Tread softly

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Public Health Nurses

How can we tackle child safeguarding without risking disengagement? DDN hears a cautionary perspective from public health nurses.

This focus on child protection is a good thing – but there are real consequences of focusing on it too much,’ said Karen Hammond of the Centre for Alcohol and Drug Studies, speaking at the recent HIT Hot Topics conference in Liverpool.

Hammond gave insight into the changing role of public health nurses in relation to mothers who used drugs – and described a very fragile relationship. Having access to families had been seen as ‘an opportunity for surveillance’, with nurses expected to take on an additional social work role, reporting on cases that they felt were high risk.

The effect of this could be to breed an ‘atmosphere of fear’ and ‘erode an already fragile trust’, denying these women a valuable source of support.

One-to-one interviews with public health nurses who worked with this group of women revealed problems with engagement: women were tending to withdraw from contact with nurses, for fear of having their children removed.

This failure to keep appointments was being blamed on their engagement with drugs and the notion of their ‘chaotic lives’, rather than ‘the cycle of fear and mistrust that had been created’.

The consistent issue to be highlighted was lack of training; many of the nurses had only had child protection as a training route to deal with these issues and thought they only needed to know about the names of drugs. This gave them perceptions such as: ‘addiction results in a loss of control and affects the ability to parent properly’; and ‘recovery is equated with abstinence’ – so any continued use signalled danger to them.

Hammond relayed some typical comments from the interviews with nurses: ‘The drug use takes over – that’s all they think about,’ and ‘They want to stop it but they can’t – the pull is just too strong.’ Children were also still deemed to be at risk when they were not actually present during drug-taking, and had been left with family members. ‘Nurses still thought [the mothers] wouldn’t manage their intoxication and it would end in chaos,’ she said.

‘Overall it was quite shocking – the belief that drug use makes you a bad mother,’ said Hammond. ‘We need to not only teach parents about risks, but also be able to facilitate some critical self-reflection that’s lacking at the moment.

‘Professional practice should reflect the evid­ence base, not political or moral frame­works,’ she said. ‘What we really need is to dismantle prohibition – but in the meantime we need to recognise that the way we’re dealing with it makes it worse.’

During the question time at the end of this session, a woman from Belfast commented: ‘I asked for help and my children were taken off me. You’re damned if you do ask for help and damned if you don’t.’

More from Hit Hot Topics in our next issue.