Hidden Harm: Parental Vulnerabilities
Hidden Harm
Recognising, understanding, safeguarding, and improving the health and well-being of children and families living in households with drug and alcohol misuse, mental ill health, parental conflict, domestic abuse, and gambling related harms, is at the core of the Hidden Harm Strategy 2021–2025. To achieve this the following seven key Strategic Priorities have been identified. These will form the foundation of the Hidden Harm Implementation Plan 2021-2025:
- Collaborative Working between Services
- Universal Prevention and Early Intervention
- Whole Household Approach
- Adverse Childhood Experiences and Being Trauma Informed
- Support, Treatment and Recovery
- Commissioning and Governance
- Data Collection.
This strategy commits Sheffield’s services to improving outcomes for whole households where drug and alcohol misuse, harmful gambling, domestic abuse and or mental ill health is a feature.
The Hidden Harm Strategy 2021–2025 will:
- Encompass a Whole Family Approach, including fathers, mothers, significant others as well as children, young people, and their siblings and ensure their voices are heard in all assessments and multi-agency meetings.
- Support practitioners and services, through delivering training and developing tools and resources, to recognise and reduce the impact on children and families of living in households with drug and alcohol misuse, mental ill health, parental conflict, domestic abuse, and harmful gambling.
- Promote collaborative working between services through shared information and discussion, shared understanding and thinking, joint assessment and plans and shared formulation.
- Acknowledge that partnership working and continuity of communication benefits families and safeguards people from being retraumatised by having to repeat their story to each service.
- Support and enable front line practitioners to look beyond the presenting problem and to utilise the full range of support available in Sheffield to offer appropriate interventions that will benefit households featuring vulnerabilities.
- Have a greater focus on intergenerational issues and transitions.
- Recognise that trauma informed services, schools and workforce will lead to a trauma informed community.
- Include, and be informed by, the views of children, young people, adults, and families.
- Ensure appropriate and relevant data is collected and monitored, and a needs assessment and audit cycle established to continually improve outcomes for families.
Further Information
Drug and Alcohol Misuse
Parental Drug and Alcohol Misuse
The term “substance misuse” will refer to the problematic use of alcohol and/or prescribed / non-prescribed drugs (legal or illicit) including the misuse of volatile substances (e.g., butane lighter fuel, aerosols) and novel psychoactive substances (NPS).
Examples where parental substance misuse may impact a child’s development or safety:
- Pre-natal exposure to drugs and alcohol may affect the baby/child’s health before and after birth. Some effects will only become evident as the child develops; some will impact on the child for the rest of their life.
- Impaired parenting capacity: the use of drugs and alcohol can be an all-consuming activity that leaves little time or space for parenting.
- Medication / drugs / alcohol not stored securely.
- Substance misuse within the family home and the child witnessing the behaviour.
- Lack of finance for the provision of basic needs due to money being spent on drugs / alcohol.
- Disruption to household routines: Lack of consistency and boundaries resulting in chaotic and unpredictable lifestyles.
- Neglect: emotional, educational, and physical.
- Substance misuse coexisting with poor mental health and / or domestic abuse or parental conflict.
- Lack of a support system for the family.
- The child taking on the role of carer for the parent.
The short- and long-term impact on children will depend on a combination of factors including their age, level of understanding, personality, circumstances, coping strategies, and degree of external support. Additionally, children’s responses can alter over time as circumstances change and children adopt alternative coping strategies.
Protective factors, positives, and strengths to consider:
- Parents engage with services and comply with drug /alcohol treatment storing medication safely.
- The parent recognises the impact their drug /alcohol use has on their parenting and their child.
- There is a non-using parent who can care for the child.
- The extended family understand the drug / alcohol misuse and provide the children with consistent attention, support and can ensure that family activities are maintained.
- The child has positive nursery, school and or community experiences.
- The child is engaged in a wide range of activities, where they can recognise that they are separate from their parents’ issues to develop their own sense of self and self-esteem.
- There is a positive relationship between the parent and child.
- There is no other family disharmony.
Collaborative working
The most effective response to children and families affected by drug and alcohol misuse comes from all agencies adopting a whole-family approach. This is based on good communication and coordinating the support provided by adult and children's services to a whole family. The aim is to secure better outcomes for the children and adults through the use of targeted, specialised and whole-family approaches to address family needs.
Central to this approach is good collaborative working by using:
- Routine enquiry.
- Robust inter-agency communication and information sharing.
- Joint assessment of need.
- Joint planning.
- Action in partnership with the family.
Action
If parents say they have issues with drugs or alcohol:
- Enquire how they feel that their drug / alcohol misuse impacts on their child? How they minimise any effect? Do they have any support systems including extended family?
- If substance misuse services are not already involved and they would like support about their drug / alcohol issue. Direct them to Likewise Sheffield or encourage them to seek support from their GP.
- Speak to the parents about the Moving Parents Together Programme which they may want to access.
- Alcohol use can be calculated, and advice given by using the Alcohol Screening Tool with the parent.
Drug and Alcohol Misuse in the SCSP Child Protection and Safeguarding Procedure Manual
For further information relating to safeguarding children please consult Section 3.3.3 of the Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures Manual 3.3.3 Safeguarding Children Living in Families with Drug and / or Alcohol Misuse Protocol
For further information relating to substance misuse and pregnancy please consult Section 3.2.2 of the Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures Manual 3.2.2 Pregnant Women, Partners and Babies where there is Substance Misuse (MAPLAG)
Further Information
Parents with substance use problems: learning from case reviews Dec 2023 summary by NSPCC has key issues and learning for improved practice around parental substance misuse and child welfare.
Children and Young People Drug and Alcohol Misuse
Drugs and alcohol can often play a role in the lives of young people, whether that be curiosity, experimentation, recreational or in some cases problematic use.
Not every young person who uses drugs or alcohol develops problems, many young people experiment with substances and not all experimentation leads to continued use or misuse. For some young people and/or those where there are fewer protective factors, substance misuse can contribute to: Poor mental health and emotional wellbeing, potential issues at school, college or work, breakdown of family and peer relationships, and engaging in risky behaviours.
It is important that children and young people receive good education, information and advice about substances and their effects.
Risks
Drug and/or alcohol use by a young person does not on its own constitute Significant Harm. However, there may be circumstances where the young person’s drug and/or alcohol misuse raises safeguarding children concerns, for example:
- The substance use is unusual in view of the child’s age; consider frequency, amounts, substance type, environment, and method of use.
- You feel the young person’s use becoming increasingly chaotic or risky.
- The substance use is/could lead to the young person being involved with criminal behaviour including radicalisation and gang involvement.
- You are concerned the young person is being exploited or coerced in any way including sexual exploitation.
- An adult is involved in facilitating the use of substances or alcohol.
- The young person is caring for another child while under the influence of substances.
Support
- If a child or young person would like harm reduction advice, information or support around their substance use encourage them to access The Corner
- 16 – 25 Outreach support service offers group work and outreach programs, catering to young people between the ages of 16 and 25 spanning across the city, including universities and the nightlife economy.
Children & Young People Drug and Alcohol Misuse in the SCSP Child Protection and Safeguarding Procedure Manual
For further information relating to substance misuse and pregnancy please consult Section 3.9.5 of the Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures Manual 3.9.5 Children and Young People who Misuse Substances
Further information
Parental Substance Misuse - Impact of parental substance misuse
FASD (Fetal Alcohol Spectrum Disorder)
FASD stands for Fetal Alcohol Spectrum Disorder (FASD). It is caused by alcohol exposure in pregnancy and can affect the developing brain and body of an individual before they were born.
It is now known that alcohol is a toxic substance that easily crosses from the mother to the fetus throughout the pregnancy and disrupts a baby’s development. A developing fetus does not have a fully developed liver, it cannot filter out the toxins from the alcohol and this causes harm. It is now known that there is no safe time, no safe type, no safe amount of alcohol to drink when pregnant.
FASD is a life-long neurodevelopmental condition causing cognitive, emotional and behavioural challenges, often referred to as a hidden disability. Each person with FASD is affected differently and has both strengths and difficulties. They and their families need support to learn FASD-informed strategies to support them in their daily lives.
A recent study in Salford (2021) gave a crude prevalence rate of 3.6% of the population living with FASD. This equates to about 300 babies a year being born in Sheffield.
FASD impacts on maternity, children, young people, and adult services, as well as individuals and families. Evidence suggests that without the correct diagnosis and support an individual is more likely to have a range of issues including poor mental health, substance misuse problems, involvement with criminal justice, homelessness and difficulties with social relationships, education, and employment.
There is no cure for FASD. Adults with FASD have the same problems they had when they were younger. Many need on-going support and help throughout their life. However, with the right support from a young age, given by informed and caring people, children can learn to work with and to understand FASD, and have more positive life outcomes.
South Yorkshire’s FASD aim is:
Further Information
Mental Health
Parental mental ill health in a parent or carer does not always have a harmful impact on a child's development. Just as there is a range in severity of illness, there is a range of potential impact on families. All services working with a family must work together to make sure that the voice of the child is heard and they are properly safeguarded.
Examples where parental mental ill health may impact a child’s development or safety
- Specific symptoms which involve the child directly, such as delusions or the child being part of the parent’s suicide plan.
- Mental ill health impacts on the parent’s day-to-day activities.
- The parent is emotionally unable to respond to the child.
- Interactions between the child and parent triggers or worsens mental ill health.
- Lack of consistency in the child’s care, for example changes in carers due to hospital admissions.
- Loss of concentration preventing the parent from keeping the child safe.
- Medication not being stored securely.
- The child taking on the role of carer for the parent.
Complicating risk factors
It is important to recognise that other issues can worsen the risk presented by mental ill health. For example, drug or alcohol misuse, domestic abuse, conflict, or limited support networks, could all show an increased likelihood of the child suffering significant harm.
Other complicating risk factors can include:
- History of mental health problems with an impact on the person’s functioning.
- Misuse of drugs, alcohol, or medication.
- Severe eating disorders.
- Self-harming behaviour and/or suicidal thoughts.
- Lack of insight about the problems and the impact on the child or insight not applied.
- Not following suggested treatment.
- Poor engagement with services.
- Previous or current compulsory admissions to mental health hospital.
- Mental ill health combined with domestic abuse and/or relationship difficulties.
- Mental ill health combined with isolation and/or poor support networks.
- Mental ill health combined with criminal offending (forensic).
Protective factors, positives, and strengths to consider
- The mental ill health is mild or short-lived.
- The parent is engaged and compliant with services.
- There is another parent or family member who can help.
- There is no other family conflict.
- The child has a good understanding of the parent’s condition.
- The child has wider support from extended family, friends, teachers, or other adults.
- The child has a secure base, a sense of belonging and security, good self-esteem, and an internal sense of worth and competence.
- The child has positive nursery, school and/or community experiences.
Working Together
The most effective response to children and families affected by mental ill health comes from all agencies adopting a whole-family approach. This is based on good communication and coordinating the support provided by adult and children's services to a whole family. The aim is to secure better outcomes for the children and adults through the use of targeted, specialised and whole-family approaches to address family needs.
Central to this approach is good collaborative working by using:
- Routine enquiry.
- Robust inter-agency communication and information sharing.
- Joint assessment of need.
- Joint planning.
- Action in partnership with the family.
Action
- Encourage the parent to seek support from their GP. The GP can help them access primary and secondary mental health services.
- Provide information about Talking Therapies who can help with stress, anxiety and depression and have online self-help resources about bereavement, low mood and sleeping problems.
Parents, Carers or Family Members with Mental Ill Health in the SCSP Child Protection and Safeguarding Procedure Manual
For further information relating to safeguarding children please consult Section 3.3.6 of the Sheffield Children Safeguarding Partnership Child Protection and Safeguarding Procedures Manual 3.3.6 Parents, Carers or Family Members with Mental Ill Health
Further Information
SHSC mental health services – further information and referral criteria for each Sheffield Health and Social Care (SHSC) service
The Think Child, Think Parent, Think Family guidance and toolkit developed by SCIE is particularly useful when working with parents and carers with mental health issues.
The Sheffield Mental Health Guide can help you identify services to support families where there are mental health issues. It provides information about mental health in Sheffield, from services to activities, and from conditions to support.
The Parents with a mental health problem: learning from case reviews summary by NSPCC has key issues and learning for improved practice around parental mental health and child welfare.
Domestic Abuse
Domestic abuse is where an intimate partner (including ex-partners) or a family member causes harm to a person aged 16 or over. This includes physical abuse, sexual abuse, emotional or psychological abuse, coercive control and economic or financial abuse. Domestic abuse also includes forced marriage and so-called ‘honour’ based abuse. Domestic abuse can continue for years even after a relationship has ended. It can have long-lasting impacts on both the non-abusing parent or carer and their child’s health and wellbeing. When domestic abuse is happening in their family, children are now recognised in law as victims of domestic abuse in their own right.
Examples of common impacts of domestic abuse on children
- Behavioural changes such as bedwetting, insomnia, issues with school attendance, problems with concentration and hypervigilance (being overly alert or sensitive to the environment).
- Unhealthy coping strategies such as eating disorders or substance misuse.
- Copying harmful behaviours against peers, parents, siblings, or other family members.
- Anxiety and depression which can lead to stress related physical conditions.
- Problems developing healthy relationships and being more vulnerable to sexual exploitation or harmful sexual behaviour.
- Overachieving due to fear of failure or repercussions from the perpetrator.
- Children acting as young carers to their parents or their siblings.
- Long-term impacts on children’s brains and their development which can be hard to overcome even into adulthood. This is sometimes referred to as developmental trauma.
- Physical injury, or even death, as a result of intervening during an incident of physical violence
It is important to recognise that domestic abuse affects children and young people in different ways depending on the child, their age, and the specific situation.
Questions to consider and discuss
It is hard for someone to disclose that they are experiencing domestic abuse. Questions such as these can be helpful:
- How are things with your partner/family member?
- Has anything happened with (…) to make you feel this way?
- Is there anything about your relationship that you would change?
Many victims and survivors may not use the label ‘domestic abuse’ for their experiences. They may describe particular behaviours and you may need to step back and view the whole situation to fully understand what is happening.
Coercive Control – Essential Considerations
- A perpetrator does very substantial harm to the children if they subject the victim/ survivor to coercive control. This abuse amounts to neglect of the children and reflects extremely poorly on the perpetrator as a parent or care giver.
- Even though the children may not have seen the perpetrator physically attack the victim/survivor the perpetrator’s coercive control is still extremely serious and is a parenting choice.
- Even post-separation, a perpetrator’s coercive control is not ‘in the past’ or ‘historic’. It is still very much relevant to parenting arrangements after separation.
- When children are reluctant, resistant, or refuse contact with a parent or carer, think about whether this is because of the domestic abuse they have lived with, listen to their worries and concerns, and take them seriously. Where children are very young listen to the worries and concerns of the non-abusing parent or carer.
Working in a Trauma Informed Way
For too long victims and survivors have felt blamed by agencies for ‘not protecting their children’ when it is the perpetrator of abuse who is causing the harm. Trauma informed practice means that the victim and survivor is believed, their strengths and efforts to keep their children safe are recognised and validated, and that services work with the non-abusing parent to increase safety. This approach means that survivors are able to trust professionals to work with them to reduce risk and harm.
Support children by using the Safe and Together Model. The principles of which are that:
- Children should be kept safe and together with their non abusing parent or carer.
- Workers should partner with the non-abusing parent or carer as their default position.
- Services need to work together to hold perpetrators to account in order to reduce risk and harm to children.
Action
- If a person discloses domestic abuse to you, it is important to complete a DASH (Domestic Abuse Stalking Harassment and Honour-Based Violence) risk assessment and refer or signpost them to IDAS (Independent Domestic Abuse Services).
- Be careful to complete the DASH safely; at a time and location that doesn’t put anyone at higher risk.
- Contact the Safeguarding Hub because Domestic Abuse is a safeguarding issue.
- When you are working with a family remember that children can be affected and harmed by domestic abuse for many years. Specialist local services such as Haven and Door 43 can provide support.
Further Information
For advice and referrals, contact IDAS via the Sheffield Domestic Abuse Helpline: 0808 808 2241 or through their website at www.idas.org.uk
DASH assessments (including the Young Person’s DASH assessment for use with young people aged 13 and over) and further information about MARAC (the Multi-Agency Risk Assessment Conference) are available at https://sheffielddact.org.uk/domestic-abuse/resources/marac-information-and-forms/
For further information regarding domestic abuse, including children being recognised as victims of domestic abuse, you can refer to the Domestic Abuse Act 2021 available at https://www.legislation.gov.uk/ukpga/2021/17/contents and the statutory guidance at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1089015/Domestic_Abuse_Act_2021_Statutory_Guidance.pdf
Support for children and young people experiencing domestic abuse can be accessed from Door 43 (https://www.sheffieldfutures.org.uk/door43/) and Haven (https://www.havenorg.uk/)
For more information about Safe and Together visit https://safeandtogetherinstitute.com/
Learning from Practice