Positive signals

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Giving families a clear and consistent route to help makes all the difference, as DDN reports.

Read the article in DDN Magazine

‘When you work with families in an uncoordinated way and you’ve got lots of different professionals trying to address issues separately, it doesn’t work,’ says Teresa Leitäo, senior policy advisor at the Troubled Families Programme. ‘It’s very overwhelming for the family and can be quite ineffective for the services involved.’

Contributing to a ‘parental alcohol and drug use’ webinar, she shared experience from the programme, which had been designed to support families with multiple vulnerabilities – mental and physical health problems and other interlinked issues.

Teresa LeitAo
‘…you’ve got lots of different professionals trying to address issues separately, it doesn’t work.’ Teresa Leitao

Services needed to work together to make referral procedures easy, spot problems early on, and put the right support in place as soon as possible, she said. This coordination would make it easier to measure data and track outcomes, and make sure that the right services were involved – including bringing together the ‘two worlds’ of family guidance and substance misuse support.

Discussing adverse childhood experiences (ACEs) had resulted in some strong partnerships, said Sheena Carr, deputy head of the Children, Young People and Families Team at Public Health England. But we needed to consider that ACEs ‘sit within a broader context of vulnerability’. A public-health informed approach was helpful in looking at causes of inequality and circumstances where activity should be prioritised, she said, and making sure children had supportive networks around them was important in helping them to deal effectively with stresses they might encounter at home.

Dr Wulf Livingstone, reader in social science at Wrexham Glyndwr University, talked about multiple vulnerabilities which often overlapped – child protection relating to substance misuse, domestic abuse and mental health. Issues such as school exclusion, food poverty and the responsibility of being a young carer – with maybe a parent that is entering end of care through drug and alcohol use – were bound to have an impact.

Often it was impossible to determine where the starting point was, or the trigger, and ‘it’s probably not helpful to look for whether or not one causes the other,’ he said. But we could be sure that ‘merely the stopping of substance use in itself is never really a solution… if that’s all we concentrate on we will probably just return people to the very difficult situation that they live in without a coping mechanism.’

Strength-based interventions were vital instead of ‘negative, deficit-based conversations’, with screening tools used whenever possible. The other really important element – as the previous speakers had said – was to work inclusively with the entire family, even if work took place independently with different members. Putting this time in would help to kick-start the appropriate interventions and identify the ‘practical day-to-day barriers’ to progress, such as no food on the table or a leaky bathroom – things that needed to be solved to create the capacity for change.

The recurring conversations about a ‘multi-agency approach’ were frustrating, he added. After all the reports that had been produced, ‘it shouldn’t really even be a conversation anymore’. We were still having people being referred to as ‘hot potatoes’ and still having families experiencing 18 hours from 18 agencies instead of 18 hours of interventions from one or two workers and agencies. Good communication should be coupled with ‘greater levels of respect between agencies and disciplines’ to bring about holistic family interventions, he said.

The Building Bridges project in St Helens, Merseyside, shared some techniques from their programmes working with families. James Mawhinney and Kayah Woods of the social work team at Change Grow Live explained that they focused on ‘behaviour and behaviour change as opposed to specific substances, because that allows us to address a realm of issues.’

One effective tool was to use the Simpson family (the Matt Groening animated sitcom) to help people understand the roles played within the family relating to addiction, as it was much easier to talk about a family other than their own. Homer was the person experiencing addiction, with the other family members feeling powerless to make any positive change themselves. Marge was in the ‘enabler’ role, while trying to hold the family together; Bart was the clown, deflecting attention from the addiction; and Maggie was the lost child, left in the background.

Talking in this way had helped families with extremely complex needs to understand their situation and the perspectives of others in the family, and talk about what support they needed. The programme was achieving very positive results in improving family relationships, giving children the confidence to engage with school again, and helping adults to stop their alcohol use.

A key part of this success was the positive focus on a strength-based approach, which was cancelling out feelings of shame and stigma. Lesley Davies, senior manager in prevention and early help at North Tyneside Council, added to this by explaining positive progress of the Bottled Up project. The North East’s drinking culture meant the area had a reputation as a ‘party capital’ and North Tyneside had ‘the lowest number of abstainers in the North East’, so they wanted to work with a wide variety of partners, including the voluntary sector, to see what they could do differently.

The initiatives that were rolled out aimed to get people talking about alcohol, particularly in families, and enable children to be more open about it instead of feeling they had to hide it. A ‘whole systems pathway’ for North Tyneside included different training packages to include the whole workforce, from brief interventions to a more specialist approach.

Where there were problems relating to drugs and alcohol, the aim was to identify them early and use a strength-based approach with the family, ‘helping them identify what they can do to move on and change things.’

Dr Wulf Livingstone
‘…merely the stopping of substance use in itself is never really a solution.’ Dr Wulf Livingstone

Getting to the stage of using evidence-based interventions effectively depended on workers going out to meet the family within the community and forming a team around them from the beginning – a team with ‘a really creative and flexible approach’. ‘We have had some parents that hadn’t engaged in programmes and treatment before,’ said Davies, so going out to do work with them in the community had had ‘a huge impact’.

The situation around COVID had obviously brought challenges with the lockdown restrictions, particularly as there had been no let-up in referrals. But it had also brought opportunities in reaching vulnerable children, as many of them enjoyed having online diary sessions and had started ‘really engaging and getting their voice across’. It had given an opportunity to talk to someone during lockdown about their parents’ drinking, ‘and also to be able to talk to other people of similar ages who are going through the same thing,’ she said.

One of the main themes to emerge from the session was that there was evidence-based practice to implement and no shortage of expertise throughout the health and social care sectors. The challenge was to streamline the approach to the family so they could take one step, then the next, with a consistent professional partner. 

The webinar, ‘Children of alcohol dependent parents’, was held by Public Health England. Resources are available at the Innovation Fund Knowledge Hub: www.khub.net/group/parental-alcohol-and-drug-use