Substance Misuse in Parents and Carers Practice Guidance
Purpose
This practice guidance is to support all partner organisations working with children, young people and their parents or carers who are experiencing substance misuse. It will define referral pathways for Children and Families, and Drug and alcohol service providers and includes information sharing and joint working arrangements for all partner organisations to follow.
This practice guidance aims to protect children, young people and adults by promoting:
- Early identification of need.
- Referral to appropriate support services for children as per agreed local North Yorkshire Safeguarding Children Partnership (NYSCP) procedures. This may include substance use services, children and families’ services and safeguarding teams.
- Joint working arrangements may include:
- Co-ordinated information sharing.
- Co-ordinated development and implementation of support plans for parents and carers and children as applicable.
- Coordinated and joint assertive engagement approach
- Joint/multi-agency supervision as applicable.
The practice guidance is based on various good practice guidance, including the Public Health England (2013) document, ‘Supporting Information for the Development of Joint Local Practice guidance between Drug and Alcohol Partnerships, Children and Family Services’
(Public Health England (2013). Supporting Information for the Development of Joint Local Protocols between Drug and Alcohol Partnerships, Children and Family Services, (Online). (Accessed 14.12.17). Available from:
Definitions
‘Alcohol and drug use’ will be referred to as ‘substance use.’ Drugs and alcohol are chemical substances that effect normal physical and psychological functioning (United Nations, 2008). They change the way that people who take them view the world and themselves, and the way that they feel (RSA, 2007). As a result, drugs and alcohol are often referred to as ‘psychoactive substances’. This does not necessarily mean that they are always dependence-creating (World Health Organisation, 2016).
‘Substance use’ is a term which refers to the use of drugs and alcohol within the NICE, 2017. It refers to intoxication by, or regular excessive consumption of, and/or dependence on psychoactive substances, leading to social, psychological, physical or legal problems. This includes problematic use of both including illegal drugs, legal highs (also referred to as ‘psychoactive substances’) and prescription only medicines. Substance use is a significant cause of premature mortality (early death) and morbidity (avoidable and early on-set diseases) within the UK.
‘Children’ and young people refers to all children and young people aged 0-18 years old, ‘young people’ – aged 10-18. This term also includes people aged up to 25 who have special educational needs or disability (consistent with the Children and Families Act 2014).
Equalities
This practice guidance applies in all situations irrespective of the race, age, gender, sexual orientation, class, culture and religious beliefs or disability of those involved.
To make sensitive and informed professional judgements about a child’s needs, and the capacity of parents or carers to respond to those needs, professionals should be sensitive to differing family patterns, lifestyles and child-rearing practices which can differ 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.
Specialist Services who work with children, young people and adults
‘NY Rise‘, the specialist children and young people’s service will work with all children and young people aged 10-18 and up to 25 years of age for those with special education needs and disabilities. They work with young people across North Yorkshire aged 10-19 and up to 24 with SEND who need specialist support around drug and alcohol use. They offer:-
- Structured support to stop or reduce drug or alcohol use
Support to improve health and well-being (including sexual health support and smoking cessation) - Education and advice around drugs and alcohol
- Support family members of young people working with NY Rise and offer onward referrals when needed
- Provide guidance to schools, colleges and other professionals around referral processes and eligibility
To make a referral or to discuss how they can help:
Telephone: 01723 330730 (option 2)
Freephone: 08000 141480 (option 2)
Email: NYYP.admin@Humankindcharity.org.uk
Website: https://humankindcharity.org.uk/service/nyrise
‘Compass Phoenix’ works to improve outcomes for children and young people in relation to their emotional wellbeing and mental health by strengthening the range of mental health support available to children and young people.
They offer a range of services including:
- One-to-one or group work support and interventions for children and young people aged 9-19 (and up to 25 for those with special educational needs or disabilities) who are experiencing mild to moderate mental health difficulties.
- Support to schools to develop a whole school approach in relation to emotional wellbeing and mental health through the delivery of training.
- Professional Consultation to school and college staff, providing advice and guidance on emotional wellbeing and mental health to help make sure that children and young people get the right support at the right time in the right place.
- BUZZ US text messaging service.
- A dedicated team help young people to make sustainable lifestyle changes to improve their long-term health, resilience and emotional wellbeing, reduce risk to themselves and others and equip them to reach their potential.
‘North Yorkshire Horizons‘ – Specialist adult drug and alcohol treatment service within North Yorkshire.
Drinkline is the national alcohol helpline. If you’re worried about your own or someone else’s drinking, you can call this free helpline in complete confidence. Call 0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm).
Alcoholics Anonymous (AA) is a free self-help group. Its “12 step” programme involves getting sober with the help of regular support groups.
Al-Anon Family Groups offer support and understanding to the families and friends of problem drinkers, whether they’re still drinking or not. Alateen is part of Al-Anon and can be attended by 12 to 17-year-olds who are affected by another person’s drinking, usually a parent.
We Are With You is a UK-wide treatment agency that helps individuals, families and communities manage the effects of drug and alcohol misuse.
Adfam is a national charity working with families affected by drugs and alcohol. Adfam operates an online message board and local support groups.
The National Association for Children of Alcoholics (Nacoa) provides a free, confidential telephone and email helpline for children of alcohol-dependent parents and others concerned about their welfare. Call 0800 358 3456 for the Nacoa helpline.
SMART Recovery groups help people decide whether they have a problem, build up their motivation to change, and offer a set of proven tools and techniques to support recovery.
Drugs Strategy
The 2017 UK drugs strategy highlighted that ‘parental drug and alcohol dependence can have a significant impact on families, particularly children’, and outlined the need to ‘support vulnerable families to break inter-generational pathways to substance dependence’. The strategy notes the importance of effective joint working between substance use and children and families’ services, focussing on an integrated and co-ordinated whole family approach.
In 2022 the government launched a new 10-year drugs strategy: From Harm to Hope. The new strategy sets out three key ambitions, to reduce supply of drugs, to rebuild a work class treatment system and to create a generational shift in demand for substances. The strategy also comes with significant financial investment in the sector and endeavours to create 54,500 more treatment places.
North Yorkshire council are currently developing a local drug strategy based on the new government strategy. The council have launched a Drugs and Alcohol Parentship Board which will be the strategic partnership approach to creating the strategy and achieving the expected outcomes.
Information Sharing and Confidentiality
Practitioners should follow their organisation’s procedures, and if they are unsure, they should seek guidance from their Safeguarding Lead. Practitioners should use their professional judgement when making decisions on what information to share and when.
The most important consideration is whether sharing information is likely to safeguard and protect a child, young person, or adult at risk. No practitioner should assume that someone else will pass on information which may keep a child, young person, or adult at risk safe.
See the NYSCP and NYSAB One Minute Guide on Information Sharing available from:
It is important to keep a written record of decisions made to either share information or not, the reasons for the decision, and if the decision is made to share information what information is shared.
Professionals Consultation Line
The Consultation Line should be used when you have concerns about a child safeguarding situation and have spoken to your Designated Safeguarding Lead and unsure how to proceed on the next steps. The concerns should be of a higher threshold than of what can be supported by Early Help.
When contacting the North Yorkshire Multi-Agency Screening Team (MAST) for a consultation you will be put through to a qualified social worker where your query will be discussed, with the child’s details remaining anonymous.
Professional’s Consultation Line number is available between 10am and 4pm on 01609 535070
Further information is available from the Professional’s Consultation Line One Minute Guide available from:
Risk of significant harm
Some children are in need because they are suffering, or are likely to suffer, significant harm. The Children Act (1989) introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children and gives Local Authorities a duty under Section 47 of the Act to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm.
The NYSCP provides additional guidance on Neglect which can be accessed from:
Children who act as carers for their parents or other relatives are eligible for an assessment to identify needs for support. A request for an assessment can be made either through NYCC customer contact centre or to young carer support services. Based on the outcome of the assessment they may either be offered early help support or support from children’s social care.
Other information, including details of local services is available from:
Raising a Safeguarding Concern About a Child
If any partner organisation has concerns that a child may be suffering significant harm or may be likely to suffer harm, the need to safeguard the child will always override a professional or services requirement to keep information confidential. Guidance for how to make a referral for a child can be found at:
Further information can also be found from:
Raising a Safeguarding Concern About an Adult at Risk of Abuse or Neglect
If any partner organisation has concerns regarding an adult at risk of abuse or neglect, they should follow their own organisation’s safeguarding adult’s policy which should be in-line with the Joint Multi-Agency Safeguarding Adults Policy and Procedures (West Yorkshire, North Yorkshire and City of York).
To raise a safeguarding concern visit:
https://www.northyorks.gov.uk/adult-care/safeguarding/safeguarding-vulnerable-adults
Referrals made to Specialist Services in North Yorkshire
Upon receipt of a referral, North Yorkshire Horizons will contact the Children and Families Service to identify if a child is actively receiving support and has a social worker. If this is the case, North Yorkshire Horizons will contact and work with the social worker.
Upon receipt of a referral, NY Rise will contact the Children and Families Service upon receipt of a referral to identify if a child or young person is known to the Children and Families Service.
If any other substance use service practitioner is working with a family which includes a child, they should check to ensure whether they are engaged with the Children and the Families Service, to ascertain the scope of the child’s support plan, and agree joint working arrangements as applicable.
Role of the Children and Families Service
The Children and Families Service will ascertain, as part of their on-going assessments, whether parents or carers are currently, or were previously, known to substance use services during the Child and Family Assessment and Child Protection Enquiries (Sections 17 and 47 Children Act 1989). If it is identified that a parent or carer’s drug or alcohol use is affecting their ability to care effectively for the child, and they are not accessing local substance use services then consent should be sought to make a referral to either adult or young people’s substance use services as appropriate for assessment. See the Public Health commissioned services webpages for details:
Early Help
Children and their families who receive coordinated early help are less likely to develop difficulties that require intervention through a statutory assessment under the Children Act 1989. In North Yorkshire, this work is coordinated through the North Yorkshire Council (NYC) Children and Families Service: Early Help who, along with other agencies such as the Healthy Child Programme teams, can work with the family to identify what help the child and family might need to reduce an escalation of needs that could require statutory intervention.
The provision of early help services should form part of a continuum of help and support to respond to the different levels of need of individual children and families.
Where need is relatively low level, individual services and universal services may be able to take swift action. For other emerging needs a range of early help services may be required, coordinated through an early help assessment. Where there are more complex needs, help may be provided under section 17 of the Children Act 1989 (children in need). Where there are child protection concerns (reasonable cause to suspect a child is suffering or likely to suffer significant harm) local authority Children’s social care must make enquiries and decide if any action must be taken under section 47 of the Children Act 1989.
If the family are already open to the NYC Children and Families Service: Early Help, Substance Use Service practitioners may form part of the integrated support plan which will be in place to meet the needs of the child and family.
If it is believed that the family would benefit from support from the NYC Children and Families Service: Early Help, then practitioners should consult the NYSCP Early Help Strategy and the Framework for decision-making: Right help, at the right time by the right person to assess what level of support may be required and make a referral for support.
Professionals can also discuss cases with their local Early Help Consultant:
- Early Help East (Scarborough, Whitby, Ryedale): 01609 534852
- Early Help West (Harrogate, Craven, Knaresborough, Ripon): 01609 534842
- Early Help Central (Hambleton, Richmondshire, Selby): 01609 534852
For more information please visit: https://www.northyorks.gov.uk/early-help
Child Protection enquiries
If there are worries about a child’s care, development or welfare, professionals in touch with the family must co-operate with the NYC Children and Families Service to enable proper assessment of the child’s circumstances, provide any support needed and take action to reduce risk to the child with the consent of the parents. The child’s welfare is the paramount consideration when deciding what to do in these situations.
Joint working arrangements
Joint home visits and support plan review meetings between substance use and the Children and Families Service practitioners will be completed where possible and appropriate. Substance use services will provide specialist input for the Children and Families Service assessments when required, including written information where appropriate and advice around drug and alcohol use issues.
Services may be asked to provide court reports or statements for families as part of the Public Law Outline process. A specific template has been developed to be used for this purpose, which includes details of engagement with the service and drug or alcohol test results. Please seek advice from the allocated Social Worker.
Substance Use and the Children and Families Service practitioners working with families will attend planning forums as appropriate (examples provided below, but should not be considered exhaustive):
- Strategy Meetings under Section 47 Children Act 1989
- Team Around the Child Meetings
- Child Protection Conferences
- Looked After Child Reviews
- Multi-Agency Risk Assessment Conference (MARAC)
- Multi-Agency Public Protection Arrangements (MAPPA)
- Planning Meetings and Discussions under the Care Act 2014
Drug and Alcohol Testing
Department of Health (2017) Clinical Guidelines and DrugScope (2011) usefully summarise the role, function, and limitations of drug testing.
Drug Screening is used for various reasons:
- Initial assessment and confirmation of drug use (although testing does not confirm dependence or tolerance and should be used alongside other methods of assessment)
• To confirm the persons’ compliance with treatment (e.g., that the person is taking prescribed medication such as methadone or buprenorphine)
• To monitor illicit drug use – to support clinical decision making and potentially to assist in setting drug specific treatment goals for the person
• Provides an opportunity for the worker to reflect real evidence of progress (or lack of progress) to the person.
The frequency of testing will depend on a number of factors including previous test results and the stage of a person’s treatment.
Drug testing:
North Yorkshire Horizons undertakes regular urine testing as part of the initiation and monitoring of a person’s opiate substitution treatment (methadone or buprenorphine) in line with clinical guidelines. Testing is undertaken regularly during medication titration and as part of prescribing reviews thereafter. It is good practice to include random tests (where the person has not been notified in advance of the test date). In high-risk cases a combination of urine and oral swab tests may be used. They may also be used when there is a dispute regarding a test result, to provide further evidence, and/ or as a motivational tool.
Alcohol testing:
During a community medically assisted alcohol detoxification, North Yorkshire Horizons will undertake a minimum of four home visits over an 11-day period and conduct breathalyser tests to ensure that the person is not drinking alcohol on top of their prescribed medication.
Sharing of test results with Children and Families Services:
As part of joint working arrangements North Yorkshire Horizons may be asked to share drug or alcohol test results that they have conduct as part of their delivery of a prescribing intervention for a person with Children’s Social Care, they may also be asked to include test result information and interpretation as part of a court report statement to inform children’s care proceedings or pre-proceedings.
North Yorkshire Horizons will share test results that they have conducted as part of their delivery of a prescribing intervention for a person with Children’s Social Care, upon request.
If any additional testing is required for the sole purposes of child protection arrangements, then Children’s Social Care will contact North Yorkshire Horizons to negotiate this on a case-by-case basis, providing the individual is engaged with the service. The allocated Social Worker must complete an additional testing form and submit this with agreement from their line manager to North Yorkshire Horizons. To request the Children and Families Service Additional Drug Testing form please email humankind.nyhsafeguarding@nhs.net.
Children’s Social Care will meet the full testing costs of any additional tests conducted. North Yorkshire Horizons will not undertake any tests on behalf of Children’s Social Care for anyone who is not engaging with the service.
Drug and/or alcohol testing information should always be considered in the context in which tests were taken, and considering other information available from North Yorkshire Horizons regarding the progress with treatment and recovery goals for anyone using the service.
Professional disagreements
At times there may be disagreements between professionals about decisions or actions required relating to a family. The child’s safety and welfare must be of paramount consideration, and professional differences must not inhibit timely and clear decision making.
The North Yorkshire Safeguarding Children Partnership’s Professional Resolutions Practice Guidance is available from:
Supervision
Line management supervision plays a key part in the management of practitioner’s cases.
Adult and Young People’s substance use services should have arrangements in place for safeguarding specific supervision.
Practitioners should discuss safeguarding issues with their line manager to access support including policies and procedures which support good practice.
Joint supervision between adult and young people’s substance use services and the NYC Children and Families Service is encouraged and should be explored on a case-by-case basis.
Substance Use and Pregnancy
Use of substances (including illicit drugs, prescribed drugs, and alcohol) by mothers/fathers/ partners and/or anyone that is involved in a child’s life does not on its own automatically indicate that children are at risk of abuse or neglect.
However, where harmful patterns of substance use is causing physical, psychological, social, interpersonal, financial and or legal problems, the implications for children and families must be thoroughly assessed, and accurate advice must be provided
Use of drugs and alcohol during pregnancy can adversely impact the developing foetus, particularly during the first twelve weeks of gestation. Risks include increased risk of miscarriage, likelihood of premature delivery, reduced birthweight and head circumference, and an increased risk of sudden unexpected death in infancy. The infant exposed to drug or alcohol use during pregnancy may also experience additional long-term cognitive and development problems.
Pregnancy may act as a catalyst for change and present a ‘window of opportunity’. Outcomes are better, both in terms of the pregnancy and the outcomes for the neonate, for women and families who engage with specialist drug and alcohol service support
Current recommendations indicate that the following advice should be given to families who are assessed as using drugs and/ or alcohol during pregnancy:
- Alcohol: individuals who are pregnant or are planning to become pregnant should not drink alcohol, as this keeps risk to the baby as minimum. If a mother is drinking dependently, or struggling to stop drinking, a referral should be made to North Yorkshire Horizons or NY Rise for specialist support. In no circumstances should a pregnant woman who is dependently drinking be told to stop drinking until assessed by a clinical specialist within North Yorkshire Horizons or NY Rise. Many women want to stop immediately to prevent suffering to their baby, but rapid withdrawal may harm the mother (and or baby) and increase the risk of a miscarriage or premature labour.
- Illicit drugs: advice given to individuals who are pregnant or are planning to become pregnant is dependent on the substance being used and therefore specialist advice should be sought from North Yorkshire Horizons/NY Rise through their single point of contact, before advice is given, see detail below.
To discuss a family that you are working with, please contact The North Yorkshire Horizons/ NY Rise single point of contact:
SPOC Telephone: 01723 330 730
If there is no-one available at the time of your call, your details will be taken, and someone will call you back. It is helpful prior to calling if you can identify the following information, but you do not have to have this before making contact:
- what drugs are being taken, how much, how often
- route of administration
- history of withdrawals if a delay in not taking substance of choice,
- are they or have they been engaged in North Yorkshire Horizons?
North Yorkshire Horizons has developed a Pregnancy Protocol (last updated 2022). The protocol aims to facilitate joint working between all agencies where a woman accessing treatment with North Yorkshire Horizons is identified as pregnant. It sets out the clear expectations of all involved professionals and the expected timescales for referral, assessment, treatment and review. See Appendix ‘X’ for the North Yorkshire Horizons Pregnancy Protocol.
Further information, advice, and guidance about substance use in pregnancy can be found in the generic harm reduction information, advice and guidance please visit: www.drinkdrughub.co.uk
The NYSCP also has practice guidance for Safeguarding Unborn Babies, Managing Injuries to Non-Independently Mobile Children, and Preventing Sudden or Unexpected Death in Infancy available from:
Safe Storage
North Yorkshire Horizons will provide anybody accessing treatment and prescribed medication a lockable storage box in which to safely store their medication. This will be checked during the initial home visit provided by North Yorkshire Horizons (for those who have children under 5 years of age living within the home). However, social workers visiting the family home should regularly check that the boxes are being used by parents and medication is safely locked away.
HEAT Tool
The Home Environment Assessment Tool (HEAT) is designed to help practitioners identify those families where there may be early signs of neglect so that prompt action can be taken to address and support families to improve home conditions and safety for their children.
The HEAT should not be used in isolation and should form part of the overall assessment that is being undertaken.
The tool recognises that practitioners must make judgements about the safety, order and cleanliness of the homes in which children live. The tool has been designed to help practitioners to be objective about their observations and evidence their concerns.
Further guidance is available from:
Appendix One
Links to resources
NYSCP referral and assessment procedures:
Link to the North Yorkshire Framework for Decision-Making: Right Help, at the Right Time, by the Right Person:
Public health commissioned services (adult and young people’s drug and alcohol services):
NSYCP Referrals to Children and Families Service Using the Updated Universal Referral Form:
Making a Referral One Minute Guide:
Using the Children and Families Universal Referral Form One Minute Guide:
- Using the Children and Families Universal Referral Form
- Parents with alcohol and drug problems: support resources – GOV.UK (www.gov.uk)
- Safeguarding children affected by parental alcohol and drug use – GOV.UK (www.gov.uk)
- Reducing Parental Conflict: innovative projects delivered to support families in conflict – GOV.UK (www.gov.uk)
Useful contact details and resources:
North Yorkshire Safeguarding Children Partnership:
North Yorkshire Safeguarding Adults Board:
North Yorkshire Council:
Tel: 0300 131 2 131
Website: www.northyorks.gov.uk
NY Rise
Tel: 01723 330730 or 0800 14 14 80 (for both select option 2)
North Yorkshire Horizons
Tel: 01723 330730
Website: www.nyhorizons.org.uk
Compass Phoenix
Tel: 01904 661916 or 0800 0087452
Website: https://www.compass-uk.org/services/compass-phoenix
FRANK
Tel: 0800 77 66 00
Website: www.talktofrank.com
Adfam
Tel: 0207 553 7640
Website: www.adfam.org.uk
Alcoholics Anonymous
Tel: 0845 769 7555
Website: www.alcoholics-anonymous.org.uk
Narcotics Anonymous
Tel: 0300 999 1212
Website: ukna.org
Al-Anon Family Groups
Tel: 0800 0086 811
Email helpline@al-anonuk.org.uk
Website www.al-anonuk.org.uk
Famanon
Tel: 0207 4984 680
Website: www.famanon.org.uk
Additional National Guidance
Public Health England have produced guidance in relation to “Parents with alcohol and drug problems: adult treatment and children and family services” available from:
The Department of Health and Social Care have produced guidance on “Fetal alcohol spectrum disorder: Health needs assessment” available from:
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