioners should feel confident in the early identification of families with additional needs and supported within the identification of services.

3. Background

There have been many reports published over the last ten years that have highlighted the negative effects of parental substance misuse to children. Guidance has highlighted the need for multi agency working and how this can benefit both the child and their family.

In June 2003, the Advisory Council on Misuse of Drugs published its “Hidden Harm” report. The report identified some features that have been reflected in this document. This report highlighted that reducing harm to children from parental substance misuse should be the main objective of policy and practice, that effective treatment of the parent can have major benefits for the child and that by working together services can make many practical steps to protect and improve the health and wellbeing of affected children.

The Victoria Climbié report by Lord Laming (2003) detailed a series of recommendations to ensure that the mistakes, lack of ‘joined up thinking’ and lack of communication between staff from different organisations would never be repeated. In their response to the Laming Report the government consulted with children and young people and laid out a series of duties, for Local Authorities, to working together to deliver better outcomes for children and young people.

The Children Act 2004 provides the legal framework for the creation of integrated processes. Section 10 of the Act establishes a duty on Local Authorities to make arrangements to promote co-operation between agencies in order to improve children’s well-being and a duty on key partners to take part in those arrangements.

In 2013 “Working Together to Safeguard Children” was published to provide specific guidance in relation to inter agency working in order to promote and safeguard the welfare of children and young people. The Working Together to Safeguard Children” document also defined ‘safeguarding as “Protecting children from maltreatment, preventing impairment of children’s health and development, Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care.” The “Working Together to Safeguard Children” document clearly states that the welfare of the child is everybody’s responsibility. Safeguarding children is a broad continuum of need and involves a broad spectrum of interventions such as, those intended to prevent children from meeting thresholds for child protection.

Furthermore under The Children Act 2004 Section 11 places duties on a range of organisations and individuals to ensure their service has regard for the safeguarding and promotes the welfare of children. In addition to this Working Together to Safeguard Children 2013 requires all Local Safeguarding Children’s Boards to gather data to assess whether partners are fulfilling their statutory obligations. This is completed through a Section 11 Self Assessment Audit.

3.1 Outcomes

With our current programmes we strive to secure better outcomes for children, young people and families by co-ordinating the support they receive from children, adult and family services. Services should work together to identify families at risk of poor outcomes to provide support at the earliest opportunity. We envisage the following outcomes will be met:

• Improved safeguarding and promoting the welfare of children and young people whose health or development may be being impaired as a consequence of parental substance misuse;
• Improved outcomes for children of substance misusing parents or carers, including children who may have caring roles in the family;
• Improved joint working between adult treatment services and children’s services, providing an integrated approach to ensure that their functions are discharged having regard to the need to safeguard and promote children’s welfare;
• Improved treatment outcomes for parents who misuse substances beginning with access to drug treatment through to support from family services and parenting practitioners;
• Improved access to adult drug and alcohol treatment services for parents using drugs or alcohol;
• Increased engagement in treatment and aftercare services for drug and alcohol users who are parents;
• Improved access to training and support to both the adult and children’s workforce;
• Ensure children and young people undertaking caring roles for their parents and siblings are supported and protected from inappropriate caring;
• Increase family interventions to prevent families being escalating into children’s social care;
• Increase the number of Early Help Assessment Tools completed

3.2 Equalities

This protocol applies in all situations irrespective of the race, gender age, sexual orientation, class, cultural and religious beliefs or disability of those involved.

In order to make sensitive and informed professional judgements about a child’s needs, and the capacity of parents/carers to respond to those needs, professionals should be sensitive to differing family patterns, lifestyles and child rearing practices which can very across different racial, ethnic and cultural groups. However, all professionals must be clear that child abuse or neglect caused deliberately or otherwise, cannot be condoned for religious or cultural reasons and the law within the UK must be adhered too.

All professionals will be aware of stereotypes and prejudices, which exist about adults who use drugs and/or alcohol. It is essential that these do not influence any assessments undertaken. Any assessment should be thorough, based on evidence from observation of the parent/s involved and ideally should be undertaken jointly, or at least discussed with, relevant specialist workers, whose views should be taken into account.

4. Information Sharing

Confidentiality can never be an absolute principle, where children require protecting, their needs are paramount and information may be shared without their parents / carers permission. It is critical that all practitioners working with children and young people are in no doubt that where they have reasonable cause to suspect that a child or young person may be suffering significant or at risk of suffering significant harm, they should always refer to Children’s Social Care.

Practitioners should seek to discuss any concerns with the family and, where possible, seek their agreement to referrals to Children’s Social Care. This should only be done where such discussion and agreement seeking will not place the child at increased risk of suffering significant harm. Any such decisions taken in the child’s best interest must be taken with overriding consideration being given to the child’s safety.

However if a child is not suffering significant harm then parental permission is needed for the sharing of information or the referral. This should be raised with the parents / carers at the beginning of professional involvement following agency’s guidelines, with emphasis on the help and support, which can be accessed by the family as a result of sharing information with other agencies.

Information Sharing Flowchart Please see Appendix 1: Information Sharing.

 There are seven golden rules to information sharing:

1. Remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately;
2. Be open and honest with the child/ young person (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be shared, and seek their agreement, unless it is unsafe or inappropriate to do so;
3. Seek advice from your line manager if you are in any doubt, without disclosing the identity of the person where possible. Guide to Integrated Working;
4. Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the public interest, where there is significant risk to children self or others. You will need to base your judgement on the facts of the case;
5. Consider safety and well-being: Base your information sharing decisions on considerations of the safety and well-being of the person and others who may be affected by their actions;
6. Necessary, proportionate, relevant, accurate, timely and secure: Ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those people who need to have it, is accurate and up-to-date, is shared in a timely fashion, and is shared securely;
7. Keep a record of your decision and the reasons for it – whether it is to share information or not. If you decide to share or not, then record what you have shared, with whom and for what purpose.
8. For further information on the above please refer to 1.3 Information Sharing and Confidentiality – Wirral Safeguarding Children Partnership

5. Rights of Children and Young People

Whenever there are concerns about a child, the family have a right to an open and honest explanation of the reason for concern. They are entitled to information about the duties and powers of relevant agencies and must be involved in all decisions affecting their lives. They should have full information, advice and support.

Every child is an individual with rights of their own. Children and young people have the right to express their views and they will be consulted and their views taken into account in all matters and decisions affecting their lives.

Parents’ views will be sought on all matters relating to their children’s well-being. They should be encouraged and supported in making their own plans for the welfare and safeguarding of their children. A range of appropriate services will be made available to enable them to do this so that children maintain their optimum standard of health and development. Provision of appropriate services at the right time and commitment from parents and relevant agencies will provide children with the necessary opportunities to fulfil their potential and achieve better life outcomes.

Only when it is necessary to safeguard a child from risk of significant harm will there be compulsory intervention in family life.

6. Information for Drug and Alcohol Professionals

Click here to view Figure 1: Universal Services for all Children.

6.1 Levels of Need

Within Children’s Services are there are four levels of need. Each child within the borough has access to universal services such as education and health, if a child has one additional need this is met with one additional service which is based within level two. If there are multiple needs, these are met with a multi agency response, this could be addressed through the Early Help process within level 3. If a child is suffering or likely to suffer Significant Harm or likely to be at risk of significant harm then this acute need is addressed through statutory social care within level 4 of the continuum.

6.2 Lower Threshold Concerns (level 2 & 3)

Where there is a child that has identified additional unmet needs or will not achieve one of their five outcomes if services are not provided please contact the Integrated Front Door for a consultation.

The caller should ensure that they have received consent from the person who holds parental responsibility in order to give specific details about the child and family members. However if consent can not be obtained the caller can still seek advice and guidance without giving the child’s and family information details.

Underpinning principles of consultation:

• Consultation may be used in any situation where there is concern for the welfare of a child and family;
• All agencies share a genuine commitment to working together;
• Consultation is a two way process that promotes a multi-agency and multidisciplinary approach;
• Professional discretion and mutual respect for professional judgement is required;
• Knowledge and expertise may be different but equally valuable to the process;
• Families should, wherever possible, always be aware of consultation and of the guidance on confidentiality.

Consultation is not a referral to another agency or a transfer of ‘ownership’ unless the agreed outcome is a referral.

Upon having a consultation, the social worker will require the following:

• A clear understanding about what you want from the consultation and to be open in your approach to suggestions about the way forward;
• Name, DOB and Address of the child (if consent has been obtained);
• Details of the concerns held;
• Details of any other professional working with the family.

Upon having a consultation the callers can expect:

• A copy of the consultation should be sent to the person seeking the advice by the person providing the consultation;
• It is the responsibility of the practitioner who initiated the consultation to inform the family of the outcome of the consultation and any action that may follow.

6.3 Child Protection Concerns (level 4)

Where a child is suffering or likely to suffer Significant Harm, or has experienced Significant Harm a referral must be made to Social Care without delay. The referral point is at Integrated Front Door (IFD), Social Care 0151 606 2008 (office hours) 0151 677 6557 (out of office hours)

IFD provides a single access point to Children’s Social Care in Wirral. IFD can also be used for consultation purposes if the caller is unclear on how to proceed, in which case you should expect a written record of the consultation.

Upon making a referral IFD will require the following:

• Full details about the child and their circumstances;
• Clear details on what concerns you have about the child;
• Whether or not the family are aware that you have contacted IFD;
• An emailed (secure)multi agency referral form following the conversation;
• Your availability to undertake a joint visit to the family with a Social Worker.

Callers should expect the following from IFD:

• Whether or not a referral will be accepted;
• If accepted the referral will be passed to the relevant assessment team;
• A Social Work Assessment of Needs and Strengths will be completed within 10 working days;
• You will be advised of the outcome of this assessment;
• Advice on how to proceed if referral is not accepted.

Social Care has a duty to take the lead role in all cases where they have accepted a referral and an assessment is undertaken. This means that the Lead Professional role is always carried out by the social worker whilst a case remains open to them.

If Social Care accepts a referral they will undertake an assessment. Assessment does not guarantee that they will provide specific services but it will determine whether services and support are required to support children to meet their potential and if so, what actions they need to complete. They will be expected to organise regular planning meetings to co-ordinate the work of all agencies concerned.

If and when Social Care eventually withdraws, and a multi-agency response is still required, they need to ensure that a meeting is called to appoint a Lead Professional.

6.4 Case Conference and Core Groups

Initial Child Protection Case Conference brings together family members, the child who is the subject of the conference (where appropriate) and those professionals most involved with the child and family.

All professionals working with the family are to attend the first conference, other professionals attending the conference should bring with them details of their involvement with the child and family, and information concerning their knowledge of the child’s developmental needs, capacity of the parents to meet the needs of their child within their family and environmental context. This information should include careful consideration of the impact that the current and past family functioning and family history are having on the parents’ capacities to met the child’s needs. Contributors should, wherever possible, provide a written report in advance to the conference and these should be made available to those attending.

It is the role of the initial child protection conference to formulate the outline child protection plan if one is required. The decision of the conference and, where appropriate, details of the category of abuse or neglect, the name of the lead social worker (i.e. the social worker who is the lead professional for the case) and the core group membership should be recorded in a manner that is consistent with the Initial Child Protection Conference Report and circulated to all those invited to the conference within one working day.

The core group is responsible for developing the child protection plan as a detailed working tool and implementing it within the outline plan agreed at the initial child protection conference. Membership should include the lead social worker, who chairs the core group, the child if appropriate, family members and professionals or foster carers who will have direct contact with the family.

Although the social worker has responsibility for the formulation and implementation of the child protection plan, all members of the core group are jointly responsible for carrying out these tasks, refining the plan as needed and monitoring progress against the planned outcomes set out in the plan. Agencies should ensure that members of the core group undertake their roles and responsibilities effectively in accordance with the agreed child protection plan.

The first meeting of the core group should take place within 10 working days of the initial child protection conference. Thereafter, core groups should meet every 6 to 8 weeks to facilitate working together, monitor actions and outcomes against the child protection plan, and make any necessary alterations as circumstances change.

All workers should prioritise these meetings and if are unable to attend to send a well briefed representative in their place.

7. Information for CYPD Workers

It is hard to know with any degree of certainty how many children are living with parents who are problem substance users when such behaviour is regularly characterised by secrecy and denial. The prevalence of substance misuse as a factor in child protection cases is often a common theme. Parents misuse substances (including alcohol) were found in a third of cases where there was current or past history of parental substance misuse within child protection cases. (Brandon et al 2009)

Areas where parental substance misuse can result in parents or carers experiencing difficulty:

• Organising their own and their children’s lives;
• Being unable to meet children’s needs for safety and basic care;
• Being emotionally unavailable to the child;
• Putting their own needs and feelings first;
• Having difficulty in controlling and disciplining their child;
• The parent becoming detached from reality and losing consciousness;
• Allocating funds to acquire substances rather than meet the basic needs of the child;
• Being involved in criminal activity;
• New mothers with a history of substance use may find it difficult to respond appropriately to their new born child, this may lead to attachment difficulties;
• Problem drug use may lead to the parent being unable to empathise with a child and their needs;
• The parent may be unpredictable or have a dramatic change of mood this may transfer onto the child;
• Dealing with the stigma attached to substance misuser parenting children.

The full impact of parental substance misuse will depend on the child’s age and stage of development as well as their personality and ability to cope. Consideration needs to be given to the types of drugs used and the effect on the individual and their parenting capacity.

For further information regarding substance misuse and the impacts upon the child/ren and for further information regarding assessment of parents involved in substance misuse please refer to the Local Safeguarding Children Board’s good practice Guidance for Working with Children and Families effected by Substance Misuse available from the policy and procedures section from the intranet.

7.1 Drug Treatment Services

The goal of drug treatment will vary depending on individual needs. Some people will aim for abstinence but others will require a considerable length of time which may involve a number of attempts before a person can get control over their drugs of dependency.

7.2 Treatment Options

Harm reduction services: including needle exchanges which operate by providing sterile injecting equipment to injecting drug users including steroids, and disposing of used injecting equipment, with the aim of reducing infection. Harm reduction schemes may also offer immunisation against blood borne disease, advice or referral to other treatment services or sexual health services.

Community prescribing specialist: offer a medically supervised substitute. This maintains the individual’s tolerance to the drug of misuse and provides a basis for providing medical and psychosocial counselling and support. Most prescribing in the UK is for opiate (heroin) dependence.

Community prescribing: GPs: provide medically supervised substitutes through a shared care approach between primary (GPs) and secondary care (specialist drug treatment) in the management of drug misusers.

Key working programmes: Often based in community drug teams or other community based services. These offer psychosocial approaches often delivered alongside pharmacological interventions, but are often the mainstay of treatment for the misuse of cocaine and other stimulants, and for cannabis and hallucinogens.

Formal psychosocial programmes: These are discrete packages of psychosocial treatment offered in a range of settings, to treat drug misuse problems or co-occurring common mental disorders. These discrete packages will frequently be delivered alongside key working and pharmacological interventions if appropriate.

Structured day programmes: offer intensive community-based support, treatment and rehabilitation. Programmes of defined activities for a fixed period of time will be on offer and will require a specific level of attendance, usually four to five days a week.

Aftercare: provision of structured support for clients on exit from another programme. The development of an appropriate package of aftercare and support should take place in the final phase of the treatment episode of service users aiming to achieve abstinence.

Inpatient detoxification: specialised units for drug users, which provide medically supervised withdrawal with 24-hour medical cover (and usually relapse prevention) and aftercare referral services.

Residential rehabilitation: intensive and structured programmes in controlled residential or hospital inpatient environments. Rehabilitation services vary in approach, programme structure, intensity and duration. The majority of residential rehabilitation services require users to be drug-free on entry, although some may have on-site detoxification facilities.

Pregnant Women: Neglect can occur during pregnancy as a result of maternal drug and/or alcohol misuse. Using substances whilst pregnant may endanger the unborn child depending on the pharmacological make up of the substance, the frequency of use and the administration.

Babies born to substance misusing mothers may experience withdrawal symptoms or ‘neonatal abstinence syndrome’. As a result of this they need extended hospitalisation after birth and have higher needs at birth and into their early childhood. While pregnancy may be a catalyst for change and is a strong motivator for mothers wishing to reduce or cease substance misuse, it is extremely important that they receive appropriate medical oversight when attempting to detoxify or reduce substance use within pregnancy. The objective is to achieve stabilisation at the lowest possible dose. Women in these circumstances may present late to maternity services due to chaotic lifestyles or a fear of being identified as misusing substances in pregnancy. This will increase the risks to the unborn child.

Pregnant women should be fast-tracked into treatment so that they can get appropriate medical support for them and their unborn baby as early as possible. Engaging the partners of pregnant women, especially if they are also misusing substances, is likely to improve outcomes for pregnant women and their babies.

Alcohol Treatment Services

Many people, who drink at harmful levels, including some dependent drinkers, are able to reduce the amount they drink without professional support. They can do this through their own motivation and often with support from family and friends. One in eight people drinking at higher-risk levels will reduce their consumption to within government guidelines as a result of simple advice from their GP or a nurse.

The services commonly use one-to-one ‘talking therapies’ or group work to help people reassess the effect alcohol is having on their lives and to help them develop strategies for drinking more sensibly.

In a minority of cases, the level of dependence on alcohol is so great that it can be dangerous simply to stop drinking alcohol without medical support. In such cases, local alcohol services can provide medically assisted withdrawal or ‘detoxification’, usually in the community. But some people need in-patient admission for this.

Alcoholics Anonymous forms mutual help groups to assist people in giving up alcohol altogether.

7.3 Local Treatment Services

Wirral Ways to Recovery is a free and confidential drug and alcohol service for adults (including offenders), young adults, families, carers and affected others in Wirral.

CGL leads the Wirral Ways to Recovery partnership and provides a range of treatment, recovery and support services for those who have concerns about their drug or alcohol use.

Wirral Ways To Recovery are a community substance misuse service who offer the following services:

• Open access for assessment etc (by drop-in) at all Hubs from 9-5 Monday to Friday.  Additionally, there is also access from 10-2 on a Saturday at the Birkenhead Hub only
• Street Outreach Teams
• Housing Support and Advice
• Community detoxification
• Foundations of recovery workshops
• Access to residential detoxification and rehabilitation
• Service user computer suites
• Specialist Nurses
• Psychological Therapists
• Recovery Champions
• Support with education, training and employment
• ‘Think Family’ workers
• Peer Mentoring training/diploma and opportunities
• Volunteering opportunities
• Family carer support services

Further information is on the WWR website, including a referral form: Refer yourself or someone else to Wirral Ways (changegrowlive.org)

8. Effective Joint Working Arrangements

The law requires a range of children’s and adults’ services to co- operate to protect and safeguard children. Some services do have the lead roles and obligations under current legislation in respect of matters such as child protection assessments and investigations; for example Children’s Specialist Services. Nonetheless, other agencies such as education and health also have explicit legal duties to co – operating children from harm and neglect.

The legislation and policy relevant to service provision for families affected by parental mental health, substance misuse and child welfare issues are as complex as the issues with which they deal, with a raft of legal and policy measures which have been introduced at different times and for different reasons. The consequence of this can be a lack of clarity and a failure by legislators and service planners to make links between different services and areas of policy and practise.

9. Differences of Opinion

There will be times in which there will be differences of opinions between professionals and/or agencies. This may be around thresholds, care plans, or ways forward with a family.

In the first instance it would be encouraged that professionals meet and try and work out any differences between them. Ultimately all professionals working with families are working towards the same goals of ensuring children’s welfare and ensuring that the families are kept together.

If professionals are unable to work out any differences between them then we would direct you to the Wirral Safeguarding Partnership’s Escalation Procedure.

10. Training and Supervision

All agencies, whether part of children services or substance misuse treatment services, should have a clear framework for supervision which includes the management of cases where there are or may be concurrent safeguarding and substance misuse issues within the family.

Managers of substance misuse treatment staff should always use supervision to discuss the care and welfare of those children who are subject to parental substance misuse and how such cases are managed. Likewise, managers of children and family service staff should always use supervision to discuss the impact of problematic parental substance misuse upon their caseload and how they liaise with substance misuse treatment services to ensure appropriate support can be given to the parent.

All professionals who may potentially work with parental substance misusers (including those who are pregnant), their children or their partners, should achieve a basic competence about substance misuse issues and how they can impact upon the welfare of the children. In addition, the same professionals should also have a basic awareness about local resources within the substance misuse treatment system and how to access them.

Similarly, all professionals who are working (directly or indirectly) with the children of parental substance misuse should achieve basic competence in all aspects of safeguarding, appropriate to their role. In addition, all professionals should have an understanding of the thresholds for referral into social care, as well as how to escalate concerns appropriately.