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Keeping it in the Family

How can workers be best equipped to identify and address parental alcohol misuse? DDN reports from Alcohol Concern’s recent conference. 

Up to 1.3m children were affected by parental alcohol misuse, Adfam chief executive Vivienne Evans told Alcohol Concern’s Happy families? Equipping practitioners to tackle alcohol issues in families event. ‘And those are just the ones we know about, who come to the attention of social services. There are a hell of a lot more that we don’t know about.’ 

When her organisation had run training on parental substance misuse in partnership with Alcohol Concern and Addaction it had been struck by ‘how many different people from different professional backgrounds and services wanted to access it – proof that it’s everybody’s business’, she said. One of the greatest challenges, however, was identifying parental alcohol misuse, she stressed. ‘Many families are dealing with alcohol use that the user doesn’t think is a problem.’

Hidden Harm

While parental substance use was often linked with mental health issues, poverty and domestic violence, and was a key factor in children being taken into care, the message of Hidden harm – that services could protect and improve the health and wellbeing of affected children by working together – was still key, she said. 

‘Practitioners, if supported and managed and trained, can intervene to help children. But we still hear of people working in children’s services saying “I don’t want to get involved with drugs and alcohol – it’s too tricky, too complicated”, and at the same time you have people in drug and alcohol services who just want to focus on the service user and not the family.’ 

One of the main lessons to emerge from the practitioner training was the importance of working with managers, she told delegates, as practitioners needed support in the workplace. However, at a time when workforce development was critical, services were finding it harder and harder to access money for training, while another funding challenge was the loss of focus on universal services, she added. ‘This is an issue for teachers, youth workers, all of us.’

Although the prevalence of alcohol misuse was ‘particularly pronounced in deprived families’, there were also significant issues with, for example, middle-aged, middle-class women, chair of the All-Party Parliamentary Group on Alcohol Misuse, and Conservative MP, Tracey Crouch, told the conference.  ‘They don’t fit the bill of the “troubled family” so perhaps they’re less likely to receive support.’ 

Reforms

It would take time for the government’s health service reforms to properly bed in, but the shift of responsibility to local level presented considerable opportunities for dealing with parental substance use, she said. ‘If you have GPs who recognise the need for services they will be feeding that up to the commissioners’, although GPs still had problems identifying people when the problem was not immediately obvious. The government’s alcohol strategy, however – which had been ‘broadly well received by public health groups’ – had made a clear commitment to identifying people at risk. 

Neglect

Alcohol was both a ‘contributor and symptom’ of neglect, director of public policy at Action for Children, Helen Donohoe, told the conference. ‘But we’re absolutely passionate that it doesn’t have to be that way.’

Child neglect was ‘notoriously difficult to define’, she said. ‘A child deserves a safe home, healthcare when it’s needed, emotional engagement and love, as well as stimulation, guidance and boundaries. As a society we have a very stiff attitude towards talking about things like emotional warmth.’ Neglect was serious, however, she stated. ‘It can kill, it can destroy a childhood and go on to destroy an adulthood as well. In the UK, it’s the most common form of child abuse, but services often feel powerless to intervene if there’s no physical abuse going on.’

Her organisation estimated that up to one in ten British children experienced neglect, she said. ‘You can’t simplify the causes, because it’s incredibly complex, but you can identify some circumstances.’ These included deprivation – ‘although that doesn’t mean that if you’re poor, you’re neglecting your children’ – poor housing, inter-generational neglect of the parents themselves, disability, mental health, domestic abuse and substance misuse. ‘ChildLine tell us they get around 100 calls a week from children worried about their parents’ drinking,’ she added. 

Action for Children was campaigning vigorously to change the law around neglect, she stressed, while better inter-agency working and early intervention were crucial. ‘We also want all social care professionals to be thinking about the child at home when dealing with adults.’

Of all the disadvantages affecting families, alcohol was the most common across all classes, said senior research fellow at the University of Oxford’s education and social policy departments, Naomi Eisenstadt. 

‘In better-off families it’s easier to hide – the house is bigger and the kids have got somewhere to do their homework. If you’re living in poverty you’re likely to be in contact with services – for your housing, your benefits – so any problems you have will be more visible.’ 

Understanding

One of the things the government could do to help was reduce pressure on parents, she said, through things like paid maternity leave, encouraging flexible working and provision of universal benefits ‘with no stigma or massive bureaucracy’ attached. ‘One problem with policy making is an absolute lack of understanding of the problems that poverty brings,’ she stated. ‘The government wants to enhance the capabilities of families, but you have a much better chance of doing that if you reduce the pressure on them. The problem with the current government is that they don’t understand that.’ 

The situation was likely to worsen, she warned, with rising unemploy­ment – particularly among women – and changes to tax credits, housing benefit and the introduction of an overall benefit cap that would inevitably hit bigger families particu­larly hard. The removal of ring fences also made it difficult to track the reductions in funding for vital services.

‘In our society, when it comes to alcohol, we have huge mixed messages,’ said children and families substance misuse consultant Wendy Robinson. ‘There’s the heavy promotion of alcohol at one end, and at the other end of the spectrum if you do have an alcohol problem then it’s something to be ashamed of.’ 

Entrenched patterns

Fixed and entrenched patterns could develop in families, she said, and what was necessary was ‘evidence-based practice and practice-based evidence – let’s learn from the services we’re lucky enough to have’. 

When engaging with families it was vital to remember that ‘reluctance and ambivalence’ were not the same as ‘denial’, she stressed, and that, for children, ‘resilience is not the same thing as coping. Our work is to ensure that the child has a voice, a presence and a primary influence, and to work to ensure that the parent works to protect the child, and not the other way around.’

On that subject, child psychotherapist and family worker at BDP Casa Family Service Islington, Retta Bowen, told delegates that ‘we often encounter children who are parenting their parent. They’ll say things to them things like  “please don’t drink too much” and “when are you coming home?” It’s important to remember that, as well as the child we’re working with, the parent has usually been through those same traumas and is using alcohol to manage unmanageable feelings.’ 

It was vital to build trusting relationships, and help parents to ‘regulate, self-soothe and recognise that they’re traumatised by their experiences’, she said. 

Services also needed to be explicit about their mission, FDAP chief executive Carole Sharma told the conference, and ensure that those values were shared by the entire workforce. 

Recovery

Any service was a learning environment for both practitioners and service users, she said, and although ‘recovery’ was a word that was often misused, there were ways to determine if a workforce was ‘recovery-orientated’. ‘Are they optimistic for the service users, do they establish partnerships with service users and their networks, and facilitate mutual aid? Also, have a look around where you work and take down all the posters with rules and regulations and images of death,’ she urged. ‘We need to professionalise ourselves – not just say we’re working with others, but show that and make sure our clients know that.’

Independent consultant Esme Madill shared the results of Comic Relief’s alcohol hidden harm project, which had funded five projects using a range of different interventions over a five-year period, to look at what worked best for the children of substance-misusing parents.  

‘Broadly, what we found to be most effective were services that were child-centred, whole-family orientated, therapeutic and evidence or experience-based,’ she told the event – particularly those child-centered services that gave children places to go and things to do. ‘Some of them told me it was the highlight of their week,’ she said.

Group work

In terms of the older children interviewed for the project, many said that while important changes had often taken place during one-to-one work, group work had been hugely important as it had made them feel less isolated. ‘They’d say things like “it made me realise I wasn’t the only one going through this, and that was a huge relief”.’

Almost all the projects had said they needed longer-term interventions, she stressed – ‘not less than five to six months, and able to extend that support later according to client need’. Full involvement of universal services was vital, she said, with primary school teachers in particular ideally placed for recognising when things start to go wrong. ‘You need strong leadership, you need to invest in partnership, and you need to evaluate the work and act on the findings,’ she told delegates. 

‘We only have one asset, and that’s our workforce,’ said Carole Sharma. ‘It’s all we’ve got.’