1.4.15 Children of Drug Misusing Parents

1. Background

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 Children of Alcohol Misusing Parents and Domestic Abuse Procedure.

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

2. Safeguards and Concerns

Professionals need to understand the complexity of the lives of drug users and how their use of substances is impacting on the day to day lives of their children. A thorough assessment which includes contributions from all relevant agencies is important to determine the extent of need and level of risk of harm to children in every case.

Where there is concern that a parent is misusing drugs the effect of this on the child needs to be considered, including:

  • Whether parents are able to meet the child's needs;
  • 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 practises;
  • 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.

3. Referrals

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 living in this household?"

An Early Help / Early Intervention Assessment should be used in the first instance to determine the levels of need. If there are concerns that a child is suffering or likely to suffer Significant Harm a referral should be made to Children's Social Care Services under the Referrals Procedure.

Where any agency encounters a woman who is pregnant and misusing substances they must make a referral to Children's Social Care Services so that a Pre Birth Assessment can be commenced.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the local substance misuse services. 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.

4. Assessment and Initial Child Protection Conference

Children's Social Care Services will consider undertaking a Single Assessment in relation to all pre-school children known to be living 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.

5. Confidentiality

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 information sharing and 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.

6. Services for Pregnant Women

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.

When a woman who is misusing drugs 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.