Hidden Harm Strategy.
Drug and Alcohol Misuse in the Household
A 3-year strategy to identify, support, safeguard and
improve the health and well-being of families where there
is drug and alcohol misuse.
2013 – 2016
Sheffield Safeguarding Children Board / Sheffield Drug and
Alcohol Coordination Team
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CONTENTS
Page
Foreword
3
Introduction
4
The scope of the Strategy 2013
5
Current good practice in Sheffield
5
New insights and understanding
8
Findings
9
Key messages from research and evidence
based practice
10
Strategic priorities
11
Measuring the impact
12
References
14
Voices and views of parents in recovery
‘My son was taken into care because of my lifestyle. If I hadn’t been a drug user he wouldn’t
have had to go through that. Being in recovery has made me more aware of my parenting.’
‘Because of my addiction my children saw things they shouldn’t have. Now they are involved in
drink and drugs. Going into drug treatment was the best thing I did. Now I am helping my
daughter with her drug problems.’
‘Being in recovery has made it possible to make decisions which are not detrimental to my
children’s well-being.’
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FOREWORD
We are pleased to welcome this 2nd strategy which has been jointly endorsed by Sheffield
Safeguarding Children Board (SSCB) and the Drug and Alcohol Coordination Team (DACT). This key
strategy marks a continued commitment by all our partner agencies to drive forward the required
changes to bring about better outcomes for this vulnerable group of children and their families.
This strategy, which will take us through to 2016, builds on the considerable progress already
achieved over the last three years, considers the findings from national and local research and
encompasses the direction of other key priorities for Sheffield.
The seven strategic priorities have been translated into a clear, measurable action plan which will
be updated on an annual basis to ensure it remains effective and relevant.
By providing the right help at an early stage and by recognising the needs of the whole household
we will reduce the need for more intensive intervention at a later stage leading to better outcomes
for children and their families.
Sheffield Safeguarding Children Board Chair
Sheffield Drug and Alcohol Coordination Team
Head of Sheffield DACT
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INTRODUCTION
In 2003, The Advisory Council on the Misuse of Drugs (ACMD) produced a report considering the
negative consequences of parental drug misuse on children and young people. It highlighted that
often the children were unidentified by services and therefore appropriate support was not
offered. The report described the adverse consequences for the children as multiple and
cumulative in nature, varying according to age, stage of development and the level of protective
factors within the wider environment.
The publishing of this report encouraged Sheffield’s adult, child and family services to give greater
consideration to the impact on children within the family when parents were known to be drug and
/ or alcohol misusers. Sheffield’s substance misuse services began to include the needs of the child
when undertaking substance misuse assessments with parents.
As a consequence of this Sheffield produced the SSCB Hidden Harm Strategy and Action Plan in
2010 aimed at improving the identification and support offered to children whose parents misused
drugs and alcohol. The key objectives were: Identifying problems earlier; providing earlier and
more joined up support to prevent problems getting worse and working more closely together.
Since 2010 significant progress has been made:
 Identifying problems earlier
o Training pathways developed for workers across the city
o Development of substance misuse referral wheel and alcohol screening tool
o Gathering information about parental status and child details is now routine with adult
substance misuse services
o Partner agency protocols include reference to the protection and identification of children
affected by parental substance misuse
 Providing earlier and more joined up support to prevent problems getting worse
o Workers within adult substance misuse services trained to deliver ‘Triple P’ parenting courses
o ‘What about Me’ (WAM) project commissioned by the council and delivered by voluntary
sector partners
o Established links made between adult substance misuse providers, health visitors and children
centres
 Working more closely together
o Hidden Harm incorporated into the Children and Young People Plan (CYPP) 2011-14
o Review of Multi Agency Pregnancy Liaison and Assessment Group (MAPLAG) completed and
current process endorsed by the Sheffield Safeguarding Children Board (SSCB).
In order to build on the progress made and to further embed areas of good practice, a review of the
Hidden Harm Strategy 2010 was undertaken in 2012/2013.
The development of this New Strategy (2013) has been informed by the findings of the review
which included recognising drug and alcohol treatment and recovery as a protective factor for
families; documenting the current practice in Sheffield; identifying new insights and understandings
as well as considering both national and local research, evidence based practice and case reviews.
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THE SCOPE OF THE STRATEGY 2013
This strategy commits Sheffield’s services to improving outcomes for whole households where drug
and/or alcohol misuse is a feature. The review into The Hidden Harm Strategy (2010), alongside the
findings from the current evidence base and the ‘new insights and understanding’, identified the
need to widen the scope of this Strategy to:
 Encompass a Whole Household Approach, including fathers, mothers, significant others as well
as children, young people and their siblings;
 Pay greater attention to households where there are issues relating to alcohol misuse, and the
use of cannabis, steroids, new psychoactive substances (‘legal highs’), and prescribed and over
the counter preparations, as well as opiate and cocaine use;
 Include primary (universal) and secondary (targeted) prevention services as well as specialist
services.
It is therefore relevant to all services coming into contact with children, young people, adults and
families.
The core of the Strategy centres on improving the ability of frontline staff in universal services to
identify those that are misusing alcohol and or drugs (including new psychoactive substances (‘legal
highs’) and prescribed and over the counter preparations) at the stage when the evidence base for
early brief interventions is strongest. Supporting and enabling front line staff to intervene,
especially in relation to drug and alcohol misuse and parenting, at an early stage should reduce the
need for more intensive interventions at a later stage.
CURRENT GOOD PRACTICE IN SHEFFIELD
Good practice across Sheffield has helped establish some effective multi-agency care pathways for
families where there is drug and alcohol misuse.
Pregnancy
 All pregnant women are routinely asked when they book for their antenatal care whether they
have, or have had, any difficulties with drugs or alcohol. Women who disclose current
difficulties with drugs or alcohol are routinely referred to the Specialist Midwifery Service.
 Onward referral to MAPLAG is made for all pregnant women assessed as; currently being in
treatment for drug or alcohol misuse; having ongoing problematic or dependent drug use;
having ongoing problematic or dependent drinking.
 MAPLAG is a SSCB meeting that shares detailed information regarding the pregnant woman and
her partner; makes recommendations about the level of risk in respect of safeguarding children
and makes onward referral for each family to Social Care Services (where child protection issues
are identified) or Multi Agency Support Teams (MAST) (where the family are identified as having
additional needs that would benefit from support).
In 2011/2012, there were 91 (1.3% of total births) babies born to mothers who disclosed drug
and/or alcohol misuse during pregnancy: 39 disclosed opiate use, 13 solely alcohol users, 39
identified drugs other than opiates.
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Data is routinely collected by both the Specialist Midwifery Team and MAPLAG
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There are established pregnancy pathways and specialist pregnancy clinics within the drug and
alcohol treatment services; one for opiate users and dependent drinkers and one for users of
“recreational” drugs and increasing risk and “binge” drinkers.
Preschool
 The Family Health Visiting team are routinely notified of all cases where an adult accesses a
drug or alcohol service in Sheffield and discloses having a child under the age of 5 in the
household. The health visitor completes a risk assessment which may include a home visit and
consideration of take up of entitlement to Free Early Learning (FEL) in age appropriate children.
At least 638 (2% of total under 5’s living in Sheffield) children aged under 5 were known to live with
either a mother or father accessing drug or alcohol treatment and support services.
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Data is routinely collected by the Liaison Health Visitor for Drugs and Alcohol.
Fact sheets and tools are available for Early Years and Child Care Providers via the SSCB website.
These include: fact sheet - the impact of drugs and alcohol on parenting capacity; fact sheet –
the impact of parental drug and alcohol misuse on child development; fact sheet - the action to
take if a parent comes intoxicated to collect their child from the early years / child care
provider; tool – model admission form that includes questions regarding drug and alcohol use;
training ensures all Early Years and Child Care Providers are aware of the resources available.
Adult Substance Misuse Services
 Every Substance Misuse service has a nominated Safeguarding Children Lead.
 Every Substance Misuse service participates in an Annual Safeguarding Audit; this includes
ensuring all staff attend safeguarding children training.
 Every adult accessing a substance misuse service is asked whether they are a parent/carer. If
they are, detailed information is collected regarding the child(ren) on an Every Child Matters
form and, where consent is given, on the National Drug Treatment Monitoring Service (NDTMS).
During 2011-12, there were 2615 adults in formal structured drug treatment and 808 adults
accessing formal alcohol treatment with a further 2270 benefitting from brief interventions and 317
extended brief interventions. 875 (32%) clients in structured drug / alcohol treatment disclosed
living with at least one child. In addition 675 clients said they were parents (25%) but do not
currently live with their child.
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Safer storage boxes are provided to every adult with a child in their household who is taking
home substitute medication (e.g. methadone)
Substance misuse services routinely attend meetings regarding the child in the family and
complete reports using a specific substance misuse report template.
Following accreditation 4 substance misuse workers are delivering Triple P parenting
interventions within substance misuse services.
A consultancy service is commissioned (Safeguarding Children Substance Misuse Service) to
provide consultancy on complex cases to Substance Misuse Safeguarding Children Leads.
Established referral pathways into both MAST using a Common Assessment Framework (CAF)
and social care are effectively used.
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Young People’s Drug and Alcohol Service
 Provide targeted and specialist interventions and treatment to young people under 18 and
advice and information to family members and significant others who may be worried about or
affected by a young person's substance misuse.
 Have a nominated Safeguarding Children Lead and all staff attend safeguarding children training
During 2011-12, there were 139 young people accessing specialist Tier 3 treatment at The Corner
(young people drug and alcohol service) out of these 22 disclosed parental drug and alcohol misuse
when asked.
Multi-Agency Working
 Protocols relating to parental drug/alcohol misuse; drug/alcohol misuse in pregnancy; and
young people misusing drugs and alcohol are part of Sheffield’s Safeguarding Children Child
Protection Procedures. Providing common risk assessment tools and a shared process for
safeguarding children.
 SSCB Multi agency training “Safeguarding children where there is drug / alcohol misuse in the
household” is well attended by all agencies and well evaluated. Up-to-date information relating
to referral pathways is always provided.
 Information leaflets are distributed by all agencies to parents who misuse drugs and alcohol.
Subjects covered: Reducing the impact on children of parental drug and alcohol misuse; safe
sleeping; MAPLAG; keeping children safe from medication; keeping children safe from alcohol;
keeping children safe from drug paraphernalia.
 Substance misuse referral wheels are distributed to all workers in children and family services.
 Sheffield Alcohol screening tool can be accessed via Social Care Services IT system helping social
care workers identify and refer appropriately parents who have issues with alcohol. (Data is
routinely collected)
 Sheffield’s newly developed Family CAF includes a section on alcohol and drug misuse, and links
to the Sheffield alcohol screening tool.
 Parenting worksheets are available via the SSCB website for use with parents who misuse drugs
and alcohol.
Specialist services for children, young people and families
 ‘What about Me?’ (WAM) is a project that provides therapeutic and social support to children
affected by drug or alcohol misuse in their household.
During 2011-12, 76 young people accessed WAM (What About Me? project) for 1-1 interventions,
group work or a combination of both. Of the 76 young people, 51 were girls and 25 were boys, they
were aged between 6 and 18, with 31 being 12 and under and 45 aged 13 to 18, the largest age
groups were 13 and 15 year olds. 10 of the young people had Child in Need Plans in place and 25
were subject to Child Protection Plans. In 60% of the cases it was family alcohol misuse that was
impacting on the young person.

Sheffield Young Carers Family Project supports young people who are caring for either, a parent
who misuses drugs or alcohol or who has a mental health issue. It acts as a bridge to a range of
universal, targeted and specialist services for all family members.
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
Sheffield Drug and Alcohol Coordination Team commission carer’s support for adult carers of
carers including support groups; a Carer Ambassador Scheme, where ambassadors are
embedded in treatment settings to identify and offer support to carers. These services are
accessed by grandparent carers, who are providing care for grandchildren on a short, long term
or permanent basis where the parent has drug or alcohol problems.
Safeguarding children
 Child Protection Conferences routinely record information regarding drug and alcohol misuse by
adults in the household; involvement, and attendance at the Conference by drug and alcohol
treatment services is also monitored.
During 2011-2012, on average 146 (approx 44%) children subject to Child Protection Plans had a
parent/carer who disclosed misusing substances. In 52 children’s cases it was opiates, in 57 it was
drugs other than opiates, and alcohol in 37 children’s cases. In 100% of the opiate cases a substance
misuse treatment service was involved and invited to the Child Protection Conference. In the cases
involving alcohol misuse it was only 20% that had a substance misuse service involved and invited
to the conference.

The SSCB Licensing Project trains licensees and their staff to reduce risk where children’s
exposure to inappropriate or dangerous adult behaviour as a result of intoxication. It also
provides guidance to parents/carers living at licensed premises to identify the risks associated
with lifestyle and environment and guidance to education, health and social care workers and
enforcement officers, to help them identify risk and share information in relation to
safeguarding children living at licensed premises. The project also engages with unlicensed
business operators to promote good safeguarding practice in relation to body modification and
new psychoactive substances (‘legal highs’).
NEW INSIGHTS AND UNDERSTANDING
In line with the findings from Silent Voices: Supporting children and young people affected by
parental alcohol misuse (2012), alcohol misuse in Sheffield households’ remains under identified.
National prevalence estimates for alcohol misuse in Sheffield suggest that amongst the 450,000
drinking aged adults there are: 92,880 increasing risk drinkers
 57,420 high risk drinkers
9000 dependant drinkers

North West Public Health Observatory (August 2011)
Indicative alcohol prevalence estimates in a range of Sheffield populations
 From the estimated 94,793 parents of 0 -16 year olds in Sheffield, 12,096 would be described as
high risk drinkers and 3,792 as dependent drinkers.
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
From the estimated 13,200 parents of babies born in Sheffield last year, 1,648 would be
described as high risk drinkers and 528 dependent drinkers
 From the 110,000 adults attending A&E last year 14,036 would be described as high risk
drinkers and 4,400 as dependent drinkers
 From the 57,000 parents whose children attended A&E last year, 7,213 would be described as
high risk drinkers and 2280 as dependent drinkers.
In Sheffield, in the period Feb 2012 to Feb 2013, less than 3% of the eligible population were
referred for alcohol treatment. Of all the referral routes self-referral was the main way in which
alcohol services were accessed. It is acknowledged that a significant proportion of the eligible
drinking population would prefer to receive treatment for their alcohol use in a primary care setting
(ScHARR 2012). Low, and in some cases no referral rates is considered indicative of systematic
failure to identify problematic alcohol use in universal services.
FINDINGS
Households where there is drug and alcohol misuse come into contact with a range of different
services on a daily basis. There is scrutiny, oversight and intelligence surrounding individuals who
are in formal structured drug or alcohol treatment. The majority of opiate and crack using parents
are known to adult substance misuse treatment services; their children are identified throughout
the care pathway and systems are in place to ensure good multi-agency working especially if the
child is preschool age.
However there appears to be greater difficulties within universal services in identifying fathers,
mothers, carers who use drugs viewed as “recreational” e.g. cannabis; powder cocaine; new
psychoactive substances (‘legal highs’); over the counter and prescribed analgesic preparations as
well as alcohol. In some cases this may be because the father, mother, pregnant woman does not
consider that they have a problem with drugs or alcohol; or the drug and alcohol misuse just
becomes one more factor in an overall complex range of issues e.g. domestic abuse, mental health
issues, eviction.
The trends identified in Sheffield are similar to those experienced in other large cities. There is a
reduction in the number of adults, including pregnant women, and young people accessing
treatment and support for opiate misuse, in Sheffield this decline is happening faster than the
national average. There is growing concern about alcohol and cannabis use but these individuals,
however problematic their use, are not finding their way to formal structured drug and alcohol
treatment. Within the drug and alcohol treatment system around 96% are opiate users.
The percentage of children subject to child protection plans where parental drug and alcohol
misuse is a feature remains stable at around 40% but the proportion that is due to parental opiate
misuse has declined. This indicates that additional needs within the family are being identified early
by the substance misuse services and the coordinated multiagency response to families is
improving outcomes for children. Sheffield compares well to other core cities in terms of the
number of children subject to child protection plans whose parents misuse opiates. However, the
number of children subject to child protection plans whose parents misuse alcohol and non-opiate
drugs is increasing.
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Therefore there is a paradox that in the city, alcohol and non-opiate use is increasing, and is having
a serious impact on the city’s children such that they are becoming subject to child protection
plans. However, these parents are not finding their way into the drug and alcohol treatment
services: the treatment population for non-opiate use is on average fewer than 100 per year and
the treatment population for alcohol is around 800 per year.
This reinforces that as a city we need to do more to recognise non opiate and alcohol use as
problematic; identify through screening those using drugs and alcohol problematically; assertively
refer them to drug and alcohol treatment services and ensure they engage.
KEY MESSAGES FROM RESEARCH AND EVIDENCE BASED PRACTICE
A ‘whole family’ approach must be adopted when providing support to those affected by alcohol or
drug misuse to harness the resource of the family to support those in treatment, and to effectively
identify and reduce harm to other family members. Over the limit: the truth about families and
alcohol (2012).
Services need to redouble efforts to identify families for whom alcohol or drug use is a problem and
in addition provide clear and unambiguous advice to all expectant and existing parents, father as
well as mother, about the harm that alcohol and drugs can do to family life. Over the limit: the
truth about families and alcohol (2012).
Pregnancy is a crucial opportunity for engaging and working with substance misusing parents, with
childbirth being a potential motivator towards behaviour change in the interests of the unborn
child. All Babies Count: Spotlight on drugs and alcohol (2013)
Being a parent of resident children can be a protective factor for those in treatment and can
support recovery goals. Conversely, parents who have had their children removed are likely to have
more complex problems that are difficult to overcome and are more likely to struggle with
addressing their substance misuse. NTA Report – Parents with Drug Problems: How Treatment
Helps Families (2013)
Opioid substitution treatment will improve as a result of changes at a system, service and individual
level. These include: treatment that works alongside peers and families to give people direct access
to, or signposts and facilitates support to, opportunities to reduce and stop their drug use, improve
their physical and mental health, engage with others in recovery, improve relationships (including
with their children), find meaningful work, build key life skills, and secure housing. NTA Medications in recovery: Re-orientating drug dependence treatment (2012)
The 2010 Drug Strategy lists four kinds of recovery capital, or resources;
• social: support from and obligations to family, partners, children, friends and peers
• physical: finances and safe accommodation
• human: skills, mental and physical health, a job
• cultural: values, beliefs and attitudes held by the individual. The potential of recovery capital
(2010)
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Effective multi-agency working is crucial to offering support to families where drug and alcohol
misuse is a feature. Juggling Harms: coping with substance misuse (2010)
Cannabis must not be ignored. Its use is linked with mental health problems for the user, and poor
speech development and vocabulary for children living in the household. Southampton Serious
Case Review (SCR) (2012)
When assessing the care of babies, children and young people, practitioners must not ignore the
long term impact of living in households with drug and alcohol misuse or the fact that drug and
alcohol misuse impacts on all parts of everyday life. Bristol SCR (2012)
Toxic trio (mental health, domestic abuse and drug and alcohol misuse) – professionals can be
overwhelmed by the number and complexity of the problems. Children often become “lost” within
the chaos. Community Care inform (Oct 12)
The effect alcohol misuse has on the individual and family life has been ignored for too long. There
is limited data available to know the true number of adults and children affected. Silent Voices:
Supporting children and young people affected by parental alcohol misuse (2012)
A desire to think the best of adults and to hope they overcome their difficulties should not trump
the need to rescue children from chaotic, neglectful and abusive homes. Working Together to
Safeguard Children (2013)
STRATEGIC PRIORITIES
Seven key Strategic Priorities have been identified. They have been derived from national good
practice, a review of the Sheffield Hidden Harm Strategy and Action Plan 2010 and a small scale
Hidden Harm needs assessment (2013).
PRIORITY ONE – COMMISSIONING AND GOVERNANCE
The Hidden Harm Implementation Group will have a strategic oversight to ensure that all
substance misuse initiatives in Sheffield incorporate a Hidden Harm perspective. This will ensure
that we have a consistent and coordinated approach to ensuring that Hidden Harm is considered
across all relevant services at planning stage and point of delivery.
PRIORITY TWO – EARLY IDENTIFICATION OF DRUG AND ALCOHOL MISUSE
Universal citywide identification of drug misuse and “screening” for alcohol misuse utilising a
whole household approach (fathers, mothers, siblings, significant others) will enable
identification and opportunities for early intervention and prevention. This will ensure mothers,
fathers, pregnant women and their partners are offered opportunities and support to address their
alcohol or drug misuse at the earliest stage and children will no longer ‘be hidden’.
PRIORITY THREE – WHOLE HOUSEHOLD APPROACH
All services have to be responsive to the needs of the individuals within the household; look
beyond the presenting problem and to utilise the full range of support available in Sheffield to
offer appropriate interventions that will benefit households featuring drug and alcohol misuse.
These interventions include dedicated provision for children affected by parental substance misuse
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which focuses on resilience, work with parents including drug and alcohol treatment and improving
parenting skills as well as joint work with families.
PRIORITY FOUR – ADDRESSING INTERGENERATIONAL DRUG AND ALCOHOL MISUSE
Effective links between universal services and specialist services; adult services, child services and
family services are crucial to good integrated practice. This will ensure that families where there is
intergenerational drug and alcohol misuse are identified either through services working with
children and young people or those working with adults, good communication pathways will enable
a comprehensive assessment and identification of the interventions the family needs to prevent /
‘break the cycle’.
PRIORITY FIVE – DRUG AND ALCOHOL TREATMENT AND RECOVERY
Accessing drug and alcohol treatment and support services is considered a protective factor for
families. Fathers, mothers, pregnant women and their partners who misuse drugs and alcohol
need services that can take account of their own life circumstances which may include chaotic
childhoods, co-existing psychological problems and social isolation, whilst also providing support for
them as parents to ensure that their children develop to their full potential.
PRIORITY SIX – WORKFORCE
Effective delivery of interventions requires a competent workforce with the awareness, tools and
confidence to identify and take action to support families where there are issues relating to drug
and alcohol misuse. Organisations must ensure they have a competent and well-trained
workforce. The issues relating to drug and alcohol misuse in the household (including routine
screening for drug and alcohol of whole household) must be addressed in all the organisations
policies and procedures; the workforce must have attended appropriate training and Hidden Harm
tools and resources must be available to and appropriately utilised by the workforce.
PRIORITY SEVEN – DATA COLLECTION
A robust, multi-agency, data recording system to monitor and track the number of substance
misusing households. This will include an outcomes framework which captures improvements in
parenting, parent and child interactions and adult substance misuse recovery.
MEASURING IMPACT
The longer term aims of the Strategy are:
PRIORITY ONE – COMMISSIONING AND GOVERNANCE
All new substance misuse initiatives in Sheffield will incorporate Hidden Harm.
PRIORITY TWO – EARLY IDENTIFICATION OF DRUG AND ALCOHOL MISUSE
All parents / carers of children entering the child protection system will be aware of their own
problematic drug and / or alcohol use and will have been offered an opportunity for intervention.
PRIORITY THREE – WHOLE HOUSEHOLD APPROACH
All services working with household members will consider drug and alcohol misuse within their
assessments and will identify appropriate interventions.
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PRIORITY FOUR – ADDRESSING INTERGENERATIONAL DRUG AND ALCOHOL MISUSE
All services will be aware of the impact of intergenerational drug and alcohol misuse and will take a
proactive approach to addressing it.
PRIORITY FIVE – DRUG AND ALCOHOL TREATMENT AND RECOVERY
All drug and alcohol treatment services will continue to identify children who live in households
with drug and alcohol misuse and will broaden their approach to consider the whole families needs.
PRIORITY SIX – WORKFORCE
All organisations will have effective structures in place to ensure workers are competent in
identifying drug and alcohol misuse use within households and following appropriate pathways.
PRIORITY SEVEN – DATA COLLECTION
Appropriate and relevant data will be collected and a needs assessment and audit cycle will be
established to continually improve outcomes for families.
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REFERENCES
Advisory Council on the Misuse of Drugs (ACMD) (2003). Hidden Harm: Responding to the needs of
children of problem drug users. The report of an Inquiry by the Advisory Council on the Misuse of
drugs.
Advisory Council on the Misuse of Drugs (ACMD) (2007). Hidden Harm – Three Years On: Realities,
Challenges and Opportunities.
Best, D. and Laudet, A. (2012) The Potential of Recovery Capital.
Bristol Safeguarding Children Board (2012) Serious Case Review (Child K)
Children’s Commissioner (2012). Silent Voices: Supporting children and young people affected by
parental alcohol misuse.
Community Care Inform (Oct 2012) Toxic Trio.
Houmoller, K., Bernays, S., Wilson, S., Rhodes, T. (2011) Juggling Harms: Coping with parental
substance misuse.
Houmoller, K., Bernays, S., Wilson, S., Rhodes, T. (2011) See me, not just the problem: Hiding,
telling, coping with a difficult family life.
Houmoller K., Bernays S., Rhodes T. (2010) Parents who use drugs: Accounting for damage and its
limitation.
National Society for the Prevention of Cruelty to Children (NSPCC) (2013) All Babies Count:
Spotlight on drugs and alcohol.
National Treatment Agency (NTA) (2012) Medications in Recovery: Re-orientating drug
dependence treatment
National Treatment Agency (NTA) (2013) Parents with Drug Problems: How Treatment helps
Families.
North West Public Health Observatory (Aug 2011)
OFSTED (2013) What About the Children? Joint working between adult and children’s services
when parents or carers have mental ill-health and or drug and alcohol problems.
School of Health and Related Research (ScHARR) (2012)
Southampton Safeguarding Children Board (2012) Serious Case Review.
4Children (2012) Over the Limit: The truth about families and alcohol.
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