Feature: All-round drugs support

Children may be off school quite a lot, not necessarily because their parents haven't got them there but because they fear their parents are using heroin back at home," says Sheryl Dago. "They'll tell the teacher they have a tummy ache so they can go back and watch them. They're almost carers."

Dago is describing the grim collateral damage from drug abuse and how it becomes ingrained across generations. She believes passionately that a co-ordinated family-based approach is the only way to help the users and the luckless, often hidden, child victims.

Only four months into her job as co-ordinator of Addaction's family-focused project in Derby, she is spearheading the charity's drug and alcohol treatment Breaking the Cycle initiative. As Dago details how she works with other agencies, you get a sense that this is ground that should have been broken on a national scale years ago. Valuable time has been lost and she is determined to ensure that these families and individuals get the service they need.

Heroin dependency

Take Rachel (not her real name), who stumbled into class A drug dependency when her supplies of codeine to dull back pain ran out. Desperate for relief from that and the effects of a violent relationship, she grabbed the phone of a friend - a heroin user - and contacted a dealer. What followed was a catalogue of misery. Her three young children were taken into care. She ran into debt and hit rock bottom.

But Dago says that, with an action plan tailored to her needs and those of her family, Rachel has attended parenting classes and the delicate process of rebuilding her life has begun.

Since Breaking the Cycle was launched in 2005 it has helped around 200 parents and more than 350 family members - three quarters of them are children and half are between one- and seven-years-old. Eighty per cent of parents involved are mothers.

Breaking the Cycle was developed after the Advisory Council on the Misuse of Drugs urged in 2003, that drug and alcohol agencies ensure children of clients receive support.

While excellent local initiatives exist, such as the Arbelour project in Scotland and Wales's Option 2 in Cardiff, it's been an area neglected at national level in England - until now. In May, the government launched its Think Family initiative to ensure adult and children's services work in tandem to respond to the needs of the whole family. Fifteen local areas are acting as pathfinders to offer disadvantaged families intensive support.

Reduction in drug use

Dago describes the project, which is also running pilots in Cumbria and Tower Hamlets, as "innovative, all-encompassing and holistic".

Early indications are that it's proving effective. An independent evaluation shows that 88 per cent of those monitored have cut substance use, harmful behaviours, shown an improvement in social and parenting skills and greater success in prioritising the wellbeing of their children.

When Dago first meets a family where parents are misusing drugs, she makes a risk assessment, identifies their initial needs and lays the groundwork for linking up with other professionals. The majority of the parents she works with are heroin users. Their needs differ: some want help reordering their finances, others support with parenting skills. The one common factor is the chaos in their lives.

The project has developed an outcome monitoring tool to chart progress and provide project workers like Dago an early indication of what works and what doesn't. The tool measures against 14 outcomes, covering issues such as education, parenting skills, family finances, harmful behaviour and social competence. "Each month we look at what they have achieved and what needs working on in relation to the outcomes," explains Dago.

In her quest to forge multi-agency alliances and break down administrative barriers, she has already developed a training package on substance use and families for other professionals. There is currently no specialist training in this area for social workers.

Dago has a relatively small caseload, currently nine families, whom she visits in their homes, weekly or fortnightly, usually teaming up in joint visits with someone from social services, a specialist midwife or Sure Start staff. It provides an ideal opportunity to make links with these other professionals and to share insights.

Previously, the work of social services and the drug service would not have been sufficiently co-ordinated to take account of the impact of drug misuse on the whole family. Dago pays great attention to family dynamics and uses a "genogramme" - a sort of sophisticated family tree to chart drug misuse - to unearth patterns of behaviour and pinpoint psychological factors that may influence relationships.

The family dynamic often appears highly contradictory. Children might be protective of their parents, they may also feel ashamed of their behaviour. But because it is endemic in the family, they may later become users "because they are so used to it". It is this spectre of intergenerational drug abuse that Breaking the Cycle is trying to tackle.

There are key differences with other treatment approaches. There is no big stick - it's voluntary and for good reason. Dago has tried in vain to get primary schools to encourage parents to self-refer but they are reluctant to do so because they fear social services will become involved and more than likely remove any children into care.

She describes herself as an advocate for the families, saying: "It's important to realise that they are not always bad parents just because they are using drugs." She is also realistic, recognising that some parents are "clearly not able to take responsibility for their children and you can see why they are not placed with them".

Unfair system

But she has witnessed the "unfair side of the system", such as when children of heroin users who were taken away from them and placed with another family member - an abusive alcoholic - presumably on the grounds that their drinking was not illegal.

Often when children are taken into care, parents do not keep appointments to see them - not out of neglect, but as Dago says: "Because it hurts so much to walk away and they would prefer not to go through that pain."

Some children avoid being taken into care because their grandparents step in to ensure the family stays together (see box).

Dago believes that nationally, services should look more closely at providing family mediation, with sufficient resources and training. "Family workers should be a priority to take this work forward," she says, stressing that the task is to "build the self-efficacy" of parents, empower them and make them socially competent, not pigeonhole them as chaotic and inadequate.

And what of Rachel? Well, she now has full custody of her three children aged nine, seven and five. That would never have happened without the Breaking the Cycle initiative and its tireless, devoted project workers.

KEEPING FAMILIES TOGETHER

Janine, 56, (not her real name) recently gained custody of her three grandchildren after a legal battle. It has cost her and her partner every penny of their savings and she says it would not have been successful without the support of Addaction in Cumbria.

"My youngest daughter Andrea was involved in drugs and a victim of domestic violence. We didn't realise how far she was into drugs until the local authority came and took away her children last May. She was using amphetamines."

The two children - Andrea was pregnant with her third - were initially placed with Janine and her partner. Janine says: "When the baby was born Andrea was told the only way she could keep him was if I moved into her house and provided 24-hour supervision."

That worked until Andrea relapsed. Last November, a judge ruled the children should stay with Janine and her husband.

However, the legal position was complicated by the fact that two fathers were also involved.

"Addaction has been fantastic. We had to get an independent social worker's report done and they paid towards the cost. The local authority gave us a negative report. The independent social worker spent two full days with us. She gave us a positive report and we got a residence order in May. I have given up work as a domestic assistant in an old people's home. In a choice between my job and the children, they come first."

Meanwhile, Andrea has emerged from rehab and sees the children once a fortnight. Janine says: "She's got to turn her whole life around. We fought to keep the children together to give her a chance to get them back in the future."