Children of Drug/Alcohol Misusing Parents

Drug or alcohol misuse of a parent or carer does not necessarily have an adverse impact on a child, but it is essential to assess its implications for any children within and connected to the family.

Drug or alcohol misuse of a parent can have an impact on children in a number of ways, including:

• Substance misuse in pregnancy may impair the development of an unborn child;
• The risk of physical injury to a child sleeping next to an adult, occurring as a result of the adult lying over or against the child (over lay) is increased if the adult is sedated due to the effects of alcohol and/or prescribed or illicit drugs;
• A parent's practical caring skills may be diminished by substance misuse;
• Substance misuse, or withdrawal from substance misuse, may give rise to mental states or behaviour that put children at risk of injury, psychological/emotional distress or neglect;
• Substance misusing parents may find it difficult to prioritise the needs of the children over their own i.e.: health appointments, schooling;
• Money available to the household to meet basic needs may be reduced;
• Members of the family, including children, may be drawn into criminal activity;
• Children may be at risk of Physical Harm, or death if drugs and drugs paraphernalia are not stored safely and children have access to them;
• Children may be endangered if they are carried as passengers in vehicles driven by a substance misusing parent;
• There are potential risks to the child from parental acquaintances or family members if they are also involved in drug/alcohol misuse;
• There are contextual safeguarding risks to be considered in regards the vulnerabilities for exploitation, for children living with domestic vulnerability such as parental substance use, and the criminal/harmful networks which may surround the child and family.

Substance misuse by parents does not automatically indicate child neglect or abuse; therefore the children of parents who misuse substances should not automatically be subject of a Section 47 Enquiry and Child Protection Conference. Such an approach may deter the parents, or other members of the family from approaching Children's Social Care, the addictions services or other agencies, for help and advice. Consideration should be given as to whether an Family Help Assessment would be appropriate for the child or young person. See The Family Help Assessment Tool or Pre The Family Help Assessment Tool.

The risk of physical injury to a child sleeping next to an adult, occurring as a result of the adult lying over or against the child (over lay), is recognised. The risk is increased if the adult is sedated due to the effects of alcohol and/or prescribed or illicit drugs. It is therefore essential that professionals working with the parents or carers of babies or young children educate parents and carers about safe sleeping arrangements, particularly those known to misuse substances where such risk to children will be higher. Adopting a Think-Family approach is crucial when working with adults who are also parents. If you are unsure how to ensure a Safer Sleep message is delivered, support can be sought from the Universal Child Health Services such as Health Visitors, to ensure the need for safe sleep education is shared and acted on.

It is important that professionals discuss safe storage of medications with parents also and the risks to children if medicines/drugs are accessible. If you have concern about the safe storage of medications/substances, you can reach out to the agency that prescribes these medications to explore ways of improving and supporting the safer storage of medications. Community Drug Services locally may also be in a position to support with this if the client is open to their service.

It is important that any professional involved with a parent or pregnant woman who is also a substance misuser is able to identify those factors which may have an adverse impact on the ability of the parents to safely care for and meet the needs of the children, and refer such concerns appropriately to the Addictions services and to Children's Social Care.

Children's Social Care will undertake a Single Assessment in line with the Framework for Assessment for Children in Need and Their Families, as with any other situation where there is concern that a child is likely to suffer Significant Harm.

Children's Social Care will also ensure that a referral to the appropriate addictions service is made, for a specialist assessment in relation to the use of drugs or alcohol, and the impact of this on the child's care.

Assessment of the likelihood of Significant Harm to children where one or both parents, or another member of the household, is a substance misuser should consider the following:

• Previous concerns regarding the care or safety of children;
• Family relationships; whether both parents or other members of the household are misusing substances; whether the parents associate primarily with other substance misuses; whether members of the extended family are aware of the substance misuse and are supportive; whether domestic violence is apparent in any of the household relationships;
• The pattern of drug use; including the drug used, the amount used and the method of use; whether the substance misuse is stable, chaotic or includes the misuse of a number of substances;
• Safety within the home; whether drugs, including alcohol and methadone, and also drugs paraphernalia, including syringes, are stored safely or whether the children have access to these items;
• Risk of fire - Referrals should be made to the fire service for home checks;
• The accommodation; whether the accommodation is stable or the household is transient; whether the accommodation is used by other substance misuser's;
• The procurement of drugs; whether the accommodation is used for dealing drugs or for prostitution; whether the children are left alone whilst drugs are procured, or taken out and exposed to dangerous circumstances;
• If parental acquaintances are also involved in substance and alcohol misuse to assess if they may pose a further risk to the child;
• Household finances; whether the substance misuse takes priority in the allocation of household finances over the provision of adequate food, clothing and a suitable home environment for the children;
• Health implications; whether the effect of substance misuse on the health of the parents affects their ability to meet the needs of the children;
• Children will often be absent from school and this can be a key indicator where the substance use is impacting on parenting
• Parental perception; whether the parents have insight into the effects on the children of their drug use, or deny any negative impact on the children and place their own needs before those of the children;
• Consideration should be given to referring children and young people to Young Carers Service.

NICE Quality Standard QS 204 Foetal Alcohol Spectrum Disorder

Guidance - Foetal Alcohol Spectrum Disorder: Health Needs Assessment

Guidance: Parents with Alcohol and Drug Problems - Adult Treatment and Children and Family Services