Children affected by Parental Alcohol Problems (ChAPAPs)

532 Pages·2010·4.2 MB·English

2010

Children affected by Parental Alcohol Problems
(ChAPAPs)

A report on the research, policy, practice and service development relating to
ChAPAPs across Europe. An ENCARE 5 Project funded by the European Union

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Professor Judith Harwin, Professor Nicola Madge and Sally Heath

Brunel University, UK
2/1/2010
Contents Page

Acknowledgements 3
Executive summary 4-9
Section 1- Introduction 10-11
Section 2- Prevalence 12-18
Section 3- Research 19-23
Section 4- Country policy and practice 24-41
Section 5-Service delivery 42-58
Section 6- Summary of key issues, discussion and conclusions 59-71
References 72-76

Appendices 77-
530

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ACKNOWLEDGEMENTS

This report has been prepared as part of the 5th EU funded ENCARE project - Children Affected by
Parental Alcohol Problems (ChAPAPs). Many people have been involved in the preparation,
consultation, collection and review of this report. We particularly wish to thank the following:

 Austria: Ludwig Bolzmann Institute for Addiction Research
 Austria: Institut Suchtpravention, pro mente 00
 Belgium: De Sleutel
 Cyprus: KENTHEA
 Czech Republic: Psychiatrcke Centrum Praha
 Denmark: Else Christensen, The Danish National Centre for Social Research
 England: Lorna Templeton, Bath University
 Estonia: Talinn Family Centre .
 Finland: A-Clinic Foundation
 Germany: Catholic University of Applied Sciences North Rhine-Westphalia, German
Institute for Addiction and Prevention Research
 Hungary: Blue point drug counseling and outpatient centre
 Ireland: Cliona Murphy, Alcohol Action Ireland
 Italy: Azienda Sanitaria Locale
 Lithuania: Vytautas Magnus University
 Netherlands: Verwey-Jonker University
 Norway: Norway Tromso University College, Faculty of Health Sciences
 Kalle Gjesvik, Faculty of Health Sciences, University of Tromsø
 Poland: Institute of Psychiatry and Neurology
 Portugal: Ministerio da Saude, Centro Regional de Alcoolagia do centro
 Scotland: Louise Hill, University of Edinburgh
 Scotland: Professor Marina Barnard, Centre for Drug Misuse, University of Glasgow
 Scotland: Professor Neil McKeganey, Centre for Drug Misuse, University of Glasgow
 Slovenia: University of Ljubljana, Medical Faculty, Department of Family Medicine
 Spain: Fundacio Clinic per a la Recerca Biomedica
 Wales:Keith Ingham Director of Children‘s Health and Social Services, Department for
Health and Social Services
 UK ChAPAPs Advisory Network (membership listed in the appendiced England report)

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EXECUTIVE SUMMARY

Background

Research has consistently shown that parental alcohol misuse can have considerable negative
effects on children, young people and the family environment. Children growing up in alcohol
fuelled family environments often do not achieve their full potential in life, have low self esteem,
lack in confidence, feel unsafe and find it difficult to trust others (Kroll and Taylor1, Gorin2,
Barnard3, Forrester and Harwin4). Adding to this, the issue of parental alcohol misuse often
remains hidden with many children and young people suffering and growing up in silence. Yet with
this knowledge, European alcohol policy has predominantly focused on the licensing and trading of
alcohol, its impact on crime and on individual health with little attention being paid to the impact of
parental alcohol misuse on children, young people and families.

This study aims to review and identify the main approaches adopted by EU Partners in addressing
the issue of children affected by parental alcohol problems (ChAPAPs), drawing specifically on
research, policy, practice and service development. This is a particularly timely study as the EU
Commission is placing more emphasis on member states to protect young people and children,
and the unborn child, from alcohol related harm across Europe. Many EU partners are also in the
process of developing and/or updating national alcohol strategies.
Method

A questionnaire devised by Brunel University (see appendix) was sent to the 21 EU partners
involved in this project in 2008. Responses were received from 18 partners representing Austria,
Belgium, Cyprus, Denmark, England, Estonia, Finland, Germany, Ireland, Italy, Lithuania, Norway,
Poland, Portugal, Scotland, Slovenia, Spain and Wales. The present report draws on information
provided within these country reports.

1 Kroll and Taylor (2003) Parental Substance misuse and Child Welfare. London; Jessica Kingsley
2 Gorin, S (2004) Understanding what children say. Children‘s experiences of domestic violence, parental substance
misuse and parental health problem. London; National Children‘s Bureau (NCB)
3 Barnard, M (2007) Drug Addiction and Families. London; Jessica Kinglsey
4 Forrester, D. & Harwin, J. (2008) Outcomes for children whose parents misuse drugs or alcohol: A two year follow up
study, British Journal of Social Work (2008) 38, 1518–1535
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Key messages
The following is a summary of the key findings:

Prevalence
 It is difficult to collect accurate data on the prevalence of ChAPAPs as problem drinking
often remains hidden within the family unit and the true scale of the problem is not known;
 Countries use different definitions of problematic drinking that are rarely stated: this can
make it difficult to tell whether international comparisons are meaningful or misleading;
 Data on prevalence often relates to the broader category of substance misuse and may
therefore provide incorrect estimates of ChAPAPs;
 Not all countries can provide prevalence rates for ChAPAPs and, where they can, these
vary according to how the information is collected;
 Governments rarely collect national data on the number of children whose parents misuse
alcohol;
 Countries reported that the COFACE survey instrument is an unreliable way of
determining national prevalence rates on the number of children living with parent(s)
misusing alcohol, even though it is widely used;
 Policy makers across Europe recognise the gap in knowledge and information on FASD,
but there is little evidence of action plans to address these issues. One exception is the
Scottish government that has committed funding to measure the incidence of FASD in the
recent Changing Scotland‟s relationship with alcohol: a discussion paper on our strategic
approach5;
 Estimates of the nature and frequency of FASD vary widely;
 A lack of follow-up studies makes it difficult to examine changes in incidence of FASD over
time; and
 Parental alcohol misuse is an important reason for family support and/or removal from the
family home in a number of countries.

Research
 There is wide variation in the scale, methodology and quality of these various studies;
 On the whole, few robust European empirical studies addressing the physical and mental
health of children affected by parental alcohol problems were reported by partners;
 Much reported research indicates that parental alcohol problems rarely exist in isolation
from other difficulties such as family relationship problems, domestic abuse, parental
mental health issues, bereavement, and financial hardship;
 Many studies identify child maltreatment and domestic violence as common outcomes of
parental alcohol problems;
 The available evidence also suggests that many children of parents with alcohol problems
are likely to have feelings of insecurity, shame and loneliness, and to suffer from anxiety,

5 http://www.scotland.gov.uk/publications/2008/06/1608434810 (2008).
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depression, aggressive behaviours, and relationship difficulties in their later lives;
 Several studies also suggest that children growing up in households with parental alcohol
misuse are at greatest risk of developing their own alcohol problems in later life; and
 A recent systematic review (Girling et al6) of international research studies on the impact
of heavy parental alcohol use on children‘s physical and psychological health in a range of
areas (foetal alcohol syndrome and ingestion during pregnancy; eating disorders,
specifically in female children; sexual behaviour of adolescence and earlier pregnancies;
hospital admissions for mental disorders, injuries and poisoning; and children‘s own
misuse of substances) might be helpful in informing future European work in this area.

Country policy and practice
(i) Governmental responsibility for alcohol-related issues
 Countries are organised differently in relation to responsibility for national alcohol policy;
In most countries, however, the Health Ministry appears to be either the lead department
or plays a significant role alongside other departments;
 Most countries have a joint approach to both drugs and alcohol which is led by the same
government department(s);
 Government responsibility for children affected by parental alcohol problems is much less
clearly defined: in most instances this specific issue is not recognised in alcohol policies or
distinguished from wider alcohol policies; and
 There is some evidence to suggest that cross government working can lead to a more
coordinated approach to alcohol policies where the needs of children affected by parental
alcohol problems are more embedded within the children‘s agenda.

(ii) Legislative and/or regulatory duties
 All countries are signatories to the UN Convention on the Rights of the Child and
accordingly have child protection policies in place;
 Commonalities exist in all states: national legislation allows for intervention, restriction and
removal of parental rights; discretion is granted to the courts in selecting suitable
measures; courts can withdraw or restrict parental custody; and proceedings are guided
by the principles (i) of reasonableness and (ii) that infringement of parental custody should
never go beyond that which is absolutely necessary in the best interests of the child;
 No country legislation or regulatory duties appear to refer specifically to parental
alcohol/substance as a form of neglect, abuse or harm, and concerns relating to harm
caused by parental alcohol misuse on the child sit firmly within the child protection
framework; and
 There appears to be a common understanding relating to professionals‘ duty of care to
inform social services if they have concerns relating to risk of harm to a child eg.
Legislation in Denmark and Slovenia provides for penal measures and fines if concerns
are not reported.

6 Girling M, Huakau J, Casswell S & Conway K (2006). Families and Heavy Drinking: Impacts on Children's Wellbeing.
Centre for Social and Health Outcomes Research and Evaluation and Te Ropu Whariki, Massey University
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(iii) National strategies and initiatives to address children affected by parental alcohol problems
 Few countries reported that they have established national strategies and initiatives to
address children affected by parental alcohol problems;
 Some potentially useful learning points are provided by England‘s Hidden Harm initiative;
 Interdisciplinary working is likely to underpin successful examples of strategies to provide
support to children affected by parental alcohol problems; and
 These strategies require adequate resources if they are to be effective.

(iv) Health/education promotion programmes to reduce alcohol consumption
 European partners reported a range of national approaches to educate young people
about alcohol. These ranged from the ‗Just Say No‘ approach, to targeted interventions
with vulnerable groups, through to wider health promotion campaigns involving families,
peers and the wider community;
 The currently favoured model of intervention provides young people with knowledge, skills
and attitudes to make informed choices about alcohol. Some countries are promoting
alcohol free lifestyles whilst others countries are focussed on sensible drinking;
 Few national interventions are evaluated and able to demonstrate an impact on young
people‘s drinking patterns;
 Approaches to health promotion campaigns with adults are in many ways similar to those
for young people in promoting sensible drinking through informed choices;
 Campaigns for adults rarely identify the adult drinker as a parent and do not generally
focus on the impact of parental alcohol drinking on the child;
 Isolated examples were reported of specific campaigns aimed at pregnant women and
focusing on the health and wellbeing of the unborn baby; and
 Two common approaches to alcohol health promotion were identified across Europe.
These were: campaigns/ programmes which aimed to reduce the amount of alcohol
everyone drinks; and those that targeted specific groups and patterns of drinking such as
‗happy hours‘, binge drinkers and high risk groups of drinkers such as young adult males.

(v) Health/education promotion programmes to address the issue of children affected by parental
alcohol problems
 Respondents mentioned very few health or education promotion programmes that directly
addressed the issue of children affected by parental alcohol abuse; and
 There was some evidence that a number of countries were beginning to use universal
parenting programmes and evidence based programmes such as Strengthening Families
programme to address alcohol issues. However the approaches were often unsystematic
and localised.

(vi) Professional training
 Except for Scotland, all countries indicated a lack of consistent and systematic
approaches to training on substance abuse and its impact on children except for
Scotland‘s nationally funded training programme called STRADA;
 It appeared that, in the majority of countries, there was no national training lead or
organisation with specific responsibility for the development or coordination of training in
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this area. More commonly, training on alcohol and its impact on children came under the
wider umbrella of child protection training;
 Professional and occupational training was reported as variable in content and quality
within individual countries;
 Training on alcohol abuse was generally reported to be poor for social workers, health
professionals and treatment agencies;
 Adopting a multi-agency approach to training for work with families affected by substance
misuse appears to be increasingly popular; and
 A minority of countries reported national occupational standards to set benchmarks for
workforce development.

Service delivery
 Countries reported a wide range of services for ChAPAPs. Some of these were dedicated
to this group while others had a broader remit;
 Many countries also provide specialist services to young people who misuse alcohol, both
in community and residential settings;
 Fathers of ChAPAPs are rarely singled out for special mention;
 Aftercare services are reported infrequently;
 The Internet is emerging as a new form of service which is potentially attractive to young
people;
 All countries have self-help groups providing a range of services (telephone help lines,
web-based information, family support);
 Non-specialist (generic) services also deal with children affected by parental alcohol
misuse as part of their wider remit. Child protection, school exclusion, truanting and
offending are amongst the main reasons why non-specialist services take ChAPAPs
referrals;
 The picture of services within countries as well as across the region is patchy and
variable; and
 Few services are evaluated.

Key factors contributing to the provision of sufficient and efficient services for ChAPAPs identified
by EU partners:
 An awareness of the issues facing ChAPAPs, and the services necessary to meet their
needs, on the part of the government, local services, voluntary organisations and the
public at large;
 A consistent political commitment and motivation to view ChAPAPs as a priority and
provide necessary services within the broader context of provision for children and
families;
 Effective and coherent alcohol policies that, among other things, restrict availability of
alcohol;
 Systematic national recording on the prevalence of ChAPAPs and on the prevalence and
recognition of foetal alcohol syndrome disorder;
 Cooperation and collaboration between different services, promoted by effective networks
and other coordinating links, as well as partnership working between central and local
government;
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 Evidence-based services and provision informed by sufficient and appropriate research as
well as examples of good practice demonstrated by international colleagues;
 High quality training for all professionals working with ChAPAPs in either a direct or an
indirect role;
 Adequate funding to resource services and initiatives beyond the short-term;
 Services to identify ChAPAPs at an early stage and particularly before parents are
provided with treatment; and
 An open-minded approach to new service developments that does not reflect a resistance
to change.

Concluding comment
Children affected by parental alcohol problems do not receive the attention they deserve. We do
not know how many children are involved, the full extent of the impact on their lives, and how their
needs might best be met. Despite a proliferation of services and initiatives developed for them
across Europe, there remain many and significant shortcomings in the policies and services
designed to promote their well-being.
This report has highlighted a shortlist of priorities for concern and action. These include the need
to promote greater awareness of the issue, more systematic identification of the young people
affected, the designation of a lead government department in each country to take responsibility
for this group, sufficient and effective interventions to overcome the disadvantages young people
may face, and a well-trained workforce to take forward excellence in practice. We realise that there
will be resources implications in all countries that will need to be taken into consideration. For this
reason, as well as to encourage early and effective action, we recommend that new developments
are closely tied into existing national provision wherever feasible.
All initiatives and developments need to proceed in tandem. Without awareness of the issues
involved, there will be no commitment to drive the policy agenda, and without knowing the scale
and nature of the problem, it will be impossible to plan appropriate levels and types of services.
Safeguarding service quality also depends on well-trained staff. Addressing all these directions of
action simultaneously is the only way to produce coherent change. We strongly urge the European
Union to take a stand in providing guidance and oversight to ensure that progress is made.

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SECTION 1- INTRODUCTION
Background
Parental alcohol misuse damages and disrupts the lives of children and families in all areas of
society, spanning all social classes. It blights the lives of whole families and harms the
development of children trapped by the effects of their parents‟ problematic drinking. 7

Children Affected by Parental Alcohol Problems (ChAPAPs) are the focus of a project funded by
the EU Commission to support a strategy to protect young people and children and the unborn
child from alcohol related harm across Europe. In October 2006, The European Commission
adopted a Communication setting out this strategy8 and identifying the following priority areas:
 protecting young people and children and the unborn child;
 reducing injuries and deaths from alcohol-related road accidents;
 preventing harm among adults and reduce the negative impact on the workplace;
 raising awareness of the impact on health of harmful alcohol consumption; and on
appropriate consumption patterns; and
 developing a common evidence base at EU level.
This European report forms part of this strategy in contributing to a greater understanding of the
situation for ChAPAPs in all participating EU countries. It draws on country reports from partners in
the project, and focuses on the prevalence of ChAPAPs, research, policy, practice and service
development in participating countries. It will be complemented by reports from other work
packages examining the psychological and physiological state of health of children and
adolescents affected by parental alcohol problems; general health-economic consequences of
parental alcohol problems; national networks and training packages to improve capacity; best
practice; and policies to support ChAPAPs.
Work package 5
Brunel University was commissioned to lead and coordinate work package five of the ChAPAPs
project. There are three elements to this package:
 Step 1 (Deliverable 2) - Responsibility for developing a survey instrument tool (in the form
of a Country Questionnaire) for all ChAPAPs partners who were asked to complete this for
their own country. The country questionnaires collected information on prevalence,
research, policy and practice and service delivery in relation to the mental and physical
health of children affected by parental alcohol misuse.

7 Turning Point (2006) Bottling it Up page 1.
8 www.eurocare.org/resources/special_topics/EU_alcohol_strategy
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