In 'Addicted Parents: Last Chance to Keep My Children' we saw Fay and Micky, who have long-standing substance misuse problems seriously affecting their ability to parent effectively, go into a family residential treatment unit with their young son. There are a range of challenges and dilemmas for both social workers and other professionals when working with families where there is problematic substance misuse affecting the lives of children.
Balancing and assessing risks, needs, vulnerabilities and rights
There are key dilemmas in supporting parents with longstanding and complex needs and balancing these with those of the child. Some of the keys skills include engagement and trust, given the stigma that families feel, the fear they have of being open (‘people lie because the truth has huge consequences’) and their fear of confronting change.
Making such assessments requires both knowledge and particular skills. This includes knowledge of the impact of parental substance misuse on the family on parenting capacity and the requisite skills and approaches required to explore this. It is also important to gain access to the wishes and experiences of the children concerned and to understand the parents’ natural resistance to change. What is needed are strategies to engage constructively and effectively to assess children’s needs, within a child development framework, as well as approaches to working with understandable resistance and denial from parents, in a constructive but effective way.
For example, persistence (‘asking the same question in three different ways’), using intuition when things do not add up, the social worker managing their own feelings of being ‘an unwanted guest’, while at the same time believing that engagement is achievable, as is change in the parents.
Discussion reflects some of the personal challenges of working with those who find change very difficult and the tension between believing in the possibility of change but being realistic about what can be achieved and what cannot. The age of the child is critical here, as change has to be achieved within the timescale for the child. This highlights the balance between engagement and sticking with parents, as a catalyst for change, and yet holding on to the central concern – the child’s welfare, emotional and physical needs, and safety as the guiding arbiter in the key decision of what is best for the child.
There is a difficult balance to achieve with an importance of guarding against drift. A social worker cannot allow themselves to become preoccupied with adult needs - however valid in terms of their disadvantaged lifestyles and economic circumstances and, as a consequence, lose sight of the child.
In making an assessment, the key elements to consider are gaining an understanding of the child’s need and wishes, inter-agency information sharing, and working together to monitor and assess the changing nature of risk. It is useful to reflect on a key challenge here. How is this ongoing monitoring of changes in parents’ behaviour, as seen by various different agencies, understood in terms of the impact on the child and his/her timeframe? The timeframe for the parental change and the child’s timeframe may not “match”.
There is the importance of supporting parents as they commit to change, because as this is likely to lead to more stability for the child if his/her parents can make sustained changes. However, is no simple decision and highlight the challenges in making such decisions. How will the child experience the environment in the unit? Will this be better than the inconsistences inherent in the home situation? Would the child’s removal provide better protection? Will change be made by the parents? Will it be significant enough change? Will it be sustained? Again the critical question implicit here is the speed of change in the context of the child’s timeframe and developmental stage.
One parent may make significant changes and the other not. Balancing needs, risks, vulnerabilities and rights, the legal rights of both parents and the child have to be weighed against the potential risks and benefits of the child’s separation form one of their parents, in terms of attachment and sense of security. Once again, the importance of timescales and the developmental stage of the child are important here. Is it good enough that the child waits months/years for the parents to meet their needs?
Both the environmental and the developmental risks of the child must be considered. The social worker must also weigh up the possible impact of contact vs no contact with the absent parent, in terms of attachment for the child, and the impact which may sabotage treatment goals. This is to weighing up both risk and protective factors, including such factors as stability over time and the presence of a cohesive parental relationship.
The social worker’s assessment must include longer-term issues. Key questions might include: What is the longer term plan?, How can the protective factors, present in parenting, be monitored by child care and other professionals in the network? How will future parental contact be best achieved so that it supports rather than disrupts the child’s development?
Assessing motivation to change and sustain change
The very different progress of both parents also raises questions and challenges about assessing motivation for treatment. Whilst there is evidence to suggest that external pressure to change can be a significant motivational driver (Forester & Harwin 2011), we also know the role that a substance plays in a relationship is a complex one (Kroll and Taylor 2003).What is the reason that one or both parents are using? What might be the underlying problems beneath the drug or alcohol use? What is the impact on the relationship when one or both give up? It is easy to underestimate the complexity of this dynamic, and, as the case illustrates, that one parent’s relapse can seriously undermine the other’s efforts (Cleaver at al 2010, Taylor and Kroll, 2003). What implications might this have for their future relationship and ongoing work?
Working with and assessing children
One of the key challenges is gaining an understanding of the child’s experiences, and his or her wishes and feelings (Barlow et al 2016). There is an importance about thinking creatively about which professionals in the child’s network might be best placed to achieve this. This raises a number of key issues - how far will loyalty to parents or fear of talking inhibit children? Will older children be more reluctant to disclose what they see, hear, feel and experience than younger children?
Key points in working with children in these circumstances include an understanding and expectation from professionals that children will find it hard to talk about parental substance misuse and how it has affected them. Here, we need to think about the importance of adapting approaches (drawing, enactment, play) or using others to do this work, taking account of the child’s development and language. It is also important to recognise that trust is a pre-requisite for any work and takes time to establish. In addition, children often move in and out of talking about distressing feelings and situations. Finally, the importance of observation and behaviour in making assessments of children in these circumstances, is crucial.
Barlow, J. Hart, D. and Powell, J. (2016) Adult Drug & Alcohol Problems, Children’s Needs: Assessing the impact of parental drug use – an interdisciplinary training resource for professionals (2nd Edition) London: National Children’s Bureau/ Jessica Kingsley Publishers
Cleaver, H., Unell, I. and Aldgate, J. (2010), Children's Needs, Parenting Capacity: The impact of parental mental illness, learning disability, problem alcohol and drug use and domestic violence on children's safety & development 2nd Edition London: The Stationery Office
Forrester, D. & Harwin, J. (2011) Parents Who Misuse Drugs & Alcohol: Effective Interventions in Social Work & Child Protection Chichester: John Wiley
Kroll, B. and Taylor, A. (2003) Parental Substance Misuse and Child Welfare London: Jessica Kingsley Publishers