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1.4.2 Alcohol and other drug use and working with families

Last Modified: 22-Mar-2022 Review Date: 04-Jan-2021

 ‭(Hidden)‬ Legislation

Overview

Alcohol and other drug (AOD) use refers to alcohol, illegal and pharmaceutical drug misuse, and volatile substance use (VSU). Alcohol, opiates, amphetamines, methamphetamines, cannabis and non-medical use of pharmaceutical drugs are often involved where there are parenting concerns. For more information on types of AOD use, refer to the AOD Support Tools (in related resources).

Family and domestic violence (FDV) also intersects with AOD misuse in that perpetrators can play a role in causing or exacerbating the adult victim's AOD use or interfere with their attempts to seek AOD use help and support. Adult and child victims of FDV can also be placed at significantly greater risk when perpetrators use alcohol and other drugs.

There is a strong link between early childhood trauma and AOD use. Research suggests that for each additional childhood adversity experience, the risk for problematic AOD use increases by 30-40 percent. In Australia, it is estimated that 1 in 3 adults exposed to childhood trauma later developed an alcohol or other drug problem later in life. Alcohol and other drug use can be a conscious strategy used to mask the distressing symptoms of Post-Traumatic Stress Disorder (PTSD). When the AOD use decreases or ceases, symptoms such as nightmares, flashbacks, dissociation, and poor sleep can return. When combined with withdrawal symptoms, this can leave a person feeling on edge, afraid, and with few other strategies to cope. 

When cessation or significant reduction of AOD use is part of a safety plan, be aware of related mental health risks.

Where a person is suffering from trauma-related symptoms, treating the addiction alone will not help the person recover.

Note: CEO refers to the Chief Executive Officer of the Department of Communities (the Department).

Rules
  • If you determine in your assessment that AOD use adversely affects parental functioning and the child's needs are not being met, you must apply the Interaction Tool and determine if there is a role for the Department. Refer to Chapter 2.2 Conducting a Child Safety Investigation for further information.

  • Where you are concerned about an unborn infant's wellbeing because of AOD use by either parent, you must conduct a Signs of Safety mapping and initiate pre-birth planning processes. Refer to Chapter 2.2 Pre-birth planning for further information.

Information and Instructions

  • Assessing parenting capacity and risk of harm
  • Referral and collaboration
  • Planning
  • Reunification
  • Emergency support
  • Assessing parenting capacity and risk of harm

    When assessing allegations of child abuse and/or neglect, use the Signs of Safety Child Protection Practice Framework. Refer to the AOD Issues - Signs of Safety Mapping and Planning Prompts, Determining Risk Factors for an Infant, and the Bilateral Schedule Interagency Collaborative Processes When an Unborn or Newborn Baby is At Risk of Abuse and/or Neglect (all in related resources) for further information. 

    You must assess parents' capacity to safely care for their children as part of a Child Safety Investigation (CSI).

    Refer to Chapter 2.2 Conducting a Child Safety Investigation for further information.

    Issues to consider when conducting a CSI include:

    • unpredictability of parent behaviour during intoxication, withdrawal or when "coming down"

    • the likelihood and impact of relapse, and 

    • the existence of co-occurring issues such as mental health issues and FDV. These significantly increase the risks of harm to the child and should be considered collectively and not as isolated or unrelated issues.

    Discussing AOD issues with parents may be met with defensiveness, denial, minimisation and secrecy. Parents may be fearful of their child being removed, have had negative experiences with authorities in the past, feel ashamed of their AOD use or have a lack of insight or ambivalence. Parents with a history of their own childhood trauma are also likely to struggle with trauma symptoms and mental health issues. To increase the likelihood of success, adopt a trauma-informed approach and make appropriate referrals to ensure the parent receives additional support.

    Where the parent is supported to manage their own trauma-issues, there is an increased likelihood of success to reduce/cease problematic AOD use and increased safety for the child.

    When working with Aboriginal families, acknowledge the additional trauma of colonisation, racism and impacts of the stolen generation.

    For additional resources on how to provide culturally competent and trauma-informed support, see:

    Ask parents general questions around AOD use when undertaking assessments to ensure early identification of issues, changes in patterns of use and the impacts, and reducing the likelihood of making assumptions. AOD Support Tools and Alcohol and Other Drug Models (in related resources) may assist you in collecting information about AOD use and its effects. The document AOD Screening Tools can also be utilised to gather further information about AOD use and Treatment Approaches for Users of Methamphetamine can provide guidance when working with parents affected by methamphetamines (both in related resources).

    Support parents to seek and receive AOD treatment and assistance. Understanding Motivation and Working with Ambivalence (in related resources) provides information on the motivational interviewing process to assist and support people through change and overcoming addiction.

    Ability to parent and provide care

    Alcohol and other drug use can have a significant impact on the ability of parents to provide adequate care for their children. There is a high risk of neglect for children whose parents misuse substances. Parents can be physically or emotionally absent and may not meet their child's needs e.g. providing regular healthy meals and hygiene routines, or ensuring children attend school.

    A parent who is intoxicated or withdrawing from AOD may have reduced ability to undertake everyday tasks and provide adequate supervision for their child. Their capacity to keep their child safe may diminish, for example, by drink driving and reducing their ability to meet financial responsibilities if they pay for substances instead of purchasing food or paying bills. Parental AOD use is a primary factor in children experiencing chronic food insecurity.  A parent may resort to illegal means or engage in criminal activity as a way of paying for alcohol and or drugs, which can lead to the child having contact with unsafe people or being placed in unsafe environments. 

    The parent's ability to meet the child's needs must be the focus of assessment.

    Direct impacts on the child or unborn baby's safety and wellbeing

    Anything consumed by a pregnant woman will be passed through to the foetus and AOD use during pregnancy can cause a range of negative health outcomes in utero and following birth for a baby. While in utero, a foetus can also suffer adverse effects due to poor diet, high stress levels and violence perpetrated against their mother.

    Newborn babies can suffer significant impacts related to withdrawal from the substances they were exposed to in the uterus. They may experience pain, discomfort and irritability which can make feeding, settling and attachment difficult for them. 

    Where you become aware of AOD use in pregnancy, acknowledge that this is likely related to attempts to cope with past trauma and current difficult situations, not a conscious decision to harm the foetus.

    Consider how to discuss and manage the following risks:

    • Withdrawal in the baby following delivery.
    • Premature birth.
    • Low birth weight.
    • Miscarriage.
    • Birth defects and impaired foetal growth.
    • Brain damage, cognitive deficits and developmental delay.
    • Co-sleeping and the increased risks with alcohol use.
    • Speech and language difficulties.
    • Social, emotional and behavioural issues.
    • Drinking post-birth and the implications for breast feeding and the effects on their capacity to care for the child.

    Infants and young children are at risk of physical and emotional abuse if a parent's response to intoxication or withdrawal symptoms is violent, reactive, irritable, or punitive.  Children may be at risk of sexual abuse, due to reduced supervisory levels or neglect, and exposure to drug use or paraphernalia (e.g. needles), drug overdose, drug dealing, and other criminal activity.  When parents are involved in drug manufacturing, children may be at risk of significant long-term physical harm through exposure to dangerous chemicals.

    Impact on the parent/child relationship

    Parents who are substance affected and/or withdrawing can have mood fluctuations leading to inconsistent parenting and are more likely to be irritable, angry and to lash out in violence due to their own physical pain and discomfort.  This can cause children to feel fearful and confused by their parent's behaviour, which may change between loving and scary.  The parent's ability to connect with their child and be responsive to their child's developmental and emotional needs can also be reduced.

    Children may also develop chronic fear if they are exposed to violence (in the home or community) and worry about their parent's wellbeing and safety.  This could include the possibility of their parents being incarcerated or them being removed from their parents' care.  Emotional stress can harm a child's physical brain development and place the child at risk of poor developmental outcomes.

    Unreasonable expectations on the child to take on parenting roles

    Children may be pressured into taking on parenting roles to help support themselves, their siblings, or their parents. Helping to care for younger children is not harmful, and in the context of Aboriginal families can be considered culturally appropriate. Where the expectations of that care are age-inappropriate and/or excessive, it can lead to disruptions in their education and feelings of isolation from their peers. Where older siblings are responsible for the care of younger siblings, including infants, the level of care provided can be inadequate.  

    Where there are concerns for parental AOD use, consider the child's practical and emotional responsibilities compared to expected responsibilities for a child of the same age and/or developmental stage where within that culture there is no parental AOD use. 


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    Referral and collaboration

    Stay in regular communication with AOD services, especially if they are adult client focussed, and work with them to undertake child centred planning together as early as possible.

    You can achieve this by including the AOD worker in Signs of Safety mapping and planning and providing them with information to help them understand the impacts of parental AOD use on children. See AOD Issues - Referral Tip Sheet (in related resources) for further information.

    Make a referral where AOD treatment and support is needed and the parent is not a current client of an AOD service.  Sharing information is encouraged where appropriate but must be in-line with s.23 of the Children and Community Services Act 2004. Information sharing reduces the likelihood of animosity between you and the AOD worker, and can help to facilitate assessment and planning.  When sharing information, you must consider the parents right to reasonable privacy and dignity.

    Appropriate services can be identified through the following:

    A list and general description of AOD services in Western Australia, can be found in the Drug and Alcohol Agencies and Services document (in related resources).  

    Refer to Chapter 4.2 Working with other agencies – memoranda of understanding and information sharing for further information.  

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    Planning

    When safety planning with parents who are engaged with an AOD worker, invite the worker to meetings where the parents support this.  Ask for a psychology consult before the safety planning meetings.  This helps you to focus the meetings on achieving and maintaining safety for the child, rather than prioritising the needs of the adults.  

    When safety planning is required to increase safety for a child whose parents engage in AOD use and it is impacting their parenting, consider the following:  

    • Partner with other agencies to identify and safety plan around the risks.  This might include asking the agencies to call you or safety network members if they have specific worries.

    • Ask what can be put in place to increase safety for the child when parents use or are likely to be 'coming down'.  Identify if someone else can look after the child or if the parents can restrict use to when the child is at school or asleep.  This plan should involve a sober adult being present.

    • Plan for and seek support from the individual's safety network to support the parents following a lapse. AOD users frequently have numerous lapses before stopping their use completely, but if a parent does not feel supported, a lapse could become a return to regular use. 

    • Liaise with the AOD worker throughout the parent or child's treatment program to be clear on treatment goals and plans (reduced use or abstinence), their compliance and progress. This is important to consider when developing safety goals.

    • Discuss with the family the option of applying for a Liquor Restricted Premises Declaration or voluntary or compulsory income management as part of the safety plan. Refer to chapter 1.4 Alcohol and other drug issues - application for a liquor restricted premises declaration and chapter 1.2 Income management for child protection for further information.

    Where a parent or a child in the CEO's care is undertaking AOD treatment or other interventions, regularly review and monitor the safety plan as the young person may be experiencing ongoing childhood trauma.

    If you are unable to engage a child in the CEO's care who is using AOD, consider developing a safety plan with their family/carers or other people significant to them.


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    Reunification

    Consider the persistent nature of some AOD issues as well as the child's need for stability when considering reunification through stability and connection planning.

    Where reunification is possible, make clear plans on how any AOD use will be managed in the future. Plans should include the impact of AOD use on their parenting capacity and what changes in behaviour are required to increase safety for the child. Ongoing contact with AOD services should also occur through the reunification process including pre-planning, transition and post‑reunification support periods. 

    If the parents have or are likely to have had an experience of childhood trauma, ask them how they can keep their children safe if and when they use, so their children do not have the same struggles they do. 

    Refer to Chapter 3.4 Stability and connection planning for further information. 

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    Emergency support


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