Integrated Impact Assessments – Children Affected by Parental Substance Use (CAPSU)
Children Affected by Parental Substance Use (CAPSU)
Minimising the impact of parental drug and / or alcohol use on children and young people remains a significant challenge. Current best estimates indicate that nationally 40-60,000 children may be affected by parental drug use. It is estimated that in Edinburgh there are 7,000 children affected by parental alcohol use and at least 2,173 affected by parental drug use.
National guidance emphasises the need to focus on a whole family approach to ensure all members of the family can access the support and interventions they require to ensure both children and adults can thrive and prosper.
Support should be offered for as long as is required and should be co-ordinated across alcohol and drug services, children’s services, criminal justice and other settings where individuals, children and families affected by substance use seek help or are protected.
Since 2016 a CAPSU service has been delivered by Circle who subcontracted Sunflower Garden for the service required by the children and young people. The service has adapted and changed to fulfil new guidance and priorities, however the two separate support services provided to the whole family and to the children have not integrated as it was originally intended to.
Due to the above original requirement, the service has been jointly funded by EHSCP and Children, Education and Justice Services (CEJS).
This contract is coming to an end in March 2025. To allow considerations of exit strategies and transition planning, committee approval was sought to extend by a further three months. This extension is meant to provide time to mitigate the impact of the change proposed which relates to EADP commissioning a Whole Family Approach support service which aligns with the Scottish Government’s funding criteria.
Children, Education and Justice Services will ensure children will continue to have access to therapeutic interventions, counselling and group work via framework agreements which supports the flexibility and requirement identified by the schools and localities who have been the main sources of referral.
Parents Advocacy in Recovery discussed and contributed an independent voice to the draft.
6 February 2025
Identify facilitator, Lead Officer, report writer and any partnership representative present and main stakeholder (e.g. NHS, Council)
| Name | Job title | Date of IIA training |
|---|---|---|
| Cat Young (Chair) | Assistant Programme Manager, Thrive | |
| David Williams | Strategic Planning and Commissioning Officer, EADP | |
| Alex Collop | Head of Operations, Circle | |
| Julie King | Project Manager Circle Harbour | |
| Katie Lawrence | Managing Co-ordinator, Children and Families Services, Crossreach | |
| Adele Ferguson | Sector Manager, CEJS | |
| Luan Sanderson | Strategic Planning and Commissioning Officer, CEJS | |
| Laura Barnett | Business Support and Communications Advisor, Crossreach | |
| Jillian Hart | Trauma Co-ordinator, Whole Family Wellbeing, CEJS | |
| Susie Fairweather | Team Leader, PrePare CEJS | |
| Dan Smith | Children’s Practice Team Manager South East, CEJS | |
| Neil Stewart | Strategic Planning and Commissioning Officer, EADP | August 2024 |
Meeting with Hub Nurse Team Leaders 5 February 2025
| Name | Job title | Date of IIA training |
|---|---|---|
| Tricia Burns | Substance Use Manager | |
| Chris Storey | Nurse Team Leader NW | |
| Andy Bain | Nurse Team Leader SE | |
| Lynn Bradford | Nurse Team Leader SW | |
| Steph Easton | Nurse Team Leader NE | |
| Ian McGillivray | Nurse Team Leader EdMac | |
| Neil Stewart | Strategic Planning and Commissioning Officer, EADP | August 2024 |
| Evidence | Available – detail source | Comments: what does the evidence tell you with regard to different groups who may be affected and to the environmental impacts of your proposal | ||||||||
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| Data on populations in need | DAISy Drug Treatment data | Local Data
New assessments at substance use services in Edinburgh identified that 22 were either pregnant or had a partner who was pregnant, 201 had 1 child under the age of 16, 111 had 2 children and 47 had 3 or more children. In total 369 had children which was 28% of people engaged. This reflects the number of children that people have, not necessarily the number in their household. It is acknowledged that this may be an underestimate as information was recorded at first assessment and people often don’t declare that they have children until they build up trust with services. The latest drug related death report for NHS Lothian (2022) indicated that of those who had information available, 19% were known to have children under the age of 16. Of these people, 10 had children living with them at the time and 4 drug related deaths occurred with children present. National Data Current best estimates indicate that nationally 40-60,000 children may be affected by parental drug use. It is estimated that in Edinburgh there are 7,000 children affected by parental alcohol use and at least 2,173 affected by parental drug use. Children’s Social Work Statistics report (2021-22) provided data on children on the child protection register, as well as children and young people looked after, in continuing care, eligible for aftercare, and in secure accommodation. The highest proportion of concerns identified at Case Conferences were, domestic abuse (16%), neglect (15%), parental mental health problems (14%), parental substance use (15%), and emotional abuse (13%). |
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| Edinburgh Child Protection Committee: Minimum Child Protection Dataset Report (July 2024) | This report highlighted that in Quarter 1, 23% of the concerns recorded were for parental drug use and Q3 and Q4 24%. Concerns about parental alcohol use were notified in 10% of registrations in Q1 and 2 and 15% in Q3 and 4. | |||||||||
| Data on populations in need | RUSSELL, L. et al., 2023. Where Are the Children?: Addiction Workers’ Knowledge of Clients’ Offspring and Related Risks. International Journal on Child Maltreatment: Research, Policy and Practice, pp. 1-12. | Research estimates that between 50% and 80% of parents involved with social services have issues with their substance use. | ||||||||
| MCNEELY, J. et al., 2018. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a 59 qualitative study of patients, providers, and staff. Addiction science & clinical practice, 13(1), pp. 1-15. | The shame and stigma attached to social work involvement fuelled a sense of fear and mistrust in statutory services, creating a barrier to disclosing substance use to workers for fear of being judged or punished. | |||||||||
| WOLFSON, L. et al., 2021. Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances 62 using a stigma action framework. Health & Social Care in the Community, 29(3), pp. 589-601. | Stigma and shame of substance use can impact access to harm reduction and community supports services. | |||||||||
| NEGER, E.N. and PRINZ, R.J., 2015. Interventions to address parenting and parental substance abuse: Conceptual and methodological considerations. Clinical psychology review, 39, pp. 71-82. | Involvement with social services can create conflicting demands which means parents having to decide between engaging in treatment or fulfilling child-care objectives. | |||||||||
| Data on service uptake/access | CAPSU Impact report 2023. | On average Circle worked with over 100 families per annum. Over the 8 years the service has been running Circle supported 820 families, 977 parents/carers and 1403 children.
Direct support with children has been provided to 365 children, 336 received individual support and 29 attended group work. On average SFG worked with 45 children per annum. Sunflower Garden currently have a waiting list of 54 children and Circle have 18 families waiting for a service, however new referrals are not being accepted due to the contract coming to an end. Main referral Sources are: Circle, 31% from Social Work, 27% from drug and alcohol services and 15% other health. Sunflower Garden, 39% from Social Services and 17% from schools, 15% from carers, 10% self referrals and 21% from health and other services. |
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| Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. | CAPSU service reports | The majority of families using this service are socially deprived and living in SIMD 1-4 receive housing benefit or are on universal credit. Main sources of referral are through drug and alcohol treatment Hubs, GP practices, Social Work and Schools based in areas of multiple deprivation.
Data from Circle indicated that 9% of their families were from the 10% most deprived areas, 35% from the 20% most deprived as below in the table.
Sunflower Garden data indicated that 14% of their families were from the 10% most deprived areas, 45% from the 20% most deprived as below in the table.
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| Data on equality outcomes | ||||||||||
| Research/literature evidence | Child Removal as the Gateway to Further adversity: Birth mother accounts of the immediate and enduring collateral consequences of child removal, Broadhurst, K. and Mason, C. Qualitative Social Work (2020) | There is substantial evidence that child removal results in an immediate psychosocial crisis often precipitating increased and highly risky substance use. Parenting roles are a key stressor for adults who use or are in recovery from drug and/or alcohol use and participating in services that address both substance use and parenting difficulties allows parents to have both needs addressed without having to prioritise one over the other. | ||||||||
| Exploring the Impact of Stigma on Health and Wellbeing: Insight from Mothers with Lived Experience Accessing Recovery Services, Lochhead et al 2024, International Journal of Environmental Research and Public Health | Mothers in recovery are stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. Staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing. | |||||||||
| Everyone Has a Story, CORRA Foundation (2015) | Children and young people need help to understand and manage change. Parents recovery journey can be a difficult and de-stabilising period for children and families and extra support should be available at those times.
A whole family approach is critical to better supporting children, young people and families. The evidence supports the need for ongoing support for children and young people who face traumatic change in their lives. The current CAPSU contract supports ongoing work with families, joint working with all partners including drug and alcohol treatment, social work and psychological therapies. |
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| Young peoples views on Services to help them deal with parental substance use. Templeton, Novak and Wall 2011, Drugs: Education, Prevention and Policy. | Young people benefitted through meeting other people and having an opportunity to talk and share experiences, learning about addiction and understanding and controlling their emotions. Their families became safer, healthier and more cohesive.
‘As a result of group or one-to-one work, young people reported the development of a greater understanding of the nature of addiction, their parent’s substance use and what it was like for their parent… In terms of personal safety, the young people talked about being better able and more confident in taking care of themselves, or in knowing what to do if they felt unsafe or in danger.” |
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| Understanding and modifying the impact of parents’ substance misuse on children. Velleman and Templeton 2018. Cambridge University Press | “The practitioner needs to work directly with the children involved, enabling them to… disengage from the disruptive elements of family life, engage with stabilising people outside the family, develop ‘confidants’ outside the family.” | |||||||||
| Medication Assisted Treatment Standards | Whole family approaches are clearly referenced throughout the MAT standards and family inclusive practice is a clear requirement of drug and alcohol services. Engagement with adult treatment services has highlighted strongly that staff don’t have the time to offer the intensity of support that parents and their families require. They greatly value a dedicated children and families service and working jointly with it to ensure parents and their families get the support they require. | |||||||||
| United Nations Convention on the Rights of the Child (UNCRC) | Scottish Government has incorporated the UNCRC into Scottish Law. The key articles are described in this document. | |||||||||
| Public/patient/client experience information | CAPSU Impact Report | Monitoring information from the whole service shows marked improvement across a subset of SHANARRI indicators. The following quotes are indicative of the impact of the service.
I believe I would still be stuck in addiction. Possibly have no contact with my daughter. Would still be stuck not knowing how to create healthy boundaries or relationships. Would still be stuck in the same or a worse place than before I started working with Circle. It has helped me build healthy relationships with my daughter, set boundaries to keep myself safe, helped me interact with others like myself, showed me support when I had no-one else, reminded me I am a person too with a voice. (confidence). Opened doors to other supports e.g. CPN, CGL, LEAP, I would have not known about if it wasn’t for my Circle worker. Children attending Sunflower Garden were asked how the support of SFG had helped them indicated by this quote from a young person: ‘Always having someone to talk to. Having help to work things out at the end of the week that lets me talk about my feelings and I feel better.’ Sunflower Garden annual report 2023/24 reported that as a result of their intervention 81% of children were safer (increased networks of support, less risk to themselves and more engaged in supportive activities), 92% were healthier (more able to cope with difficulties, more able to express their feelings and increased emotional wellbeing), 89% were more included (more settled and engaged in school, more confident to try new things and increasingly heard in decisions that affect them). |
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| Everyone Has a Story, CORRA (2015) | Highlights the need for children and young people to have a safe space to tell their story, listening to children effectively improves a child’s experience of support. Learning from this review emphasised the need to continue working with children and parents throughout the process of recovery and to continue for as long as is required. Parental recovery from substance use is a stage in the process and children, parents and whole families have to re-adjust to more involved and active parenting. Support is required in the longer term to assist this significant change. | |||||||||
| Connections are Key: Unlocking the heart of relationship based practice, CORRA Foundation (2000) | This scoping and archive review suggested that relationship-based practice is particularly useful when supporting children and families living with drugs and alcohol. Addiction can often be perceived as an isolated issue that affects the individual only, however it is shared with those living with the person too. The evidence suggested that bridging the gap between support services for children and support services for adults leads to improvement in family function.
Service design should facilitate collaboration and values the role of each contributing agency. Practice should be based on relational approaches, and value the skill and the relationship (and therefore understanding) of the young person or families’ needs. |
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| Evidence of inclusive engagement of people who use the service and involvement findings | Circle and Sunflower Garden collect regular evaluations of the service from families using it to help inform quality improvement.
As part of the consultation process for the new specification individual interviews and a focus group were conducted. |
Direct engagement with parents has told us that they have greatly benefited from the support which is available but that they only found out about it once concerns had been raised and child protection measures were in place or recommended. They reflected that, given the progress they had made through support, if they had the option to engage earlier it may have helped to stabilise their own lives and those of their children and keep the family together.
Parents also talked about Social Workers not understanding substance use, treatment and recovery and feeling that they didn’t take into account aspects of coercive control and domestic abuse. They felt the relationship with Social Workers wasn’t good, they were not trusted and there was no space for restorative work. An indication of the possible impact of having access to trusted and skilled support services is highlighted by this comment: ‘I believe I would still be stuck in addiction. Possibly have no contact with my daughter. Would still be stuck not knowing how to create healthy boundaries or relationships. Would still be stuck in the same or a worse place than before I started working with ******.’ |
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| Service engagement with children, young people and parents has identified additional areas of support which the services including father’s work, groupwork with children peer support etc. | ||||||||||
| Services that could meet the need | The Family Hub Collaborative | This is a collaborative between Circle, Home-Start Edinburgh, Stepping Stones North Edinburgh, Home Link Family Support, Citizens Advice Edinburgh (CAE), CEC Early Learning & Childcare (ELC) and NHS Parent & Infant Mental Health Service (PAIRS). The project aims to develop a transformational partnership approach that will test bespoke holistic whole-family support throughout the early years. The project will ensure that appropriate, universal, and enhanced support is available at the earliest stage possible for families with a child under 5. | ||||||||
| Services that could meet the need | Edinburgh Family Support Partnership | The Edinburgh Family Support Partnership is a collaboration between CEC Social Work Service (Social Care Direct and Family Group Decision Making) Children 1st, Barnardo’s, Safe Families, Citadel Youth Centre (NE Locality) and Edinburgh Community Food. The Collaboration will develop multi-disciplinary teams situated in each of the four localities across the city to transform the way families receive early and preventative help and support. This collaboration aims to improve partnership working between existing services. | ||||||||
| Services that could meet the need | Parent Infant Partnership | A collaboration between: PrePare (City of Edinburgh Council); Dean and Cauvin Young People’s Trust (3rd Sector); Lothian PAIRS (NHS); and Family Group Decision Making (City of Edinburgh Council). The collaborative has a focus on the early years and will work with families from conception, until the child’s 2nd birthday (the first 1,000 days) where risk and need is high. The Parent Infant Partnership will create a clear pathway of specialist support that: Increases direct support available; Is clear to access by universal and additional support services; Brings together skilled and experienced parent-infant services. | ||||||||
| Services that could meet the need | Family Group Decision Making (FGDM) | FGDM is a process that involves a child’s extended family in planning and making decisions about their care and well-being, empowering families to find their own solutions and develop a plan to address difficulties. The Edinburgh service has 1 post to focus on substance use although this is often an issue with the families they support. | ||||||||
| Services that could meet the need | Flexible Framework agreement for accredited pathways and certified counsellors and therapists within CEJS services. | This framework is available for schools, social workers and colleagues across the Council to purchase a service for any child they identify would benefit from counselling or other therapeutic supports. Both organisations currently providing this service have been awarded a place on this framework to deliver wellbeing and therapeutic interventions, counselling and support for children and a Holistic Whole Family Support integrated with groupwork programme to support early intervention and prevention. | ||||||||
| There is a Young Carers Support Service which supports school aged young carers. It is a consortium of 3 organisations which cover the city and within this they offer specific support to young carers affected by parental/carer substance use: | They provide a drug and alcohol support service which provides a confidential service to young people who care for, or are affected by, a parent or family member with problematic drug and/or alcohol use. Young people have access to a range of services – one to one support, group support and residential and day trips.
They also offer an information and advice service and schools awareness. |
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| Evidence of unmet need | 389 referrals of people to drug treatment services (28%) in Edinburgh in 2023/24 had children and whilst they may not all be with the parents at that time and not all families will need support there is a potentially larger cohort of families who may need support.
Adult treatment services acknowledge that they often don’t have the information required or the opportunity to meet with families in their own homes to assess additional support needs and risks. Referrals to Social Care Direct about possible concerns do not record substance use as a factor therefore there is a lack of clarity on the level of need. Parents and particularly women experience a heightened level of stigma associated with their substance use and are often reluctant to engage with treatment. The level of need is therefore not clearly identified. |
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| Good practice guidelines | All national guidance directs ADPs and Children’s Partnerships to take a ‘Whole Family Approach’ to supporting people and families and to work together with Children’s Partnerships to support families and keep them together where possible. | Reports and guidance detailed below. | ||||||||
| The Promise: The Promise
The Promise Action Plan: https://www.plan2430.scot/ |
The Promise (2020) is Scotland’s response to the Independent Care Review findings. A key message throughout the Promise is that families must be supported to stay together, even where risks are evident. | |||||||||
| Rights, Respect and Recovery (SG 2018) | Rights, Respect and Recovery (2018) calls for the development of a whole family approach underpinned by family inclusive practice across alcohol and drug services, criminal justice and other settings where individuals and families affected by substance use seek help or are protected. It sets out to define the intent of developing whole family approach/inclusive practice in Scotland by linking the needs of individuals experiencing difficulties with alcohol and drug use with those who may be directly or indirectly affected.
This contract provides services over many of the priority areas of the strategy. |
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| Families Affected by Drug and Alcohol Use: A Framework for Holistic Whole Family Approaches and Family Inclusive Practice (2021) | Progresses the key actions and commitments from Rights, Respect and Recovery (2018) and creates a useful and helpful framework for ADP, Children’s Partnership and others, ensuring that collaborative approaches to local planning, development and delivery of services across statutory and third sector partners contribute to improved outcomes for children, young people and families. It sets in context the need for whole family support to keep families together wherever possible and to ensure that all members of the family have the support they need. It also highlights that children should have access to support in their own right and for as long as required. | |||||||||
| Getting Our Priorities Right (GOPR) | The Whole Family approach is reinforced by Getting Our Priorities Right (GOPR) Scotland’s guidance for services working with children, young people and families affected by substance use. It recommends that, “All child and adult services should focus on a ‘whole family’ approach when assessing need and aiming to achieve overall recovery. This should ensure measures are in place to support ongoing recovery”. GOPR sets this within the context of the GIRFEC national practice model and professionals in the team around the child and family working together to co-ordinate support through a child’s plan | |||||||||
| ADP Scottish Government funding letter | Clearly identifies the responsibility for ADPs to fund and support whole family services.
27. £3.5 million is committed to support the implementation of ‘Drug and alcohol services – improving holistic family support: A framework for holistic whole family approaches and family inclusive practice’ also known as the Whole Family Approach Framework. This was published in December 2021. Chapter 11 and sets our expectations for local areas to put in place accessible, consistent, sustained and inclusive support for families. |
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| National Drugs Mission | Sets out the principles of how we will improve holistic family support for families affected by drugs and alcohol by taking a whole family approach and using family inclusive practice. This is aligned to the Government-wide programme of work to improve support for children and families, such as The Promise, Getting It Right For Every Child, the National Framework Principles of Holistic Whole Family Support and the Whole Family Wellbeing Fund. | |||||||||
| Carbon emissions generated/reduced data | N/a | |||||||||
| Environmental data | The services are delivered within localities and the communities in which people live reducing the need for transport. | |||||||||
| Risk from cumulative impacts | Evidence shows that engagement in treatment is a protective factor against poorer health and potential risks including drug related death.
Women who have had children removed are known to be ambivalent about their health and take greater risks with their substance use. |
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| Other (please specify) | ||||||||||
| Additional evidence required |
The tables compare the potential impact of two approaches:
- Maintaining the current provision (a specialist block-purchased, jointly funded contract for CAPSU services)
OR
- Ending some or all of this provision and replacing or supplementing it with the above listed “other services that could meet the need” (including spot purchase of individual interventions via the existing contracts and frameworks).
These options represent key changes in the pathways to services which can be accessed by parents, children and families affected by substance use from a centrally funded block contract available to all families in need accessed through professional and self referral.
| Equality, Health and Wellbeing and Human Rights | Affected populations |
|---|---|
| Positive
In relation to children and young people –
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Negative
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| Family Support and Social Networks | Affected populations |
|---|---|
| Positive
In relation to children and young people –
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Negative
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| Economic | Affected populations |
|---|---|
| Positive
With no contractual restrictions there is opportunity for a wider range of providers available through an established framework to offer services to support whole family wellbeing. |
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| Negative
Reduction in income for for services and loss of highly skilled staff |
If the service is commissioned, it will be third sector providers who will undertake the provision of these services. Equality, human rights, children’s rights, environmental and sustainability issues will be addressed as part of contract monitoring within the terms and conditions of the contracts being accessed (frameworks or other contractual agreements).
A communications plan will be developed involving the organisations delivering the service to build on their relationships and contact with people who may be affected.
If yes, it is likely that a Strategic Environmental Assessment (SEA) will be required and the impacts identified in the IIA should be included in this. See section 2.10 in the Guidance for further information.
No, these services will not result in significant environmental effects.
| Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) | Who will take them forward (name and job title) | Deadline for progressing | Review date |
|---|---|---|---|
| Inform providers of any decisions made regarding funding and next steps | EADP/HSCP | 1 April 2025 | |
| Begin procurement process which will include co-producing service specification for the contract required by EADP | EADP | TBC | |
| Work with providers on transition plans and exit strategy as required | CEJS, EADP | 1 April 2025 | |
| Communicate with internal teams currently referring to the service that access to support should be via contracted framework providers | CEJS | 1 April 2025 (tbc) |
EADP: There are limited mitigating options for all of the areas identified in section 8. There are no equivalent services providing a whole family approach for families affected by problematic substance use. Should the service cease to exist alternative options will need to be identified and funding accessed to support them. EADP will work with existing providers to continue support for families in the short term and engage with partners to co-produce a service specification and progress a commissioning process for a service which will provide whole family support for families affected by parental substance use.
CEJS As identified above there are a number of alternative services which can be timely, effectively and compliantly accessed to support the requirement. As there has been very limited connection between the service provided to the whole family by Circle and the service provided to the children by Sunflower Garden, there won’t be any negative impact if the two services are separated. Referrals can continue via the same route (schools, social work teams) and service will be provided calling off an existing framework. Three months extension will be key to complete the transition.
There are established contract monitoring processes in place to monitor the impact of services block purchased or through the framework.
Andrew Hall
Service Director – Strategy