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June 2014 |
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another finding from the serious case
reviews studied in the document was
that practitioners often ‘missed or
minimised’ risk factors during the
family’s contact with services, taking
an ‘overly optimistic’ view of progress
on the part of parents who were ‘able
to manipulate or deceive’ services into
believing they were making positive
changes. The report calls for
professionals to be more ‘robust’ in
their work with families, with some
cases described as ‘an accident
waiting to happen’.
So, are drug workers open to
manipulation by parents? ‘I think
manipulation’s quite a hard word to
use – it’s a very judgmental word,’
says Bandcroft. ‘Maybe “optimistic”
about changes in clients. One of the
things that we’ve certainly observed is
that people would make plans with
people, set them goals, and they
wouldn’t reach them, so they’d make
some more. Now that may be fine
when you’re dealing with an individual
adult drug user, but I think that when
there’s children involved quite often we
don’t ask ourselves the question
“what’s the child’s everyday life
experience of this?”
‘In the drugs world, the client’s
needs and setting the client goals and
being optimistic about their future has
always been to the fore, but I think
that very often we haven’t looked at
people even in terms of couples or
relationships,’ she continues. ‘In a
partnership you need to make sure
that if both are engaged in treatment
then they have the same regimes, and
that you also think about what your
experience of it would be if you were
the 18-month-old baby in this family.’
‘This is a constant message that we
learn from all the safeguarding training
– to have professional concern,’ says
Yates. ‘It’s always difficult to make that
judgment because you’re wanting
people to do well and you’re trying to
encourage people, and yet you have to
keep your eyes open for the
possibilities you could only know
about if you’ve been properly trained.
It’s an element of the training – to be
aware that these cases happen.’
Sue Bandcroft did find her
involvement with serious case reviews
– she also chaired a case review sub-
group on safeguarding children with
substance-misusing parents –
encouraging in some ways, however.
‘One of the positives that I found for
the drugs world – which is actually in
the recommendations of the Adfam
report – is having somebody on the
serious case review sub-groups, or
however the local authority does it,
who’s from a substance misuse
background. I was a commissioner of
services so I was able to know what
services were available and what
would be suitable.’
Disturbingly, however, though
ingestion of OST medications by
children is often the result of unsafe
storage, there are also the ‘rare but
real’ cases where methadone is
deliberately given to children to pacify
them, as had happened in five of the
cases studied by the report. ‘In several
more cases the practice was
suspected, or how the child ingested
the drugs is unclear,’ states the
document. ‘It was clear from the
serious case reviews that professionals
working with these families had not
accounted for this possibility, and this
was mirrored by the interviewees in
this research.’
‘That was another important
message that came from the review I
was involved in,’ says Bandcroft.
‘Nearly all drugs workers with
someone on a methadone script talk
about lockable cupboards, lockable
boxes – a whole emphasis on ensuring
the person has a locked box – but little
is ever discussed about not giving the
methadone to a child. You can have as
many locked boxes as you like, but –
to think the unthinkable – if somebody
is actually giving it to a child it doesn’t
matter that it’s locked away.’
Even among experienced
practitioners who are fully aware of the
dangers of children accessing OST
drugs, the ‘practice of administering
drugs to children was difficult to
accept or address’ says the report.
The answer, says Bandcroft, is for this
to become part of a forceful
generalised message, ‘rather than it
looking as if you’re focusing on the
individual. If there’s children involved
then the message has to include
“never give the methadone to a child”.’
In fact, Judith Yates’ local service in
Birmingham has now done exactly
that, as a direct result of Adfam’s
findings. ‘When you read through any
report like this you think “yes, I knew
that” and “yes, we need to do that”
and then you look for something which
you’re not quite expecting, and I
suppose the idea that methadone
might be used as a soother or pacifier
was a surprise to me,’ she says.
‘They found cases where there
were signs that opiates had been
given to the babies regularly, and one
parent saying that it was sort of
normal, accepted practice in their area.
On the back of that we’ve changed our
leaflet to include explicit warnings
such as “never give your baby or child
even a tiny amount of methadone or
other opiate for any reason” and
“babies and small children have died
after tiny amounts of methadone have
been given”.’
But if the key to addressing these
disturbing issues is effective
communication, then there’s also
another message that has to be put
over clearly, she believes. ‘Social
workers and health visitors and
everyone who isn’t a drug treatment
worker needs to be firmly informed that
parents being on opiate substitute
treatment is the most important thing
for the safekeeping of the children. If
the parents are not on opiate substitute
treatment, but are using illicit drugs,
then that’s when the children are at
most risk. Anything that threatens the
ongoing engagement in treatment is
increasing risk to the children.
‘Most social workers now accept
that, but it’s ongoing education –
particularly I think for health visitors
and midwives sometimes – that OST is
a good thing, not a bad thing,’ she
says. ‘Clearly, the vast majority of
parents on opiate substitution who’ve
got children are taking their medication
properly and safely. And keeping it
away from their kids.’
Report available at
www.adfam.org.uk
‘We’ve changed
our leaflet to
include explicit
warnings such
as... “babies and
small children
have died after
tiny amounts of
methadone have
been given”.’
DR JUDITH YATES
I think that...
quite often
we don’t ask
ourselves the
question
“what’s the
child’s everyday
life experience
of this?”.’
SUE BANDCROFT