The UK experience the Government response to Hidden Harm

1
The UK experience the Government response to
Hidden Harm

• David Best
• Birmingham University
• National Treatment Agency

2
Overview of the presentation

• Hidden Harm and the original survey
• Changes to the follow-up survey
• Overall implications of the new assessment
• Overview and conclusions

3
Research Evidence

• Bancroft et al, 2004
• - parents unable to provide consistent practical
  or emotional care
• - parental drug use assoc. anxiety and social
  stigma
• - parental alcohol assoc. violence and
  abandonment
• - felt childhood was shortened through early
  responsibilities of own and sibling wellbeing.
• NSPCC 1 in 4 neglect cases directly related to
  parental alcohol misuse
• Among children raised by alcohol dependent
  parents
• - 66 physically abused / witness domestic
  violence
• - 26 sexually abused
• - 33 physical / sexual abuse reported to occur
  regularly

4
Advisory Council on the Misuse of Drugs (ACMD)

• Set up under MDA (1971)
• Significant contributions on drug-related deaths
  and AIDS/HIV
• Hidden Harm established under the Prevention
  Working Group (PWG) chaired by Lawrence Gruer
• To examine pregnancy and pre-adolescent phase
• Method involves expert witnesses, collation of
  existing evidence and, in the case of HH,
  collection of new information

5
KEY TARGET POPULATIONS

• Pregnant drug users
• Children of PDU (definitional issues?)
• Drug using parents
• Professional groups (maternity, social services,
  addiction services)
• Policy makers
• Other relevant professional bodies (education,
  primary care, housing, etc)

6
Regional databases

• Parenthood data on 221,000 PDU in contact with
  treatment services 53 of women and 40 of men
  had dependent children
• However only 46 of these had children living
  with them 9 were in care
• 22 of 15-19 PDU in treatment had dependent
  children

7
Harm to children of drug misusing parents

• ACMD Hidden Harm report (2003) 250-350k children
  in England and Wales with drug misusing parents
  780,000 - 1.3 million living with alcohol
  misusing parents(PMU, 2004).
• Objective identify harms, risk of harm,
  monitoring data collection needs, capacity
  competence of mainstream specialist services
  and intervention opportunities.
• Every child matters report (2003) identified 5
  outcomes crucial to well-being in childhood and
  later life
• being healthy, staying safe, enjoying and
  achieving,
• making a positive contribution achieving
  economic well-being

8
Survey Methods

• Questionnaire survey
• Distributed to three services social services,
  maternity services and drug services
• Two mailing waves
• Follow-up phone calls

9
Responses to questionnaires
10
Specialist drug services (1)

• 75 had contact with pregnant DU but 52 had
  services for pregnant users
• 53 had services for drug using parents
• 31 provided services for the children of DUP
• 34 had training for working with pregnant users
• 33 had protocols for this

11
Specialist drug services (2)

• Residential units were markedly less likely to
  have services for pregnant users, clients with
  children, children but better data collection on
  pregnant drug users
• Relatively low rates of variations in service
  provision across the four countries
• ONLY 68 OF SPECIALIST SERVICES EVEN RECORDED THE
  NUMBER OF CLIENTS DEPENDENT CHILDREN

12
Maternity Units

• 92 assessed drug and alcohol status of women
• 1 of all deliveries were in women with problem
  drug use
• 57 had protocols for the antenatal management of
  drug users
• 71 had protocols for the management of
  withdrawals in neonates
• Around two-thirds had regular contact with drug
  services or social services

13
Social work services

• Parental problem substance use was identified in
  24 of cases of children on the child protection
  register
• 58 reported regular contact with maternity
  services and 64 regular contact with drug
  services
• However only 24 reported regular contact with
  GPs relating to parental substance use issues

14
Survey recommendations

• DH should ensure that all maternity units and
  social services record PDU by a pregnant woman
  or by a childrens parents to ensure accurate
  assessment
• All specialist drug and alcohol services should
  ask about and record number, age and whereabouts
  of all of their clients children in a routine
  manner

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KEY MESSAGES FROM HIDDEN HARM

• Estimate of between 250,000 and 350,000 children
  of PDU in the UK
• Parental drug use causes serious harm to children
  from the age of conception to adulthood
• Effective treatment of the parent can have major
  benefits for the child
• Joint working can help to protect and improve
  health and well-being of the child
• Number of children affected will only reduce as
  the number of PDU decreases

16
Key areas of development

• Consistency of data collection and recording
• Effective information sharing and case linkage
  information
• Joint training and development of inter-agency
  protocols
• ownership of joint working linked to targets
  and evaluation of impact
• Strategic planning and development

17
The Scottish response

• Recognition that services for children were
  poorly linked and co-ordinated
• Supported joint planning initiatives
• Initiatives for joint inspection and quality
  assurance
• Establishment of Hidden Harm New Agenda Steering
  Group
• Document targeting staff in criminal justice,
  substance misuse services and young peoples
  services to highlight good practice, set
  expectations and promotion of policies at DAT
  level to push this agenda forward

18
The English response

• Mainstreaming approach under Every Child Matters
• Rejection of recommendation of inclusion in NDTMS
  
• No targets set
• ACMD took rare step of commissioning an
  implementation working group
• Follow-up survey embedded within that

19
SO HOW HAVE THINGS CHANGED?

• Follow-up survey of services in 2006
• 259 specialist drug services completed and
  returned the questionnaires
• 86 questionnaires were completed and returned by
  maternity services

20
Changes in specialist services
21
Changes in forms of service provision since
Hidden Harm
22
Service provision by having Hidden Harm in agency
23
Overall implications of the follow-up report 3
years on

• Main improvement in data is in Scotland, as is
  addition of DIR form
• Significant increases in research and evaluations
  of local projects
• Evidence of improved service coordination
  including the North-East network
• However, evidence of further polarisation of
  commitment and postcode lottery

24
Conclusions

• Picture in UK muddied by larger agenda of Every
  Child Matters
• Scottish response much more credible than English
  response
• Failure to deliver adequate accounting mechanisms
  or CAF
• Need to have better baseline and local ownership

25
Overview

• Problem of data paucity and lack of governmental
  leadership
• Problems of training, joint working and ownership
  at local level
• Limited information on models of good working
  based on limited research
• Huge implications for effective treatment
  planning and effectiveness
• Initial targets of ensuring basic evaluation of
  existing practice and mapping of service
  provision, combined with needs assessment of
  parents, children and range of service providers