Toolkit for health visitors

Supporting children in families where there is parental alcohol misuse

The health visitor role and remit - and what you need in order to be able to fulfil them
Health visitors assess families in order to promote the welfare of the family as a whole and to ensure families in need access services that can help them provide good enough parenting for their children.

Health visitors are in a unique position to promote resilience to long term harm in children from families where parents misuse alcohol because of their role with the family as a whole. This toolkit focuses, in the main, on supporting children directly, independently of promoting change in the drinking behaviour of parents. But for health visitors who only see children within the family situation, and then when the primary focus in on very young children, promoting resilience to long term harm in children of problem drinking parents in reality means assessing and potentially taking action with family members other than the children themselves.

This does mean that health visitors are likely to want more information about alcohol related problems than other professional groups – such as those within the education system where the focus is restricted to picking up on signs in the child that something is wrong at home.

It is important to recognise that delivering interventions for parents with alcohol problems does not come within the brief of the health visitor. But given that health visitors are working with whole families and not just children, the health visitor will need to be able to:

Identify families where parental alcohol misuse may be a problem
Make a reasonable judgement of the extent to which parental drinking is, and is not, affecting good enough parenting
Offer appropriate advice to parents misusing alcohol, which may include brief interventions as well as referral elsewhere.

However it is essential that concern about parental drinking should not focus attention on the parental drinking problems to the exclusion of support for the children. In particular the health visitor should:

Assess for adequate parenting capacity
Assess the availability of factors known to help protect a child of alcohol misusing parents from long term harm
Recognise that, regardless of whether or not they can promote change in the drinking behaviour of the parents, they can support the development of good enough parenting
Recognise that this will help ensure children are protected
Access or develop other support systems for children to enable development of the means to protect against harm

Opportunities to identify families misusing alcohol
Whilst health visitors have a very broad role with families, the day to day pressures of the job often mean that many health visitors can only focus on families where there is a new baby. So at the very least there are the following opportunities for spotting families where alcohol misuse is a significant factor:

At the primary visit within 10 days of a women giving birth
At the six week check
At the twelve week check
At the seven month check
At the two year development check.

The rest of this section sets out how a health visitor might go about determining if alcohol misuse is a problem in families within the context of the minimal contact a health visitor may have with them and where nothing is previously known about that family. Often more information about many of the families visited will be available, as the child visited might not be the first and other professionals may also be in contact. This might make assessment of the situation easier.

The main advice to health visitors is to take a child centred approached in working with families where alcohol misuse is a problem. This is the usual way most health visitors already work and it means focusing on the needs of the child, rather being drawn into, and often immobilised by, the parent’s drinking behaviour. Not only can the latter be difficult to change, but focusing on this does little to help the child. It can also mean that child protection procedures are begun when it might not be appropriate and therefore could be damaging to the child. Focusing on the child’s needs and ensuring that these are met helps the child, engages the parent where possible to do so and ensures that interventions such as invoking child protection procedures are only used when it is appropriate.

Identifying and assessing families where parental alcohol misuse may be a factor
As stated above, the most important thing is to adopt a child-centred approach and avoid focusing on parental drinking as the main concern. However health visitors are visiting families, sometimes for the first time, where the children are very young. This inevitably throws the focus on the parents – at least in so far as whether or not the parents use alcohol inappropriately.

What action can and should be taken as a consequence of identifying parental alcohol problems? The guidance set out below may help you to think about this and further information to help you is in Alcohol and alcohol-related problems.

Circumstances	Likely action required	Additional notes
There are no concerns about parental alcohol misuse at all	None
Some concern that one of the parents might be misusing alcohol but insufficient information given by the family and no direct ‘evidence’	Using usual health visitor protocols the health visitor will assess for any risk to children Assess as far as possible general parenting capacity as is normally carried out by health visitor If possible pass on basic advice on ensuring safety of child relevant to alcohol. Make a note of concerns and to reassess in whatever way is appropriate (at next routine visit or earlier if this is too far away) Concentrate on building up a good relationship with the main carer and offering general support Start to work out what resilience factors are in place
Drinking of at least one parent is causing some issues for the family	As above the Health Visitor will assess for risk to children Listen to the problem being described Make a basic assessment of the issues and problems caused for the children Offer advice as appropriate Seek advice from alcohol agency to guide you in respect of the adult’s drinking This family will need extra monitoring Support to the family should focus on ensuring that factors known to promote resilience to long term harm to children are in place within the family situation Referral to other family support agencies should be considered	Most families where alcohol is an issue will fall into this category The advice and information offered will differ in cases where the drinker is the main carer (usually the mother) or is the partner of the main carer
At least one of the parents is likely to have a serious problem with/be dependent on alcohol	As above the Health Visitor will assess for risk to children An assessment of parenting capacity is required Health visitors are advised to take advice from alcohol specialists on what advice to offer either the drinker or the partner of the drinker This family will need extra monitoring Support for the non drinking partner will also be required	Action taken will be very different depending on which parent is the main carer of the children
Immediate problem in that parent is drunk	If main carer take usual emergency action as per when children are found in an unsafe situation If another adult is present assess for child safety and act accordingly Make plan to assess whole situation at later date when immediate situation is dealt with

Most of the information and skills required are those already core to health visiting. The additional information required concerns how you might investigate whether an alcohol problem exists or not (see the following section) and assessing the degree to which this is a problem for the children.