Assessment and intervention

Suggestions about how to assess a person’s substance use have been made in the section on Identifying and Assessing Substance Use. This section will focus on assessment and intervention in relation to parenting in particular.

All local authorities should have guidance on working with parents who use substances problematically. The local ACPC (Area Child Protection Committee) will likely have taken the lead in drawing up guidance on this issue. Contact the ACPC chair or policy lead in the local authority. Social workers in the voluntary sector need to ask for policy guidance and documents from their employing agency too.

The following checklist may help social workers reflect how well equipped they are to assess and intervene with a parent using substances:

• Do you have the knowledge and skills to carry out a level 1 assessment (DH 2002) (see section on ‘Identifying and Assessing Substance Use’)?
• Have you honestly and openly reflected on your value base in relation to working with drug and alcohol users and how this will impact your intervention?
• Have you got/read your agency policy on working with alcohol and drug users?
• Do you have a list of the alcohol and drug agencies in your locality?
  What are their policies on child protection?
• What are their referral procedures and how long is their waiting list?
• Do you have a basic understanding of their different approaches to understanding and working with substance use, eg. social or medical models of substance use?
• Do they undertake family work, couples counselling, family support?
  Who is your contact in these agencies?
• How does your agency work in partnership with these services?

Assessment
The main challenge of assessing parents using substances is that historically one agency has done the assessment of the substance use and one agency has done the assessment of the parenting. These assessments have been underpinned by different goals, professional role, philosophies and so on. Bringing the two together arguably remains a challenge but both children’s and substance use services are increasingly working together and pooling expertise. Child care and substance use services must work together to properly assess the impact of the substance use on the parent and the extent of the risk to children.

There is not a simple ‘off the peg’ assessment tool for social workers to use for assessing parental substance use. This section will offer some guidance but much of it relies on workers having a good basic knowledge of substance use as well as the skills to be able to use the available guidance in the first place!

If substance use is an issue in relation to parenting, social workers need to be able to ask about it in a way that reduces denial or minimisation of any problem (see ‘Identifying and Assessing Substance Use’). They also need to be able to give something in return in the form of information and knowledge about what specialist support is available (see ‘Specialist Intervention and Treatment’).

The focus of the social worker’s assessment will be to:

• Carry out a level 1 assessment of the parent’s substance use
• Explore the impact of alcohol or drug use on the parenting capacity of the adults in family
• Establish how, and whether, this effects the development and safety of the children

Harbin and Murphy (2000) developed a model for assessing parental substance use that fits with the Assessment Framework.

However, parental substance use may also have an impact on children's developmental needs and may also have an impact on family and environmental factors. Conversely, the stage of a child's development and family and environmental factors may also act as resilience or protective factors.

Thus it is evident that properly assessing the impact of parental substance use, and determining what is directly related to the substance use as opposed to other factors, is not going to be achieved using a one-off tick box assessment form.

Further, children's views need to be sought. Questions need to be age and development appropriate, however, Kroll and Taylor (2003: 260) suggest questions that include the following:

• What is it like when their parent is under the influence of alcohol/drugs?
• What is it like when they're not?
• What would they most like to be different? Or stay the same?
• Are there things that happen that make them scared? (particularly important given the association of substance problems with domestic abuse and violence).

Kroll and Taylor suggest other questions explore caring responsibilities of the child and whom they can turn to for support.

A further set of guidelines for assessing risks from parental substance use was produced by SCODA (Standing Conference on Drug Abuse) in 1997. As SCODA no longer exists, these are now available from Drugscope. However, they have been criticised for not including children’s views. The guidance is in the form of questions for professionals to ask themselves following assessment. Thus it is helpful in suggesting topic areas that should be covered in the assessment. It does not recommend how the questions should be asked or what the questions should be.

Intervention
Specialist agencies are more than likely going to work on the parent’s substance use only unless they have specialist staff working with families or are one of the fewer services working with families and/or children in their own right.

Social work intervention can therefore focus on the following:

• Working with parents on positive involvement with their children
• Working with parents and other social networks to ensure that protective and resilience factors are in place or built up
• Addressing other family needs at the same time, eg. health, domestic abuse, housing or financial problems. NB. The more support the family has the greater the chance of risks to children being reduced and the greater the chance of the parent successfully addressing the alcohol or drug problem. This needs to happen alongside any support the parent may seek for their substance use – not before or after only. Specialist services that focus on the family’s holistic needs rather than singling out the substance use have demonstrated considerable success (see ‘Good Practice’ section).
• Monitoring parenting ability and its impact on children
• Supporting other family members in their own right (see ‘Supporting Families’)
• Facilitating holistic package of care and support for substance using parent(s), non substance-using partner, children and family unit.

Research shows that children view agencies helping their parents very positively. If social workers are seen by the child as helping mummy or daddy get help rather than punishing them, the relationship between child and social worker is likely to be far better. Social workers need to check whether local substance use agencies have family groups or children/family workers on staff. If not, ask them for information on substance use services that work with families. (See ADFAM website for information too – www.adfam.org.uk.)

Where intervention is at crisis point and the child is subject to removal from the home or other child protection procedures, the social work intervention with the parent and other family members needs to continue wherever possible. This will maximise the chances of the child being returned to their family unit (if and when appropriate) and maximise the chances that the family will be better prepared to provide a safe and healthy environment for the child.

References

• Department of Health (2002) Models of care for the treatment of drug misusers. London: DH
• Harbin, F. and Murphy, M (eds.) (2000) Substance misuse and child care. How to understand, assist and intervene when drugs affect parenting. Lyme Regis, Dorset: Russell House Publishing
• Kroll, B. and Taylor, A. (2003) Parental Substance Misuse and Child Welfare. London: Jessica Kingsley
  

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