Home > Hidden Harm strategic statement.

Dillon, Lucy (2019) Hidden Harm strategic statement. Drugnet Ireland, Issue 71, Autumn 2019, pp. 11-12.

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As previously reported in issue 69 of Drugnet Ireland,1 the Health Service Executive (HSE) and Tusla, the Child and Family Agency, jointly launched the Hidden Harm strategic statement, Seeing through hidden harm to brighter futures,2 in January 2019. The strategic statement outlines how these two State agencies will work together to bridge the gap between adult and children’s services in favour of a more family-focused approach in identification, assessment, and treatment that will improve the wellbeing and minimise the risk of hidden harm to children and families affected by alcohol and drug use.

Minister of State at the Department of Health with responsibility for Health Promotion and the National Drugs Strategy Catherine Byrne TD opening the 2019 National Drugs Forum in Croke Park on 5 November 


Hidden harm definition

The experience of children living with parental problem alcohol and other drug use, and the resultant effect on them, is widely known as ‘hidden harm’. There are two key features to this term: first, the children are often not known to services; and, second, they suffer harm in a number of ways as a result of compromised parenting, which can impede the child’s social, physical, and emotional development (p. 8).2



It is widely accepted that this is a significant problem in Irish society. Addressing hidden harm is a priority for Government, as reflected in the policy documents Better outcomes, brighter futures and Reducing harm, supporting recovery.3,4 Under the national drugs strategy’s first goal, to promote and protect health and wellbeing, Tusla and the HSE are the lead agencies on the strategic action to ‘mitigate the risk and reduce the impact of parental substance misuse on babies and young children’ (p. 31).4 Through the National Hidden Harm Project, they have committed to working together in a planned way to improve services and outcomes for children affected by parental problem alcohol and other drug use in Ireland.


Strategic statement

The strategic statement reflects this commitment and is grounded in an extensive body of work by stakeholders. This includes the work of the North South Alcohol Policy Advisory Group’s Subgroup on Hidden Harm; the Hidden Harm National Steering Group; learnings from national practice sites and input from a variety of stakeholders, including practitioners and managers from the Drug and Alcohol Task Forces, HSE Drug and Alcohol Services, and Tusla. It is seen by its authors as laying out ‘the national standard upon which Hidden Harm work should be measured’ (p. 15).2 It applies not only to staff of both State agencies but also to all voluntary and community groups in receipt of funding from HSE and Tusla, including the Drug and Alcohol Task Forces and their funded projects.


Vision of strategic statement

The vision of the statement is for the two agencies ‘to work together effectively at the earliest possible stage to support children and families’ (p. 28). At its core, it focuses on the joint working and connecting practice of relevant stakeholders. To deliver on the vision, the statement outlines sets of strategic objectives, shared principles for partners, and common practice standards to guide practitioners:

Partnership may be described in this context as ‘joint business’ between Tusla and the HSE. It is not expected that HSE Drug and Alcohol service staff become specialists in child welfare and protection, nor that Tusla staff become expert in drug and alcohol treatment and therapy. Rather, that through the implementation of this Statement, both Tusla and HSE staff develop deeper knowledge and practice application on Hidden Harm in a complementary way. (p. 17)2


Other activities

The statement is part of a suite of activities and outputs coming from this joint working. Other components are:


Hidden Harm Practice Guide: This is an ‘educational resource to enhance knowledge and skills, in identifying and responding effectively to parental problem alcohol and other drug use in terms of its impact on children and to support the continuing professional development of health and social care practitioners’ (p. 2).5

Information leaflet for practitioners: Opening our eyes to Hidden Harm aims to help frontline workers support children and young people affected by parental alcohol and other drug use. It includes key messages on the nature of hidden harm and how to find and offer support.6

National interagency training programme for staff groups working within HSE and Tusla: This will be based on the practice guide and will encompass areas such as alcohol and drug theoretical frameworks and practice; child development and the impact of problem alcohol and other drug use; and attendant difficulties of mental health and domestic violence on parenting ability.


1  O’Dwyer C (2019) Launch of new Hidden Harm initiative. Drugnet Ireland, 69 (Spring): 1–3. https://www.drugsandalcohol.ie/30627/

2  Health Service Executive (HSE) and Tusla (2019) Hidden Harm strategic statement: seeing through hidden harm to brighter futures. Dublin: HSE and Tusla. https://www.drugsandalcohol.ie/38617/

3  Department of Children and Youth Affairs (2014) Better outcomes, brighter futures: the national policy framework for children and young people 2014–2020. Dublin: Stationery Office. https://www.drugsandalcohol.ie/21773/

4  Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017-2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/

5  Health Service Executive (HSE) and Tusla (2019) Hidden Harm practice guide: seeing through hidden harm to brighter futures. Dublin: HSE and Tusla. https://www.drugsandalcohol.ie/30190/

6 North South Hidden Harm Group (2019) Opening our eyes to Hidden Harm: empowering frontline workers to support children and young people affected by parental problem alcohol and other drug use. Dublin: HSE and Tusla. https://www.drugsandalcohol.ie/30190/

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