Safeguarding Children of Drug Misusing Parents

The Advisory Council on the Misuse of Drugs (ACMD) Report 'Hidden Harm – responding to the needs of children of problem drug users' estimated that there are between 200,000 – 300,000 children of problem drug users in England and Wales, i.e. 2-3% of all children under the age of 16. The report also concludes that parental drug misuse can and does cause serious harm to children at every age from conception to adulthood. 

Parental problem drug use may be characterised by the use of multiple drugs, including by injection, and is strongly associated with economic deprivation and other factors that affect parenting capacity. The adverse consequences for the child are typically multiple and cumulative and will vary according to the child's age and development. See also Safeguarding Children of Alcohol Misusing Parents Procedure and Safeguarding Children at Risk because of Domestic Abuse Procedure.

An appropriate response to these children often require the close collaboration of a number of agencies including local Drug Action Teams, Health and Maternity services, Adults’ Social Care Services and Children’s Social Care Services, Adult Treatment Services, Courts, Prisons and Probation services.

Drug use in itself is not always reason for considering a child to be suffering or likely to suffer Significant Harm although it may be a contributing factor. 

Professionals working with children need to understand the complexity of the lives of drug users and gain confidence in working with people who use drugs. 

A thorough assessment by all relevant agencies is required to determine the extent of need and level of risk of harm in every case.

Where there is concern that a parent is involved in drug use, the effect on the child needs to be considered, including:

• The child’s physical safety while drug use is taking place;
• Possible trauma to the child resulting from changes in the parent’s mood or behaviour;
• The impact of the parent’s drug use on the child’s development including the emotional and psychological well being, education and friendships;
• The impact on new born babies who may experience withdrawal symptoms;
• The extent to which the parent’s drug use disrupts the child’s normal daily routines and prejudices the child’s physical and emotional development;
• The impact on the child of being in a household where illegal activity is taking place particularly if the home is used for drug dealing;
• How safely the parent’s drugs and equipment are stored;
• Dangerously inadequate supervision and other inappropriate parenting may include exposure to other drug misusing adults;
• Intermittent and permanent separation;
• Inadequate accommodation and frequent changes in residence.

The circumstances surrounding dependent, heavy or chaotic drug use may inhibit responsible childcare, for example, drug use may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks.

Any professionals, carers, volunteers, families and friends who are in contact with a child in a drug-misusing environment must ask themselves “What is it like for a child in this environment?”.

The Multi-Agency Threshold Descriptors will assist in determining the level of vulnerability of the child and at what point a referral should be made to Children’s Social Care Services under the Referring Safeguarding Concerns about Children Procedure. 

An Early Help approach will assist staff determining risk thresholds and the need to gather and share information in the interests of the child/ren.

Information gathered during the Early Help Assessment should form the basis for the referral.

Where any agency encounters a substance user, who is pregnant and misuse indicates that their parenting capacity is likely to be seriously impaired, they must make a referral to Children’s Social Care Services.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach /Care Co-ordination procedures will apply including input from the link midwives and a social worker from Children’s Social Care Services, who will be invited to any meetings taking place in respect of the child/ren. 

Where a newly born child is found to need treatment withdrawing from substances at birth, a pre-discharge discussion should take place and consideration should be given to holding a Strategy Discussion before the child is discharged home.

Children’s Social Care Services will consider undertaking a Child's Assessment of all pre-school children in a drug-misusing environment.

Where there are children in older age groups in a drug–misusing environment and there are concerns about the children and the impact of the parents and carers’ lifestyle, the same referral and assessment process applies and must include any considerations that the child might themselves be misusing drugs with or without the parent’s knowledge.

The assessments should consider and take account of whether the person concerned is hiding or denying their substance misuse; whether they are engaged in any rehabilitation programme; whether they receive support from a partner, family or friends; the impact of the drug misuse on the quality of care given to the child and the day-to-day environment of the child. 

Throughout the assessment process and where it is decided to hold a Strategy Discussion and convene an Initial Child Protection Conference, those agencies who have worked with the parents in relation to their drug use must be asked to contribute to the assessment, be invited to participate in and attend all relevant meetings.

If the concerns are in relation to an unborn child, the maternity services, both hospital and community based, must be involved and invited to attend.

See also Information Sharing Procedure.

Confidentiality is important in developing trust between drug using parents and staff in agencies working with them in relation to their drug use.

Families with a drug-using parent need to be able to ask for advice from appropriate agencies and to work together with them to safeguard their children. Services need to be accessible and attractive to drug using parents and pregnant women who use drugs.

No agency can guarantee absolute confidentiality. All agencies, both statutory and non-statutory, should have written procedures on confidentiality which provide for the sharing of information where there is concern about the wellbeing of a child who may be suffering or likely to suffer Significant Harm. When agencies start any work with drug-using parents or with pregnant women who use drugs, these procedures must be explained to them.

All maternity services should have procedures for pregnant women who use drugs that encourage them to go to antenatal services and help them to stabilise, reduce or stop their drug use.

Special consideration is needed in relation to pregnant women who misuse drugs. Where professionals are in contact with a woman who misuses drugs, access to counselling should be offered as early as possible about the likely health risks and discomfort the drug misuse may pose to the baby. Current, relevant and factual information needs to be offered in a non-judgemental and supportive manner, rather than giving directive, subjective and uninformed advice. Specialist advice is available from The Community Drugs Team.

Many pregnant drug users do not attend for antenatal care, presenting instead in late pregnancy or even in labour. This should not automatically be regarded as indicating lack of co-operation, it may be that the woman did not realise she was pregnant or due to fear that the child may be taken from her.

Experience or expectation of unsympathetic or hostile Health or Social Workers my deter women from attending for ante-natal or medical care. Many drug using women suffer low self-esteem, depression, anxiety states and guilt, therefore receiving a positive and supportive response when presenting for ante-natal care, is very important.

When a woman with a drug problem attends for antenatal care, she should be encouraged to contact the Substance Misuse Team for assessment and advice on the treatment options available to her.

See also: Safeguarding Unborn and Newborn Babies Procedure.