Safeguarding Children of Parents with Substance Misuse Problems and Other Vulnerabilities in Essex

1. Safeguarding Children of Parents with Substance Misuse Problems and Other Vulnerabilities in Essex Presentation to ESCB 19 October 2010

2. INTRODUCTION PROJECT BACKGROUND POLITICAL CONTEXT Government Commitment Coalition agreement to ‘investigate a new approach to families with multiple problems’ focusing on 50,000 ‘high need’ families e.g. 400 most challenging families in each authority Government Priorities Strip away obstacles that stop disadvantaged children succeeding Safeguarding children at risk Improving the cost effectiveness of children’s services Building capacity and resilience within families and communities Local policy commitments Ensure that all children thrive Parents are supported Families affected by substance misuse receive more integrated help • Responding to issues raised in JAR, by NTA and in SCRs • Project funded by EDAAT, overseen by a Steering Group, to: • Raise awareness • Develop better understanding and improve practice • Build a case for changing the approach to complex families Methodology • Interview programme – frontline practitioners, team leaders and senior managers across the partnership • Listening to parents and children affected by these issues in Essex • Online survey for practitioners • Data analysis • Literature review • Visiting evidence based programmes

3. DRIVERS FOR CHANGE(from DfE) Challenge • Find a more sustainable approach to funding for family intervention/support services using evidence and cost effectiveness Solution • DfE/ADCS cost-effective children’s services project – focus on family intervention to reduce entrants of older children into the care system Financial Context • Decisions about investment (and achieving savings) will be made locally…. BUT there is a strong case for continued investment in family intervention

4. WHAT IS THE PROBLEM? • Key “parental vulnerabilities” were identified as • Drug & Alcohol misuse • Domestic violence • Offending • Mental health problems • These parental vulnerabilities have been shown to be • Intergenerational • Overlapping, Mutually reinforcing & Long-term • Impact not just on individual but also whole family and wider community • They often impact negatively on children • Immediate safety, with clear links to child protection • Long-term outcomes • Parents with multiple vulnerabilities can create “complex families”, which • Cost society a lot of money (£250k-£350k per year) • Are a challenge to services • Evidence shows we do not do well in improving their outcomes

5. LOCAL NEED In Essex, we estimate that there are: • 7,300 children (under 16) who have at least one parent who is a dependent drug misuser • 57,902 children who have at least one parent misusing alcohol • 46,636 children with at least one parent with a mental health problem • 2,620 children who have at least one parent with drug misuse, alcohol misuse AND mental health problems • 26,200 children experiencing parental domestic violence • 5,240 families with four or more vulnerabilities • 732 births to substance misusing mothers per year

6. CHILDREN LOOKED AFTER Of the 1,465 children looked after in Essex, from our study of cases, we conservatively estimate that there are: • 492 have a substance misusing parent • 527 have parents involved in domestic violence • 211 have alcohol misusing parents • 421 have parents with mental health problems • 386 have parents involved in offending

7. Overlapping Parental Vulnerabilities (PVs) From case file audit of CLA Most CLA in Essex have parents with more two or more vulnerabilities

8. Essex Prevalence Estimates by Team Young Person’s Substance Misuse Service DRUGS: 13% ALCOHOL: 19% DV: 8% MH: 15% CRIME: 8% Family Services ALCOHOL: 16% DV: 46% MH: 52% CRIME: 0% CAMHS DRUGS / ALCOHOL: 25% MH: 50% Children’s Social Care DRUGS: 48% ALCOHOL: 33% DV: 39% MH: 52% CRIME: 0% Adult Substance Misuse Services DRUGS: 50% ALCOHOL: 25% DV: 9% MH: 8% CRIME: 15% Children Looked After DRUGS / ALCOHOL: 53% DV: 36% MH: 29% CRIME: 26% Permanency DRUGS / ALCOHOL: 58% Adoption DRUGS / ALCOHOL: 67% As cases become more severe, we see a rising prevalence of parental substance misuse

9. PARENTS IN TREATMENT • Essex has an estimated 3,486 crack &/or heroin users • 1,603 (46%) of these will be parents • Those in treatment had 2,990 children – a minority were in care • Analysis of treatment data shows • Those parents outside of treatment were more likely to be chaotic than non-parents • Those parents entering treatment were more likely to be stable • Parents were more likely to have dual diagnosis • Parents stay in treatment less than half the average duration • Parents were less likely to complete in a planned way • However, those parents that completed treatment had similarly good outcomes

10. Parents do not engage in treatment as well as non-parents

11. ISSUES • We heard that services did not feel “able / allowed” to work with whole families and many were clear that their priority was the adult or child who was their “client” • Members of complex families are often dealt with as individuals & their vulnerabilities often dealt with in isolation • Services often wait until a crisis has occurred before taking action with complex families • Essex has not identified the priority, high-cost complex families nor costed their impact • There are some excellent family & parenting projects across the county, but these are not well enough joined up, many are short term pilots or geographically limited, making it difficult to have a consistent system across Essex

12. GAPS & BARRIERS • Services do not habitually record these vulnerabilities • Subsequently we do not know actual numbers of children affected • No system to flag families with multiple parental vulnerabilities • No systematic approach to listening to and involving complex families in designing and evaluating services • No clear, consistent strategy for complex families, so we tend to deal with each family on an ad hoc basis • Failing to “future proof” families once a child is taken into care • Working with complex families as whole families is not a priority for everyone • Some adult services are not set up to be “family friendly”

13. WHAT WORKS EFFECTIVE PRACTICE EFFECTIVE PROGRAMMES Family Recovery Project (Westminster) Average saving per family is £13,883 Family Intervention Project (Essex and other areas) The average saving per family per year is £81,624 – some research estimates it could be up to £200k per year Option 2 (Cardiff + other areas) on average each appropriate referral saved the local authority £1,178 per child Families First (Middelsbrough) The mean average cost saving Substance Misusing Parents Project (Kent) Cost-benefit associated with these outcomes was between £15,094 and £90,940 FDAC, M-PACT, Family Pathfinders • High quality key-workers with low caseloads (e.g. 4-6 families per worker) • Ways of whole family working that are empowering and build on family strengths • Respectful, persistent working styles. Flexibility to use resources creatively. Incentives/rewards and focus on consequences secure families’ engagement • Support that is not time-limited (average 12-18 months) and is available ‘out of hours’ • Effective multi-agency relationships (co-ordination, clear arrangements for joint working e.g. with CSC, adult services) • Parenting support through evidence-based parenting programmes

14. THE CHALLENGE • The challenge in Essex is to • Do better for complex families • Improve practice and public services • Save taxpayers money / cost avoidance • Improve family outcomes • Evidence tells us that it can be done, a number of programmes show that by • Working jointly with whole families • Taking an approach to build strengths & reduce risks • We can keep children safe, keep families together, improve long-term outcomes and avoid future costs

15. NEXT STEPS • Report findings & recommendations to ESAB / ESCB • Identify & cost priority complex families across Essex • Introduce a staged model of improvement: • Joint working protocol • Training, Support and Co-location • Evidence-based Programme • Better join-up of safeguarding for adults & children • Activate senior level champions

16. CONCLUSION • If we can see these families coming and know that they are not likely to do well in our normal service responses, then we have a duty to do something different with them in future • Now is the right time to look again at families with complex needs and use the evidence and policy direction to change our approach for the better