Are we doing enough to protect children from their parents\u2019 drug and alcohol use? At a recent safeguarding conference there was plenty of cause for concern, as DDN reports. \u2018Graham Greene said \u201cThere is always one moment in childhood when the door opens and lets the future in.\u201d We are responsible for opening that door,\u2019\u00a0Joy Barlow told the Adfam\/DDN Everybody\u2019s business safeguarding conference, sharing her vision that we should refocus on the rights of the child. The event brought together professionals with an interest in this sensitive issue and did not shy away from the challenging questions. Why were we missing signs that children were at risk? Were we aware that methadone soothing took place? How could we work more effectively with fewer resources? Why were we scared of even talking about this issue? \u2018This is one of the most difficult and fraught areas of practice,\u2019 said Barlow, who was formerly head of STRADA (Scottish Training on Drugs and Alcohol). \u2018We need to incorporate respectful uncertainty,\u2019 she said, quoting Dr Marion Brandon\u2019s research from serious case reviews. \u2018We need to demonstrate empathy and acceptance, but balance it with a healthy dose of scepticism\u2026 if the truth is not always presented to us, we have to ask why.\u2019 Tackling safeguarding needed a fundamental shift in thinking, according to many of the day\u2019s speakers and workshop contributors. Nic Adamson, CRI director, said drug and alcohol workers \u2018often used to see it as their job to rock up and defend the client.\u2019 But this area required a different way of working: \u2018We need to learn to challenge clients\u2019 behaviour \u2013 really challenge it,\u2019 she said. \u2018It\u2019s a Pandora\u2019s Box \u2013 there\u2019s a fear in what we do,\u2019 said one delegate, and this theme kept resurfacing, in relation to safeguarding, methadone, and the delicate issue of challenging clients and asking them difficult questions. \u2018There are around 400 adult deaths involving methadone a year. Say this in the wrong room and you can be intellectually decapitated,\u2019 said Martin Smith of Derbyshire Safeguarding Team, who brought the risks to children into sharp focus. \u2018Hair testing has shown that methadone soothing is more common than we like to acknowledge,\u2019 he said. Examples from his caseload included a child death which the mother had said was accidental, but tests had shown the child had been routinely given methadone: \u2018A methadone storage box had been in place, she attended appointments, her engagement was good, there was a supportive grandmother \u2013 she gave the picture that all was OK.\u2019 In another case, \u2018a woman let a toddler ingest enough methadone to kill an adult\u2019. \u2018We lack honesty and courage as a sector \u2013 let\u2019s not shy away from difficult challenges,\u2019 he said. \u2018It\u2019s really hard to hear the bar is so low in certain areas\u2026 we\u2019ve all got work to do.\u2019 Austerity is \u2018the spoiler\u2019 that leads to \u2018the deadening hand of\u00a0conflicting\u00a0priorities\u2019, Pete Burkinshaw\u00a0PHE Rachael Evans, policy and research officer at Adfam, brought evidence from case reviews that the charity had examined to produce the new report, Medications in drug treatment: tackling the risks to children \u2013 one year on. The main findings confirmed that there was insufficient appreciation of the dangers of OST by parents and professionals, and critical issues around safe storage. Practitioners were struggling to accept the idea of intentional administration of OST and felt that having these conversations might risk disengagement. \u2018We\u2019re so busy we forget to ask the right questions,\u2019 commented Sue Smith, CRI\u2019s national safeguarding lead. \u2018But we need to challenge\u2026 it\u2019s our role.\u2019 \u2018I was bemused and shocked that my staff used to struggle around asking about safeguarding,\u2019 said Birmingham commissioning manager, Max Vaughan. But, he added, \u2018the combination of policing and being supportive can be really difficult.\u2019 It was about confidence, suggested one delegate, adding \u2018It shocks me that other agencies say \u201chow do we ask those questions?\u201d You just do. You have to.\u2019 So apart from asking the right questions \u2013 about drug and alcohol use, drug storage, and making sure that risks to children were minimised \u2013 what were the key areas for improvement? Better engagement between all of the professional partners involved with the family came high on the list. In Birmingham, the safeguarding structure involved team leaders, who had been fully trained in safeguarding , providing real-time updates to social workers, explained Micky Browne, CRI\u2019s safeguarding lead. The Multi-Agency Safeguarding Hub (MASH) not only improved collaborative practice, but it also reduced inappropriate referrals, he said. \u2018The better agencies work together, the more efficiency will develop in the long term.\u2019 \u2018This is one of the most difficult and fraught areas of practice.\u2019\u00a0Joy Barlow (below left), pictured with (clockwise) Sue Smith, Max Vaughan, Martin Smith, Carole Sharma and Judith Yates. DS Steve Rudd, of Birmingham police, added: \u2018When we sit round the Mash table now, we look a what\u2019s happening \u2013 do police actually need to run off and lock mum and dad up? In multi-agency working we all come from a different angle. We\u2019ve developed an under\u00adstanding of where we\u2019re all coming from and issues are very quickly resolved.\u2019 Exchanging data that was easy to comprehend was key to creating multi-agency risk assessments, said Sue Smith. Joy Barlow believed that we needed to overturn our culture of \u2018educating in silos\u2019, bringing drug and alcohol content to social work courses. \u2018You\u2019ve got to get people together in terms of learning and development,\u2019 she said. The Federation of Drug and Alcohol Professionals (FDAP) were working with Adfam to develop standards and identify competencies that people working with families should all have, said FDAP\u2019s chief executive, Carole Sharma, who added: \u2018This sector has been guilty of generating mystique around ourselves. We need to undo this.\u2019 Dr Judith Yates was hopeful that Adfam\u2019s new report would provide focus and remind commissioners of their power to make a difference. \u2018I remember the Hidden Harm report landing on my desk and it\u2019s stayed with me,\u2019 she said. \u2018Four years ago health visitors hadn\u2019t had training on alcohol. I hope Adfam\u2019s report will encourage people, including pharmacists, to talk to each other.\u2019 Inevitably the question of diminishing resources came up throughout the day, and PHE\u2019s Pete Burkinshaw describ\u00aded austerity as \u2018the spoiler\u2019 that led to \u2018the deadening hand of conflicting priorities\u2019. But Martin Smith urged delegates to remember that \u2018profit should never come before the needs of children\u2019. \u2018We\u2019ve got to have courage and honesty \u2013 and we\u2019ve got to find evidence to back up what we\u2019re trying to change,\u2019 he said. Among the challenging questions fired at the panel during the final session was the issue of whether child\u00adren should be trained and support\u00aded to administer naloxone to their parent in the event of an overdose. Should they be given that responsibility? While Dr Judith Yates was among campaigners who had welcomed the recent extension of naloxone prescrib\u00ading, she was worried about \u2018children having to parent their parent\u2019: \u2018It depends on the age of the child,\u2019 she said. \u2018There\u2019s something not right about a six-year-old being entrusted to save a life.\u2019 Martin Smith said the level of responsibility was too high, while Max Vaughan agreed \u2018it doesn\u2019t feel safe or right\u2019. Sue Smith said that it shouldn\u2019t be entrusted to a child \u2018at this stage\u2019. But several delegates threw back a challenge of double standards, referring to the \u2018stigma of this client group\u2019. \u2018Workers in this field have passion\u00a0and commitment, it\u2019s harder than\u00a0rocket science.\u2019 Vivienne Evans, Adfam. \u2018Many children are left to manage chaotic drug use who haven\u2019t had proper support,\u2019 said one. \u2018Children, whether we like it or not, are managing their parents\u2019 drug use. We\u2019re guilty of double standards.\u2019 At the beginning of the day, Joy Barlow had said: \u2018I\u2019m elated at what we\u2019ve achieved and also severely disappointed at what we\u2019ve achieved\u2019 in this area of practice. Adfam\u2019s chief executive, Vivienne Evans, finished on an optimistic note by saying that workers in this field had passion and commitment, which was \u2018harder than rocket science\u2019. \u2018This is hugely complex and difficult work,\u2019 she said. \u2018We need to have that optimism that we can give children the best start.\u2019 \u2018I was spotted, supported and encouraged,' Ian Day. In an emotional speech to the main conference, Ian Day looked back to 12 years ago when he was \u2018deeply entrenched in addiction\u2019.\u00a0When his partner became pregnant he made a decision to be \u2018a great dad\u2019 \u2013 but nine months later he was in prison.\u00a0\u2018We slipped through the social services net,\u2019 he said. \u2018They had to be the enemy. But we were difficult people to work with.\u2019 With his daughter taken into care he had spells of homelessness before being introduced to treatment service by an old friend, who was in treatment now herself and \u2018looked good\u2019. This is where \u2018interventions came into play\u2026 it was a small window of opportunity to help a person. I was spotted, supported and encouraged\u2019. Six months out of treatment, he approached social services to try to win custody of his daughter who had been taken into foster care. He was \u2018not, on paper, the person you\u2019d give custody of a child to\u2019 \u2013 \u2018at that time the reaction was \u201cyou\u2019re male\u201d, I had nowhere to live and I hadn\u2019t seen my five-year-old for three years. So I had to prove I could be that person.\u2019 Securing a flat took two years, during which time he was tested continually by the agencies involved. \u2018I had to see my daughter in a room with a person taking notes \u2013 I was very nervous,\u2019 he said. \u2018I got enrolled on courses and at the time it felt very demeaning \u2013 they asked very obvious questions. It was very frustrating, but looking back it was the right thing because of my previous history.\u2019 With \u2018all of the agencies speaking to each other throughout\u2019 he had his day in court and won custody. Now settled with his daughter and current partner of six years, he says he is grateful for the \u2018safe environment\u2019 created by agencies working in partnership, which led him to an outcome he never dreamed possible. A grim picture Adfam\u2019s new report shows children are still dying after ingesting medications used to treat drug addiction. Its author Rachael Evans, Adfam\u2019s policy and research officer, shares findings Adfam has particularly focused on safeguarding over the past couple of years. Publishing our new report Medications in drug treatment: tackling the risks to children \u2013 one year on, our research revealed that far more children than previously thought are dying and being hospitalised after ingesting medications prescribed to treat their parents\u2019 drug addiction. \u2018Specialist workers and midwives help a service maintain a whole-family focus.\u2019\u00a0Rachael Evans, Adfam In the ten years to 2013, at least 110 children and teenagers aged 18 and under in the UK died from the toxic effects of OST medications. In the same time, at least 328 children in England were hospitalised and diagnosed with methadone poisoning. Of the 73 deaths in England and Wales, only seven resulted in serious case reviews (SCRs). Since Adfam first reported on this tragic phenomenon in 2014, these cases have continued to happen, with at least three new SCRs in the last year. While many children will have consumed the medications accidentally, some were given them by their parents in a misguided attempt to help soothe or send them to sleep.\u00a0The statistics also show the majority of fatal poisonings involve older, rather than younger children \u2013 but little is known about how or why these incidents occur. OST is proven to reduce dependence on street heroin, and by doing so it saves lives, improves health and wellbeing and cuts crime. The rightful place of these medications in addiction treatment is not at issue, but it\u2019s imperative that the risks they pose to children are better addressed and future incidents prevented. Our report makes a number of recommendations to help do this, starting with the need for all incidents involving a child\u2019s ingestion of these medications to be fully investigated and recorded \u2013 and analysed centrally by government, with the learning shared with local services. The wide range of professionals who come into contact with parents and carers prescribed OST medications must all be trained about their potential harm to children, and services must work together and share information more effectively to minimise risk. Parents must also be educated about the potentially fatal risk posed by OST medications, and given a secure box to store them. Vivienne Evans, Adfam\u2019s chief executive, said: \u2018The lessons from previous tragic cases have not been heeded, and a year after we called attention to the issue, children are still dying. The vast majority of parents prescribed these medications will use them safely and appropriately \u2013 but the number of children now identified as having been harmed lends the issue even greater urgency. Systemic and cultural failure means services are still not working closely enough to safeguard vulnerable children.\u2019 Our research, along with the training we have delivered to local authorities, has identified some areas of good practice. One drug treatment service has appointed two specialist family workers to work with pregnant service users and families. Specialist workers and midwives can help a service maintain a whole-family focus, and this model was praised by SCR panels. Another promising model is the development of inter-agency joint protocols between drug services and health visiting teams, so that information is shared and joint home visits can be conducted. More information and examples of good practice can be found throughout the report. By the end of 2015, Adfam will have trained 19 local councils to reduce the risks to children posed by these medications, and we hope to continue this crucial work in 2016.