Welcome

Learning from

Serious Case Reviews

- Parental Substance Misuse

The aim of the event The aim of the day….

• Local serious case reviews

• Findings and Learning

• Local good practice and resources

• Networking and practitioner discussions

Oxfordshire Safeguarding Children Board

Maggie Blyth - Independent Chair

What is the Safeguarding Children Board?

Created by: Children’s Act 2004

A formal board (network) of organisations

Members: police, social care, education, NHS, probation, district councils…

Includes: lay members and community representation

Aim: to improve how local organisations work together to ensure children stay safe

Who is part of the Oxfordshire Safeguarding Children Board?

What is the role of the OSCB?

• Safeguarding & Child Protection Procedures

(available on the OSCB website: www.oscb.org.uk)

• Multi-Agency training

• Quality Assurance: checking and scrutinising

• Communicating & raising awareness

• Serious Case Reviews

Child Death

Overview (CDOP)

The executive group

Revie of cases

Quality assurance

Training Multi agency working • CSE

• Procedures • Disabled children

Comms • Area groups • Education • Health

Health & wellbeing Board

Children’s Trust MAPPA

Community Safety Partnerships

OSAB Domestic Abuse

Chief Executive of the County

Council Children in Care

Council Oxfordshire Youth

Parliament Sounding Boards

Safeguarding forum

Review of cases

(CRAG)

Quality assurance

& audit

Serious Case Reviews

LSCBs are responsible for commissioning a serious case review (SCR) when there has been a death or serious injury to a child/children A panel decides whether an SCR should be undertaken. Each agency involved is required to provide a report detailing their involvement with the child/young person or parents An independent author produces an overview from all these reports, highlighting learning points and making recommendations for the agencies

Jo Melling

Head of Commissioning, Drugs and Alcohol, Public Health

Clare Dodwell

Commissioning Manager, Drugs and Alcohol, Public Health

Parental Substance Misuse

Serious Case Reviews – Parental Substance Misuse

Parental substance misuse has been a factor in a number of serious case reviews in Oxfordshire and nationally. Local serious case reviews featuring parental substance misuse;

• Child H • Upcoming SCR on Child Sexual Exploitation • Drug and Alcohol Action Team (DAAT) Audit

National Findings from SCR’s:

SCR Local and National Findings

National Findings from SCR’s:

The NSPCC report in 2013 found that in serious case reviews since 2010 where PSM was a factor, children died or were seriously injured due to: • Sudden Infant death syndrome • Accidental ingestion of drugs • Accidents (fire, drowning) due to inadequate

parental supervision • Parents deliberately giving child drugs

National Findings from SCR’s:

SCR Local and National Findings

National Findings from SCR’s:

• The importance of timely and thorough assessments • Professionals should be more curious and focussed

to address specific concerns • Professionals make assumptions about the actions

of other professionals without checking • Adult was viewed as an individual, not as a parent • Professionals must be alert to and take note of new

and increased risks and alter support and intervention as appropriate

• Remain alert to risks even if the parent seems to be complying at that moment

SCR Local and National Findings

Local Findings from SCR’s:

• Parent placing their own needs before those of the child

• Lack of professional’s curiosity about self reported information

• Professionals not realising the full impact on the child

• Support not being offered to the child • Little professional challenge to lack of progress

against plans or agreed actions • Over confidence in parents capacity to improve

without regular professional support • Effort and attention paid to chaotic parent led to

the focus on the child often being lost

Learning from SCRs - PSM

Good Practice – Ensure that you are using all available tools and resources, and take advantage of all relevant training

Be Proactive – Ensure you are aware of the other organisations and professionals working with the child/family and that you understand the interventions

Support the child – Refer to CAN for support, and young carers service if appropriate

Support the parent/s to engage with services for their own needs which will help them in their parenting

Learning from SCRs - PSM

Deal with fact - Do not automatically take the parent/individual’s information as fact – Be curious and evidence it See the client as a parent – Remember that behind your client could be a child/ren at home affected by the adult’s behaviour

Assess the level of risk – This will change throughout the family’s engagement and non-engagement

Understanding the Child’s Perspective

Jade and Lorna

Shaun Hanks

Principal Social Worker, Oxfordshire County Council

Local Good Practice

Child Development Impact on Long Term Outcomes!

• Pre-birth Health (Child & Parent)

impact on physical development

• 0-2 Years Health, Stimulation, Protection, Internal working model

• 3-4 Years Physical Harm, meaningful ‘Play’, stigma, anxiety

• 5-9 Years School, Emotional Development

• 10-14 Years Substance Misuse, Anger/Guilt

• 15 + Emotional Regulation, Violence

Protective/ Resilience factors

• Ante natal care

• Focus on Parents Health/ Understanding behaviour/ Boundaries

• Positive role models/ attachment figures

• Child not witnessing substance misuse

• Finances

• School attendance/ Education/ interests

• Young carers supported

Assessment/Support

• Adult & Child (Information Sharing) • Evidence based (OSCB Toolkit) • Strengths & Risk factors (Analysis) • Working ‘with’ as much as possible • Challenge & Support

Significant Harm (child protection) Significant Impairment (child in need) Guidance/ Support (Early Help/ CAF/TAC)

OSCB Toolkit

• Alcohol AUDIT

• Caring Activities and Outcomes

• How Caring Affects Me

• Drugs Screening Form

• Childcare Development Checklist

• Local Resources

OSCB.org.uk

Ali Mills

CAN - Young people’s drug and alcohol

service

Local Good Practice

Oxfordshire

Bedfordshire

Northamptonshire

1:1 work with young people who misuse

1:1 work with young people affected by someone else's use – Hidden Harm

1:1 work with Children affected by parental misuse – play therapy (Bedfordshire & Northants)

CAN YP Services

I didn’t CAUSE it

I can’t CURE it

I can’t CONTROL it

I CAN help take care of myself

I CAN communicate my feelings

I CAN make healthy choices

I CAN be happy with who I am

Hidden Harm

Not alone

Safe people – protective behaviours

Dependency

Feelings & emotions

It’s ok to talk

Self esteem work

Outcomes tool

Hidden Harm 11+

1. Education/Training

2. Social Life

3. Personal Safety

4. Well Being & Self Esteem

5. Support & Security

6. Drugs & Alcohol

7. Relationship with User

Outcome tool

Young people aged 5-11 yrs. old

Parents assessment/involved

Protective behaviours

Feelings & emotions

Worries – worry box

Art work/stories

Part of CP plan

Play therapy

Moving Parents & Children together

Action on Addiction

Families Plus

8 x weekly sessions

Family review

Reunion

Children must be over 7

No DA issues/concerns

M-Pact

Refreshment Break

THE CHALLENGES WORKING WITH A DRUG USING PARENT

D R A Y M E N A S I M S U B S T A N C E M I S U S E S P E C I A L I S T D O C T O R L I F E L I N E R E C O V E R Y S E R V I C E O X F O R D S H I R E

A Case Study

Introduction

Focus on the challenges presented by a service user recently attending Lifeline

1. Outline the case study

2. Discuss drug screening and the relevant drug screening results in this case

3. Identify a few of the most important challenges posed

4. Discuss management of these challenges

5. Summary

Outline of Case Study

35 yr old mother of four

Illicit drug use since aged 19 and IVDU since aged 28

History of ‘falling off’ her methadone prescription

Regularly drug screened over a 10 month period

Outline of Case – Suspect Urine Samples

Produced 12 urine samples which were negative for all tested substances except methadone

Urine samples produced at times felt cold with a green tinge

This raised the suspicion that she was adding methadone mixture to urine samples that were not her own

When confronted she vehemently denied this

She informed her social worker that Lifeline has ‘got it wrong’

Outline of Case – Pregnancy

Towards the end of this period of regular drug screening, she reported to be five months pregnant

The likelihood that she was using illicit drugs whilst pregnant was a major concern

She continued to deny tampering with suspect urine samples

Outline of Case – Difficulty

She presented a convincing portrayal of commitment to a drug free lifestyle and was extremely adept at explaining away concerns

As long as no evidence existed to the contrary, she was able to minimise her reported drug use to those involved in her and her children’s care

Drug Screen Kits

Drug Screens

MTD EDDP 6-MAM OPI COC Crack THC MAMP AMP BZD BUP BrAC

01/11/2013 √ X X X X X

14/11/2013 √ X X X X X X

28/11/2013 √ X X X X X X X

12/12/2013 √ X X X X X X X

17/01/2014 √ X X X X X X X

01/02/2014 √ X X X X X X X 0

28/02/2014 √ X X X X X X X X

21/03/2014 √ X X X X X X X X 0

11/04/2014 √ X X X X X X 0 Oral (Lab)

11/04/2014 √ √ √ √ X X X X X X

18/04/2014 √ X X X X X

07/05/2014 √ X X X X X X 0

28/05/2014 √ X X X X X X Oral (Lab)

16/06/2014 √ √ X X X X X X X 0

Challenges - Deception

She gave the impression that she was abstinent and engaging

meaningfully in treatment, and for sometime this had been convincing

Although we had suspicions about tampered samples they still concealed any evidence of drug use

After her first oral drug screen came back positive for heroin and cocaine, she stated she would refuse to perform any further oral fluid tests

She explained this positive result as a ‘once off’

Meaningful work around her drug use was impossible due to her refusal to acknowledge a problem

Challenges - Barriers

At her case conference she presented a picture of

someone committed to complying with the child protection plan set

However, following this meeting, she had numerous excuses as to why she couldn’t attend appointments

At one point she ‘fell off’ her methadone prescription giving her an explanation as to why her next sample was positive for heroin

We were forced to continue treating a service user who was not engaging with us

Hair Strand Sampling

The best way to establish the amount and frequency of drug use over a period of up to 12 months

We recommended this intervention to social services in this case because: 1. Point of care screening was creating a barrier to her regular attendance

2. She was steadfast in denying her drug problem, despite the evidence of point of care

screening

Summary

Service users can present convincing portrayals of genuine engagement with drug treatment services in order to give an appearance of addressing substance misuse issues

Point of care drug screening is a useful tool in drug treatment services but has

limitations especially with regards to safeguarding

A urine sample can be tampered with which leaves no evidence of drug use Ideally toxicology for the purpose of safeguarding takes place outside of drug

treatment services, so that the service user does not associate attendance with testing

Hair strand sampling is a useful tool in managing these challenges Meaningful engagement in treatment can help enable a drug using parent to make

the sometimes necessary changes in order to reach their potential as a parent

Thank You

Felicity Bagshaw

Virtual College

Online and Face to Face Training

e-learning for Oxfordshire A range of courses including:

• An Introduction to Safeguarding Children • Awareness of Child Abuse and Neglect • An Awareness of Domestic Violence including the Impact on Children and Young

People • An Introduction to Female Genital Mutilation (FGM), Forced Marriage, Spirit

Possession and Honour Based Violence • Hidden Harm – Parental Misuse • Parental Mental Health • Risk Taking Behaviour • Safeguarding Children and Young People from Abuse by Sexual Exploitation • Strategic Managers Integrated Working – Common Assessment Framework (CAF)

Total number of courses completed - 1835

To book an e-learning course from your learner dashboard, click on the Requested Learning tab

Then click on Course Request

Face to Face training events are listed first, with e-learning courses below. Either use the quick search field and enter the type of course you are looking for, or use the scroll bar to locate it, click to highlight it green, then click on the Request Course button.

The next screen gives you a description of the course, if it’s suitable for you, and how long the course lasts. If this is the course you need, click on the Request Course button, otherwise return to the course directory to search again.

On the next screen, you can enter the reasons why you need to attend the course, enter 0 in the course costs box (courses are free), then submit your request.

e-learning courses are allocated immediately, and will appear on your Active Learning tab on your learner dashboard. Click on the Action arrow, and this will take you to a list of activities in the course.

Work your way through the course by clicking on the Start link on the first activity.

If you have any problems in accessing any of the courses, please check the Frequently Asked Questions that can be found on the Help and Support link at the top of the dashboard. If this does not help, use

the form to email your query, or telephone our Learner Support team on 01943 885095

• What would you do to safeguard the child and reduce harm?

• What resources would you use and what referrals would you make?

• How can you ensure professional curiosity and looking behind the parent?

Table Discussions

• Learning from Serious Case Reviews • Training? Resources? • Network and make links with services • Be curious, dig deeper and look behind the

presenting issue • How can you Improve your practice • Complete an evaluation form

Thank you!

Going forward…..