Response to Hidden Harm in Northern Ireland

1. Response to Hidden Harm in Northern Ireland Davis Turkington Senior Officer (Health & Social Wellbeing Improvement) Public Health Agency

2. Background • UK Hidden Harm Reports (2003, 2007) • O’Neill Inquiry (2007)

3. Hidden Harm(2003)

4. When parents use drugs:Key findings from a studyof children in the care ofdrug-using parents Hogan, D and Higgins, L. Dublin: Trinity College, 2001

5. Hidden HarmThree Years On(2007)

6. Hidden Harm:responding tothe needs of children of problem drug usersACMD 2003

7. 6 key messages • We estimate there are between 250,000 and 350,000 children of problem drug misusers in the UK – about one child for every problem drug misuser; • Parental problem drug misuse can, and does, cause serious harm to children at every age from conception to adulthood; • Reducing the harm to children from parental problem drug misuse should become a main objective of policy and practice;

8. 6 key messages • Effective treatment of the parent can have major benefits for the child; • By working together, services can take many practical steps to protect and improve the health and well-being of affected children; • The number of affected children is only likely to decrease when the number of problem drug users decreases.

9. Hidden HarmThree Years On:Realities,Challenges andOpportunitiesACMD 2007

10. Purpose • To describe and comment on progress on implementation of the recommendations of the original Hidden Harm report • To provide practice examples and information about implementation initiatives • To identify key learning for the future

11. Northern Ireland in 2007 report • “work in Northern Ireland to respond to Hidden Harm has taken some time to get off the ground” • “It is early days for work on ‘Hidden Harm’ in Northern Ireland.”

12. Northern Ireland in 2007 report • “There is clear evidence of progress in England, Scotland and Wales in relation to safeguarding the welfare and protection of children of problem drug users. However, progress varies across different areas in the four different countries.”

13. Northern Ireland in 2007 report • “The Northern Ireland New Strategic Direction for Alcohol and Drugs includes a significant range of targets for training at both regional and DACT level……….However, there is no specific reference in the document to training to equip workers to respond to the specific needs of children of problem drug users”

14. O’Neill Inquiry • Recommendation 17(Mental Health / Childcare Interface ) • DHSSPS and Boards should ensure that each Trust puts in place a joint protocol designed to manage the interface between mental health and child care services

15. Scale of the Problem • Hidden Harm – partly because the data was not being collected. • ACMD estimates extrapolated from what data was available. • Did not include people who had problems with alcohol but not with other drugs.

16. Scale of the Problem • 200,000 and 300,000 children in England and Wales where one or both parents have serious drug problems. • Between 41,000 and 59,000 children in Scotland with a problem drug using parent.

17. Scale of the Problem - NI • Problematic alcohol misuse is a significantly more widespread problem than illicit drug misuse • It is estimated that 1 in 11 children in the UK are living in a family where there is an alcohol problem. In the 2001 Census, there were 451,514 children in Northern Ireland: it could therefore be extrapolated that there are approximately 40,000 children in Northern Ireland living with parental alcohol misuse.

18. Scale of the Problem - NI • In 2007/08, 22% of problem drug misusers presenting for treatment were living with children, which equates to 412 adults although the number of children is not identified. However, this is clearly an underestimate, as it only captures information about the children of parents who are seeking treatment.

19. Scale of the Problem - NI • 40% of children on the child protection register are there as a direct result of parental substance misuse. • 70% of our “Looked After Children” are living away from home as a direct result of parental substance misuse.

20. Interagency Protocols • Protocol to Promote Inter-Agency Working with Children & Families Affected by Substance Misuse (Eastern Health and Social Services Board, 2006) • Joint Service Protocol to meet the needs of children and unborn children whose parents or carers have alcohol or substance misuse problems ( Western Health and Social Care Trust – Health and Social Care Board, 2009)

21. Interagency Protocols • Effects of parental substance misuse on children • Confidentiality/information sharing • Roles and responsibilities – Adult substance misuse services and family & childcare services • Assessment and referral • Both protocols supported by training programmes

22. Regional Hidden HarmAction Plan - DHSSPSNI • This plan focuses on children born to and/or living in households where there is alcohol and drug misuse, including the misuse of over-the-counter and prescribed medication. • Regional framework for the development of local Hidden Harm action plans.

23. Public Health Agency/Health and Social Care BoardHidden Harm Action Plan • Approved by DHSSPSNI October 2009

24. Policy Context • New Strategic Direction for Alcohol and Drugs 2006-2011 • Our children and young people, our shared responsibilities 2006 • Our Children and Young People – Our Pledge 2006 • Care Matters in Northern Ireland 2009 • Families Matter: Supporting Families in Northern Ireland 2009

25. Principles • The welfare of the child should be the paramount consideration. • Work with the complexity of the issue. • A non-judgmental approach • A shared commitment and response • Provision to respond to the needs of children and families affected should be integrated within mainstream Children's and Adult services

26. Principles • A focus on prevention and early identification • Not all families affected by substance misuse will experience difficulties • Parental substance misuse may have significant and damaging consequences for children • Building on family strengths

27. Principles • Services need to be based on: • What children say they need • What parents/carers say they need • Evaluation of effectiveness.

28. COMPLEX NEEDS COMPLEX SAFEGUARDINGAFEGUARDING Continuum of Service Provision ei Provision FAMILY SUPPORT FAMILY SUPPORT EARLY INTERVENTION EARLY INTERVENTION P PREVENTION REVENTION Baseline for Hidden Harm Baseline for Hidden Harm Training and workforce development Training and workforcedevelopment Public awareness Public awareness J Joint protocols ont protocols Structure

29. Priority Areas • Training and Workforce Development (Regional) • Joint Leadership and Interagency Working Arrangements (Regional) • Hidden Harm Information Baseline (Regional) • Public Awareness and Good Practice (Regional) • Continuum of Services (Local)

30. Implementation Regional Hidden Harm Quality Assurance Group Local Implementation Groups Northern LIG Eastern LIG Southern LIG Western LIG

31. Projects/services • Examples: • Joint Agreement between Adult and Children’s Services in responding to the needs of Parents with Mental Health issues and/or Substance Misuse, Their Children and Families • PHAROS project (Barnardos) • Steps to Cope

32. Projects/services • Midwifery training • Taking the Lid Off • NSPCC awareness raising campaign

33. Baseline and monitoring data • Gateway services • Addiction Services • Children's Services Planning • + services such as: • School counselling • Youth service • Sure start • Youth justice