Assess and plan for safety

Parents need to take the responsibility for the ways in which they will keep their child safe. They also need to be clear about the specific behaviours or ways their child may be seriously hurt or injured from their parent’s substance use.

The safety plan needs to make sense to parents and their networks and use language they understand.

Immediate safety and support plans

It is important to assess acts of protection, strengths and resources, if applicable, to help determine whether an immediate safety plan may be possible. 

Work with the family and their safety and support network to attempt to create a plan that will provide safety for the child in the short term. Immediate safety plans are to be reviewed at least every 7 days, but monitoring these plans may sometimes be a daily occurrence. Network members can be called on to assist in the monitoring of the plan. 

If the family does not have a safety and support network, this is the time to help them identify who may be able to help them. Network members can be extended family, friends and neighbours who care about the child and are able to work both with the family and Child Safety.

Tools such as genograms, eco-maps and the Circles of Safety and Support tool can assist practitioners to identify network members.

Remember, when you are assessing safety with a family and developing an immediate safety plan for a child are, you are to:

• Ensure the parent is not affected by alcohol or drugs when developing an immediate safety plan as they must have the ability to consent to the plan. 
• Be realistic—Think about the parent’s level of problematic substance use and the nature of their use. Parents who come to the attention of Child Safety are more likely to have chaotic, reactive, opportunistic and persistent use. You need to consider this when developing your safety plan.
• Do not use alcohol or drug testing as a safety plan action. Testing only lets you know what substance a parent is using. It does not create safety for a child. The practice guide Alcohol and other drugs testing is best used in case planning when you are working with the parents to create lasting change.
• Be purposeful and transparent in safety plan actions to keep a child safe. For example, require parents to: 
  • have a strategy for storing drugs safely and cleaning up paraphernalia
  • stop other alcohol and other drugs users attending the home not take their children with them when buying drugs
  • plans to manage use, including nominating specific safe adults who can care for children when they are using or coming down
  • carry out safe sleeping practices
  • develop strategies for breastfeeding and feeding a baby to minimise the risk of co-sleepinghave a safe adult stay with the family.

Long-term safety and support plans

Long-term safety and support plans are to be developed with the children, family and their safety and support network. The network is made up of a range of people, and could include family members, professionals, carers, and community members. These network members will support parents, children and young people in developing and maintaining safety through case planning and safety planning.

The use of safety and support networks in the child safety context aims to build on and strengthen the natural networks of a child or young person and their family. Safety and support plans provide clarity to all network members about their purpose, the known worries, goals and action steps as well as the non-negotiables and ‘what ifs’ everyone should plan and have contingencies for.

Long-term safety and support plans can support safe and effective reunification, family contact within a more natural setting and the maintenance of connections with family, community and culture.

Safety planning for infants

Using drugs (including prescribed medications) or alcohol may make parents fall into a deep sleep, which can be dangerous for their baby. Tell them that if they are going to use drugs or drink alcohol:

• they should never have the baby sleep with them in their bed. They should always put their baby in their cot
• there is a risk they may not wake for the baby’s next feed or if the baby becomes distressed
• they need to make a ‘safety plan' and have a responsible adult to take care of the baby if they decide to use drugs or alcohol.

Use of a parent’s support network

Assist parents to make a list of telephone numbers of people who can help them in times of stress- the family's safety and support network. The list could include:

• family members or friends
• members of community
• their GP
• their child health nurse
• their drug and alcohol counsellor.

During the immediate safety plan period, contact the family’s safety and support network to see:

• what has been happening
• what they have seen
• if anything has changed in the home
• if they are worried than they were a few days ago.

While we know that services do not equate to safety (behaviour change leads to safety), part of reviewing the safety plan means checking with services and other professionals who are also working with the family. It is essential to share information in relation to the worries, progress and successes. For further information, refer to Safety and support networks. 

Case planning with parents

Before you start building a case plan with parents, it is important to summarise and be clear with them about what needs to change and why.

• Explain to them the way you have made sense of their alcohol and other drugs use and what it means for their child. (This is the outcome of your safety and risk assessments).
• Ask if there is anything you have got wrong or misunderstood.
• Ask for feedback on what they do or do not agree with and let them know it's okay if they do not agree with everything.
• Acknowledge areas of difference and look for common ground for the future.
• Remember that change takes time.

Commitment to change

A parent’s ability to make the changes they need through a case plan relies on their commitment to keeping their child safe, their willingness to do what needs to be done and their ability to follow through.
The following tips can help you think about what you have heard parents say, what you have seen and what you understand from your assessment about how ready they are to make the changes their child needs now.

Does the parent know things need to change?

• Does the parent understand how their substance misuse affects the child?
• Are they clear about what needs to change and how they can do it?
• Does the family have a different perspective about what needs to change? If so, are you able to acknowledge these differences and overcome them together?

Are they ready to change?

• What was the parent’s readiness for change at the time you first spoke about your worries? How has this changed over time or not?
• Where is the parent in The cycle of change now? What is happening that leads you to make this assessment?
• What ‘change talk’ have you heard? (Change talk is when a parent expresses their desire, need, ability or reasons to change their current behaviour, as in: ‘I want to change my life. I want things to be better.’)

Are they not yet ready to change?

• What tells you they are not ready? Where do they sit in the change cycle?
• Are they using ‘sustain talk’? (Sustain talk is when a parent expresses their ambivalence to change. They may express defeat—‘I’ve tried that before’, ‘I can’t do that’, ‘It is not a problem that needs to be fixed.’)
• Are they talking to you about their reasons for not changing? For example, ‘I have been drinking for so long I can’t stop now, I would have to move away and cut people out of my life to stop. I don’t want to have to deal with my past.’

A willingness to change

• How willing is the parent to work with you and alcohol and other drugs services towards change?
• How willing is the parent to open up and talk about what needs to change, how, and who can help them?
• How willing is the parent to take steps that will support change, such as letting go of people who may enable their alcohol and other drugs use, reconnecting with people who can help them, letting people help them, or seeking treatment
• What ideas have they talked about for their healing and treatment?

An ability to change

• Has the parent started working with services already?
• If not, what is getting in the way for them and how can you support them?
• If there is a barrier, what is it and what can you do to support them in overcoming it?
• What services and supports are available for the parent to access?
• What support network does the parent have to help them and their child?

Safety and support networks

A safety and support network is a team of family, friends, community members, carers and professionals who are willing to meet with the child or young person, the family, and Child Safety and work together to keep the child or young person safe.

Network members are not ‘add-ons’ to the case work but are integral to case and safety planning. In this integrated practice approach, network members are essential to enhancing safety as they keep in regular contact with the child or young person and their families, take specific actions when situations become fragile or dangerous, and listen and respond to the child or young person and their worries.

An important difference between a safety and support network and a more general ‘group of concerned people’ is that safety and support network members know the harms that have already been experienced and the worries and goals for the future.

They know the risks of future harm to the child or young person should nothing change in the family or if new issues emerge. The key premise for any safety and support network is that network members are:

• informed
• willing to help
• clear about what they must do to respond.

Use the following list of questions with parents to help identify or develop a safety and support network with the children and parents.

Talk to parents about how the various people in their lives:
•    influence their alcohol and other drugs use
•    feel about the parent making positive changes
•    feel about treatment and recovery.

These conversations are often complex, as alcohol and other drugs can play a significant part in the social lives and relationships of people with problematic alcohol and other drugs use.

These relationships may be important and meaningful. If a parent senses you are asking them to cut ties with certain friends or groups, they may feel challenged and upset.

It is not your role to tell parents who they can and cannot spend time with when they are not looking after their child (such as when the child is at school or being looked after by someone else).

In your conversations, help a parent explore how the relationships in their life impact on their substance use and parenting. Your conversations should help a parent come to their own conclusions about who is a positive influence in helping them seek treatment and recover.

If you think a parent’s friend, partner or anyone else in their life is a potential risk to a child, you will need to:

• have up-front and frank conversations about this with parents
• develop safety plans that help keep their child safe and
• be clear about what is required (and expected) to keep their child safe.

For example: A parent may see and spend time with people who drink or use drugs and it may take time for them to let go of these relationships. This will be their choice as they move through treatment and recovery. However, you will need to be clear that although they maintain these relationships, their child should not be spending time with anyone who causes a risk.

Substance testing

If it has been determined that a parent’s substance use has or will have a detrimental impact on a child’s safety, belonging or wellbeing, particularly when a parent is not ready to disclose their substance or alcohol use, then substance testing may be used to confirm or dispute allegations of substance use to assist in assessment of harm and risk of harm to a child. 

The purpose of substance testing is to monitor the agreed case plan goals or safety planning to inform ongoing assessment and decision-making, or child and family court proceedings.

All case plan goals related to substance misuse where substance testing is recommended, should also include actions and plans to change parental behaviour. This includes referrals of support to alcohol and other drugs services. 

Testing is most helpful when used in combination with:

• collaborative partnership and ongoing assessment of a parent’s substance use
• ongoing assessment of the impact of substance use on parenting capacity
• observations of a parent’s behaviour and functioning
• collaboration and input from alcohol and other drug support services, where possible.

Before suggesting parental substance testing, consider what you are hoping to achieve from receiving the test results. Common misunderstandings of substance testing include: 

• It does not indicate impairment or intoxication at the time of testing.
• It does not measure parenting capacity or behaviour.
• It does not prove exactly when and how often a substance was used—only that metabolites were excreted within the detection timeframes.

A negative test does not guarantee non-use, especially for substances with short half-lives (half the drug has excreted) or if the detection timeframes are exceeded.

Urine and hair testing does not detect synthetic or novel psychoactive substances unless specifically requested for example, synthetic cannabinoids.

Substance testing types

Different types of substance testing can determine the substances in a person’s system. They include urine testing (urinalysis), hair testing, and carbohydrate deficient transferring testing.

Urinalysis

Urinalysis is best used to detect the recent use of substances, alcohol and certain medications. The timeframes are typically up to 3-4 days for most substances, and approximately 12 hours for alcohol. See the QML website for what substances are regularly tested using urinalysis.

 The urinalysis testing results turnaround is between one to three business days. 

Hair testing

Hair testing is best used for observing historical substance use over an extended period, depending on the length of the hair shaft. It’s useful for identifying long-term or chronic patterns rather than recent or single-use instances. It is not effective for assessing immediate risk. 

Typically, one centimetre of hair from the crown/scalp equals one month. The standard hair sample consists of 100-150 strands from the crown of the scalp. Body hair can be used if head hair is not available however it is less precise. 

Substances bind to the hair differently, with some substances having a long incorporation in the hair such as GHB, LSD and inhalants. See the QML website for what substances are regularly tested using hair samples. 

Carbohydrate deficient transferrin testing

Carbohydrate deficient transferrin (also known as CDT) is a blood test used to assess the alcohol consumption of a person. A molecule involved in iron transport in the bloodstream and when a person consumes alcohol excessively, the structure of the transferrin changes, leading to an increase in Carbohydrate deficient transferrin levels. Carbohydrate deficient transferrin Carbohydrate deficient transferrin levels typically normalise within several weeks of abstaining from alcohol use.

Carbohydrate deficient transferrin is typically used as a marker for chronic, excessive alcohol use. It can detect binge drinking however that depends on the amount and the time between binge drinking sessions. 

Urinalysis vs hair samples

Use hair testing when:

• you need a long-term pattern of substance use (weeks to months)
• the goal is it verify chronic or repeated use
• the person has been abstinent for more than 5-7 days and you want to verify past behaviour.

Use Urinalysis when:

• you need to detect recent use (last few hours to a few days)
• there is a need for rapid results (for example, safety assessment)
• you want to verify abstinence immediately prior to contact or visitation
• you are working with substances poorly detected in hair (for example, GHB, LSD).

Substance testing myths