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1.4.1 Alcohol and other drug issues

Last Modified: 18-Oct-2018 Review Date: 04-Jan-2021

Purpose

To guide child protection workers in assessing and responding to alcohol and other drug use issues.

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

Practice Requirements

  • Where alcohol and other drugs (AOD) are adversely affecting parental functioning and the child’s needs are not being met, a Safety and Wellbeing Assessment (SWA)must be undertaken.
  • Where AOD issues are identified as affecting the SWA of a child, child protection workers must consider the impact of any co‑occurring family and domestic violence or mental health issues through the SWA.
  • Where there are concerns for the wellbeing of an unborn baby because of a pregnant woman using AOD, Signs of Safety mapping and planning must occur as part of pre-birth planning processes.
  • Child protection workers must, where appropriate for the child's age, interview the child as part of the SWA to assess how the parent’s AOD issues impact on the parent’s capacity to meet the child’s needs.
  • If a young person in the CEO's care has an AOD issue, a safety plan must be developed with the young person and/or their family and carers, and details recorded in Assist.
  • If a young person presents to a district office (but is not in the CEO's care) with an AOD issue, referral to Parent Support must be considered and a safety plan developed with the young person and/or their family and carers.​
  • Where a parent or a young person in the CEO's care is an existing client of an AOD service, the child protection worker must liaise with the service to exchange information and consider the effect of any treatment plans.
  • Where a young person is known to the Department, (but not in the CEO's care) and is an existing client of an AOD service, the child protection worker or Parent Support worker must liaise with the service to exchange information and consider the effect of any treatment plans.
  • When undertaking an external Signs of Safety mapping to assess an allegation of abuse and/or neglect, consideration must be given to any AOD specialist working with a parent or young person being invited to participate.

Procedures

  • Overview
  • Assessing parenting capacity and risk of harm
  • Young people in the CEO’s care experiencing alcohol and other drug issues
  • Referral and collaboration
  • Planning
  • Reunification
  • Emergency support
  • Overview

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

    AOD 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 and their needs, such as appropriate supervision, having regular healthy meals, hygiene, attending school, emotional attention and nurturing may not be met. Parents can be physically or emotionally absent and not provide for very basic needs.

    Children are at risk of physical and emotional abuse if a parent’s response to intoxication or withdrawal symptoms is violent, reactive or punitive. They may also be at risk of sexual abuse due to supervisory neglect. Exposure to drug use, drug paraphernalia (for example, needles), drug overdose, drug dealing and other criminal activity is possible. When parents are involved in drug manufacturing, children may be exposed to dangerous chemicals.

    Children may also develop pervasive fears of fights and violence (to parent or themselves), of the parent being incarcerated or the child being removed, or for parents’ wellbeing and safety. The added emotional stress can harm the development of children’s brains and impair cognitive and sensory growth. Therefore children are at risk of poor developmental outcomes.

    Babies in the womb can experience the adverse effects of poor diet, AOD use, and violence perpetrated on their mother. If the mother is using alcohol the child is at risk of Foetal Alcohol Spectrum Disorder (FASD). FASD is a term used to describe the range of effects that can occur to an individual who was exposed to alcohol during pregnancy. These can include, but are not limited to birth defects, brain damage, poor growth, developmental delay, vision and hearing problems, language and speech deficits and social and behavioural problems. Further information regarding FASD is available in the FASD Resource Library (in related resources).  

    Other peri-natal complications may include withdrawal symptoms and premature births. Where a child protection worker becomes aware of AOD use in pregnancy they should discuss these risks with the mother.

    People who have an AOD issue may also experience a co-occurring mental health issue and AOD issues can contribute to family and domestic violence. Where these issues occur together, children can be placed at significantly greater risk.  

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    Assessing parenting capacity and risk of harm

    When assessing allegations of child abuse and/or neglect the Signs of Safety Child Protection Practice Framework must be used. Please refer to the AOD Issues - Signs of Safety Mapping and Planning Prompts and the Bilateral Schedule Interagency Collaborative Processes When an Unborn or Newborn Baby is At Risk of Abuse and/or Neglect (in related resources). 

    Consideration should be given to the following:

    Ability to parent and provide care

    A parent who is intoxicated or withdrawing from AOD may have reduced ability to undertake everyday tasks and provide adequate supervision of their child. Their capacity for keeping their child safe may diminish, for example, by drink driving. Their ability to meet financial responsibilities, including paying bills and purchasing food and clothes, may not be met in order to purchase AOD. A parent may use prostitution as a way of affording AOD. The parent’s ability to meet the child’s needs should be the focus of assessment.

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

    Anything consumed by a woman whilst pregnant will be passed through to the foetus. The range of negative health outcomes for a baby from AOD use during pregnancy can include withdrawal, premature birth, abnormal birth weight, miscarriage, birth defects and impaired foetal growth and development, such as brain damage and social, cognitive and behavioural issues.

    Where there is parental AOD use, children are at greater risk of experiencing neglect or physical, emotional or sexual abuse as well as exposure to criminal or dangerous activity associated with the parental AOD use. Children may also experience housing instability and disrupted education, and be harmed through access to AOD or equipment.

    Impact on the parent/child relationship

    Parental AOD use and withdrawal can cause the parent’s mood to fluctuate which can lead to inconsistent parenting. The parent’s ability to connect with their child and be responsive to their child’s developmental and emotional needs may also be reduced.

    Unreasonable expectations on the child to take on parenting roles

    Children may be forced to take on parenting roles to help support themselves, their siblings or their parents. An assessment of the child’s practical and emotional responsibility, in keeping with their age and level of understanding, needs to occur.

    Issues to consider when undertaking a SWA include:

    • unpredictability of parent behaviour during intoxication or withdrawal
    • the likelihood and impact of relapse, and 
    • the existence of co-occurring issues such as mental health issues and family and domestic violence. These significantly increase the risks of harm to the child and need to 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.

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

    Child protection workers can play an important role in supporting 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.

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    Young people in the CEO’s care experiencing alcohol and other drug issues

    AOD use by young people can cause physical and mental health injury, developmental and social problems, and the risk of involvement with the criminal justice system. Substances used by young people often include alcohol, cannabis, amphetamines, volatile substances and pharmaceutical drugs for non-medical use.

    Where a young person in the CEO's care has an AOD issue, child protection workers must make sure that referral to appropriate services, treatment and support occurs. Collaboration needs to occur with the referred agency. See AOD Issues - Referral Tip Sheet (in related resources) for further information on collaborating with other agencies.  

    The young person’s care plan and the Quarterly Care Review must be updated accordingly. If the young person is placing himself or herself at a high level of risk the child protection worker must inform their team leader.

    When a young person is involved in the Drug Court or Youth Substance Treatment Intervention Regime (YSTIR) programs, child protection workers should:

    • assist the Court or Drug Court assessment teams
    • participate in the Drug Court pre-court discussions, and
    • provide support to the young person while they undertake Drug Court or YSTIR programs. 

    Where a young person is known to us, but not in the CEO's care and has an AOD issue, child protection or Parent Support workers must consider the young person's circumstances, including co-occurring issues such as isolation, disengagement from education, family and domestic violence, and other at-risk behaviours.  Safety planning and referral to appropriate services, treatment and support options should occur. ​
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    Referral and collaboration

    Child protection and AOD workers may have differing aims with AOD services being adult client focused and child protection services being focused on the needs and safety of the child. It is important to make sure that there is regular and open communication with AOD services and to undertake child centred planning together as early as possible. This can be achieved through the AOD worker being included in Signs of Safety mapping and planning. See AOD Issues - Referral Tip Sheet (in related resources) for further information on working with other agencies.

    Where AOD treatment and support is needed and the young person or parent is not a current client of an AOD service, then a referral should be made. Child protection workers should make referrals in line with the Memorandum of Understanding (MOU) with the local Community Alcohol and Drug Service (CAS). Information should be shared in line with s.23 of the Child and Community Services Act 2004 to facilitate assessment and planning.

    Where there is no local MOU, appropriate services can be identified through the following:

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

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    Planning

    Where an AOD worker is involved with a young person or parent, they should be included in safety planning. The child protection worker will maintain a focus on planning to achieve safety and wellbeing for the child.

    If a child protection worker is unable to engage a young person in the CEO's care who is using AOD, then consideration should be given to developing a safety plan with that young person’s family/carers.

    Considerations that may be helpful when developing a safety plan for allegations of abuse and neglect cases where AOD use is occurring and/or escalating could include:

    • strategies to increase safety for the child when the parent(s) is using AOD
    • mechanisms for monitoring AOD use and its impact on parental functioning
    • partnering with other agencies to manage the identified risks, and
    • carefully planning for and managing risks when the parent(s) intend to use AOD or for when they are 'coming down' and withdrawing (involving a sober adult), and this compromises their capacity to care for their child.

    Where a parent or a young person in the CEO's care is undertaking AOD treatment or other interventions, the safety plan must be monitored and reviewed.

    The following should be considered:

    • integrating relapse and prevention strategies into safety planning
    • liaising with the AOD worker throughout the parent or young person’s treatment program to be clear on treatment goals and plan (reduced use or abstinence), their compliance and progress. This is particularly important to consider when developing safety goals, and
    • the individual’s safety network should also be informed and included in safety mapping and the development of safety goals and plans.   

    Case practice tools such as urinalysis (UA) testing, applying for a Liquor Restricted Premises Declaration or voluntary or compulsory income management should be considered as part of the safety plan and should be discussed with the AOD worker treating the young person or parent.

    UA testing is a tool used to identify the type, level and frequency of AOD use. UA testing should be used to complement, not supplement, AOD assessment and treatment from an AOD service. Where there is parental AOD use, UA testing can provide a broader understanding of the parent’s AOD issue and their ability to provide for the child’s safety and wellbeing. Refer to Chapter 1.4: Alcohol and other drug issues - drug testing.  

    There are significant links between parental alcohol over use and child abuse and neglect. Child protection workers can apply to have the premises occupied by a family declared liquor restricted where excessive alcohol use is significantly affecting the safety and wellbeing of children. Refer to Chapter 1.4: Alcohol and other drug issues - application for a liquor restricted premises declaration.

    Income management can assist families to organise their finances to better provide for their children’s needs and reduce the use of AOD. Refer to Chapter 1.2: Income management for child protection. 

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    Reunification

    Child protection workers need to consider the persistent nature of some AOD issues as well as the child’s need for stability and permanency when considering reunification and permanency planning.

    Where reunification is possible, clear plans on how any AOD use will be managed into the future must be made. Ongoing contact with AOD services should occur through the entire reunification process including pre-planning, transition and post‑reunification support periods.

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    Emergency support


    • Overdose – to identify the various signs and causes of AOD overdose and action to take in an emergency, refer to the following:
    • Intoxicated or aggressive clients – refer to the Administration Manual entry Dealing with aggressive behaviour by clients.
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