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5.6.4 Children of Parents Who Misuse Drugs or Alcohol


  1. Introduction and Recognition
  2. Information Sharing
  3. Referral to Children's Services
  4. Referral During Pregnancy
  5. Babies Withdrawing from Substances
  6. Further Guidance

1. Introduction and Recognition

When referring to substance misuse this protocol will apply to the misuse of alcohol as well as 'problem drug use', defined by the Advisory Council on the Misuse of Drugs as drug use which has: 'serious negative consequences of a physical, psychological, social and interpersonal, financial or legal nature for users and those around them'.

When considering concerns about the misuse of drugs, alcohol or any other harmful substances it is usually in the context of concerns about the parent and any partner of the parent and any other adult drug user living in the same house hold as the child and therefore the impact on the child. It is important to remember that the parent may be a child, that is under the age of 18 years themselves, and therefore in need of additional services and assessments. The under 18-age group receive services from CGL, Change Grow Live Hertfordshire. CGL give enhanced priority to referrals involving pregnancy or where there are safeguarding concerns.

This chapter applies to all age groups of parents and the services available to the children and their parents. All services must collaborate and share information regardless of the ages of the parents and carers.

Parental substance misuse of drugs or alcohol becomes relevant to child protection when substance misuse and personal circumstances indicate that their parenting capacity is likely to be seriously impaired or that undue caring responsibilities are likely to be falling on a child in the family.

Substance misuse may include experimental, recreational, poly-drug, chaotic and dependent use of alcohol and / or drugs.

Misuse of drugs and/or alcohol is strongly associated with significant harm to children, especially when combined with other features such as domestic violence, mental illness and personality disorder.

The risk to child(ren) may arise from:

  • Use of family resources to finance parents' dependency, characterised by inadequate food, heat and clothing for children
  • Exposing children to criminal or other inappropriate adult behaviour
  • Unsuitable care givers or visitors - e.g. customer or dealers
  • Being passengers in a car being driven by a driver who has been drinking or using drugs
  • Effects of alcohol or drugs which may lead to dis-inhibited behaviours e.g. inappropriate display of sexual and/or aggressive behaviour
  • Chaotic drug use which may lead to increased irritability, emotional unavailability, irrational behaviour and reduced parental vigilance
  • Withdrawal symptoms including mood disturbances
  • Unsafe storage of drugs or injecting equipment
  • Adverse impact of growth and development of an unborn child
  • Risk to the newborn infant of being born with withdrawal syndrome
  • Increased risk of the child developing alcohol and drug use problems themselves (and associated risks of unwanted sexual encounters and injuries through fighting / accidents
  • Taking on a caring role which impacts on their emotional, physical and social wellbeing.

Parental non-compliance with treatment plans should raise professional concerns about the risk to the children.

2. Information Sharing

Partnership working across agencies is vital for effective assessments of risk and to ensure child(ren)'s safety and involves:

  • Communication
  • Sharing of information
  • Co-ordination of responses

To benefit treatment, parental drug and alcohol users should be asked to agree to their information on substance use and treatment being shared with children, parenting and family services. However, in accordance with the Information Sharing and Confidentiality Procedure, consent is not needed where there is an immediate risk to the life of a child(ren) or for the unborn child or where seeking such consent would place the child(ren) or for the unborn child at increased likelihood of suffering Significant Harm.

Care programme meetings regarding parental drug or alcohol use must include consideration of any needs or risk factors for the children concerned. Children's Services should be given the opportunity to contribute to such discussions. A representative from substance misuse services should attend Child Protection Conferences if a child of a parental drug or alcohol user is the subject and should provide written reports where necessary.

Strategy Discussions and Child Protection Conferences must include workers from any drug and alcohol services involved with the family.

3. Referral to Children's Services

If staff in drug and alcohol services have concerns regarding the care of the child (or unborn baby), they must discuss them with their line manager or supervisor immediately.

If it is clear that a child is at immediate and serious risk an urgent referral must be made to Children's Services in accordance with the Contacts and Referrals Procedure.

If there is any uncertainty about whether a referral is appropriate advice should be sought from the social work team duty manager / worker.

Child care concerns which do not involve child protection can also be referred for advice and support on a child in need basis as a Common Assessment with the agreement of the parent / carer.

A GP who has concerns and is uncertain about the appropriate action should discuss with the 'named doctor' or 'named nurse' for child protection in her/his Trust.

Substance misuse services should endeavour to be kept informed about the outcome of the referral to Children's Services and be aware of subsequent social work or other family support service involvement with the family. This is critical to ensure that information can be shared and links between agencies can be made as needed.

4. Referral During Pregnancy

If a professional is aware a pregnant woman or her partner is involved in significant substance misuse, a referral should, if there are concerns about the welfare of the baby during pregnancy or after the birth see Pre-Birth Assessment and Guidance Procedure be made as early as possible,

A referral must be made to Children's Services if one or more of the following criteria are met:

  • A previous child has been removed or is living permanently with another carer
  • The woman has been using heroin, methadone, cocaine or comparable substances for a significant period
  • The woman is continuing to use heroin or misuse methadone and making insufficient preparations for her baby's arrival
  • Her use is characterised by multiple drugs / drugs and alcohol
  • Family's lifestyle is known or reported to be chaotic and / or unhygienic
  • Another household member is known or reported to be involved in significant substance misuse
  • The absence of extended family / friends able to provide extensive support to the substance misusing prospective parent(s).

The midwifery service must initiate a phone and written referral as soon as it becomes aware of concerns relating to substance misuse, using a Single Service Request Form.

The midwife should ensure Hep B and HIV screening has been recommended to all drug abusers (Hep C screening is also recommended for intravenous users or for those who are Hep B or HIV+) and that the results are available in the hospital notes (see Pre-Birth Assessment Procedure that apply in these circumstances).

5. Babies Withdrawing from Substances

Where a baby is born suffering from withdrawal symptoms the midwives must refer the baby to Children's Services immediately. The baby has suffered significant harm and the Contacts and Referrals Procedure apply. Unless the baby is already the subject of a Child Protection Plan, Children's Services should convene a Strategy Discussion with Joint Child Protection Investigation Team (JCPIT), medical professionals and any other relevant professionals (see Hospital Appointments, A & E Attendance and Discharge Procedure)

This discussion will need to decide and plan:

  • The assessments to be initiated, including whether or not to initiate Section 47 Enquiries
  • If it is safe for the baby to be discharged / remain at home
  • Health and Children's Services plans to provide support and monitor progress
  • Arrangements for notification of discharge from hospital - Children's Services should be informed by hospital staff as early as possible prior to discharge.

6. Further Guidance

The HSCP is developing a 'Drug and Alcohol Treatment Services and Family Services' protocol to address safeguarding. This is due Spring 2010 and will be included in a future update.