1. Lessons about safeguarding children when there are drugs/alcohol in the family The Road to Recovery Conference Brighton Oasis Project 5 September 2013 Gretchen Precey: Independent Social Worker

2. Lessons about safeguarding Risk is inevitable Parental substance misuse can be fatal for children- the story of Child T Reducing risk by improving professional practice Parental substance misuse: whats the damage to children? The contribution of women only substance misuse projects to safeguarding 3. CRI Safeguarding Training 3 The risk infested waters of decision making in child protection 4. There is no absolute criteria on which to rely when judging what constitutes significant harm Judgements on how best to intervene will often and unavoidably entail an element of risk Working Together to Safeguard Children 4CRI Safeguarding Training 5. Risk management cannot eradicate risk; it can only try to reduce the probability of harm. The big problem for society (and consequently for professionals) is working out a realistic expectation of professionals ability to predict the future and manage risk of harm to children and young people Munro 2011 2.32 5CRI Safeguarding Training 6. Reading SCR Seminar 7 Chronology of events 10/03 case opened by Reading CS on referral by Eire SEHB 09/10/03 Child T born 01/04 assessment begun by Family Support Team 01/05 case closed 03/05 case re-opened: serious Domestic Violence and T said to be dirty 06/05 T in police protection and foster care for 5 days 07/05 CP conference registers T on grounds of neglect 10/06 Legal Planning Meeting called due to escalating concerns about Ts care and parental domestic violence and substance misuse 24/10/06 Decision to replace application for care proceedings with intensive support package 29/10/06 T dies 7. Reading SCR Seminar 8 Relevance of practice and procedural issues to the case of Child T Start Again Syndrome Eligibility criteria and thresholds for action Information Sharing Working with Neglect 8. Reading SCR Seminar 9 Start Again Syndrome Used as a defence by workers to overwhelming information and feelings of hopelessness Each pregnancy or birth presented as a fresh start Parents fail to engage with agencies/ agencies fail to engage with parents Focus is on the present not on the family history, lack of progress not taken into account Growing evidence base that short-term, behavioural approaches are not likely to succeed with families with long standing, complex problems 9. Reading SCR Seminar 10 Eligibility Criteria Confusion and misunderstanding about thresholds Pre-occupation with eligibility criteria for services rather than a primary concern about the child or children with whom they were working Rectifying long standing problems with thresholds will be a key test of LSCBs 10. Reading SCR Seminar 11 Information Sharing It is what is done with information, rather than its simple accumulation, that leads to more analytic and safer assessments Communication problems were common Direct verbal communication more immediate and effective way to share concerns Lack of confidence, knowledge, experience, status resulted in failure to challenge information 11. Reading SCR Seminar 12 Practitioners should be encouraged to be curious and to think critically and systemically. Being aware of the way in which separate factors can interact to protect from harm or cause increased risk of harm is vital. Many of these families were also known to adult services, the well being of children and families must also be a priority for those working in services for adults 12. Reading SCR Seminar 13 Understanding neglect In these families parents tended to avoid agencies, but agencies tended to avoid or rebuff parents Most likely to be affected by the start again syndrome Family history is complex, confusing and overwhelming for practitioners Risk of recurring abuse is higher with neglect than other types of maltreatment 13. Reading SCR Seminar 14 Responding to neglect Debilitating impact on professionals must be recognised Clear mechanisms for reporting risks and protective factors Long term plans of intervention over an extended period is necessary its never too late to start again mentality (ref Think Family) can be counter-productive when working with neglect 14. ESCB Enhancing Professional Practice 15 Findings from Biennial Analysis of Serious Case Reviews The children (189) 2/3 under 5; under 1 60% of children died 17% subject to child protection plans 13% were on care orders or accommodated 45% of families highly mobile 50% of parents had criminal record 75% affected by DV, mental illness, substance misuse 75% did not cooperate with services The professionals Overwhelmed professionals/overwhelmed families Lack of clarity about procedures and confidentiality Assumptions about involvement of others Over emphasis on strengths Fixed thinking: neglect and rough handling Dearth of information about fathers and men Unrealistic expectations about capability of less experienced staff (CAF) 15. The chaotic behaviour in families was often mirrored in professionals thinking and actions. Many families and professionals were overwhelmed by having too many problems to face and too much to achieve. These circumstances contributed to the child being lost or unseen. The capacity to understand the ways in which children are at risk of harm is complex and requires clear thinking. Practitioners who are overwhelmed, not just by the volume of work but also by its nature, may not be able to do simple things well. Brandon et al 2009 16ES LSCB Learning Event 16. 17 Invisible Children Overwhelmed, chaotic families, negative support, drugs, violence, mental ill health, criminality Fixed views about family (e.g. men) fixed assessment Views (e.g. neglect) Efforts not to be judgemental, Whole picture missed, separate specialisms offer support Too much to achieve, Low expectations, success Is getting through the door, muddle about confidentiality ES LSCB Learning Event 17. New Learning from Serious Case Reviews 2012 Throughout the studies there was a sense of disconnection from the children themselves:- not paying attention to childrens emotional development and not thinking about what its like to be a child living in that family or beyond the school setting; seeing the disability not the child; and most powerfully holding back from knowing the child as a person. ES LSCB Learning Event 18 18. Oasis Presentation Reading 20 Problem drug and alcohol use figures in 25% of all children with a Child Protection Plan 19. Oasis Presentation Reading 21 Hidden Harm (ACMD 2004) 250,000 - 350,000 children of problem drug users in the UK Equivalent of 3 - 5% of all children under 16 Not all drug use is incompatible with being a good parent 64% of children of problem drug users live with their parents Most of the rest live with relatives 5% are in care 20. Oasis Presentation Reading 22 We need to have a variety of thresholds in responding to the impact of parental substance misuse. If all we possess in our threshold tool-kit is the hammer of child protection, then we tend to respond to every demand as though it is a nail, when often it may be a screw, a tack or even a drawing pin. Murphy and Harbin 2003 21. 23 Impact of Substance Misuse on Family Life Uncertainty and chaos Children witnessing parental drug use Criminal activity Disrupted education Children as carers Fear of censure and separation CRI Safeguarding Training 22. Barriers to talking to children about parental substance misuse Secrecy Shame Fear of being removed from home Loyalty Professionals lack of confidence/awareness 24CRI Safeguarding Training 23. Oasis Presentation Reading 25 Problematic Substance Misuse and Parenting Poor sensitivity Unresponsiveness to childrens emotional cues Heightened physical provocation and intrusiveness Some ambivalence about having / keeping children 24. Oasis Presentation Reading 26 Adverse effects on children Failure to thrive / developmental delays Blood borne virus infections Poor health care Emotional, cognitive, behavioural and psychological problems Early substance misuse Offending behaviour Poor educational achievement 25. Risk of Foetal Alcohol Syndrome Disorder 27 Lifelong condition not subject to detox after birth Learning disabilities Behaviour problems Distinctive facial features Scale of children with FASD only beginning to be recognised CRI Safeguarding Training 26. 28CRI Safeguarding Training 27. If there had been an Oasis Project in Reading would Trae-Bleu have survived? 28. Oasis Presentation Reading 30 Underpinning Principles Drug use cannot be tackled in isolation from womens other needs Women-centred / needs-led Motivational, harm minimisation / solution- focused approaches Trust and therapeutic alliance Acknowledging, accepting and containing maternal ambivalence toward change in illicit drug use and parenting responsibility Relational and attachment-based interventions 29. Oasis Reading Presentation 31 POCAR approaches Work on recognising own emotional regulation - maternal reflective functioning and separation of experiences Work on representations of child / parenting Work on inferences about childrens emotional needs / intentions, within a child development context Work on developing sensitive responses to cues / needs Emphasis on harmony and emotional regulation: reciprocal calm states Investment shift from craving to care-giving