Safeguarding Children Affected by Problematic Drug and Alcohol Use (Parental and Child use)
Scope of this chapter
This chapter provides a comprehensive summary of the issues, plans and actions required when there are concerns for either parents or children who are drug users. The chapter includes a guide to early identification of substance abuse.
Related guidance
- Being Alert
- Recognising Disguised Compliance & Disengagement Among Families: Practice Guidance
- Parental Mental Health Guidance
Amendment
This chapter was refreshed in April 2025.
Drug and alcohol use by parents or carers does not inevitably lead to poor outcomes for children, but each aspect of their lives may be affected.
- In 2023, the Department for Education statistics on the characteristics of children in need found that parents using drugs was a factor in 13% of Child In Need cases and parental alcohol use was a factor in 14%1.
- In her 2020 study, Roy highlighted an array of literature supporting the fact that problematic drug and alcohol use can have a significant impact on a child's overall well-being and development and that children living with these issues are more likely to have other factors that could lead to harm than their counterparts2.
- Evidence shows that intervention for the family can have a positive impact for the child if the intervention acknowledges that there should be a balance of focused short-term work and longer-term support3
As highlighted above, problematic drug and alcohol use may just be one factor within the family that is having a negative impact on a child's outcomes. Three prevalent risk factors that are acknowledged as often being present together are mental ill health, domestic abuse and problematic drug and alcohol use. In a study of serious case reviews, the presence of one of the factors were found in at least 50% of reviews, 52% of reviews showed the presence of two factors in different combinations and 22% showed a presence of all three factors4. However, whilst the study highlighted the prevalence of the three factors and therefore the importance of focusing on these, it also showed that many serious case reviews did not feature these factors. However, the research indicates that, whatever the primary cause of a parent's difficulties in caring adequately for their child, problematic drug and alcohol use is likely to add to those difficulties.
It is acknowledged that not all individuals using drugs and alcohol have problems with parenting: understanding drug and alcohol use, the behaviours of the parents and the impact of this on the child requires careful assessment to unpick the interrelated factors within a family and the environment the child lives within. This policy offers guidance and a framework for achieving this. The procedures within this document also refer to use of new psychoactive substances which are substances which produce similar effects to illegal drugs (such as cocaine, cannabis and ecstasy) controlled by the Psychoactive Substances Act 2016.
In 2022, the Office for Health Improvement and Disparities collated resources, information and guidance to support commissioners, service providers and others providing alcohol and drug interventions. Please visit the site for more information: Alcohol and drug misuse prevention and treatment guidance - GOV.UK.
(3) Parental substance misuse | NSPCC Learning
(4) Toxic terminology - AOCPP - Association of Child Protection Professionals
The purpose of this policy is to offer guidance for all staff working with children and families in understanding:
- The impact of drug and alcohol use on parenting capacity;
- The risks to children of parental drug and alcohol use;
- The risks of child drug and alcohol use.
This policy also guides practitioners on what action they should take to:
- Identify children at risk;
- Assess parenting capacity;
- Assess risk to children;
- Make appropriate multi-agency referrals and work effectively to safeguard and promote the wellbeing of children.
Providing early help is more effective in promoting the welfare of children than reacting later. Early help means providing support as soon as a problem emerges, at any point in a child's life, from the foundation years through to the teenage years.
Effective early help relies upon local agencies working together to:
- Identify children and families who would benefit from early help;
- Undertake an assessment of the need for early help; and
- Provide targeted early help services to address the assessed needs of a child and their family which focuses on activity to significantly improve the outcomes for the child. Local authorities, under Section 10 of the Children Act 2004, have a responsibility to promote inter-agency cooperation to improve the welfare of children.
Professionals should, in particular, be alert to the potential need for early help for a child who:
- Is disabled and has specific additional needs;
- Has Special Educational Needs;
- Is a young carer;
- Is showing signs of engaging in anti-social or criminal behaviour;
- Is in a family circumstance presenting challenges for the child, such as problematic drug and alcohol use, adult mental ill health, domestic abuse; and/or is showing early signs of abuse and/or neglect;
- If you are concerned that there is an element of coercion or exploitation being used against the child outside of the family home then a Child Exploitation Screening Tool should be completed. The worker should also explore if parental capacity to protect children is reduced due their own problematic substance and or alcohol misuse.
Local agencies should work together to put processes in place for the effective assessment of the needs of individual children who may benefit from early help services.
Children and families may need support from a wide range of local agencies. Where a child and family would benefit from coordinated support from more than one agency (e.g. education, health, housing, police) there should be an inter-agency assessment. These early help assessments, such as the use of the Team Around the Child (TAC) or an Early Help Assessment (EHA), should identify what help the child and family require to prevent needs escalating to a point where intervention would be needed via a statutory assessment under the Children Act 1989.
For an Early Help Assessment to be effective:
- The assessment should be undertaken with the agreement of the child and their parents or carers. It should involve the child and family as well as all the professionals who are working with them;
- A teacher, GP, health visitor, early years' worker or other professional should be able to discuss concerns they may have about a child and family with a social worker in the local authority. Local authority children's social care should set out the process for how this will happen; and
- If parents and/or the child do not consent to an early help assessment, then the lead professional should make a judgement as to whether, without help, the needs of the child will escalate. If so, a referral into local authority children's social care may be necessary.
For more information about the Early Help Assessment, please visit: Lincolnshire Safeguarding Children Partnership - Early Help and Team Around the Child.
If at any time it is considered that the child may be a Child In Need as defined in the Children Act 1989, or that the child has suffered significant harm or is likely to do so, a referral should be made immediately to local authority children's social care. This referral can be made by any professional.
Agencies, when beginning work with any service user, should inform the service users as a matter of course about their policy on information sharing and confidentiality and explain the kinds of situations where they may need to share information. Agencies should give some indication of why, and with whom they may need to share information. They should ask for the service user's consent to sharing necessary information in advance. This will save time, misunderstanding and potential conflict later. Concerns that a child may be suffering Significant Harm, or is likely to, will always override a practitioner or agency requirement to keep information confidential. Practitioners have a responsibility to act to make sure that a child whose safety or welfare may be a risk is protected from harm, sharing information appropriately. Further information is available via Protocol on Sharing Information in Order to Safeguard and Promote the Welfare of Children.
Children can be adversely affected by parental drug and / or alcohol use in many ways and the potential for suffering significant harm as a result should not be underestimated. Although not all children whose parents abuse drugs and / or alcohol will be adversely affected. Please refer to Appendix 1: Indicators for Children at Risk of Problematic Parental Drug and Alcohol Use for early indicators of potential harm.
Agencies might use different screening tools to identify the risk.
Please refer to Appendix 2: Developing Assessment for an example of a screening tool for use with parents with problematic drug and alcohol use.
Please refer to Appendix 3: Assessment for Pregnant Clients for an example of a screening tool for use with children using drugs and alcohol.
Note: Children (including all children up to their 18th Birthday) may be referred to Horizon within Lincolnshire, see Lincolnshire Recovery Partnership (turning-point.co.uk). Horizon may continue to work with that child until they are 21 if required. However, any identification of drug use in adults (18 plus) would be referred into one of the two available adult drug and alcohol services.
Agencies identifying concerns will need to assess the initial level of concern and which aspects of the child's development are being affected. This assessment should focus on the impact upon the child rather than the adult's drug and/or alcohol use.
Please refer to Appendix 4: Parental Drug and Alcohol Checklist for guidance on what to prepare for an assessment.
There will be circumstances where you do not think the child is at risk of suffering or likelihood of suffering significant harm but feel that their health or development may be at risk if they do not receive additional help from one or more services. Interagency work should start as soon as there are concerns about a child's welfare, not just when there is a 'Child Protection' concern.
The TAC process has been designed to help practitioners assess needs at an early stage and then work with the child / young person, their family and other practitioners and agencies to meet these needs. As such, it is designed for use when:
- You are worried about how well a child / young person is progressing;
- You might be worried about their health, development, welfare, behaviour, progress in learning or any other aspect of their wellbeing;
- A child / young person or their parent / carer raises a concern with you;
- The child's or young person's needs are unclear, or broader than your service can address i.e. multi agency;
- The child or young person would benefit from an assessment to help a practitioner understand their needs better;
- For information and support on how to access the TAC process please visit Lincolnshire Children, Team Around the Child website.
If multi-agency work with the child and family does not result in a plan which is meeting the needs of the child a referral should be made to Children's Social Care via the Customer Service Centre (01522 782 111 or 01522 782 333 out of hours) who have a duty to consider whether a Children's Social Care Assessment is required. You can make referrals to Social Care for 'children in need' in the same way you would for 'children in need of protection' (i.e. a telephone referral followed up with a written referral). Once an assessment has been undertaken this may result in the child being made subject to a 'child in need' plan under Section 17 of the Children's Act 1989.
Child and Family Progress Plans are implemented and monitored in a similar way to Child Protection Plans. An initial meeting is held followed by a review meeting at regular intervals thereafter to monitor the implementation of the plan. In some circumstances the child may move between the 'child in need' 'Team Around the Child' and 'child protection' process as the level of risk and the needs of the child change.
If you think a child may be suffering, or at risk of, suffering significant harm, you must refer the child to Children's Social Care via the Customer Service Centre (01522 782 111 or 01522 782 333 out of hours) or call the Police. Unless the child is at immediate risk of harm a referral to social care is likely to be the more appropriate route. A referral can be made by telephone and you will be asked to follow up a telephone referral in writing.
If you think the child may already be subject to a child protection plan you can ring and ask them to check their records by carrying out a 'child protection enquiry' through the safeguarding unit on 01522 554 061.
Any professional who has had contact with the child or family, however minimal, is expected to contribute to the child protection process including attending child protection conferences and submitting a report.
Carers Trust say that 'A young carer is someone aged 25 and under who cares for a friend or family member who, due to illness, disability, mental ill health or an addiction, cannot cope without their support. Older young carers are also known as young adult carers and they may have different support needs to younger carers.' In Lincolnshire we work with our partner agencies to make sure that the right person has a conversation with a young person about their caring role and responsibilities, we would always recommend that this is someone that the young person chooses to talk to about their situation and that the Early Help Assessment can be used as a tool to record the conversation and come up with a plan with the young person, if they have unmet support needs.
A young person who we know as a Young Carer at 16 years old will be offered a Transition Assessment/Conversation, they can choose either someone they know to complete this i.e. school, college etc, or they can choose children's services Early Help Young Carers Service to complete this with them or they can request this is completed by adult services and this would then pass to Carers First to reach out and make contact with them. Carers First are our commissioned provider who provides our Young Adult Carers a stepping stone into adult support services, if this is what they feel would meet their needs best.
Our Young Carers Service can be contacted via youngcarers@lincolnshire.gov.uk
Adult carers can contact Lincolnshire Carers Service on 01522 782224 or by emailing carers_team@lincolnshire.gov.uk
The best source of information about the drug and alcohol treatment services in Lincolnshire is through their websites. Contact with the drug or alcohol treatment services can be made by any agencies, families and friends or clients themselves. There is also a service available (for those aged under 18) in Lincolnshire that will provide specific help with any problems the young person may be having around drugs and alcohol.
Please visit the Lincolnshire Recovery Partnership (turning-point.co.uk) website for contact details of the local agencies.
There are many useful websites with information and support available around drugs and alcohol:
- Young Oasis (Lincoln based support for carers/families);
- NHS Choices (alcohol);
- NHS Choices (drugs);
- NHS (Change for Life);
- Talk to Frank;
- Families (Drug and Alcohol Support);
- Alcoholics Anonymous;
- Alcohol Change;
- Beating Addictions;
- Drink Aware;
- Drug Scope (Archived via DrugWise);
- Drugs Line;
- Double Impact.
Other Telephone Helpline are also available, for example:
- Narcotics Anonymous - 0300 999 1212 - www.ukna.org;
- Alcoholics Anonymous - 0845 769 7555;
- Drinkline - 0800 917 8282;
- FRANK - 0800 776 600;
- Families Anonymous - 0845 120 0660.
Please also refer to the Pre Birth Protocol for a pathway to assist with the decision making process when undertaking pre-birth assessments.
When professionals have concerns and consent is provided, a pregnancy test should be carried out. If the woman is pregnant she should be encouraged to inform her GP as soon as possible and/or referred to Maternity Services. Please refer to Appendix 5: Problematic Parental Drug and Alcohol Use Including Young Parents for factors to be considered when working with pregnant women who also use drugs and alcohol. When consent is not provided, professionals should follow their internal safeguarding procedures and call Customer Service Centre to discuss.
A multi-agency meeting may be called at any point during the course of the pregnancy to coordinate the care plan. Within Maternity Services and drug/alcohol services a Community Midwife would identify concerns relating to drug and alcohol use and respond/refer as appropriate. Safeguarding midwife has monthly meetings with drug/alcohol services to discuss and share information and to co-ordinate best practice. This will include other relevant agencies as appropriate.
A planning or Strategy meeting for the expectant mother may be called at any time by any agency to update and coordinate the multi-agency care plan. Please refer to the Pre-Birth Protocol for specific details of what should happen and when including when to refer to children's services. It is important to note that the birth of the baby is a significant event, and this period may be challenging or overwhelming particularly if there are other risk factors.
A decision on whether a Pre-Birth Child Protection Conference is required can also be made at these meetings. Children's Services, the GP, health visitor, staff from the maternity and neonatal services and drug/alcohol agencies, with the prospective parent or parents/family may be invited.
Some pregnant patients want to give up using drugs/alcohol. All treatment options should be client led and therefore discussed with the woman. Professionals can encourage communications with their partners to ensure they are part of any support plans, where it is appropriate to do so. Professionals will take into account the woman's wishes regarding their use of drugs/alcohol for the duration of the pregnancy, however the priority will be safeguarding the unborn baby and if the woman's treatment options differ from that of the professionals; this will be discussed with the woman regarding safeguarding of the unborn baby being the priority.
Appropriate drug/alcohol treatment will depend on the amount and types of drugs/alcohol used, as well as the patient's motivation, current situation and past history. The care plan should aim to reduce risks to both parent and unborn child. Prescribing substitute or maintenance drugs should be carried out by the drug/alcohol agency. The National Institute for Health and Care Excellence (NICE) guidance allows, in certain circumstances, Nicotine Replacement Therapy to be prescribed.
Prescribed substitute medication (e.g. methadone) should be given in addition to routine pain relief. A medical alcohol detoxification regime may need to be considered on admission for dependent drinkers and this will be discussed between midwifery and the drug/alcohol service.
The mother and baby should be admitted to the postnatal ward together. Neonatal admission will only occur if prematurity or a medical condition merits it.
Encourage attachment and bonding - encourage positive parenting and comforting the baby. It is highly unusual for a baby to have withdrawal at birth. These symptoms may start soon after the birth, peak at four days and disappear by two weeks. Some substance withdrawal symptoms may present later.
Breast-feeding should be encouraged, as with any mother, so long as the drug and/or alcohol use is stable and the baby is weaned slowly. The actual amount of drug that is passed into baby is low and, in general, the advantages of breast-feeding far outweigh the disadvantages.
Concerns for pregnant patients who use large quantities of substance should be discussed with the Infant Feeding Midwives, the Safeguarding Midwife and the drug/alcohol service. Hepatitis B and Hepatitis C infection poses no additional risk to baby. Women who are HIV positive are advised not to breast feed due to the risk of transmission.
If a mother discloses her drug use during labour or post birth, the safeguarding midwife and/or the local Alcohol and Drug Team should be contacted immediately to discuss treatment options for mother so that she is more likely to stay on the ward. Observations of withdrawal are same as any baby. A multi-agency group should make an assessment of her home circumstances and support networks as soon as possible.
For any safeguarding concerns prior to discharge, please refer to Discharge Planning from a Healthcare Hospital when there are safeguarding concerns.
Continue with any care plans in relation to the child (e.g. child protection or children in need).
Those who are experiencing domestic abuse may use alcohol and/or drugs as a coping mechanism to manage the abuse. Alcohol/drug use can also be embedded in a relationship by the person abusing them. This can increase their dependence on the abuser which enables the abuser to control the person being abused for example by:
- withholding the alcohol/drugs;
- withholding the money to purchase alcohol/drugs.
(Both can be to enforce withdrawal and the symptoms that are associated with this):
- encouraging engagement in criminal activities to fund alcohol/drugs;
- over supplying the alcohol/drugs and the impacts that are associated with this.
All of these examples feed into Coercive and Controlling Behaviour. Any of these can be manipulated by the abuser to maintain control and give a facade to others that the abuser is in control and the person being abused is under the influence of substances. This could make the person being abused, look like an unfit parent, when actually they have no control over the situation, as it is being orchestrated by the abuser for this very effect.
The abuser can also actively encourage the person being abused to leave alcohol/drug treatment and disengage with services as a way to maintain control and ensure they remain dependent on the alcohol/drugs and subsequently the abuser. Should someone disengage with services and programmes designed to support someone to safely become abstinent, this could put their health at great risk. Therefore, offering support for alcohol/drug issues where domestic abuse is present, needs to be offered thoughtfully and with care, to aid the person, not putting them at more risk.
The double stigma associated with being both a victim of domestic abuse as well as having substance misuse issues may compound the difficulties of seeking support, especially if there are other stigmas attached for example:
- status within the community;
- any criminal activities that may be attached to the alcohol/drug use:
- theft to aid purchasing alcohol/drugs;
- forced into sexual activities to aid purchasing alcohol/drugs;
- drug dealing/running, cuckooing etc.
The relationship between a person's alcohol and drug issues and experiences of domestic abuse may not (or not all) be linked. Assessment and interventions for these people therefore need to be conducted separately, although as part of the same work plan, and at the same time.
Alcohol/drug use needs to be addressed alongside the issues of mental ill health concerns and domestic abuse. AVA (Against Violence and Abuse), have two toolkits for those working with people affected by domestic abuse where there is alcohol/drug issues and mental health needs:
There is also training on this via AVA Complicated Matters: Domestic and Sexual Violence, Substance Use and Mental Distress (CPD Accredited) - AVA - Against Violence & Abuse (avaproject.org.uk).
If at any stage of this process differing opinions arise professionals should initiate the Professional Resolution and Escalation Protocol.
Some children may be living in families that are considered resistant to change or engagement with services. RiP Prompt Briefing offers information relating to why families may be resistant and guidance as to how organisations and professionals can overcome this.
Further guidance is also available within the LSCP Policy and Procedure Manual:
Procedures for working with hostile, non-compliant clients and those who use disguised compliance within the context of safeguarding children. See Recognising Disguised Compliance & Disengagement Among Families: Practice Guidance.
Attending drug and alcohol services and adhering to drug screening/breathalysing tests should not be considered engaging with treatment if this is the only part of their treatment programme they adhere to.
If you wish to access further training around the issues contained within this policy around drug and alcohol use and children's safeguarding then please visit: LSCP Training - LSCP (lincolnshirescp.org.uk).
Drugs and alcohol training, tools and information to help professionals and practitioners build knowledge and skills and can be accessed here: Training and Development, Adfam. However, please refer to specialist services wherever possible for targeted support for the family.
- Age of child e.g. newborn babies are at higher risks due to their reliance on parents for all physical and emotional needs;
- Emotional difficulties e.g. crying for no apparent reason, inexplicable feelings of anger;
- Attachment issues and behavioural difficulties e.g. bullying;
- Being left home alone or with inappropriate carers;
- Developmental delay;
- Presenting as not being used to a routine e.g. irregular attendance at nursery or school;
- Neglect and other forms of abuse, high levels of accidents in the home, possibly due to poor parental supervision;
- Family dislocation e.g. moving schools, relationship conflict, domestic abuse;
- For children with disabilities there can be increased risks to their safety and inconsistent approach to the management of the child's medication;
- School problems e.g. truancy, levels of attainment dropping, difficulty in concentrating;
- Offending behaviour;
- Early use of drugs and alcohol – minimisation of the risks associated with or a very strong dislike of drugs and alcohol;
- Feelings of gloom, worthlessness, isolation, shame and hopelessness, poor self-esteem, disempowerment;
- Unwillingness to expose family life outside scrutiny, social isolation, not taking friends home;
- Tendency to keep secrets;
- Role reversal and confusion e.g. protecting others, acting as a mediator and/or confidant, taking on an adult role;
- Extreme anxiety and fear, fear of hostility, violence.
When deciding the appropriate response to the concerns there will be a need to evaluate the seriousness of the information available. In order to do this, it may be helpful to:
- Speak to the parents about the concerns and obtain their views about the situation and what services/support they think they need;
- Speak to other colleagues including in other agencies who know the child and their parents;
- Use professional curiosity to explore and understand the lived experiences of the family;
- Consider how to obtain the voice of the child;
- Use a diary to monitor patterns of behaviour or concerns over time;
- Check your agency records and produce a chronology;
- Ask the parents whether they are currently/have recently engaged with drug and alcohol treatment services;
- Speak to your line manager or a professional with responsibility for child protection/safeguarding children;
- Seek consent of involving extended family members where appropriate;
- Consider triggering a Team Around the Child (TAC).
Workers can then utilise their skills to further explore issues, examine discrepancies or positively reinforce behaviours. Example questions which can be asked or included in assessments:
- Describe the concerns you have about your children at the moment?
- Tell me about the relationships within the family. Describe the support you have?
- Explain would need to change in order for you to be the parent you want to be?
- Describe the effect your drug and alcohol use has on your children?
- Being a parent is stressful at the best of times, explain what extra support you think you and your family might need?
All pregnant women should be asked about their use of prescribed and non prescribed drugs, both legal and illegal, as part of routine enquiries about general health during pregnancy. Time should be allowed for the exploration of the patient's and the professional's concerns about the risks for both the mother and the child. This needs to be done sensitively so that the woman is not deterred from seeking help, even if she continues to use. However, practitioners should ensure that the woman and her partner are aware of the impact of the following behaviours:
- The use of tobacco, street drugs, alcohol and some over the counter drugs, including the adverse effects of some medicines;
- Chaotic drug/alcohol use; e.g. polydrug use, erratic dosage precipitating withdrawals or intoxication;
- Ask the client whether she is currently/has recently engaged with drug and alcohol treatment services;
- Injecting and sharing of drug using paraphernalia;
- Unprotected sexual activity.
If the woman's partner also uses drugs/alcohol, they should be encouraged to access treatment as this increases the chances that the patient will be able to control her drug/alcohol use during pregnancy. Pregnant women and their partners who smoke cigarettes should be identified and specialist smoking cessation offered as early as possible. Where appropriate an amended version of this document should be provided and explained to patients and their partners. Drug/Alcohol Workers, Maternity Staff and other practitioners working with pregnant women, children and their families should consider the following as a part of the on-going assessment process:
- Which drugs/alcohol are being used;
- Current amounts of drug/alcohol use;
- Patterns of use;
- Route of administration (injecting or smoking);
- Other risk behaviour related to the drug/alcohol use;
- Stage of pregnancy;
- The woman's support networks;
- The needs of unborn child;
- Whether the women has other children; their living situation; and their main carer/guardian;
- Concerns about woman's partner using drugs or alcohol;
- Concerns about Domestic Abuse.
Last Updated: April 22, 2025
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