Gretechen Precey - Independent Social Worker Lessons about Safeguarding Children when there are Drugs/Alcohol in the family from The Road to Recovery Brighton Oasis Project Annual conference 2013

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: what’s 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

7. 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 T’s 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

8. 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

9. 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

10. 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 LSCB’s

11. 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

12. 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

13. 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

14. 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
• ‘it’s never too late to start again’ mentality (ref
Think Family) can be counter-productive when
working with neglect

15. ESCB Enhancing Professional Practice 15
Findings from Biennial Analysis of Serious
Case Reviews
The children (189)
• 2/3 under 5; ½ 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)

16. The chaotic behaviour in families was often mirrored in
professional’s 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

17. 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

18. New Learning from Serious Case Reviews 2012
• Throughout the studies there was a sense of
disconnection from the children themselves:-
not paying attention to children’s emotional
development and not thinking about what it’s
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

20. Oasis Presentation Reading 20
Problem drug and alcohol
use figures in 25% of all
children with a Child
Protection Plan

21. 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

22. 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

23. 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

24. 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

25. Oasis Presentation Reading 25
Problematic Substance Misuse
and Parenting
• Poor sensitivity
• Unresponsiveness to children‟s
emotional cues
• Heightened physical provocation and
intrusiveness
• Some ambivalence about having /
keeping children

26. 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

27. 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

28. 28CRI Safeguarding Training

29. If there had been an Oasis Project
in Reading would Trae-Bleu have
survived?

30. Oasis Presentation Reading 30
Underpinning Principles
• Drug use cannot be tackled in isolation from
women‟s 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

31. 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 children‟s 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