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Learning from case reviews involving parental substance misuse

NSPCC briefing

November 2013

This at-a-glance briefing pulls together and highlights the learning from case reviews into the death or serious injury of a child where parental substance misuse was a key factor.

It is based on case reviews published since 2010.

Recommendations around assessment and professional awareness and skills
Recommendations around working with the family


Parental substance misuse is widely recognised as one of the factors that puts children more at risk of harm. In these case reviews, children died, or were seriously injured in a number of different ways:

  • sudden infant death syndrome associated with co-sleeping
  • accidental ingestion of drugs
  • accidents (fire, drowning) due to inadequate adult supervision
  • parents deliberately giving children drugs.

The biggest risk posed to children is that parents, when under the influence of drugs or alcohol, are unable to keep their child safe (i.e. overlay and accidents caused through lack of supervision).


Many of the learning and recommendations contained in the case reviews repeat lessons from numerous other reviews.


There is a clear message about the importance of timely and thorough assessments with regards to all the children cared for by substance misusers. The assessments need to be child-focused. They should present a clear picture of the user’s drug and alcohol consumption, and carers’ usage and behaviour must be properly analysed to understand the risks that this poses to the children. This should include an assessment of parenting capacity.

Where other risk factors are also present (parental mental ill health, domestic violence), the relationship between these factors and a parent’s substance misuse should be taken into account.

Risk assessments should be a dynamic rather than a static (one-off) process, which are reviewed in the light of emerging evidence.

Rule of optimism

Professionals too often trusted the parents’ self-reporting of their drug and alcohol consumption. Their substance misuse was known about but not seen as excessive or problematic. Some reviews talk about tidy and clean homes and happy and healthy children.

Communicating with parents

It is important that information is delivered in such a way that parents are able to understand it. Professionals should regularly check that parents have understood the risks and are complying with the advice. Written leaflets are not suitable for functionally illiterate adults.

Some parents said they did not feel that the risks of co-sleeping had been explained in such a way that they had fully understood them, or had taken them on board.


Work with adults often focused on their individual needs rather than their role as parents.

In other cases, the focus was on looking for a holistic family support package, which meant the immediate risks faced by the child were not prioritised, and the needed safeguarding action was not taken.

Recommendations around assessment and professional awareness and skills

  • A child-focused assessment must be carried out with regards to the needs, safety and welfare of every child who is looked after by substance misusing adults.
  • The assessment must look at parenting capacity and must analyse the adults’ substance misuse and behaviour to understand its impact on the children in their care.
  • Professionals should treat with caution the substance misuser’s account of how much and how often they drink/take drugs.
  • The assessment must consider whether safeguarding action is necessary.
  • Professionals must be alert to and take note of new or increased risks and be prepared to take safeguarding action at any point, if and when it becomes necessary.
  • Professionals must remain alert to risks even if the parents seem to be complying at the moment.
  • Professionals must be aware of, and understand, the risks to children posed by parental substance misuse. They must be confident in challenging carers about the risks they are exposing their children to.
  • Professionals must be aware of, and understand, the risks to children posed by co-sleeping. They must be comfortable with discussing these risks with carers and crucially know how to give advice around safe sleeping arrangements.

Recommendations around working with the family

  • Drugs and alcohol in the home must be stored securely at all times, out of the reach of children.
  • The risks of children ingesting drugs or alcohol must be explained to all substance misusers, in a way they understand and are able to take on board.
  • Children must be unable to get close to potential hazards in the home (eg. ponds or heating appliances).
  • The risks of co-sleeping must be explained to all adults who look after the children, in a way that they understand and act upon.

Professionals working with substance misusing families should check compliance with the issues listed above on every visit/meeting.

New and increased risks include:

  • new partner (or previous partner coming back)
  • involvement of extended family members in family life
  • non-family visitors to the home
  • missed appointments with any agency
  • dropping out of treatment programme
  • domestic abuse or mental ill health problems
  • criminal activity or anti-social behaviour incidents
  • stress (which may impact upon substance misuse habits)
  • moving home.

Contact the NSPCC's information service for information on case reviews or any child protection topic

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