With 2013 marking the ten-year anniversary of Hidden harm, social care professionals gathered at the Adfam annual conference in London to reflect on the progress so far and what the future might hold. Kayleigh Hutchins reports.
Children don’t care about the substance – drugs and alcohol are all the same,’ said Adfam chief executive Vivienne Evans, introducing the day by highlighting the improved focus on the family since Hidden harm. But, she emphasised, much more work was necessary to ensure that families were getting the support they needed.
‘Alcohol is a drug – it’s a drug of dependence,’ said Ian Gilmore of the Alcohol Health Alliance UK, highlighting the effects that changing drinking patterns in Britain were having on families. A combination of new products appealing to children and teenagers, low pricing at supermarkets and an ‘alcogenic’ environment had led to 10 to 15-year-olds being exposed to 10 per cent more advertising than adults.
‘So long as we have alcohol 24/7, children are going to think it’s normal to drink,’ he said. Alcohol killed more people under 60 than drugs, tobacco, and unsafe sex. ‘When put in context of harm done to families, there is public support for alcohol reforms,’ he said, adding that the harms of passive smoking ‘paled in comparison’ to the harms of drinking.
Joy Barlow of STRADA gave delegates a snapshot of how services had become more responsive. ‘Ten years ago, we wouldn’t have seen the people or organisations here today,’ she said, adding that multi-agency work had improved in recent years. Nonetheless, not enough emphasis had been placed on the effect of stigma and parental recovery on children, who ‘deserved to be a part of recovery, as they had been a part of the addiction’. Care professionals would need to be mindful of the emotional impact on children as well as the physical, she said, noting that children were aware when they ‘came second to a substance’.
Annette Dale-Perera of the Central and North West London NHS Foundation Trust urged delegates to ‘work together more closely and more smartly.’ Trends in adult drug use had changed significantly since Hidden harm, said Dale-Perera, adding that the new generation of young adults and parents had generated new issues. Lower engagement with drug services had gone hand in hand with high-risk trends such as poly-substance use and an increase in stimulant drugs among single parents to ‘keep them going’. The long-term effects of these trends were still unknown, and the cuts to public spending and devolution to local authorities would offer both challenges and opportunities in the future, she concluded.
‘Skilling up’ the workforce was the priority for Ruth Allen of the College of Social Work, who identified by a show of hands that most delegates were employed in social work, but only one or two had received drug training. ‘Social workers should be equipped to recognise the effects of substance use on children and the family,’ she said.
The workforce needed to feel empowered to challenge both stigma and the person affected – with the college there to support and train them. Professionals needed to ‘make judgements without judgmentalism’, said Allen, and to have a ‘whole systems approach’ to care.
Public Health England’s perspective was given by Lynn Bransby. ‘We see recovery as being defined by individuals, and we see it as being ambitious,’ she began. People were receiving a different service now, she said, and were being shown they were capable of recovery.
However, many with substance use issues still feared ‘that talking about having children would lead to a negative intervention.’ PHE’s priorities involved early intervention and working with the ‘troubled families’ agenda, to make sure there was a working system at local level to identify families needing help. ‘There are reasons for optimism in this agenda, and it would be a damn shame if it went backwards,’ she said.
In the afternoon’s ‘practice minibites’, Hardey Barnett, senior practitioner at the Family Drug and Alcohol Court, outlined its programme, which had been set up to help families cope with court proceedings to decide the permanent residency of children. Removing the adversarial element of the process, while offering support to the family, the pilot paved the way for an outcome that was best for the whole family, he said.
Sarah Ingram of Greenwich Children’s Services identified that parental substance use was often ‘just a part of a bigger picture,’ and highlighted the need for accurate and age-appropriate information and support for children who were acting as carers for their parents. Professionals needed to develop a shared ethos, she said, and improve inter-agency working.
Ryan Campbell, new chief executive of KCA, discussed the charity’s family intervention programme, which also recognised that substance use issues rarely existed in isolation. The programme was helping families to work through the surrounding problems, encouraging parents to find practical solutions and building trust with the workforce. ‘Parents with substance misuse issues aren’t bad – they love their children just as much as any other parent, sometimes more so,’ he said.
Delegates’ questions were answered by a panel of experts, chaired by broadcaster and Adfam patron Eddie Mair
Vicki Crompton, Cambridge Safer Communities Partnership: What can be done to break down the barriers to providing a joined-up approach in the workforce at senior management level?
Sarah Galvani, Tilda Goldberg Centre: ‘Keep going, don’t give up. Get a meeting with the director of children’s services, present to them what you do and what you can to offer them.’
Emily Robinson, Alcohol Concern: ‘One thing that motivates directors is money and targets, and if you can find the right money and targets that link up, that might be helpful. Rather than starting with the people, start with the targets and the numbers.’
Lisa Phillips, BEE Happy: How can more be done to cascade information about parental substance use to women of child-bearing age to prevent harm to unborn babies?
Emily Robinson: ‘It’s going to be hard until we have a better idea of what is and what isn’t a safe level of alcohol consumption. At the moment, alcohol guidelines are being reviewed, and perhaps we should be stronger about the restrictions on pregnant women.’
Liz McGill, Hampshire County Council: How can we deal with the expectations of service delivery versus recovery timelines?
Roger Howard, formerly UKDPC: ‘Recovery is a process, not a destination – and it’s not the same as abstinence.’
Kathy Evans, Children England: ‘It’s really important to be careful of dangling the motivation of getting your child back in treatment… to use that in the treatment process is high risk.’
Nick Barton: ‘Try to cut down to what is achievable within the timeframe that you’ve got.’
Jax Beatty, Action on Addiction: What do the panel think about the social inequality between those that get to keep their children, and those that lose them?
Roger Howard: ‘It’s the poor who get the social work and the crime and the police, and other people get something else. What do you do about that inequality? The biggest thing is social and economic improvement. How do you sensitise practitioners to this stigma and look at people differently? It’s about culture change towards people, and that’s a long haul.’
Jake Robinson, Kirklees Lifeline: Is there anything we can do to foster better engagement, particularly to ensure better outcomes for children?
Nick Barton: ‘One of the places we think we can increase engagement is in schools, where problems often come to light first – but then you’ve got to have a confident workforce who feel comfortable confronting them.’
Kathy Evans: ‘Most human beings’ first preference is to work through their problems with the help of their friends and family and not go to a professional. We need to think about how we equip ordinary people to understand how they can better support family members through problems.’