Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

Living with an elephant: Growing up with parental substance misuse

Although parental substance misuse is now a focus of concern in child welfare practice, we know little about what it is really like for children who grow up in families where adult drug and/or alcohol use is an issue. Set against a backdrop of research links between parental substance misuse and child maltreatment, this article examines a number of studies that focus on the experiences of children and young people in this context. Emerging themes are identified which provide insight into the world of children for whom a substance is, effectively, a family member –‘the elephant in the living room’– and the implications for practice, particularly in relation to children's visibility, disclosure and confidentiality, are considered. It is argued that a focus on the ‘elephant’ often leads to children remaining ‘invisible’ to those whose role it is to ensure their welfare.     

A family affair? Kinship care and parental substance misuse: some dilemmas explored

Both the Children Act 1989 and the Human Rights Act 1998 support the principle that children should remain within their birth families wherever possible and that this option must be considered when children are unable to live with their parents. Where parental substance misuse is an issue, family placements, whether formally or informally arranged, are increasingly being used and the support of grandparents, in particular, has been identified as a significant protective factor for children. This paper examines some of the issues that can arise with such placements, particularly in view of the part that substance misuse may play within the wider family system, the impact of parental drug and alcohol use on attachment and child development, and the complex dynamics that can ensue. Drawing on themes emerging from parental substance misuse literature and kinship care research, some practice dilemmas will be explored. While acknowledging the complex aetiology of substance misuse and the dangers of pathologizing family systems in which it is found, some hypotheses about potential risks and challenges will be debated. It will be argued that, although such placements can often provide children with a safe haven, they may demand a specific type of support and monitoring, if children’s welfare is to be safeguarded.     

Parental substance misuse and child care social work: findings from the first stage of a study of 100 families

Parental misuse of drugs or alcohol is known to be a common issue for child care social workers, yet there has been surprisingly little British research on the topic. The study reported here attempts to address this gap. All files going for long‐term allocation in four London boroughs over on average 1 year were examined (290 files). Parental substance misuse (PSM) emerged as a major feature of social work caseloads. Of the 290 cases, 100 (34%) involved concerns about parental substance misuse. The families involving substance misuse were more vulnerable on a variety of measures: the children were younger, the parents had more individual problems and the families lived in more difficult social situations. PSM cases tended to be ‘heavy end’ at the point of allocation: they accounted for 62% of all children subject to care proceedings and 40% of those placed on the child protection register. There was a fairly even spread between alcohol and drug misuse, and a number of cases involved both. Substance misuse specialists were rarely involved in working with families, primarily because parents said that they did not think that they had a problem. Suggestions for ways in which policy and practice with PSM might be improved are made in light of these findings.     

Adapting the Friends of the Children programme for child welfare system‐involved families

Research has shown the importance of long‐term, caring adults for children in foster care. This paper reviews the Friends of the Children (FOTC) long‐term mentoring programme and how it was adapted to serve children and families with child welfare system involvement. This study's two research questions are (1) How do Friends (FOTC's paid professional mentors) currently work with, and in turn, have an impact on, child welfare‐involved families? and (2) How can Friends better support child welfare system‐involved caregivers and families to promote family stability, permanence, and child well‐being? Data were collected from 21 caregivers (foster and biological), 24 FOTC Friends, five child welfare workers, and five teachers. Qualitative analyses of focus group, interview, and open‐ended survey data revealed a wide variety of ways Friends currently support children and families. In addition, several recommendations were made for strengthening programming. These findings provide valuable insights into providing long‐term mentoring to child welfare system‐involved children and families.     

A space of safety: Children's experience of equine‐assisted group therapy

Owing to a shift in alcohol and other drug practice towards a more ecological understanding of the impact of problematic parental substance use, children who were previously forgotten by practitioners are increasingly being included in alcohol and other drug service provision. Occurring concurrently with these changes has been a boom in interest in non‐talk‐based therapies to enhance child well‐being. Examples of such therapeutic interventions include adventure‐based activities, theatre, yoga, music, and purposeful interaction with animals. The latter approach, increasingly delivered by social workers, is known as animal‐assisted therapy and involves the inclusion of animals in a goal‐directed intervention. Equine‐assisted therapy (EAT) is a specialised branch of animal‐assisted therapy in which horses are used to cofacilitate therapeutic interventions. Although EAT practitioners argue horses are uniquely effective therapeutic animals, a strong evidence base has not yet developed. The present study utilised qualitative methods to explore children's individual experiences of an EAT program. Thematic analysis of interview data found that EAT is beneficial to children experiencing problematic parental substance use as it offers an environment in which children can feel safe and secure and are supported to grow, personally and socially, by mastering fears, making new friends, and improving their interpersonal behaviours.     

Substance‐dependent women becoming mothers: breaking the cycle of adverse childhood experiences

Parenting may be particularly challenging for substance‐dependent mothers who have grown up with parents who themselves had substance use disorders (SUDs). The aim of this study was to explore how substance‐dependent mothers describe their childhood experiences with substance‐abusing parents and the association between these earlier experiences and their own role as caregivers. Using purposeful sampling, mothers admitted for 1 year to a family ward at a substance abuse clinic were approached. Through in‐depth, qualitative interviews, nine substance‐dependent mothers described their lives in the form of present, past and future tense. The findings indicate that substance‐dependent women, who have experienced SUDs in their families of origin, face several major challenges when they become mothers. Some describe having lived their whole lives ‘on the edge of society'. This makes their rehabilitation process more complex. All mothers work to abstain from substances, process traumatic experiences and integrate their family into society. They need help to build supportive social networks and to establish a safe and predictable family environment for themselves and their children. The therapeutic implications of these findings will be discussed.     

Dilemmas when working with substance abusers with multiple and complex problems: the case manager's perspective

Since the 1990s, case management has been implemented in the USA and Canada – and recently also in various European countries – to support substance abusers with multiple and complex needs. Although this intervention is often presented as a set of standardised functions, its application is often a subjective task involving various dilemmas, which may influence case management outcomes significantly. Based on a comparison of case managers' experiences in Denmark and Belgium, we focus on several core dilemmas in case management for substance abusers with complex problems. Case management practices vary from one project to the next and even within the same project. Such differences are apparently related to the way in which case managers approach dilemmas such as those existing between control versus self-determination, or between systematic versus ad-hoc planning. The conclusion is that it is vital to discuss these dilemmas during training courses and supervision meetings in order to ensure that the intended form of intervention is actually delivered on the ground.     

The challenges presented by parental mental illness and the potential of a whole‐family intervention to improve outcomes for families

Parental mental illness (PMI) can negatively affect the lives of all family members, and there is acknowledged need to work with family and social contexts to promote recovery. However, programmes undertaking such work remain rare and knowledge concerning mechanisms through which PMI impacts families and through which recovery might be achieved is underdeveloped. This paper outlines a new family intervention programme and presents evidence from focus groups with 16 professionals into their experiences of work with families with PMI. Evidence suggests that interactional effects of PMI, family communication and family relationships are key to understanding its impacts, but professionals are liable to struggle to engage with these due to concerns over stigma, lack of skills and low confidence. Positive impacts on practice were achieved through raising awareness of the whole‐family context in relation to PMI, building confidence to raise and engage with PMI and the provision of structured tools for use with families. Positive impacts on the lives of family members were then achieved by professionals in relation to symptoms for the ill parent, the burden on children and overall family well‐being, strongly mediated through improved family communication, understanding and relationships. Implications for policy and practice are considered.     

Child Well‐Being Scales (CWBS) in the assessment of families and children in home‐care intervention: an empirical study

This paper reports research carried out in Italy designed to investigate the usability of Child Well‐Being Scale (CWBS) for the outcome evaluation of home‐care interventions for vulnerable families and children in need. Using a pre‐ and post‐test design, the study traces the changes in 18 vulnerable families and 23 children in need included in a programme of home‐care intervention over a period of 11 months. All the families and children were assessed twice: at intake and at the end of the intervention (after 6 months). Furthermore, 10 families and 11 children had a longer intervention and were assessed three times. Moreover, two focus groups involving 13 home‐care workers and 11 face‐to‐face interviews were used to collect practitioners' points of views on CWBS. The results generally support the idea that families' and children's situation improved over time, as shown by an improvement in almost all of the considered dimensions after 6 months and after 11 months. Specifically, the families improved more on household adequacy in the long term while children on the child performance dimension improved in the short term. Practitioners reported that CWBS was an aid to multi‐professional decision‐making, as the systematic evaluation of the subscales was a practical base upon which to activate shared decision‐making during the casework.     

Resisting your good intentions: substance‐misusing parents and early intervention to support and monitor children in need

Children from substance‐misusing families face elevated risks in growing up well and safe. Early intervention is an opportunity for local authorities to offer support and keep a watching brief on children's welfare. However, the basis upon which agencies voluntarily engage with families in advance of major problems becoming evident is far from straightforward. This qualitative pilot study in Scotland followed professional decision‐making over 6 months (n = 20 professionals) with a small number of families (n = 6) defined as in need of supportive intervention. This support was allied with an intention to monitor the family situation, which, in these data, appeared to affect the willingness of families to engage with services. As services sought to increase their voluntary oversight, sometimes by threatening escalating involvement, so families by various means appeared to resist it. Successful early intervention is reliant on voluntary family participation and thus requires close attention to means of positive and motivated parental engagement to disarm resistance.     

Children's experiences and needs in relation to domestic and family violence: Findings from a meta‐synthesis

Domestic and family violence is a significant issue experienced by many children that can have severe detrimental impacts to their health, development, and well‐being. Despite the significance of this issue, it is only recently that children have been included in research that seeks to understand the impacts that domestic and family violence may have on their lives. This paper reports on the findings of a meta‐synthesis, which explored qualitative research about children's experiences of domestic and family violence. Thirty‐two studies, including from the United Kingdom, North America, and Australia were included for review. The meta‐synthesis found that children describe domestic violence as being a complex, isolating, and enduring experience that often results in disruption, losses, and challenges to their significant relationships. Children's common feelings of fear, worry, powerlessness, and sadness were also uncovered, in addition to the strategies they employed to try and facilitate the safety and emotional well‐being of themselves and their family. Children's wants and needs are also highlighted. The findings demonstrate that despite the increasing interest in children's experiences of domestic and family violence, qualitative research remains limited, with many gaps evident. Implications for research, policy, and practice are considered.     

Parents Whose Children with Learning Disabilities and Challenging Behaviour Attend 52-week Residential Schools: Their Perceptions of Services Received and Expectations of the Future

This paper reports the findings of a survey of parents whosechildren attended 52-week residential schools. Seventy-threeparents completed a postal questionnaire which asked questionsabout three main areas: support and services received priorto their child’s entry into residential education; perceptionsof the quality of care and education provided by residentialschools; and concerns for their child’s future care andwelfare. Telephone interviews were conducted with 14 parents,to obtain additional information on the topics addressed bythe questionnaire. Parents were critical of services and supportreceived prior to their child’s entry into residentialeducation and reported high rates of exclusion from local services.Residential schools were generally perceived as providing agood quality of service, though considerable concern was expressedabout their geographical distance from the family home, andthis had a significant impact on the frequency of visits. Parentsexpressed high levels of concern about the future care and supportneeds of their children. Further research is required to understandthe relationship between the availability and quality of localservices and the need for 52-week residential schools. The impactof distant residential education on parent–child relationshipsand on future demand for residential care is considered.     

The nature and culture of social work with children and families in long‐term casework: Findings from a qualitative longitudinal study

Social work in the United Kingdom is preoccupied with what social workers cannot do due to having limited time to spend with service users. Yet remarkably little research has examined what social workers actually do, especially in long‐term relationships. This paper draws from an ethnographic study of two social work departments in England that spent 15 months observing practice and organizational life. Our findings show that social work some of the time has a significant amount of involvement with some service users and the dominant view that relationship‐based practice is rarely achieved is in need of some revision. However, families at one research site received a much more substantial, reliable overall service due to the additional input of family support workers and having a stable workforce who had their own desks and were co‐located with managers in small team offices. This generated a much more supportive, reflective culture for social workers and service users than at the second site, a large open plan “hot‐desking” office. Drawing on relational, systemic, and complexity theories, the paper shows how the nature of what social workers do and culture of practice are shaped by the interaction between available services, office designs, and practitioners', managers', and service users' experiences of relating together.     

Mapping the journey: outcome‐focused practice and the role of interim outcomes in family support services

Longitudinal costly evaluations will always be important in order to understand the factors that impact on child, family and community well‐being over the long and medium term. However, in a policy era that accords major importance to the achievement of outcomes, e.g. payment by results, ‘outcome theology’ can pose threats to service access and professional morale in family support. It is essential therefore, to ascertain the short‐term outcomes of services in order to capture the trajectory of progress by families under stress. This paper critiques the concept of ‘the outcome’. It traces the development of this trend in policy and describes an alternative but complementary approach, which is based on capturing interim outcomes in family support services.     

Congruence and incongruence in the perception of ‘family’ among foster parents,birth parents and their adolescent (foster) children

Over recent decades, listening to children's voices and viewing children as competent actors has gathered momentum in research as well as in practice. Acknowledging children's perspectives requires sensitive listeners who are willing, deliberately and as realistically as possible, to reconstruct children's ways of seeing. In our study, based in Norway, we investigated the views of 22 adolescents in long‐term foster care and 15 of their birth parents and 21 of their foster parents. Using Q methodology, we explored congruence and incongruence in the perception of ‘family’ among foster parents, birth parents and their adolescent (foster) children. We found three family perspectives among the adolescents. Within two of these perspectives, there seem to be more congruent understandings of the children's perspectives among the parent groups. We discuss some main implications in light of these findings. In Norway, as in many other countries, the policy of child welfare is that children first and foremost should grow up with their birth family. When out‐of‐home placements are necessary, a basic principle is that children should remain in contact with their birth family.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

Enhancing the rights and well‐being of people with acquired brain injuries in the criminal justice system: Some findings from a qualitative study

This article focuses on the issues currently facing people with an acquired brain injury (ABI) in the criminal justice system in the state of Victoria, Australia and, in particular, the impact of this condition on people suffering various forms of social disadvantage. This qualitative study involved in‐depth interviews with key stakeholders, such as service providers working in the system, court personnel including Magistrates and Judges, legal practitioners and persons living with an ABI and their carers. The aim was to determine the advantages and limitations of current policy and practices, and to identify possible actions which could lead to improved outcomes for this cohort. This paper responds to our research findings in relation to two key areas: first, the awareness of ABI amongst legal practitioners and service providers, prompting the need for better education, training and professional development; and second, the requirement to improve processes for identification, assessment and support, for people involved in the criminal justice system with ABI. A number of systemic modifications and educational initiatives are recommended to address the unreasonable and unacceptable impacts on persons living with an ABI in the criminal justice system.     

Blocking the solution: Social representations of threats and (non)dialogue with alternative representations in Greek‐Cypriot newspapers during peace negotiations

This paper first identifies representations of threats in Greek‐Cypriot newspapers related to the negotiations for a Cyprus settlement. Then, it identifies how alternative representations to these core representations of threats are managed through the use of a number of semantic barriers. Therefore, it problematizes the role (function) that such representations of threats play in undermining the potential for transformative dialogue in a post‐conflict and divided country in need of conflict transformation. Focus is on the editorials of two newspapers during a four‐month period before the collapse of the July 2017 Cyprus peace talks. Both were suspicious and polemic vis‐à‐vis the said negotiations but used different strategies to oppose them. Simerini convened recurrently threats such as Turkification, state dissolution and threats against Hellenism. Phileleftheros focused on the issue of security drawing red lines on various dossiers under discussion in the negotiations. The paper contributes to the theoretical debate of the relationship between social representations and identities and the role of threats and historical narratives in undermining transformative dialogue through the use of semantic barriers.