Memorandum by the NSPCC (AL 14)
EXECUTIVE SUMMARY
The purpose of this evidence is to inform the
Committee of the significant impact that alcohol misuse by parents
or carers can have on the children and young people in their care.
First, we provide a brief background to the
NSPCC and the expertise that informs our submission. Secondly,
we present factual information about the impact of parental alcohol
misuse on children and young people. Thirdly, we consider a model
of child and family support the NSPCC has provided in partnership
with the Alcohol Recovery Project, in Camden, London since 2002.
We conclude with a set of recommendations for action.
We would be pleased to supplement this written
evidence with oral evidence to the Committee. In addition, if
members of the Committee would like to learn more about therapeutic
support for children and families dealing with alcohol misuse
we would be very pleased to host a visit to a suitable NSPCC project.
INTRODUCTION
(i) The National Society for the Prevention of
Cruelty to Children (NSPCC) is the UK's leading charity specialising
in child protection and the prevention of cruelty to children.
The NSPCC exists to end cruelty to children through a range of
activities which aim to prevent child abuse, help children at
risk of abuse and help abused children to overcome the effects
of abuse.
(ii) We have a range of services throughout England,
Wales and Northern Ireland. Their work includes:
(a) Providing telephone support for children
and young people via ChildLine.
(b) Providing telephone support for adults
concerned about the welfare of a child.
(c) Providing support for vulnerable children,
young people and their families to help keep these children and
young people safe and well cared for.
(d) Providing services for children and young
people who need help to overcome the impact of abuse.
(iii) The NSPCC broadly welcomes the Government's
focus on alcohol use and its impact on children and young people.
However, we are concerned that the dominant feature of this work
is the threat that children and young people present to themselves
and others by inappropriate patterns of drinking, as opposed to
the threat posed to young and vulnerable children by alcohol misuse
by their parents or carers.
(iv) The NSPCC is concerned to highlight the
considerable impact of alcohol on the safety and well-being of
children and young people living with alcohol misusing parents
or carers. We therefore welcome this Inquiry and the opportunity
it presents to highlight this issue which has been neglected for
too long and barely features in the national policy framework
governing alcohol issues.
(v) The evidence we present is based on our extensive
experience of child protection and in particular the knowledge
and understanding of our practitioners providing services to children
and young people affected by parental alcohol misuse. We also
draw upon the testimony of children and young people using our
helpline service, ChildLine, and other services dedicated to children
and families experiencing alcohol-related dysfunction.
FACTUAL INFORMATION
Alcohol and maltreatment
(i) Child maltreatment is the outcome of
a series of complex and inter-related factors of which parental
alcohol misuse can be one. A significant proportion of child abuse
involves parental alcohol misuse, and children and young people
living in these circumstances are at increased risk of maltreatment.
This does not mean that all children of alcohol misusing parents
or carers will always, or even typically, experience maltreatment.
However, a significant number of them will, and this is of particular
concern to the NSPCC.
(ii) It is difficult to provide an exact
figure for the numbers of children and young people who are living
with parents or carers who misuse alcohol. Quantitative reports
typically conflate drug misuse and alcohol misuse into a generic
heading of "substance abuse". However, the Cabinet Office
(2004) estimates that between 780,000 and 1.3 million children
are affected by parental alcohol problems, a figure which broadly
corroborates the estimate of 920,000 provided by Alcohol Concern
(2000).
Recommendation 1
Data collection and published data, for example
as produced by the Office for National Statistics or the annual
Child & Adolescent Mental Health Mapping exercise, should
routinely disaggregate drug misuse from alcohol misuse where this
is possible. Many parents and carers will use alcohol alongside
other substances. This information should be clearly recorded.
The gender of the misusing parent/carer and the nature of the
substance abuse(s) of each should also be recorded. This would
enable:
— Appropriate research to be undertaken
to uncover the forms of child maltreatment associated with alcohol
abuse and whether these are significantly different to maltreatment
associated with other forms of substance abuse.
— Whether there is a distinctly gendered
element to different forms of substance abuse and associated forms
of child maltreatment. This would be helpful for identifying primary
causal factors and, therefore, the most effective forms of support
and intervention.
(iii) In the year ending March 2008, ChildLine
received more than 80 calls each week (a total of 4,176 calls)
from children and young people where alcohol misuse by a "significant
other" was the substantive reason for the call. We cite some
anonymised ChildLine case examples below to illustrate the impact
of parental alcohol misuse on children.
(iv) Alcohol misuse has a significant impact
on the life and family experiences of children and young people,
for example:
(a) Conflict and particularly exposure to domestic
violence, is commonly associated with alcohol misuse. Gilchrist
et al (2003) found alcohol to be a feature in 62% of prosecuted
cases of domestic violence, while 48% of offenders were alcohol
dependent.
"Dad drinks a lot and gets drunk at weekends.
My step-mum's pregnant, and he pushes her about when he's drunk.
I keep telling her to leave him, but she always goes back and
I'm worried about her children. Mum says he used to push her around
too".
(ChildLine call 2007-08).
(b) Physical abuse and neglect are often associated
with parental drinking (Forrester et al, 2006).
"She [mum] gets violent with my little sister
as well. She always goes out, and leaves me and my sister alone,
when she gets back she smashes up the house, and takes it out
on my little sister when she's done nothing wrong. I've been to
school with bruises and when they ask I have to lie and pretend
I've done it myself".
(ChildLine call 2007-08).
(c) Relationships between children and their
parents and carers or peers are likely to be affected. Children
and young people typically feel ashamed and embarrassed by the
behaviour of a drinking parent (Tunnard, 2002).
(d) Parenting capacity may be compromised as
a result of alcohol misuse, resulting in emotional unavailability,
variable or volatile behaviour (Cleaver et al, 1999), and
in some cases behaviour that is abusive or neglectful.
"I can't live with mum as she does drugs
and goes drinking every night ... dad hit [my] sister once but
she called the police and he never hit her again ... dad hardly
food shops ..."
(ChildLine call 2007-2008).
(e) Role reversal is a common feature in families
affected by alcohol misuse, where children will accept responsibility
for the care and well-being not only of siblings, but of the alcohol
misusing parent(s) (Tunnard, 2002).
"... didn't go to school today ... had to
look after the kids again |"
(ChildLine call, 2007-08)
(f) Poverty: Limited family funds, if diverted
into buying alcohol, can result in real deprivation and/or pressure
on individuals within the family. A failure to pay household bills,
the mortgage or rent, can, over time, have a dramatic and detrimental
effect on a family's security and relationships (Tunnard, 2002,
Forrester et al, 2006).
(v) The experiences of children living in
a family environment where alcohol misuse is a significant factor
are wide-ranging and unpredictable. What is known is that children
of alcohol misusing parents "|have higher levels of behavioural
difficulty, school-related problems and emotional disturbance
than children of non-problem drinking parents, and higher levels
of dysfunction than children whose parents have other mental or
physical problems". (Alcohol Concern, 2009)
(vi) The outcomes for these children are
equally diverse, and include in particular: anti-social behaviour;
emotional problems; poor educational engagement and difficulty
in developing or sustaining trusting relationships (ibid). Parental
alcoholism is also a major predictor of alcohol use in adolescents.
The children of alcohol misusing parents or carers are at greater
risk of alcoholism than the children of non-abusing parents or
carers (Chassin et al, 1999)
(vii) Parental misuse of drugs or alcohol
is a common issue for child care social workers. In a qualitative
examination of social work case files, Forrester et al (2006)
found parental substance misuse emerged as a major feature in
34% of cases. These cases tended to be associated with more severe
levels of concern, for example, they accounted for 62% of children
subject to care proceedings and 40% of those placed on the child
protection register. The study also highlights "the central
importance of alcohol misuse", for while drug misuse receives
more attention than alcohol misuse, by researchers and the media,
Forrester et al's sample found more cases involving alcohol
misuse overall. In addition, those cases involving alcohol found
a higher incidence of violence and were less likely to involve
a substance misuse professional. "It is therefore clear that
alcohol misuse is a central issue for social workers".
(viii) In the main, the children tended
to be younger and part of a family where both parents were substance
misusers, or to come from single parent families where the lone
parent was a substance misuser (Forrester et al, 2006).
Families were typically chaotic; characterised by violence, relationship
breakdowns, housing difficulties and unemployment. The concerns
surrounding children's welfare were predominantly associated with
neglect (ibid).
(ix) Notwithstanding the above, referrals
from health visitors and general practitioners were the exception
rather than the rule (ibid) suggesting that substance misuse issues
are either not being identified or not being referred by community
health professionals. Primary health care professionals play a
crucial role in the early identification of alcohol misuse, and
in the development of multi-agency assessment and support. The
government's plans to expand the health visiting workforce are
warmly welcomed. However, it is important that this expansion
is not confined to targeted interventions such as Family Nurse
Partnerships. The universal service traditionally supplied by
health visitors and widely welcomed by families is a resource
in which the NSPCC would wish to see significant investment and
growth.
Recommendation 2
We recommend increased investment in the home
visiting universal health visiting service, in addition to government
plans to expand Family Nurse Partnerships and to ensure the availability
of a health visitor at children's centres.
Recommendation 3
We also recommend that qualitative research
should be undertaken to establish why community health professionals
are not identifying and/or referring parents/carers with problems
associated with substance, and particularly alcohol, abuse.
(x) Forrester et al (2006) identify
the legal status of alcohol and its prominent role within society
as being a possible partial explanation for the challenges that
arise when working in this area. They conclude this may be the
reason why the inter-agency framework works less well in relation
to alcohol misuse than to other substances.
(xi) The National Service Framework for
Children Young People & Maternity Services (NSF) (2004) is
clear that the children of substance and alcohol misusing parents/carers
are likely to need particular support.
Recommendation 4
The abovementioned research might usefully be
extended to include an examination of why the inter-agency framework
works less well in relation to alcohol misuse than to other substances.
This would inform the development of appropriate practice and
procedures in a multi-agency environment.
xi. Finally, Forrester et al continue
that social workers are ill-prepared for work with substance-misusing
parents and lack appropriate training. This is compounded by the
lack of involvement of substance misuse professionals in care
plans.
Recommendation 5
All professionals working with children and
families should be required to undertake appropriate multi-agency
training concerning the impact of parental/carer drug and alcohol
misuse on the children for in their care.
(xii) Anecdotal evidence from the NSPPCs
services indicates a high level of substance misuse in cases of
serious or fatal child abuse, and this is verified by studies
into fatal child abuse which record the persistence of "substance
abuse" as a risk factor: 60% of cases (Wilczynski, 1995);
57% (DCSF, 2008)i. Further interrogation shows a complex picture
of co-morbidities, without any clear indication of a primary causal
factor. For example: 66% of cases show incidence of domestic abuse
and 55% of cases show incidence of mental health disorders. What
is clear is that substance misuse, though rarely a causal factor
when taken in isolation, is a high risk factor when associated
with either or both domestic abuse and/or a mental health disorder
(DCSF, 2008).
Recommendation 6
Detailed scoping for further research into co-morbidities
should be undertaken as a matter of urgency. This should, in particular,
consider how, where multiple factors are present, the primary
cause might be identified, as this will shape the support offered
to parents, carers and families.
(xiii) The link between alcohol misuse and
non-fatal child abuse is also clear. Robinson & Hassle's study
in Camden & Islington (2000) found that alcohol played a part
in around 25% of known cases of child abuse and that domestic
violence, drug misuse and alcohol misuse were found to be the
highest contributory factors within the family unit affecting
the welfare of the child. Of particular concern, particularly
given the frequency with which it occurred, was the fact that
substance misuse was not included in assessment (Robinson &
Hassle, 2000). These findings bear out the current experiences
of NSPCC teams working with substance misuse, including alcohol
misuse, where adult and children's services do not typically plan
jointly for children in need and children who are subject to a
child protection plan.
Recommendation 7
The Department of Health and the Department
for Children, Schools & Families should develop a stronger
policy focus on the impact of parental alcohol misuse on children.
Recommendation 8
The Department of Health and the Department
for Children, Schools and Families should develop joint guidance
for all professionals working with children and families reinforcing
the need to:
— Ensure that assessments explicitly
include and record an assessment of need and risk in connection
with alcohol and/or substance abuse.
— That this assessment should record
alcohol misuse as a separate factor to other forms of drug abuse.
— That the gender of the substance/alcohol
abusing parent/carer should be routinely recorded.
— That an appropriate record is made
of plans for support, intervention and review.
Recommendation 9
This information should be aggregated within
Local Authority Children's Services Department and used to inform
Primary Care Trust (PCT) Joint Strategic Needs Assessments (JSNAs)
and Local Authority Children & Young Persons' Plans (CYPPs).
Recommendation 10
The Department of Health and the Department
for Children, Schools and Families should consider the development
of a joint performance indicator concerning the identification
of parental/carer alcohol misuse, the rate of referral and the
impact of treatment in terms of the effect it has on family stability.
In addition, women experiencing domestic violence
are 15 times more likely to misuse alcohol than the general female
population and this affects their parenting capacity (Stark et
al, 1996; Stephens et al, 2000; Humphreys et al,
2003)
Other research suggests that children are more
likely to suffer physical abuse if the father is the drinker,
and neglect if the mother is the drinker (Cleaver et al.,
1999).
Recommendation 11
Further research should be commissioned to establish
to what extent abuse associated with alcohol misuse is gendered.
This will inform the nature of intervention and support provided.
xv. Alcohol misuse is typically conflated
into a generic figure for "substance misuse". This is
not helpful for developing social policy on alcohol-related harm
and arguably serves to mask some of its negative effects. Alcohol
is qualitatively different from other substances included in the
term "substance misuse" in that it is a legal substance,
is widely and easily available, relatively cheap and widely socially
embraced across class, gender and many cultures (more so, arguably,
than abstinence). It is the ease of access to alcohol, and the
relative acceptability of its use, that inadvertently conceals
the extent and severity of its impact on family life.
Recommendation 12
Substance abuse data should be disaggregated
into component parts showing "alcohol misuse" and other
substance misuse. This would:
— Provide a clear source of quantitative
evidence to inform practice and policy in this area.
— Provide commissioners with high-quality
information concerning the sorts of specialist services required.
xvi. Routine assessment of parental alcohol
use is widely undertaken, and should form a part of all ante-natal
presentations (RCOG, 2006). This should include enquiries concerning
alcohol use by partners.
xvii. Similarly, routine assessment of parental
alcohol misuse should form a part of all post-natal enquiries
and this should include enquiries concerning alcohol use by partners.
Recommendation 13
Alcohol (mis)use should form a routine and consistent
element of post-natal assessment by health visitors and/or general
practitioners.
THE NSPCC & ALCOHOL
RECOVERY PROJECT
FAMILY ALCOHOL
SERVICE
"Children and young people and families
receive high quality services which are coordinated around their
individual and family needs and take account of their views".
(National Service Framework for Children's &
Maternity Services, 2004, Core Standard 3)
"The stresses of parenthood can precipitate
or exacerbate parents' difficulties. In some cases, children may
be at risk of harm as a result of their parents' problems; substance
or alcohol misuse, in particular, can lead to a chaotic lifestyle".
(National Service Framework for Children's &
Maternity Services, 2004, p.79, para 9.2)
The Family Alcohol Service (FAS) started in
May 2002, as a partnership project between the NSPCC and the Alcohol
Recovery Project (ARP), to provide therapeutic and family support
services to families in Camden and Islington where there are parental
alcohol problems.
(i) It is one of a number of NSPCC projects providing
support services to children and families experiencing parental
alcohol problems. Such services are relatively rare.
(ii) The project aims to bridge the gap between
services to adults and services to children by offering support
to the whole family through one service, using a solution-focused
approach which emphasises the values and strengths of family members,
looking at their motivation to change their behaviour to concentrate
on the needs of their children.
"Despite the evidence that many families
and children are badly affected [by alcohol misuse], recognition
of their experiences, alongside service provision for these families,
has been limited. Traditionally services have focused on the needs
of problem drinkers |" (Velleman et al, 2003)
(iii) Following a short assessment period, FAS
offers a range of services, suited to the needs of each family.
This may include family sessions, individual work with the drinking
parent and the non-drinking partner, couple sessions, as well
as individual play therapy sessions with children affected by
their parents' alcohol problems.
"I come here when Mummy is not well and
it's nice to have someone to talk to".
"It's great to come to this place—you
can talk about difficult stuff".
Feedback from service users: NSPCC Family Alcohol
Service
(iv) The aim is to increase children's resilience
and ability to cope with their situation, as well as helping parents+
recognise the impact their drinking has on their children and
make positive changes to benefit them.
"FAS listens to me when I talk about the
things I do well for my family, not just the bad things".
"Alcohol misuse affects all the family—the
work you do with the whole family makes sense".
Feedback from service users: NSPCC Family Alcohol
Service
(v) FAS work with families for about six to nine
months on average in an intensive way, often seeing more than
one family member for individual sessions. Referrals mostly come
from Social Services but the project also works with other alcohol
agencies as well as health services. Self-referrals are also encouraged
and often these are more motivated to attend and make positive
changes.
(vi) An evaluation of the first 12 months of
this project was published in 2003. It found, amongst other things
that:
— The FAS engaged with 74 families including
120 children in the first year of service.
— Many of the children were on the child
protection register, the subject of care proceedings, living with
other family members or in care.
— Family members were "enthusiastic
in their praise for the service. Both referrers and FAS staff
have reported significant success in engaging difficult-to-treat
families in the change process".
— Children became less anxious and more
able to express and resolve negative feelings about their home
circumstances. School attendance and achievement improved.
— Most importantly: the aspiration of the
FAS was to be seen as an example of good practice. The evaluation
found that "| FAS has made a good start on becoming just
that, demonstrating some inspiring and innovative work in an extremely
difficult area of practice".
Safe, Sensible, Social: The next steps in the
National Alcohol Strategy (HM Govt, 2007) acknowledges the risks
parental alcohol misuse presents for children and young people,
but does not include any recommendations in this context.
Recommendation 14
We recommend that the Department of Health and
the Department for Children, Schools & Families develop a
stronger joint focus on the issue of parental alcohol misuse and
its impact on children and young people.
Recommendation 15
We further recommend that consideration is given
to the provision of more family-focused therapeutic work with
alcohol misusing parents/carers and their children, such as that
outlined above and in line with the requirements of the Department
of Health, National Service Framework for Children's & Maternity
Services, Core Standard 3.
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