You have noticed that a mother has been looking increasingly worried, and that her anxiety is affecting her two young children. Have you wondered if her stress is linked to substance misuse? What if it is - or isn't? How do you broach the subject? How do you start the process for change for the mother or her drug-using partner? And how do you keep the family 'on track'?
These were the questions addressed by the First Steps project, funded by the Department for Education as part of its strategy to improve outcomes for families with multiple problems and rolled out in 15 children's centres.
As well as improving staff skills, knowledge and practice in identifying and supporting families affected by substance misuse, the project also sought to improve, by 10 per cent, the engagement and retention of these families in the 15 centres.
Mairi Ann Cullen, senior research fellow at the University of Warwick and part of the team evaluating the project, says, 'The project was about creating a stigma-free, family-focused and consistent foundation for good practice, where it was okay to talk about substance misuse and easy to access pathways of support.
'The aim was to roll out the training in the 15 trailblazer centres then develop practice to disperse across the web.'
Leading the project was specialist drug and alcohol treatment charity Addaction, which approached staff development on three levels:
- a one-day training course attended by some 2,350 children's centre staff
- partnership working between First Steps family development managers and the children's centre teams to embed the training in everyday practice, and
- developing e-learning resources and working protocols for effective practice, including core standards, all of which are now generally available.
SUCCESSES AND CHALLENGES
Before the training, 'a substantial proportion of staff felt scared; they felt lacking in knowledge and that they didn't have the skills to address the issues,' says Ms Cullen.
Practice was also found to be inconsistent within, and across, centres. 'There was good practice going on,' adds Ms Cullen. 'However, sometimes someone had just said the wrong thing and parents had been knocked back by the experience and started using again.'
As for parents, those accessing children's centres were generally positive about their experiences, while others were often trapped in 'a circle of high anxiety and low confidence', says Ms Cullen, 'with a complete lack of knowledge of children's centres and a huge sense of fear about what to expect and that people might want to take away their children.'
The one-day training course proved 'extremely successful', producing 'highly significant' and often 'lasting' improvements in staff knowledge, skills and confidence, says Ms Cullen - 'partly because the content was based on learning from talking to parents and to children's centre staff about their experiences and perceived needs'. 'Highly valued' too was expertise from Addaction's First Steps family workers.
However, the work to embed the training in 15 children's centres has also to be seen in the context of budget cuts and the reconfiguring of children's centre services. 'So,' says Ms Cullen, 'some centres weren't able to move forward as fast as they wanted.'
Nor were all the centres able to submit data on improving the engagement and retention of parents with substance abuse. The two centres that did showed their 'identification of parental substance misuse rose significantly', as did their 'successful long-term engagement of these families,' notes the evaluation.
Nevertheless, concludes Ms Cullen, 'it was an extremely valuable pilot. Parents that we spoke to said it made a huge difference to them. It provided treatment for the substance user and support for partner and children, it helped the families to rebuild relationships and it gave them access to the children's centre services, which were greatly valued.'
CASE STUDY: OVERLAND CHILDREN'S CENTRE
Emerging as one of the 'stars' of the project, says Ms Cullen, was Overland Children's Centre in Tower Hamlets, east London.
Its community lead Sarah Bromfield explains, 'Before the project, we would see from local data and out in the community that there was an unaddressed need, but we didn't talk openly about drug and alcohol misuse in the way that we talked about domestic violence and mental health. So we wanted to create a more open culture, and we went from working with nought families to 23 families in 14 months.'
Ms Cullen explains the success of their approach, 'At Overland, the whole team learned to see substance misuse through the eyes of both the child and the parent, so increasing their empathy for families, and the judgemental hat was put away.
'As well as their willingness to embed the training within the centre, they approached it at a strategic level as well, as it became clear that it was impossible to improve integrated working by working in one centre. Change spread out across the area, across the borough.'
Whereas previously the various agencies had tended to work in silos, Overland quickly established partnerships with local adult treatment services and Addaction's Breaking the Cycle Project to develop and promote best practice.
To achieve this, the centre carried out a training needs analysis and developed a wide variety of methods to improve practice, from bespoke training to Addaction First Steps family development managers sharing case conferences. Admin and play and learning staff, often the first points of contact for families, were given best practice training. Family support workers practised their skills in raising the topic of substance misuse with families. Peer-to-peer mentoring, shadowing and joint home visits all helped staff to share their skills and knowledge. Ms Bromfield became a member of Tower Hamlets Hidden Harm steering group - which aims to safeguard children living with parents who misuse drugs and alcohol - and, as part of the pilot, supported Overland in developing toolkits for use in adult services and children's centres nationally. A Hidden Harm conference was held to help spread the word.
Amidst the changes, says Ms Bromfield, 'We also came to see that we do not have to be drug and alcohol experts. We are part of the support, but there are other agencies to deal with treatment.
'We realised that through partnership working, by bringing all the available services together, we could work together to holistically support family recovery. We recognised the potential vulnerability of a child where parental substance misuse was prevalent, and our priority was to support families to feel valued and reduce the stigma so often associated with drugs and alcohol.
'Our approach was to take positive steps towards promoting the long-term resilience and social inclusion of the children and families attending the centre.'
CASE STUDIES: OVERLAND FAMILIES
Asad and Kanz - treatment for drug misuse
Drug-user Asad feels First Steps gave his wife, Kanz, and children somewhere to go to meet people and someone to speak to - in this instance, family worker Falisaha.
She became a trusted companion for his wife and was the reason for Asad agreeing to meet First Steps worker, Stuart, whom he liked and listened to. Asad agreed to go in to treatment and at the time of the project evaluation interview had been clean for eight months.
In addition to First Steps, Asad and Kanz say they benefited from the everyday work of the children's centre, especially learning how to play and sing songs with their children. This was echoed by other parents and in Asad's case helped him rebuild his relationship with his children.
Farhanah - support in understanding drug use
Farhanah's husband is a drug user and had been in prison. After the birth of her daughter, her midwife had put her in touch with Overland's family worker, Shuja. He introduced Farhanah to First Steps worker Stuart, who in turn introduced her to Sharmin, an Addaction Breaking the Cycle family worker.
Through Sharmin, Farhanah increased her understanding of her husband's drug problem, so she was better able to recognise the signs when he was using and to challenge him about it.
She valued Overland as a secure place for her to come to, while her family worker gave her emergency numbers to use day or night.
Her husband had always denied using drugs, but Sharmin's regular visits encouraged him to open up about his past and the reasons for his drug-taking, leaving Farhanah grateful that her husband was now more honest about his drug use.
Tamsin - support after a partner's relapse
Through First Steps, Tamsin's husband Thomas had been put in touch with Lifeline, a cannabis treatment organisation, but had stopped attending. Tamsin was struggling with Thomas's promises of giving up because his £10-a-day habit had landed the family in debt, they were facing eviction, and she and the children were going without.
Additionally, she was having to deal with a range of other issues, from her son's poor sleeping patterns and her own psychological problems to a drug-dealing neighbour and a faulty gas meter.
Tamsin felt Thomas would resume treatment if she accompanied him, but didn't want her children visiting a treatment service. To update Overland about her situation, she attended the centre evaluation interview. The family support lead and centre manager organised immediate support for Thomas's drug use and counselling for Tamsin.
MORE INFORMATION
- First Steps evaluation reports and best practice guidance are at www.addaction.org.uk/page.asp?section=134§ionTitle=Research+reports.
