1.5.2 The Use of Assessments in Care Proceedings and Childcare Planning for Babies of Substance Misusing Parents |
Contents
- Introduction
- Factors Identified by Research Affecting Outcomes
- Grid of Factors
- Care Planning
- Joint Work with Substance Use Team
- Treatment Options
- Contacts
1. Introduction
This guidance intends to assist social workers and their managers when consideration is being given to the use of assessments in Care Proceedings, and child care planning for babies of drug and alcohol misusing parents.
This guidance follows on from and takes into account the assessment of both the substance use and, more importantly, the effect of the substance use on the users parenting.
2. Factors Identified by Research Affecting Outcomes
Research has highlighted a tendency for some professionals working with substance misusing parents to be either over optimistic or unduly pessimistic in their analysis
of whether or not to return children home to their parents. This may be particularly true in relation to alcohol misuse. Cases involving drug misuse are far more likely to go into Care Proceedings while those where alcohol misuse is a key feature are more likely to go down the Child Protection route. There may be a number of legitimate reasons for this but there is some evidence to indicate that there is a tendency to attempt rehabilitation home even when the odds looked extremely bleak and to the detriment of the children (Harwin and Forrester, edited by Rena Phillips).
Whilst it is important to remember that all children and families are unique it is also important to note that there is a plethora of research relating to parents and their children where substance misuse is an issue. Such research has looked at the many factors affecting the outcome of working with families and it is now possible to identify the most common (Jo Tunnard, 2002; Becker & Duffy, 2002)
Therefore, these factors, both negative and positive, should be taken into account when considering the type of assessments needed when there has been a decision taken to initiate Care Proceedings.
3. Grid of Factors
Below is a grid which gives the range of factors which influence outcomes for parents using substances. The factors do not carry the same weight. The most protective factors are the support of the partner, grandparents and extended family; the greatest negative factor is the presence of a substance-using partner. With these provisos in mind the table below can be used in the following way: the factors should be circled in the relevant boxes marked A-D. If there are more ‘A’s than anything else than this would indicate a poor outcome of intervention. More ‘C’s and ‘D’s on the other hand would indicate a more positive outcome
Factors Affecting Outcomes
Click here to view Table containing Factors Affecting Outcomes
4. Care Planning
If the pregnant woman and /or partner are not engaging either with Family Services, drug services or the midwives, and the substance use is chaotic, then consideration must be given to:
- Informing all hospitals about the pregnancy and estimated date of delivery
- Pre birth case conference
- Notifying professional network of the pregnancy and pre birth planning
- Legal planning
If the pregnant woman and/or partner are partially engaged with the midwives, Family Services and drug services, then consideration should be given to:
- Pre birth planning (meeting or conference)
- Notifying professional network of the pregnancy and pre birth planning
- Joint planning with Substance Use Team and maternity substance use staff
- Legal planning
The Core Assessment and the use of the Grid Table should help to identify those families where successful rehabilitation is likely or not. Further assessment may be required to look at the parents’ parenting ability, and the parents’ drug use, to help plan the support substance user needs to care for their baby.
If in the pre birth and legal planning process, there is a decision that the local authority will not offer the parents a parenting assessment or a drug rehabilitation and parenting assessment, then advice from the legal team, FS&CP advisers and the Substance Use Team should be sought about the reasons and the research factors informing the decision making.
5. Joint Work with Substance Use Team
In the first instance it is recommended that a referral is made to the Substance Use Team, who work with the Community Assessment and Primary Services(CAPS).
If you in doubt about making a referral, please contact the Team Manager or the Duty Social Worker for an informal discussion.
Substance Use Team
The Basement
69 Warwick Road
London
SW5 9HB
Tel: 020 7938 8270
Community Assessment and Primary Services (CAPS)
69 Warwick Road
London
SW5 9HB
Tel: 020 8746 5800
It is recommended that the Substance Use Team, the service user and the children and family social worker meet to plan the intervention and then meet at agreed intervals to review the plan. Funding issues, if relevant, will need to be discussed outside these meetings.
6. Treatment Options
6.1 Role of the Substance Use Team
The Substance Use Team is a care management team who assess substance users’ needs for rehabilitation and treatment, and then care co-ordinate the case. Children and families work is seen as a priority by this team.
If service user shows no motivation and fails appointments, then there is a cut-off point for the Substance Use Team to pursue engagement. Sometimes, some low-key intervention continues in order to help the service user to engage with the service. But would not usually extend beyond a period of 3 months.
If the service user is prepared to engage, then there are a number of options, depending on the persons substance use and particular needs. The crucial question is: does the person need to reduce and stabilise their substance use, or is the need to be totally drug-free. Most of the rehabilitation options-both the community programmes and residential units -centre round the person being substance free. But there are parents who successfully look after their children on methadone programmes, and parents who have successfully controlled the substance use in order to look after their children.
6.2 Detoxification
If the service user uses opiates and/or alcohol, then the person is referred to CAPS for a medical assessment, to see if a detoxification programme is advisable. People can go straight from detoxification to a rehabilitation centre. Detoxification can be community or in-patient based.
6.3 Rehabilitation options
The substance use Team consider the following factors in coming to decisions about the rehabilitation option most suitable for the service user:
- What the service user requests
- What support the service user has in the community
- Past experience of rehabilitation
- History of substance use
- Abstinence in the past
- Length of use
- Risky lifestyle
- Dangerous circumstances (e.g., involved in dangerous criminal activity, threatened with violence)
- Homelessness
6.4 Community Rehabilitation
The expectation is that the service user should be substance free. The length of time of most community rehabilitation options is six months, with an initial 12-week intensive programme. There are:
- Structured programmes, for example SHARP, and the Core Trust (who can work with children)
- Package of care made up from different agencies
- Interim day programmes, for example Drug and Alcohol Foundation
- Blenheim Project Crack Day programme
- Solution Focused Family therapy service
Most of these programmes will have child care implications for parents. The structured programmes are very intensive and may not easily run alongside any structured parenting assessment.
6.5 Residential Rehabilitation
The expectation is that the service user should be substance free. In general terms, people who have a long, chaotic and heavy usage of substances go into structured residential rehabilitation. The time scale is mostly 12 weeks, but six months in total with aftercare. It may be more appropriate to consider placements without children of parents of older children or where the children are in stable placements with relatives. There are limited numbers of residential rehabilitation units, with only a few specialising in parenting assessments, so waiting lists are to be expected. If children are being placed with their parents, then Children and Families fund the children’s places. There is a cut-off age for children, in general the residential units do not accept the over 12’s.
6.6 Drug Testing
Children and Family social work teams are frequently asked by the courts to set up regular drug testing, to check whether the person in rehabilitation or in the parenting assessments centre is drug-free. Some community treatment and programmes and rehabilitation units carry out random tests throughout the programme, other programmes do not test since they are working with people on the basis of trust and are confident that it would become quickly apparent if the person was using substances. It is very hard to find a community resource which will undertake drug testing.
6.7 Reduction and Stabilisation of Substance Use
There are some options in the community, which help people to reduce and stabilise their substance use. Examples include:
- Methadone programme for opiates use. CAPS can set up methadone programmes and will then refer to the Drug Treatment Centre if longer term prescribing is needed.
- Alcohol projects to help people drink safely
- Psychology and family therapy
7. Contacts
In the first instance it is recommended that a referral is made to the Substance Use Team. Below are contacts for some of the main resources used but there is more complete information available in the Substance Use Directory located on the Intranet.
Substance Use Team
The Basement
69 Warwick Road
London
SW5 9HB
Tel: 020 7938 8270
Community Assessment and Primary Services (CAPS)
69 Warwick Road
London
SW5 9HB
Tel: 020 8746 5800
Drug Treatment Centre and Maternal Health Service
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH
Tel: 020 8846 6111
Alcohol Resource Centre (ARC)
314 Ladbroke Grove
London
W10 5NQ
Tel: 020 8960 5505
Space KC – Earls Court
4 Hogarth Road
London
SW5 0PT
Tel: 020 7373 2335
Space KC – Golbourne Road
51 Golbourne Road
London
W10 5NR
Tel: 020 8960 5510
Westminster Drug Project
470 Harrow Road
London
W9 3RU
Tel: 020 7266 6200
Blenheim Project
321 Portobello Road
London
W10 5SY
Tel: 020 8960 5599
Womens Drop In Afternoon (Thursdays)
5 Wolverton Gardens
London
W6 7DY
Tel: 020 8846 7870
Further Reading:
- Children exposed to parental substance misuse edited by Rena Phillips (particularly chapters 3, 7, 8, 10)
- Substance Misuse and Child Care Edited by Fiona Harbin and Michael Murphy (particularly chapters 1, 2)
- Parental Drug Misuse - a review of impact and interventions studies Jo Tunnard, research in practice, 2004.
- Parental substance misuse and Child welfare: a study of social work with families in which parents misuse drugs or alcohol the first stage report, June 2002 (Nuffield foundation- Harwin/Forrester
- Women Drug Users and Drugs Service Provision Jane Becker and Claire Duffy (Home Office publication, 2002)
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