Response to Hidden Harm in Northern Ireland

Davis Turkington

Senior Officer (Health & Social Wellbeing Improvement)

Public Health Agency

Background

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

Hidden Harm(2003)

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

Hidden HarmThree Years

On(2007)

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

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;

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.

Hidden HarmThree Years On:Realities,Challenges andOpportunitiesACMD 2007

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

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.”

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.”

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”

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

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.

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.

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.

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.

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.

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)

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

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.

Public Health Agency/Health and Social Care Board

Hidden Harm Action Plan

Approved by DHSSPSNI October 2009

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

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

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

Principles

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

Baseline for Hidden Harm

Baseline for Hidden Harm

Training and workforce

development

Training and workforce

development

Public awareness

Public awareness

J Joint protocols

ont protocols

P PREVENTIONREVENTION

EARLY INTERVENTIONEARLY INTERVENTION

FAMILY SUPPORT

FAMILY SUPPORT

SAFEGUARDINGAFEGUARDING

COMPLEX NEEDS

COMPLEX

Continuum of Service

Provision

ei Provision

Structure

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)

Implementation

Regional Hidden Harm Quality Assurance Group

Local Implementation Groups

Northern LIG

Eastern LIG

Southern LIG

Western LIG

Projects/servicesExamples:• 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

Projects/services

• Midwifery training• Taking the Lid Off• NSPCC awareness raising campaign

Baseline and monitoring data• Gateway services• Addiction Services• Children's Services Planning• + services such as:

School counselling Youth service Sure start Youth justice