Addressing child protection

   How might professionals take a different view?

There are two obvious solutions to this.

First, generic professionals whose job is to focus on children, should do exactly that!

Although it is easy to see why many of us focus on the adult issues (after all, we professionals are adults too, and we want to ‘understand’ the issues), the fact is that our task is to focus on the child, and the child’s distress.

As generic professionals, we need to focus on the child by using some very simple skills.

• Recognise that the child is distressed (even if they are showing it by acting out or being very quiet).

• Provide appropriate time and space and privacy to allow the opportunity for the child to talk about what the problem is, if they feel able to / that they want to . Allowing the child to talk may be enough. Often this is all that a child will need.

• We may need to provide some encouragement to the child, such as ‘Maybe you don’t feel like talking to me because you think I’ll go and talk to your Mum / Dad about what you say. Nothing will be done without you knowing about it. I won’t do anything behind your back.’

• Actively listen to the child, if they do decide to make use of this time and space.

• Help the child explore some of the issues for them (what are they worried or concerned about; do they feel that the parental problem is their fault; are they in any physical danger?).

• Help the child look at what sorts of options are available to them (how are they coping; are there other ways of coping; who else have they told; should they tell others; who else is providing support for the child; do they want us to tell others, and if so, who?)

• Help the child decide what to do, what achievable goals they might be able to set, empower the child to take some action to reach those goals and continue to offer support as they attempt to cope.

It is also really important for us to recognise that our simple intervention could have an immensely positive impact on the child and on their ability to become / remain resilient in the face of parental alcohol problems.

We know now that having a helpful relationship with a stable adult figure, and having outside interests (eg school work, after school activities, involvement in sport or cultural activities, etc) are highly protective factors with both short and long-term benefits in terms of the child’s resilience.

It may be that the child will need to be referred on as well (to social services if there are clear child protection dangers which emerge when the professional offers support in the way outlined above, or to CAMHS if more serious psychological difficulties become apparent), but that needs to be a later task, not a first one.

There may also be the possibility of referral on to less intensive forms of further help, such as to pastoral care / school counsellor / school nurse.

Some schools and communities also have other, informal, procedures for gathering professionals together to co-ordinate work with families where there are concerns but where a child protection referral is not yet needed. These might involve an informal care committee (see appendix 1) involving school, social services, and other community resources (police, primary care, etc).

A second solution involves gaining new knowledge and skills. Because it is understandable that adult professionals should seek to understand the parental problem, the existing knowledge and skills that we have can be extended. We can transfer the existing skills and methods of working that we already use in some situations into another ‘parental problem area’. It would be empowering for us as generic professionals to be able to better understand (parental) alcohol problems, the issues, and any potential dangers. We need to feel that we can appropriately and safely provide support to the child, as we would with more ‘normative’ parental problems.

Bibliography

Anderson, P. (1985) Managing alcohol problems in general practice, British Medical Journal, no. 290, pp1873-1875.

Beich, A., Gannik, D. and Malterud, K. (2002) Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners, British Medical Journal, no. 325, p870.

Bush, R.A. and Williams, R.J. (1988) Generalist health and welfare worker's response to alcohol-related problems: role legitimacy and the need for role support, an example from an Australian rural community, Drug and Alcohol Dependence, no. 22, pp105-111.

Gomel, M.K., Wutzke, S.E., Hardcastle, D.M., Lapsley, H. and Reznik, R.B. (1998) Cost-effectiveness of strategies to market and train primary health care physicians in brief intervention techniques for hazardous alcohol use, Social Science Medicine, no. 47, pp203-11.

Gorman, D.M., Werner, J.M., Jacobs, L.M. and Duffy, J.W. (1990) Evaluation of an alcohol education package for non-specialist health care and social workers, British Journal of Addiction, no. 85, pp223-233.

Hansen, L.J., Olivarius, N., Beich, A. and Barfod, S. (1999) Encouraging GPs to undertake screening and a brief intervention in order to reduce problem drinking: a randomized controlled trial, Family Practice, no. 16, pp551-7.

Johansson, K., Bendtsen, P. and Åkerlind, I. (2002) Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care, Alcohol and Alcoholism, no. 37(1), pp38-42.

Kaner, E.F., Lock, C.A., McAvoy, B.R., Heather, N. and Gilvarry, E. (1999) A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners. British Journal of General Practice 49: pp699-703.

Lock, C.A., Kaner, E.F., Heather, N., McAvoy, B.R. and Gilvarry, E. (1999). A randomized trial of three marketing strategies to disseminate a screening and brief alcohol intervention programme to general practitioners, British Journal of General Practice, no. 49, pp699-703.