Hidden Harm Tool Kit for Practitioners December 2017

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1 Hidden Harm Tool Kit for Practitioners December 2017

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3 Hidden Harm The potential for parenting capacity to be undermined and children s health and development to be harmed by parental substance misuse is considerable, particularly when other risk factors such as domestic abuse and mental health difficulties are present. This substance misuse can have an impact on the health and development of children, from before the baby is born all the way through to when they are an adult themselves All practitioners should consider Hidden Harm in early help and childcare assessments Assessment Triangle (DoH 2000) Uncover Hidden Harm What substances? Amount? How Obtained? How taken? When (pattern of use) Triggers to usage? Who with? Are children present? Others using in the house? Cost? Lifestyle past and present? Chronology? Impact on health, behaviour and mood? Impact on Parenting Capacity: Basic care Ensuring Safety Emotional warmth Stimulation and development Guidance and Boundaries Stability Priorities Drugs or Child? Strategies in place to protect the child? Partner - include non-resident partners or the child s father? Networks of support? Carer s Priorities Drugs or Child? What is the day to day life for the child? Is there evidence of child neglect? What is the bottom line? Consider the Adverse Childhood Experiences (ACE )Pyramid:

4 Question Hidden Harm ASSESS it : Don t ignore drug and alcohol use, don t over-react either each situation is different. Assess to understand the impact on the child(ren) See life from the child s point of view. What is life like when they wake up? When they go to bed? When parents are intoxicated or withdrawing? What are their hopes and fears? Who can they turn to? What is their engagement with school and social activities? Is the child in a carer role? Explore the views of the child. Remember, the needs of the child must take precedence over the needs of the substance using adult. Use the tools available to assist your assessment Audit is a useful tool to quantify alcohol use and its impact. The Hidden Harm questions listed here, Adult Wellbeing Scale and resource highlighted will help you assess and identify problem drug use and impact on parenting. All can be used to inform an assessment e.g. Early Help or Single Assessment. If there is evidence of child neglect use the GCP2 Use pre-birth assessments. These can provide a valuable opportunity to engage parents, who are often very highly motivated to make changes in their lives. Find out whether substance use is the only parental problem. If so, then prospects for success are higher. Where there are multiple parental problems (e.g. mental health difficulties, domestic violence, financial difficulties), then prospects of being able to offer safe and longterm care to children are significantly reduced. Substance use makes all other problems worse. Do not assume that abstinence will always improve parenting skills. There may be risks of relapse, or parents may struggle to adjust to a drug free lifestyle or relationship. Withdrawal from drugs can significantly impair capacity to tolerate stress or anxiety. Stability in treatment might be a more realistic option. Base your judgements on evidence not optimism. If substance use is enduring and chaotic, and there is no evidence of improvement, then this will undermine other interventions or support offered. Remember that most drug and alcohol users want to be good parents. But be aware that their expectations may be too high: that the child will compensate for past unhappiness or provide an incentive to remain drug free. They may set themselves unrealistic goals. This may lead to attempts to become abstinent too rapidly, with considerable risk of relapse. Consider the importance of drug and alcohol use in the parent s life. If a parent s primary relationship is with a drug, then it will adversely affect their relationship with others including children. If household resources financial, practical and emotional are diverted to substance misuse, there will be deficits for the children. Substance misuse may also be linked to domestic abuse the perpetrator may use the substances to control; or, the victim may use substances to escape. Ask for details of the Substances used and their effects. Substance use is not a single phenomenon but includes a wide range of behaviours. Specific information about the nature of substances used, and the lifestyle implications of such use, is needed in order to assess the impact on parenting. Consider the History of Substance Misuse Have there been previous attempts to change, relapse or decline of support. Check systems and services to develop an understanding and chronology. Apply the cycle of Change Be aware of your own views and feelings about drug use. Consider how these might affect your judgements. Recognise that parents are likely to be anxious They will worry about losing their children. This fear factor is likely to lead to reluctance to seek help or a denial or minimisation of problems. Children may share this fear of being separated from their parents. Challenge secrecy Include fathers/partners. Assessment can sometimes focus on mothers, but others may have an equal impact on the children. They may also affect treatment outcomes if one partner is more motivated than another to address their drug problem. Link with extended family. They are likely to be a source of useful information and may also be a vital support to the children. Family group conferences may make a real contribution to decision making. Consider timescales in the context of the child Can positive change be realistically achieved soon enough for the child? Adapted from Adult Drug Problems, Children s Needs by Di Hart and Jane Powell. Published by National Children s Bureau, 2006 and SCODA Assessment Tool

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8 Alcohol - Brief Intervention

9 Alcohol - Brief Intervention

10 DASH Domestic Abuse Risk Assessment Please contact DVAP for information and advice. The DASH assessment training information is available on the ERSCB website: It is advisable that this training is completed before undertaking DASH assessment as the training will support practitioners to: Explore each agencies responsibilities to identify, assess and manage where there is a risk of domestic violence, stalking, harassment and honour based violence be able to use the DASH risk assessment checklist to inform the assessments they are undertaking understand the barriers to disclosing domestic abuse which may exist be able to identify factors which may lead to changes in the level of risk

11 Hidden Harm Useful Resources Strategy : Parental alcohol and substance misuse and the impact on the child Procedures and Guidance: Working with substance misusing parents and those who come into regular contact with children and young people Can be found on the ERSCB website: Good Practice Resources: ERSCB Training : General: Assessment Tools: AUDIT Adult Alcohol Use Question Hidden Harm GCP2 Graded Care profile for child neglect (requires licensed training available from ERSCB training) DASH Domestic Abuse Risk Assessment Adult Wellbeing Scale Generic Assessments: EHA Early Help Assessment Single Assessment (including Pre-birth assessment as appropriate) Can be found on the ERSCB website: Alcohol & Drug Service (East Riding Partnership) : Hidden Harm: Video on Adverse Childhood Experiences (ACE):