Home > Stakeholder consultation on Hidden Harm.

Lyons, Suzi (2014) Stakeholder consultation on Hidden Harm. Drugnet Ireland, Issue 49, Spring 2014, pp. 15-16.

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‘Hidden harm’ (HH) is the term now most often used to describe the experience of children living with, and affected by, problem alcohol and other drug use by parents. The term conveys the two key features of that experience: these children are frequently not known to health or social services, and they are exposed to harm, often through physical or emotional neglect.1,2,3 Experience from other countries has shown that despite evidence to show the negative impact of HH, there is lack of policies on how to effectively address HH. The other two main areas where HH is of concern are domestic violence and parental mental health disorders. 

In June 2013 a project management steering group on hidden harm was established, led by the National Social Inclusion Office, Mental Health and Addiction Services North West, and the new Child and Family Agency.
The group has already identified two national practice sites, Donegal and the Midlands, to begin HH practice working, with the initial focus on the needs of children and families where there is parental problem alcohol and/or other drug use. The overall aim is to raise awareness and to work with children affected by HH but also to develop a HH protocol to ensure the welfare and protection of children through interagency working aimed at early identification and support.
As part of this process, a stakeholder consultation meeting took place on 28 January 2014 in Sligo. The aim of this consultation was to learn from the experience and practice of those currently working in the area, including health, social work, and drugs and alcohol services across the two national practice sites, in order to inform the strategy for HH nationally and also to contribute to the current policy and practice debate in this sensitive and difficult area.
The objectives of the consultation were to:
·         promote open dialogue on appropriate responses to children and families whose lives are affected by drug and alcohol use;
·         gain a baseline understanding of awareness pertaining to HH among practitioners;
·         draw on the views and experiences of stakeholders;
·         inform the current practice debate on HH;
·         identify current practice in responding to HH;
·         identify practice issues that may pose a barrier to addressing HH; and
·         inform the development of a national practice guide for addressing HH.
The meeting was opened by Ms Marion Rackard, National Social Inclusion Office, followed by a welcoming address from the chair, Mr Fred McBride, newly appointed chief operations officer of the newly created Child and Family Agency. He spoke about three key objectives for the HH process: a clear policy direction; joint integrated protocols; and political ownership of the parameters of risk management. Then Mr Joe Doyle, National Social Inclusion Office, gave a comprehensive overview of the background to the national policy documents which had led to this initiative. This was followed by a presentation by Dr Aisling Gillen of the Child and Family Agency in which she explained the rationale behind the focus on HH. She outlined the key elements built into the HH steering group action plan, including supporting practitioners and partnerships for cohesive working relationships; the need to develop national practice guidelines on addressing problem parental alcohol and other drug use; and the need to develop a framework for delivering on HH inclusive of a national strategy, protocol, suggested performance measures and monitoring processes. 
Dr Joy Barlow OBE (pictured) gave a powerful presentation about the Scottish experience, including mistakes made and lessons learnt. She spoke about the importance of early identification of children at risk, the need to estimate numbers, the importance of staff training and development, and partnership. She also noted that, based on the Scottish experience, Ireland now had an opportunity to act given the priority problem alcohol use now has. She stated that the 2011 report Hidden realities provides baseline data on the number of children affected by parental alcohol use.4
Presentations by speakers from Northern Ireland followed, from Ms Cathy Mullan and Mr Davis Turkington, both from the HH Public Health Agency, and Ms Cathy Comiskey, child and family liaison practitioner. They gave very useful, interesting and practical accounts of how they had worked through the process of developing a protocol, setting out roles and responsibilities, implementing policies and how this all works in reality.5,6 Videos and powerpoint presentations delivered on the day are available at http://www.drugs.ie/features.
This was followed by a facilitated structured round-table discussion among those attending the meeting, addressing a series of questions, the outcome of which will inform the ongoing process.
There are two more consultations planned to feed into this process:
·         Phase 2: Views of families
·         Phase 3: Views of commissioners, managers, practitioners and researchers working in health, social work, and drugs and alcohol services and other relevant departments, e.g. justice
The Substance Misuse and Child Welfare Special Interest Group in Northern Ireland is a forum for those interested in this area, and is now open to all practitioners both North and South. The aim of the group is to:
       share and discuss the implications of research findings;
       disseminate developments in policy and practice;
       promote the evidence base informing policy and practice developments; and
       network and share resources.
Members will receive regular updates through a Listserv mailing list and seminars will be organised. To become an email member contact David Hayes at d.hayes@qub.ac.uk.
1. Advisory Council on the Misuse of Drugs (2003) Hidden harm: responding to the needs of children of problem drug users. London: Advisory Council on the Misuse of Drugs. www.drugsandalcohol.ie/5456
2. Scottish Executive (2004) Hidden harm: Scottish Executive response to the report of the inquiry by the Advisory Council on the Misuse of Drugs. Edinburgh: Scottish Executive. www.gov.uk/government/uploads/system/uploads/attachment_data/file/120619/0012816.pdf
3. The Council of Australian Governments (2009) Protecting children is everyone’s business: national framework for protecting Australia’s children (2009–2020). Canberra: Commonwealth of Australia. www.communities.qld.gov.au/resources/childsafety/child-protection/national-framework.pdf
4. Hope A (2011) Hidden realities: children's exposure to risks from parental drinking in Ireland. Letterkenny: North West Alcohol Forum.www.drugsandalcohol.ie/16250
5. Public Health Agency, Health and Social Care Board (2009) Hidden harm action plan: responding to the needs of children born to and living with parental alcohol and drug misuse in Northern Ireland. Belfast: Department of Health, Social Services and Public Safety. www.drugsandalcohol.ie/15570
6. Public Health Agency, Health and Social Care Board (2013) Regional Joint Service Agreement – Hidden Harm protocol. Belfast: Public Health Agency, Health and Social Care Board. 


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