Looked after children and substance misuse – guidance for foster carers

Introduction

This chapter is based on the Brighton and Hove Children and Families' Looked After Children and Substance Misuse Policy and Guidance for Brighton & Hove Foster Carers which your supervising social worker can obtain for you.

Use of alcohol and/or experimentation with drugs is part of normal growing up for many young people. Looked after young people may be particularly vulnerable to problematic drug and alcohol use. In order that you may help minimise the risks to young people’s welfare, foster carers need to feel informed about the facts and supported by other people working with the child in their care.

Expectations of foster carers

If you feel comfortable in discussing substance use and misuse you could be really effective in meeting some of the particular needs of looked after young people. With the support of training and other professionals you can play a key role in:

• encouraging young people to behave sensibly in relation to drugs and other substances
• identifying when a young person’s substance use is becoming a problem and that s/he may need more specialist help
• helping young people access medical assistance in an emergency and providing a safe, understanding home for young people suffering the effects of substance use
• providing opportunities for young people to talk about negative experiences of drug use within birth families/peer groups
• discussing substance misuse at key meetings such as LAC reviews
• establishing ground rules and open communication with the young people in your care
• liasing with school and ensuring a consistent approach is adopted.

Health issues

Smoking is the biggest single cause of bad health and early death in the UK. Alcohol has no real safe limits for under 18 year olds. Binge drinking is the most dangerous. It can potentially lead to accidents, unsafe sex and violence and can cause acute alcohol poisoning. Similarly Cannabis is more harmful than most young people recognise. It harms the lungs and heart and can cause mental illness in some young people. The more often it is smoked and the stronger the mix, the more harmful it becomes. Hard drugs such as heroin, cocaine, barbiturates and Temazepam cause serious health problems which require specialist help. Solvents can cause sudden death through asphyxiation.

People use drugs for different reasons, in different ways in different situations:

EXPERIMENTATION- because they are curious about the effects

RECREATIONAL- for pleasure, or for social reasons (when going to a club or a party)

PROBLEMATIC DRUG USE- has a harmful effect on a person’s life.

-ONLY A SMALL PROPORTION OF PEOPLE WHO EVER TAKE DRUGS WILL BECOME PROBLEMATIC USERS.

DEFINITION OF USE/MISUSE

USE:

“Any substance use that does not dramatically alter a person’s lifestyle or place them at particular risk”.

MISUSE:

“Substance use where a person’s lifestyle is detrimentally altered by that use. This phrase ‘detrimentally altered’ can be used in a very broad sense and could equally refer to adverse financial consequences as to medical and social problems”.

Sutherland, I, (2004) “Adolescent Substance Misuse: Why one young person may be more at risk than another, and what you can do to help”, Russell House Publishing, Dorset.

Advice on first aid

If a young person suffering from the effects of substance misuse requires first aid health professionals advise you do the following:

• base what you do on what you see – treat according to the symptoms, not what you think has been taken
• keep calm, give water to drink – not tea or coffee
• put to bed if coherent with normal breathing and colour. Lay the young person on the side and stay with them if in any doubt about the level of consciousness or not waking properly when vomiting
• if unconscious, put in recovery position and call 999
• if you need advice but it is not yet an emergency, you can ring

NHS Direct on 0845 46 47.

Substance misuse and babies

(This section may have particular interest for parent and baby carers.)

Using tobacco, alcohol or illegal drugs has an adverse effect on the foetus. Many women who misuse drugs use all or combination of these substances – this makes sorting out the specific effects in the long term difficult to predict. Some babies are born with addiction and withdrawal symptoms and need specialist care. Medical instructions should be followed carefully and all appointments attended. These babies are sometimes highly sensitive and need careful handling, feeding and regular weighing. There are professionals available to help you care for these babies.

The effects on a child of a mother who takes heroin & barbiturates can be as follows:

• neo-natal withdrawal or abstinence syndrome – can occur in labour, or any time up to 72 hours after birth, depending on a mother’s consumption of opiates. Signs and symptoms are excessive sneezing, irritability, tremors, fits, respiratory distress, abnormal sleep patterns, fever, poor feeding and vomiting. Treatment is reducing doses of opiate based medicine – often morphine or phenobarbitone, which is prescribed by a Neonatal Paediatrician. The doses are gradually reduced, and the aim is to prevent as many of the above symptoms as possible. As the baby gains weight, the same amount of drug will become less effective, so it is important that the weight is monitored regularly, and note taken of any symptoms or changes in behaviour. If you find the dose is reducing at the wrong pace for the child, you should contact the Paediatrician or Nurse from the Special Care Unit to discuss the right dose
• breast feeding is encouraged, but must not be stopped abruptly as this could cause some withdrawal. It is less clearly a benefit if the mother’s use is chaotic with unstable use
• there is no clear evidence about longer term effects on children, but there is thought to be some links with activity and attention disorders and with social behaviour and emotional difficulties
• there may be a risk of the baby contracting one of the blood borne viruses, namely HIV, Hepatitis B and Hepatitis C. These infections can pass to the baby in the womb and at the time of birth. There is a risk if the mother has injected or snorted drugs, or lived in intimate contact with a partner who is a risk. Mothers who receive full antenatal care should have been tested routinely for HIV & Hep B in pregnancy. They are also tested for HEP C if the risk is known at the time. The doctors involved with the baby will judge whether there is a need to test the baby – this is done either at the follow up clinic at the Royal Sussex County Hospital or at the Royal Alexandra Children’s Hospital. At all times it is important to follow safe and hygienic practice. This means covering any open cuts or grazes on yourself, cleaning up any spilt blood promptly with hot water and cleaner (no special disinfectant is required) and never sharing toothbrushes or any other items that could have blood on them – such as tissues, or as the child grows, razors; blood borne viruses are not easy to catch – normal day to day care does not pose a risk. If necessary, the baby may have immunisations for Hepatitis B. At present there is no immunisation for HIV or Hepatitis C.

There is increasing evidence to show that alcohol is very damaging for the growing foetus – particularly from day 18 of pregnancy through to birth. The effects last for life. In the USA the recommendation is for NO alcohol at all during any stage of the pregnancy – and it seems likely that we need to adopt the same advice.

The damage to the foetus depends largely on how much alcohol has been drunk and at what stage of the pregnancy – but as the brain is developing all the necessary cells and connections from Day 18 – the effect can be from minor to major- involving growth and appearance as well as development and intelligence.

Services available to help and advise:

• One Stop Clinic Staff – Health Visitor Liaison Team, Royal Alexandra Hospital Tel 01273 328145
• Trevor Mann Baby Unit, Royal Sussex County Hospital, Tel 01273 696955
• Local Health Visitor, Baby Clinic and GP
• Nurse Consultant for Looked After Children – Tel 01273 295466

Substance misuse and the law

The Misuse of Drugs Act (MUDA) 1971 covers the control, dispensing and classification of drugs and is concerned with:

• the classification of illegal drugs into A, B, and C categories according to current knowledge about potential harm (alcohol, tobacco and solvents are legal to purchase from shops at certain ages)
• sentences and penalties for supply, cultivation and possession of drugs in each category
• possession and supply. Supply means giving or selling, not just selling
• Police have a right to stop and search if they suspect that a person has drugs, stolen goods or weapons on them
• House search with owner’s permission, although a warrant could be sought.

If the police find drugs, including Class B drugs like cannabis, they can arrest a young person between 10-17 years old and their parents or carers will be contacted.

Possible consequences for young people of conviction for drug offences

The following consequences can arise for young people convicted of drug offences:

• doors to education and employment can be closed
• the refusal of visas to travel to countries like Canada, USA and Australia
• young people persistently under the influence of substances like alcohol in public places, could be more likely to have an Anti Social Behaviour Order placed on them.

Legal obligations placed on carers

You should feel able to consult with social workers about issues of young people’s possession and/or use of substances in your home, such as:

• MUDA requires professionals to ‘take reasonable steps’ to prevent drug use, cultivation or dealing ‘on the premises’
• taking ‘reasonable steps’ would include establishing clear boundaries about the possession and use of drugs in your house. If a young person hands over drugs to you after you have discovered them in their possession, you should:
  • either destroy them by flushing them down the toilet. This is an adequate legal defence (against charges of possession). You should do this in the presence of another responsible adult. If this is not possible lock it away until you do have someone with you. Record details and inform your supervising social worker and the child’s social worker.
  • or take them to the police. There would be no legal obligation to tell the police the young person’s name and you should discuss this with the young person’s social worker
• you should not feel obliged to confiscate drugs from a young person, if you think this could lead to an aggressive incident or the young person absconding. Your and the young person’s welfare and safety must remain primary, but do contact the young person’s social worker as soon as possible
• If you feel a young person’s substance misuse has resulted in them needing medical assistance, this should be acted on promptly. Discussion about how to deal with the possession/use of drugs in your house can be had at a later date.