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1 Introduction

1.1 Background

In 2003 the UK's Advisory Council on the Misuse of Drugs ( ACMD) published "Hidden Harm" which highlighted the plight of children affected by parental drug use.

The key messages of the report were that:

• parental problem drug use can and does cause serious harm to children of every age;
• reducing the harm to children should become a main objective of drug policy and practice;
• effective treatment of the parent can have major benefits for the child;
• by working together, services can take practical steps to protect and improve the health and well-being of affected children; and
• the number of affected children is only likely to decrease when the number of problem drug users decreases.

The Executive responded to the "Hidden Harm" report in October 2004. In its response, the Executive covered not only the issues identified in the ACMD report about parental drug use and its impact on children, but also those related to parents with alcohol problems. This was because it was recognised that many children suffer from parental problems with both and that many services offer support for both addictions. An update of progress since the Executive's response can be found in Annex 1.

1.2 "Hidden Harm - Next Steps" - purpose and content

"Hidden Harm" vividly describes the situation of many children and young people living in substance misusing households. They often suffer in silence; they are often not known to services; they often do not know to whom they can turn for help; and the impact of poor parenting on them can have long-lasting and devastating effects.

All professionals who come in contact with substance misusers and/or their children have a responsibility to ensure that children in these circumstances are identified as early as possible and are given appropriate support and protection. Early identification and the right kind of support - both for parents and children - can often mean that children can remain with their parents, but there are some circumstances, for example, serious and chaotic drug use, when the risks to the child are so severe, that staying with their parents cannot be an option. For all professionals the needs of the child must take precedence over the needs of the drug using adult.

This document identifies, and brings together, a range of actions and initiatives that the Scottish Executive is taking forward and will take forward, in partnership with a range of local partners - Alcohol and Drug Action Teams ( ADATs), NHS Boards, local authorities, the police, the courts and the Scottish Prison Service ( SPS) and their partner agencies - to improve the way in which agencies identify, protect and support children and young people living with parental substance misuse.

However, we are not starting with a blank sheet. Publication of "Getting our Priorities Right", and the proposals described in "Getting it Right for Every Child", set out a comprehensive approach to unifying and integrating services so that children get the help they need when they need it.

"Hidden Harm - Next Steps" focuses on action by the Executive and its statutory partners. However, the role of the voluntary sector is also extremely important and must be an integral part of delivering the agenda. In December 2005 the Executive launched " A Vision for the Voluntary Sector". This recognises the role that voluntary organisations play in the delivery of services, in uniting and building communities and promoting positive change in society.

The voluntary sector is often very effective at reaching families where there is potential risk and where there may be parental reluctance to engage with official agencies for fear of children being removed. Children and young people themselves often feel more able to access the support they need from a voluntary organisation.

This work has benefited from the input from an Implementation Group, the remit and membership of which is contained in Annex 2. It has also been informed by a wide-ranging consultation exercise undertaken in 2005, which involved practitioners, families affected by drug use, and children and young people. Annex 3 provides a summary of the main points from these consultations.

Each section of the publication focuses on a stage of a child's development, from before birth through to adulthood, but it also covers generic issues - such as care and protection, health, parents in the criminal justice system and the wider environment in which a child lives - which are not age-specific.

Each section is set out as follows:

• key issues from the point of view of the child;
• best practice for agencies in how to tackle these issues;
• action that the Executive is taking forward; and
• issues requiring further action.

"Hidden Harm - Next Steps" covers the spectrum of issues related to "Hidden Harm" and is relevant to a wide range of agencies. However, we recognise that some practitioners may wish to concentrate on the section(s) relevant to their particular interests and responsibilities. For this reason, we have replicated in each section issues/actions that apply more broadly.

1.3 "Hidden Harm - Next Steps" - the wider context

This work should be considered within the wider context of the Executive's strategies for tackling drug and alcohol problems, which are summarised below.

1.3.1 The Executive's strategy for tackling drugs

The Executive has a comprehensive strategy for tackling drugs, which is based on the premise that illegal drug use is not inevitable, and that we need to tackle this by prevention, intervention and enforcement. The key priorities are to:

• reduce the use of drugs amongst children and young people, through education and public information;
• reduce the harm done to children and young people living in drug-taking families;
• increase the number of problematic drug users getting timely and effective treatment;
• reduce re-offending, by increasing the number of drug-misusing offenders entering treatment;
• reduce the availability of drugs; and
• support communities hardest hit by serious drug-related crime.

Particularly relevant to this work is the Executive's approach to drug treatment, which is based on the following principles:

• We must support people who have become addicted to drugs, particularly Class A drugs, such as heroin and cocaine, because this group is the most likely to damage themselves, their children and the wider community, through offending to support their addiction. Support must be based on the understanding that drug addiction is a chronic, relapsing condition and full recovery for some is a long process. However, the presumption, at the start of and during the treatment and rehabilitation process, must be that people can move towards a drug-free life, and actions by agencies should be geared towards helping to achieve this outcome.
• There is no single treatment option that works better than others. Different options work for different people. Methadone prescribing has its place, by helping people with chaotic lifestyles to stabilise enough to think about the next stage in the journey towards a drug-free life. However, methadone should not be seen as a permanent or single solution and should be used as part of a package of support aimed at helping address the underlying problems which often lead to drug addiction, with the aim wherever possible of a drug-free life.
• With the right treatment and support, many parents with drug problems are capable of caring properly for their children. However, chaotic drug misuse and good parenting are incompatible. The best interests of the child or children in the family must be paramount and all local agencies must work together to ensure that their needs are met.
• We must guard against unrealistic optimism on the part of agencies supporting adults that can result in abuse or neglect of children, while parents are repeatedly given chances to change. Early identification at the stage of pregnancy, integrated assessments and clear care plans with timescales are needed to ensure that the needs of the child are given due priority and not allowed to drift.

1.3.2 The Executive's strategy for tackling alcohol problems

The Executive published the "Plan for Action on Alcohol Problems" in 2002. The Plan set the strategic framework for local and national action in the areas of culture change, prevention and education, provision of services and protection and controls.

We will publish an updated plan later this year, which will build on progress made and set out further actions for the next three years. The update will provide a framework of action to accentuate the positive and tackle the negative aspects of drinking cultures in Scotland. Our long-term aims are to promote a cultural shift away from binge drinking and ensure that people with alcohol problems have access to appropriate support. The update reflects developments in relation to protecting children, including the publication of "Hidden Harm - Next Steps".

1.4 Summary of Key Actions

The actions set out in this document form part of the ongoing commitment by Scottish Ministers to improve the identification, support and protection of children who suffer from the effects of parental substance misuse.

It is based on the premise that everyone's responsibility - including those whose professional relationship is with the parental substance misuser - must be to the child first and foremost.

This document includes a wide range of actions that are being taken, or will be taken, forward by the Executive and local agencies to improve the way we respond to the needs of this particularly vulnerable group of children and young people. The key actions include:

• legislating to require the sharing of information amongst agencies for child protection purposes;
• improving contraception and family planning services for substance misusers;
• improving the way that holistic maternity services for drug using women, addiction services and services for children and families work together;
• presenting legislation to implement "Getting it Right for Every Child" to place a duty on all agencies to identify the needs of children for whom they have responsibility;
• early and better identification of the needs of vulnerable children and appropriate, integrated and timely support, through "Getting it Right for Every Child";
• establishing incentives for GP practices to put in place protocols so that young carers will be put in contact with local support services and support agencies; and
• expanding the Scottish Drug Misuse Database to ensure that information on dependent children of drug using parents is collected when clients present for treatment.

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