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Evidence based practice

Option 2 uses a number of well-researched, evidenced tools when working with families. However, we are constantly looking for new and innovative ways to enhance our work and believe research led practice, enabling us to work in a way that affords families every opportunity to remain safely and cohesively together, is the way forward.

“Not all parents who use drugs and/or alcohol present a danger to their children. Indeed, much research indicates that in isolation problem drug use of a parent presents little risk of significant harm to children.” (Cleaver et al., 1999. p23)

When working with families we rarely start by addressing the substance misuse issues but concentrate on the families’ perception of what the difficulties are. Often isolation, social depravation, poverty and lack of supportive relationships impact on the families’ ability to function adequately and the drug and/or alcohol use is a symptom, rather than a cause of these difficulties - parents are misusing substances as a response to or way of managing other difficulties. That is not to say that neither the families nor we ignore the substance misuse issues impacting upon them. This is reflected in our goal setting statistics where an average of 92% of families set goals that relate to parents either becoming drug or alcohol free or reducing their use.

“However, research does suggest that both alcohol and drug misuse when combined with other parental problems can significantly increase the dangers to children.” (Hogan 1998; Sher 1991).

“It is estimated that some 800,000 children in England and Wales are living in a family where a parent has an alcohol problem.” (Brisby et al 1997, p.7)

Also, that one-third of referrals to social services departments due to childcare concerns, were due to drug and alcohol problems, although in some teams the rate was even higher than this.

“Social workers estimated that at least 50% and in some cases up to 90% of parents on their case load had either mental health, alcohol or substance misuse difficulties” (Kearney et al, 2000, p.8).

There is much to be learned from what parents tell us in relation to how they manage life as parents, the role played by their substance misuse and the dynamic between their histories, life in the present and the social and environmental context in which they find themselves. Parents who misuse alcohol and/or drugs are all too aware of the consequences of their behaviour and take appropriate steps to minimise the impact on their children. However, many may be unable to face these consequences without intensive specialist support.

When a family’s problems become so severe the referring social worker feels that the best alternative for the children is placement outside of the home Option 2 is designed to give the social worker and the family another option: a service that is more intensive, accessible, flexible, and goal-orientated than traditional supports.

Instead of relieving family pressure by removing the child Option 2 aims to add resources to relieve pressure and to facilitate the development of a safe, nurturing environment for the children within the context of their family as opposed to the care system which brings it’s own set of problems.

“Being looked after in the care of the local authority’s social services department is often cited as a risk factor for the development of serious drug misusing problems. Looked after young people are well represented in many of the other high-risk groups such as non-school attendees, children excluded from school, young offenders, teenage prostitutes, pregnant teenagers, homeless people etc.” (Gilman, 1999 p.24).

Children’s accounts of living in a family with alcohol misusing parents are mixed. Some talk about the difficult aspects of providing care and support to parents, however, many children view their help as contributing to reciprocal relationships within the family. The research shows that children are active social players and they may negotiate their roles and responsibilities within families.

"Children living in situations where there is domestic violence, parental substance misuse or mental health problems may not necessarily undertake more practical tasks in the home than other children, but they may feel more responsible" (Joseph Rowntree Foundation, 2004).

A fundamental part of the process of Option 2 is including children in the work with the family. Children in the studies on substance misusing parents, in particular, stressed wanting parents to talk to them more:

“Grown- ups think they should hide it and shouldn’t tell us, but we want to know. We want to be involved and we want our mums to talk to us about what they are going to do-we could help make decisions.”(Mullender et al.,op.cit.)

Children say that being involved in finding solutions to problems helps them to cope.

“People tend to protect children and young people. For me, this translated into ignoring my need to be informed and involved. My life was affected anyway and if I had guidance it might have made the experience more positive. I need good, age specific information about my mother’s condition and it’s consequences. And I need someone to talk to who would listen in confidence and help me to express and explore the complex feelings and situations I was dealing with.” (Marlow, J. 1966. Helpers, Helplessness and self-help.)

Listening to what children and parents tell us about what they need, what would help, and what has not worked and what has worked previously is a crucial part of our work. Research shows that services should address family needs rather than those of the drug or alcohol user.

“People need to be seen in context, with substance misuse as one of the many issues with which they may be struggling. Appreciating the totality of peoples lives rather than simply dealing with the perceived ‘problem’ will achieve a number of aims. It will enable people to be regarded as individuals in their own right and in relation to all the roles they play not just as “druggies” or “drunks”. This may in turn reduce the degree to which they feel stigmatised and discriminated against. It will also enable strengths as well as shortcomings to be identified." (Hogan and Higgins 2001).

Often practitioners assess the likelihood of future harm to children based on evidence of past family history. Option 2 works with the here and now, concentrating on the reality of the situation as the family see it. By being inclusive and working with the whole family this allows us to define problems in a way that generates options for change whilst recognising the strengths within the individual family members. Our aim is to enable people to feel more hopeful and in control of their situations.

Cheryl Symons

Bibliography

Cleaver, H., Unell. I. and Aldgate, J. (1999) Children’s Needs – Parenting Capacity: The Impact of Parental Mental Illness, Problem Alcohol and Drug Use and Domestic Violence on Children’s Development. London: The Stationary Office.

Hogan, D. and Higgins, L. (2001) When Parents Use Drugs: Key Findings from a Study of Children in the Care of Drug Using Parents. Dublin: Children’s Research Centre, Trinity College, Dublin.