Caught in the Crossfire

Adults Issues placing Children and

Young People at Risk
Seminar
Parental Drug and Alcohol Misuse
Faye McCorey – Consultant Midwife
Martin Weatherhead – Named Doctor for PCT, Clinical Director Counted 4
Jan Welbury – Designated Doctor Safeguarding and LAC

11th March 2008 Caught in the Crossfire

Aims of the seminar

To enhance the confidence of
Designated and Named Professionals
in supporting the investigation and
management of cases involving
substance misuse.

11th March 2008 Caught in the Crossfire

Objectives
To use a case study to consider and discuss:
– the nature of drug and alcohol misuse
– the issues for children, parents and extended family
– the practical issues of professional management
– the legal requirements of case management
– the outcome for families where misuse is an issue

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 Part 1
Hayley (aged 25 years) presents to her GP. She is
pregnant, her LMP suggests gestation is 5-6 months
but her periods have never been regular – in part
because of her known drug and alcohol misuse.
The GP knows the family well, Hayley has 3 sons who
are looked after and her relationship with the boy’s
father, George, who also misuses drugs and alcohol
has been violent.
Hayley tells the GP that Children’s Services know about
the pregnancy.

11th March 2008 Caught in the Crossfire

Part 1
Questions:
– What action should the GP take?
– Who should the GP contact?

11th March 2008 Caught in the Crossfire

Issues for Primary Care

• History/exam – don’t forget standard medical treatment/assessment and drug
and alcohol history (including smoking).
• ICE – why late presentation?
• Refer:
– Ante Natal Clinic
– Community Drug Team (if not in treatment)
– Social Services (if appropriate) – When?; Consent?; How?
• What to include in a referral? (and to whom)
– paternal behaviour (Serious Case Review evidence)
– positive and negative
– core GP obligation
– to Children’s Services - proforma
• Who co-ordinates the response? Information gathering in the early stages
especially.
– should be clear in LSCB guidance(all GPs should not only know where they
are (QoF) but understand the content and their use as a reference)
• How does the Primary Care Team communicate in a fragmenting world?
(Children’s Centres – non co-location with GPs)

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 Part 2
The maternity unit receive the GP referral of
Hayley outlining the social circumstances

Faye to alter this to serve her needs - send it to me

and I will update the master copy

11th March 2008 Caught in the Crossfire

Part 2
Questions:
• What issues need to be considered
• What should the care plan include
• Who needs to be involved
• What strategy could be adopted to
manage the pregnancy and delivery

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Part 2
• Routine discussion – e.g. screening, breast-
feeding, analgesia
• setting realistic goals
• initiating/sustaining change
• risk reduction/harm minimisation
• confidentiality vs sharing information
• personal/professional boundaries

• ….talking taboos
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 Part 3
Hayley and George have been referred to the
DAT. Both have previously been in treatment.
George had received a community order
(DTTO – Drug Testing and Treatment Order)
but breached the conditions on a number of
occasions and received a custodial sentence.
Hayley had been referred by the GP and she
initially engaged well but her compliance
wavered when George came out of prison.

11th March 2008 Caught in the Crossfire

Part 3
Questions:

• What contribution can the DAT make?

• What concerns will there be for the parents and the
unborn baby in relation to drug and alcohol misuse?

11th March 2008 Caught in the Crossfire

Issues for DAT

INFORMATION SHARING:

• Support the parent – optimise treatment (Hidden Harm)

• Destabilisation v. Ideal opportunity, “turn over a new leaf”. Detox
role
(“Want to detox” Why? – prolonged neonatal stay. Detox in
pregnancy (alcohol))
• Support the obstetric team
• An “alternative view” to Children’s Services
• Support the Primary Health Care Team
• Testing – why? Role of testing
• Multi-agency approach

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 Part 4
• The 3 boys are placed with foster carers:
• Michael (aged 10years) is placed with Joshua (aged 3
years) and has been doing well at school. He has been
able to relinquish the care of Joshua and take his place
as a child in the household. The foster carers have
applied to become long term foster carers to Michael and
Joshua.
• James (aged 6 years) displays challenging behaviours
and is placed separately as the only child in placement.

11th March 2008 Caught in the Crossfire

Part 4 cont.
• Hayley has twice weekly contact with the boys but is not
reliable often failing to arrive or too heavily under the
influence of drugs for contact to occur causing great
distress, particularly for James who was favoured by his
mother.
• Contact is of poor quality, Hayley treats Joshua like a
baby and overindulges James but cannot contain his
behaviour.
• James is loud and confrontational on returning from
contact, When contact fails he is fretful and anxious and
his sleep is disturbed.

11th March 2008 Caught in the Crossfire

Part 4 (cont)
• Hayley has wants the children returned to her and
George, their relationship has been characterised by
violence and George has served a number of custodial
sentences for violence and drug related offences
• George does not have PR for Michael and Joshua but
does have PR for James who is not his birth child
• Since disclosing her pregnancy Hayley has decided to
agree to the plans for the boys as she wants to
concentrate on caring for her new baby. She and George
have been reconciled and he supports her wish to care
for the baby.

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 Part 4 (cont)
• Baby Danielle is born at 35 weeks gestation, she is on the
2nd centile for weight and the 9th for head circumference

• Hayley wants to breast feed Danielle

• Danielle becomes restless and jittery, she has a high-

pitched cry and is difficult to feed.

11th March 2008 Caught in the Crossfire

Part 4
Questions:
What are the issues for:

• Hayley

• George

• The Children

11th March 2008 Caught in the Crossfire

Issues for Paediatrics

• An ability to recognise the signs and symptoms
and patterns of behaviour of drug and alcohol
misuse
• Congenital syndromes associated with maternal
substance misuse
• Neonatal abstinence syndrome
• Breast feeding in drug misusing mothers

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 Remember Other Agencies
• MHS
• CAMHS
• Police
• Probation
• Judiciary
• Education

11th March 2008 Caught in the Crossfire

• What part does each agency play in the

management of this case?
• An essential part

11th March 2008 Caught in the Crossfire

Issues for Designated and Named

Health Professionals
• HIV / Hepatitis / Drug misuse / Breast feeding
• Alcohol / fetal alcohol syndrome
• Congenital syndromes related to drug misuse

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 Summary
• Links between drug and alcohol misuse, mental health
issues, violence and criminal behaviour
• The intergenerational cycles of misuse
• The need to understand the long-term nature of
intervention and support required to break the cycle
• The need for a transparent, tightly coordinated,
multidisciplinary and interagency care plan
• The need to engage the parents, children and the
wider family in the care plan
• The need for professionals to feel confident and
supported in managing the issues
11th March 2008 Caught in the Crossfire