Dr. Donald Forrester Reader in Child Welfare Director of Child and Family Welfare Research Unit University of Bedfordsh

1. Parental substance misuse and child welfare: reflections on research, practice and policy Dr. Donald ForresterReader in Child WelfareDirector of Child and Family Welfare Research Unit University of Bedfordshire

2. Aims • Consider extent and nature of PSM • Identify issues in work with PSM • Reflect on own research on social work and PSM • Argue that focus on PSM could transform children’s Services by: • Improving the research base • Re-focussing on the quality of the worker/client relationship • Allowing an alternative paradigm for the delivery of services

3. Alternative aim Attempt to relate practice and research knowledge to policy implications Answer “what would you do?” question

4. What is “parental substance misuse”? Use of drugs or alcohol by a parent or carer that is associated with harm to a child • Tricky word – “associated” • Does not have to be dependent use • Not behaviour of parent – harm to child that defines misuse

5. How many children are affected by PSM? • Very difficult to study • Drugs 250-350,000 (2-3%) • Alcohol c.1,000,000 (6-9%) • Somewhere between 1 in 14 and 1 in 10

6. Key challenges: • Identifying PSM • Is substance misuse happening? • Is it harming the child? • Substance misuse interacts with other issues • Parental substance misuse is “Somebody Else’s Problem”

7. “Somebody Else’s Problem” Douglas Adams describes the "Somebody Else's Problem field“ People may see it, but they take absolutely no notice of it. Much simpler than making something invisible, “because it relies on people's natural predisposition not to see anything they don't want to, weren't expecting, or can't explain.”

8. Key challenges: • How can we intervene? • Role of service • Raising the issue with parents • Focussing on parent/child/family • What works?

9. Focus of my work • Much is about transporting ideas from the substance misuse field to children’s services Four studies • Description of social work caseloads and what happens to children • Attempt to train workers in MI • Exploration of communication and PSM • Evaluation of “Option 2”

10. Study 1: PSM and Children’s Services • Followed-up 185 children allocated a social worker for 2 years (information from file studies) • Key Findings • Most (54%) no longer living with mother, many in care • Welfare of children who came into care improved; • That of those at home got worse – often much worse • Workers felt very stuck in their work – with parental denial a defining issue

11. Study 2: Motivational Interviewing • MI centrally concerned with “denial” and strong evidence it works with alcohol misuse • Trained 40 social workers in MI • Key Findings • Wide variation, but overall big improvements in communication; qualitative evidence of impact • Still none demonstrated skilful MI; 9 did not demonstrate basic listening skills • Key issue: highly confrontational initial responses

12. Study 3: How do social workers talk to parents? What “works”? • 24 interviews between social workers and simulated clients • Child care concerns and alcohol problems • Research questions: • How do social workers manage the complexities of such interviews? • What “works”? What doesn’t?

13. What did social workers do? • Every worker clear about concerns – and almost all clear about a plan • A lot of questions – mainly closed • A lot of raising of concerns – little of strengths • Empathy (1 to 5): 2.4 • between ”not listening” and “minimal listening”

14. What “worked”? • Defined by client’s response • Developed/used two concepts: • Resistance • Disclosure • What influenced parental response? • Various things a little • Empathy a lot

15. Empathy and Client Resistance and Disclosure

16. Study 4: Evaluation of Option 2 • Crisis intervention service, using MI and other approaches for children at “heavy end” • Very brief intervention • Compared care outcomes for 279 children who received the service and 89 in a comparison group • Qualitative interviews in 11 families

17. Findings • Option 2 did not reduce care entry • It does: • Delay care entry • Shorten time in care • Make return home more likely • This does reduce cost significantly • Clients very positive about Option 2 – particularly compared to “normal” social work • Urgently requires further research looking at welfare outcomes

18. Where does this leave us (me)? • Child protection services have made enormous strides in recognising harm to children within families • They struggle to combine raising concerns with empathy/sensitivity • There are indications that this can be done – and that doing it well can make a difference • What are the implications for policy development?

19. Reforming Social Services • Social Services focus of policy attention for long time • But how to make things better? Tried: • More and more procedures • Managerial targets and control • Increased bureaucracy • More interagency working • These have all been well intentioned • not all been complete failures • But the system is fundamentally flawed

20. Why have policies failed? • Key issue – how to create change • What would YOU do to make things better? • Little research or policy guidance on how work should be done • Assumption that forms or performance indicators or procedures will address it • Failure to focus on what happens when professional (social worker) meets client

21. Evidence based practice and policy reform • ALL “evidence based” approaches focus on what happens when worker meets client • They provide: • a structure for understanding and • intervening and • a set of skills to do so • Common features: • Highly skilled and empathic communication • A structured intervention

22. What makes EBP “work”? Variation in success within particular approaches striking • Successful EBP involves: • Training • A very strong focus on SUPERVISION • Taped practice reviewed for learning • Research and evaluation

23. How to master any skill?

24. What works in human services? • Focus on what happens when worker meets client • Strong support for development of professional excellence • Ongoing relationship between research and practice

25. Conclusion • Taken together these • Provide a coherent picture of how professionals should be helping the most vulnerable people in society in the most effective way possible • Indicate helpful policy responses to allow this • So I see the substance misuse field as helping social work rediscover its central purpose and rationale