‘Alcohol, Child Care and Parenting: A handbook for practitioners’
Robinson, W and Dunne, M., NSPCC/Camden and Islington NHS

Extract from page 74

1. Anxiety:
This may be a general feeling, or specifically to do with the child, or with the parent, or both. It may be founded on something that happens, or something less obvious. It may be more about yourself than the child or parent.

What to do? First ask yourself:

• Is this something about me, or about someone else?
• Then – is it an impression? Based on an event? Or an interaction?
• And – can I describe what I feel, what I saw?
• Shall I watch and wait?
• And how long for?
• What would make me less anxious? More anxious?

2. Concern:
This is likely to be more concrete than an anxiety. It may result from more close observation made after you registered the first anxiety. Again, there may be something about yourself in this, your values, assumptions, prejudices; keep checking this out.

Consider:

• What effect does ‘it’ have on the child?
• Is ‘it’ to do with an aspect of the child and his/her behaviour?
• Or is it to do with an aspect of the parent and his/her/their behaviours?

What to do?

• First, you should talk to someone else, describing what worries you.
• Then, can I put it into words so the parent can hear my concern?
• And, if not, how long should I/we watch and wait before doing so?
• What formal record should now be made?
• Record what has been done about it so far
• Is it possible to have an in-house consultation about the situation?
• Is it to do with a ‘child in need’ or a child in need of protection?
• What do I have to do in either case?

3. Professional observation:
This takes things further than the ‘concern’ stage in that you, your manager and the agency recognise that there is now a professional responsibility in this situation. There are now some ‘facts’ to be considered: there is a known situation, observed and reported to the parent/carer. Along with that there is some expectation of change, perhaps explicitly (eg the child has been dressed inappropriately for the weather conditions) or vague. The concern itself becomes a ‘fact’, an element in the situation, which neither agency nor parent can avoid.

What to do?

• First, what service can you offer to parent or child to help the situation?
• Then, how long to maintain support before ‘normal’ service is resumed or the situation has not improved and further action is required?
• And, what contact should you have outside your agency, either for consultation or referral, either as a ‘child in need’ or for protection services?
• Keep the carer, and child of appropriate age, informed of your thinking and actions at all times.

4. Decision to act – referral:
This step takes you out of your in-house procedures.

• Referrals need to be child-focused firstly, reflecting your thinking about the possible impact on the child of what you are concerned about.
• Then, give clear information about the events, circumstances which gave concern, with examples, and what approach has been adopted in-house.
• Parental involvement, response to concerns raised and engagement in any support provided is essential information.
• Some information about each person in the family known to your agency is helpful, giving a fair picture of strengths and weaknesses.

During this whole process ensure that:

• Observation is child focused
• Issues and actions are recorded
• Discussed with carer and clear information given
• Discussion and consultation within agency, plan for management of concerns
• Recognition of change – step-down of concerns or –
• Increased concerns; decision making for action

If it is clear that either parent might have an alcohol problem

The focus should remain on the children and, in respect of a new born at the primary visit, the safety and general physical wellbeing of the child. Health visitors should adopt their normal practice in assessing risk to the children and take action based on this assessment.

Clearly the children will be more at risk:

• If the drinking is happening during the day
• If the child is left alone with a drinking parent
• If both parents misuse alcohol
• If the drinking problems cause the parents to neglect their child
• If the drinking problem triggers family violence

If there is no immediate risk to the child the health visitor should consider what support services could help the family and what on-going monitoring systems would be appropriate to continuously assess and support adequate parenting capacity.