Parental Substance Misuse and Entrenched Neglect

1. Parental Substance Misuse and Entrenched Neglect Gretchen Precey: Independent Social Worker neglect and substance misuse

2. Neglect • Persistent failure to meet a child’s basic physical and/or psychological needs, resulting in serious impairment to the child’s health or development • Faltering growth • failure to provide adequate food, shelter, clothing, safety, health and education neglect and substance misuse

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4. Findings from Biennial Analysis of Serious Case Reviews The children (189) • 2/3 under 5; ½ under 1 • 60% of children died • 17% subject to child protection plans • 13% were on care orders or accommodated • 45% of families highly mobile • 50% of parents had criminal record • 75% affected by DV, mental illness, substance misuse • 75% did not cooperate with services The professionals • Overwhelmed professionals/overwhelmed families • Lack of clarity about procedures and confidentiality • Assumptions about involvement of others • Over emphasis on strengths • Fixed thinking: neglect and ‘rough handling’ • Dearth of information about fathers and men • Unrealistic expectations about capability of less experienced staff (CAF) neglect and substance misuse

5. The chaotic behaviour in families was often mirrored in professional’s thinking and actions. Many families and professionals were overwhelmed by having too many problems to face and too much to achieve. These circumstances contributed to the child being lost or unseen. The capacity to understand the ways in which children are at risk of harm is complex and requires clear thinking. Practitioners who are overwhelmed, not just by the volume of work but also by its nature, may not be able to do simple things well.Brandon et al 2009 neglect and substance misuse

6. Overwhelmed, chaotic families, ‘negative’ support, drugs, violence, mental ill health, criminality Fixed views about family (e.g. men) fixed assessment Views (e.g. neglect) Invisible Children Efforts not to be judgemental, Whole picture missed, separate ‘specialisms’ offer support Too much to achieve, Low expectations, ‘success’ Is getting through the door, muddle about confidentiality neglect and substance misuse

7. Start Again Syndrome • Used as a defence by workers to overwhelming information and feelings of hopelessness • Each pregnancy or birth presented as a ‘fresh start’ • Parents fail to engage with agencies/ agencies fail to engage with parents • Focus is on the present not on the family history, lack of progress not taken into account • Growing evidence base that short-term, behavioural approaches are not likely to succeed with families with long standing, complex problems neglect and substance misuse

8. Emotional development and faltering growth in young children • The importance of feeding children; inter-relationship between the physical and emotional development of young children • It’s not just about weight gain, mechanics of feeding and developmental scales Practitioners need to be aware of the parent’s reactions to their child, and to specifically observe and reflect on the child’s responses to his or her caregivers. These are the foundations of emotional development and of attachment behaviour. What happens during feeding provides powerful clues to emotional development (Brandon et al pg 8) neglect and substance misuse

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10. Neurobiologists have explored the deep significance of attachment, affect regulation, and the quality of early parent-child relationships to the way the brain processes information and experience, particularly emotional experience in the context of attachment relationships, and how its hard-wiring, biochemistry and neurological organisation is shaped by those very experiences. (David Howe 2005) neglect and substance misuse

11. Nature, Nurture & Resilience (Vizard 2010) Effects on Brain Development(Schore, 1994; Perry, 1997, Glaser ,2000) • Babies of depressed mothers – 48% show reduced brain activity particularly in the left frontal cortex (which is associated with joy; interest; anger), • Early experiences of persistent neglect and/or trauma result in neurophysiologic changes in the brainstem and midbrain leading to: anxiety; impulsivity; poor affect regulation, and hyperactivity. • Deficits in cortical functions result in poorer problem-solving, and impoverished capacity for empathy. Such children become the delinquents and psychopaths of the future (Gerhardt et al., 2004). neglect and substance misuse

12. Evidence from Brain Scans 2. Nature, Nurture & Resilience neglect and substance misuse

13. 2. Nature, Nurture & Resilience neglect and substance misuse

14. 2. Nature, Nurture & Resilience (Vizard 2010) So.........studies show adverse effects on the developing brain from abuse and neglect on: • Brain structure • Brain function But............there is also evidence of ‘catch up’ with brain development when ‘nurture’ improves And...........child resilience moderates between nature and nurture neglect and substance misuse

15. No, I knew they loved me but they just didnae care that I was there and I needed stuff as well. And I needed this and things and they were just away taking drugs and stuff Elaine 14 ( Barnard and Barlow 2003) neglect and substance misuse

16. Problematic Substance Misuse and Parenting Poor sensitivity Unresponsiveness to children’s emotional cues Heightened physical provocation and intrusiveness Some ambivalence about having / keeping children neglect and substance misuse

17. Assessing the quality of life of the child of substance misusing parents (Swadi 1994) Procurement of substance: child left alone or exposed to violence/danger Family’s social network: degree of contact with non-drug users, family support Parental attitude to substance misuse: responsibility, denial, insight, recognition of effect on child, motivation to change Child’s perceptions: feelings of responsibility for parent, fluctuations in quality of care, feel safe and protected • Home environment: financial and geographic security, visitors to the house • Provision of basic necessities: food and clothing, supervision, school • Pattern of parental substance misuse: type, frequency, needle disposal, presence of child, attempts at treatment • Effect on parental mental state: cognitive ability, judgement neglect and substance misuse

18. Summary of adverse effects of maltreatment on child’s development and wellbeing (MacMillan 2009) • Infancy • Injury • Affect regulation • Attachment • Growth and developmental delay • Childhood • Anxiety disorders • Mood disorders disruptive behaviour • Academic failure • Poor peer relationships • Adolescence • Conduct disorder • Alcohol and drug abuse • Other risk taking behaviour • Recurrent victimisation neglect and substance misuse