Transcript Slide 1

London Safeguarding Children Board
Seminar 1
Specialist Substance Misuse Workers
and Children’s Social Care
Gill Watson – Parental Substance Misuse and Childcare Social Worker
ISLINGTON
Alison Johnson – Senior Practitioner Substance Misuse
CAMDEN
Suzanne Olsen – Substance Misuse Social Worker
LAMBETH
The problem in Islington
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Glasgow prevalence study (Hay et al, 2008): estimated 3575
problem drug users (heroin & crack) in Islington
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Second highest number of PDU’s in London
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Current numbers of PDU’s in treatment: 815
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1806 adults in drug treatment in 2006/7
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Alcohol Needs Assessment Research Project: 5% alcohol
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dependent population (= 7178 Islington residents)
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645 adults in alcohol treatment in 2005/6
A new approach
•Pre publication of Hidden Harm
Interventions came too late
Lack of coordination, poor links and mutual mistrust
Non-systemic approach, concentrating on individual adult needs
•2 specialist substance misuse/ childcare posts paid for by adult pooled treatment
budget (PCT)
•Overall aims
Increase awareness of the needs of children amongst treatment workers
Improve partnership working
•Location and designation of workers
Needs Assessment
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Audit of clients in treatment with Trust services with children (3
month snapshot 2005/6)
 20% across NIDS, SIDS & AASCI
 43% of those had current Children’s Social Care involvement
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Audit of Children’s Social Care cases - PSM
 30% of children on CPR
 45% of care proceedings cases
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Lack of consistent screening and recording in both sectors
Needs Assessment cont.
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Parental substance misuse, mental ill health and/ or domestic
violence were a feature in over 80% of all child protection
registrations in 2007
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For drug & alcohol together, about 40% over 2007/8.
For the 3 month period June-August 08, in this period a total
of 110 contributory factors were listed breaking down as
follows:
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Drugs 22 (20%)
Alcohol 16 (14.5% )
D/V 34 (31% )
MH 20 (18%)
Interventions in Treatment Services
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Parental Substance Misuse Service: Social worker and health
visitor based in adults’ drug & alcohol treatment services since
late 2005
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Strategic, consultative and direct work focus
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Health visitor taking lead on antenatal and under 5s
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Social worker taking lead on over 5s
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Assessment of the family with the referring agency to ensure that
children’s health and social care needs are being met
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40 average monthly contacts during 2007-08
Interventions in Treatment Services 2
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Joint home visits with treatment keyworker to make assessment
of children and family needs, home circumstances including safe
storage of medication.
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Moving towards using the CAF
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Referring individual family members or whole family to services
for ongoing support or further assessment, including:
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Young Carers
IYPDAS
CASA Family Service
CASA FPF
Chance UK
Children’s Social Care
Interventions in Children’s Social Care
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Assessment of treatment needs and impact of use on children
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Parental drug & alcohol assessment and testing
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59 referrals for testing 2007/8, of which 51 were engaged
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Positive outcomes (defined by children remaining at home with a
child protection or children in need plan and children reunited
with parents) have been achieved for 28 adults (47%) & 40
children including 1 unborn
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Referral onto and engagement with community based treatment:
43 (73%)
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Referral into residential rehab: 11 (19%)
Outcomes
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Good buy-in from adult alcohol and drug treatment services
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Multi-agency working: we are better together
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Changes in culture and practice
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Addressing the needs of children affected by parental substance
misuse
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FAB group: partnership between Islington Young Peoples’ Drug &
Alcohol Service, CASA Family Service and Family Action Young
Carers Project
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Hidden Harm Steering Group
MALT and background to the post of
Senior Practitioner Substance Misuse
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The post of Senior Practitioner Substance Misuse was
commissioned in response to Hidden Harm (2003). The purpose
is to reduce harm caused to children through parental drug and
alcohol use.
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The post is located within a multi-agency team Camden MALT.
This is a specialist CAMHS service managed jointly by Health and
Safeguarding. The core task of the team is to provide a clinical
service for children subject to Child Protection Plans, and for
children and young people who are Looked After by Camden Local
Authority.
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The team has an assertive approach, working with high need,
hard to reach families. The team works within the Safeguarding
Framework, to support Local Authority Care Plans and assist the
Local Authority with their decision making about children and
young people.
MALT and background to the post of
Senior Practitioner Substance Misuse
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The post offers guidance concerning realistic expectations relating
to abstinence, reduction, and safety in substance misuse in a
timeframe that reflects the needs of children.
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A key message from the Hidden Harm report offers a different
approach to themes, legislation, culture and beliefs normally
undertaken around research and policy and one which represents
the thinking behind this current post.
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The post will reflect ideas and responses that will improve
outcomes for children and promote the recommendations of
Every Child Matters.
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‘Effective treatment of a parent can have major benefits for the
child’ (Hidden Harm 2003)
Senior Practitioner Substance Misuse
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Specialist resource undertaking direct work with the family to
consider the effect of substance misuse on children, parenting,
emotional well being and relationships.
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Planned pieces of work with parents, carers and children over a
series of sessions that supports care planning and decisions
required of Social Work Teams.
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Assessments will aim to engage family members in appropriate
treatment and offer insight into family history, functioning,
lifestyle, identity, drug use, priorities, consistency and their ability
to parent.
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Joint working with Adult Treatment Services and Forward (Young
Person’s Drug Service).
Senior Practitioner Substance Misuse
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In 2007/08, 31 families accessed substance misuse advice and
guidance via this post. 14 were in proceedings. 15 were CIN
with a child protection plan and 3 were CIN only.
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The parents were offered individual work, support in engagement
with the range of community treatment services, 1 community
care assessment undertaken to support in patient and residential
services.
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Motivational Interviewing, solution focused theory and systemic
theory are the fields of practice used.
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Children were assessed and engaged in Psychotherapy,
Psychology, Family Therapy and the FWD young person’s drug
service.
Recent developments – Systemic Workshops
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Systemic Workshops
• In January 2008 2 systemic workshops were dedicated to
substance misusing families. 6 substance misusing families
have accessed this service so far. Completed sessions for
each family carried an average of 8 sessions.
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Extended family members were invited to attend the systemic
workshops, independently of the client where appropriate.
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The systemic workshops have been instrumental in working
with substance misuse in a manner that was unavailable
elsewhere. The clients received powerful feedback from
family members about their substance misuse.
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The reflecting team consists of a Consultant Family Therapist,
Psychologist, Senior Practitioners, Trainee Family Therapist,
and Family Support Worker.
Recent developments – Family Support Worker
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Direct work with young people and their families around parental
alcohol and substance misuse.
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Assist young people in developing positive relationships with their
family and friends. Work will establish good communication skills
and assist resilience for individuals and their families.
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Provide support to families affected by alcohol and substance
misuse around harm reduction, signposting on support services
available, support in attending appointments and parenting skills.
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To support parents to access treatment and for those in
treatment to have access to parenting support.
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Develop closer integration between existing agencies that support
families affected by alcohol and substance misuse. Raise
concerning parenting, safety, children and issues outlined in the
Hidden Harm Agenda.
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Working with FWD (Camden’s Young persons Substance Misuse
Service) with training, group work and casework.
Recent Developments –
Strengthening Families Programme
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Programme is an evidence-based family skills programme.
Together, parents/carers and children learn to:
• Improve Family Relationships
• Increase Communication and Understanding
• Increase Coping Skills
• Improve School Success
• Reduce Harm and Promote Positive Change with Alcohol and
Substance Misuse.
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Parent Skills Training Group: Parents learn to increase positive
time with children, manage stress, give clear directions, develop
behavior change charts, hold family meetings, and use effective
discipline.
Young People’s Life Skills Training Group: Young people
learn communication skills, “the magic rules of success,” peer
resistance, recognizing feelings, consequences of substance use,
anger management, problem solving, dealing with criticism, and
other social skills.
Family Skills Training Group: In the second hour parents and
young people practice together new skills learnt in their separate
groups such as communication, problem solving and discipline,
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Specialist Substance Misuse Social Worker
Lambeth Children and Young People’s Service
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The Specialist Substance Misuse Social Worker post was created
initially on specific recommendations made by research
undertaken in Lambeth which assessed the needs of women
substance misusers in the borough.
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The post has evolved to also respond to the Advisory Council on
the Misuse of Drugs (ACMD) publication: Hidden Harm –
Responding to the needs of children of problem drug users
(2003).
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The post reflects the commitment of Lambeth CYPS in partnership
with the Lambeth DAAT to reduce harm to children as a result of
parental drug and alcohol misuse.
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The Specialist Substance Misuse Social Worker was appointed in
September 2005
Specialist Substance Misuse Social Worker
Lambeth Children and Young People’s Service
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This is a permanent post, based and line managed within the
Family Support and Child Protection (FSCP) team in CYPS. The
post is jointly funded by Lambeth CYPS and Lambeth Young
Persons Substance Misuse Grant.
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Specialist Substance Misuse Social Worker has regular clinical
supervision meetings with the Head of Service, Lambeth
Substance Misuse Team, Adult and Community Services.
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The Team Manager, Head of Service and Specialist Social Worker
meet quarterly to oversee development of the post.
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The Senior Commissioning Officer from Young People’s Substance
Misuse attends the quarterly meetings.
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The management structure is an excellent example of partnership
work.
Children in Need and Child Protection
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When parental substance use or misuse is an issue, the ongoing
work of the Specialist Social Worker contributes to the allocated
Social Worker’s assessment of parenting capacity, family and
environmental factors and the child’s developmental needs. This
includes both the direct work with the parent and consultations
with the allocated Social Worker.
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Child Protection Plans and Child in Need Plans routinely include
either i) referral to or consultation with the Specialist Substance
Misuse Social Worker or, ii) ongoing work between parent/s and
Specialist Social Worker. The Specialist Substance Misuse Social
Worker attends Core Group meetings, CP Conferences and CiN
meetings.
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The Specialist Substance Misuse Social Worker is embedded in
the work of CYPS.
Parents who experience problematic
drug or alcohol use
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The Specialist Substance Misuse Social Worker works with
parents that may not be ready, willing or able to engage with
local drug and alcohol services. The Specialist Social Worker will
meet with parents (usually at joint home visit in the first
instance) to seek their views, to work motivationally with them in
an attempt to support them to begin to access services in the
community.
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The Specialist Social Worker will work with the parent’s readiness
to change and, when appropriate, will link or refer the parent to
appropriate local services.
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In some cases, the Specialist Social Worker will complete a
Community Care Assessment (under the NHS and Community
Care Act, 1990) and link the parent to the Adults and Community
Services Substance Misuse Team for onward referral to
abstinence based support and rehabilitation services.
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–Specialist Substance Misuse Social Worker co-facilitates a
parenting skills course for service users of the Lambeth Drug and
Alcohol Service (SLaM)
Specialist Substance Misuse Social Worker
Intervention Outcomes –
from a sampler of 60 families to June 2008:
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For 58% of families, the specialist social worker’s interventions
played a significant role in safeguarding children
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74% of these families had children on the children protection
register/subject to child protection plan, all due to substance
misuse and related issues
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For 20% of families: family breakdown and local authority care
were prevented or families were successfully reunited
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55% of the families had problems related to parental alcohol
use/misuse
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43% of families had problems related to parental use/misuse of
class A drugs
Exercise
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What do you think are the challenges?
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Consideration may be given specifically to:
• The practitioner
• Treatment Services
• Safeguarding and Social Care
• Policies and guidance