The Advisory Council on the Misuse of Drugs (ACMD) Report 'Hidden Harm – responding to the needs of children of problem drug users' estimated that there are between 200,000 – 300,000 children of problem drug users in England and Wales, i.e. 2-3% of all children under the age of 16. The report also concludes that parental drug misuse can and does cause serious harm to children at every age from conception to adulthood.
Parental problem drug use is characterised by the use of multiple drugs, often by injection, and is strongly associated with economic deprivation and other factors that affect parenting capacity. The adverse consequences for the child are typically multiple and cumulative and will vary according to the child's age and development.
An appropriate response to these children often requires the close collaboration of a number of agencies including local Drug Action Teams, Health and Maternity services, Adults’ Social Care Services and Children’s Social Care Services, Adult Treatment Services, Courts, Prisons and Probation services.
Drug use in itself is not a reason for considering a child to be suffering or at risk of suffering Significant Harm although it may be a contributing factor.
Professionals working with children need to understand the complexity of the lives of drug users and gain confidence in working with people who use drugs.
A thorough assessment by all relevant agencies is required to determine the extent of need and level of risk of harm in every case.
Where there is concern that a parent is involved in drug use, the effect on the child needs to be considered, including:
The circumstances surrounding dependent, heavy or chaotic drug use may inhibit responsible childcare, for example, drug use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.
Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug-misusing environment must ask themselves “What is it like for a child in this environment?”
Walsall’s Child Concern Model for a common assessment of all children will assist in determining the level of vulnerability of the child and at what point a referral is made to Children’s Social Care Services under the Referrals Procedure.
The majority of pregnant substance misusing women will have been identified by maternity services and referred to the relevant service. The Care Planning Approach /Care Co-ordination procedures will apply including input from the link midwives.
Where any agency encounters a substance user who is pregnant and whose degree of substance misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children’s Social Care Services.
Where a newly born child is found to need treatment withdrawing from substances at birth, a Strategy Discussion/Meeting must take place as soon as possible and before the child is discharged home – see also Child Protection Discharge Procedure.
Where the criteria for a referral to Children’s Social Care Services are met, an Initial Assessment must be undertaken, and a Core Assessment considered, in relation to all pre-school children in a drug-misusing environment.
Where there are children in older age groups in a drug–misusing environment, the assessment process must include any consideration that the child or children might themselves be misusing drugs with or without the parent’s knowledge.
The assessments will consider and take account of whether the person concerned is hiding or denying their substance misuse; whether they are engaged in any rehabilitation programme; whether they receive support from a partner, family or friends; the impact of the drug misuse on the quality of care given to the child and the day-to-day environment of the child.
Throughout the assessment process and where it is decided to hold a Strategy Discussion/Meeting and convene an Initial Child Protection Conference, those agencies who have worked with the parents in relation to their drug use must be asked to contribute to the assessment, be invited to participate in and attend all relevant meetings.
If the concerns are in relation to an unborn child, the maternity services, both hospital and community based, must be involved and invited to attend.
Confidentiality is important in developing trust between drug using parents and staff in agencies working with them in relation to their drug use.
Families with a drug-using parent need to be able to ask for advice from appropriate agencies and to work together with them to safeguard their children. Services need to be accessible and attractive to drug using parents and pregnant women who use drugs.
No agency can guarantee absolute confidentiality, however, and all agencies, both statutory and non-statutory, should have written procedures on confidentiality which provides for the sharing of information where there is concern about the wellbeing of a child who may be suffering or at risk of Significant Harm. When agencies start any work with drug-using parents or with pregnant women who use drugs, these procedures must be explained to them.
For further guidance, see Information Sharing and Confidentiality Procedures.
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