There is an ongoing challenge across public services in responding to pressing social issues. A default position is often to commission research about the problem, but may do little to provide evidence beyond what is already known, or challenge taken for granted assumptions about how services should respond.

The impact of Parental Alcohol Misuse (PAM) on children and family life is a growing problem. Recent studies highlight the impact of parental alcohol misuse on children with approximately 1 in 5 children and young people in the UK being affected. In Doncaster it is estimated there is in excess of 800 children who live in the household of an adult with alcohol dependence. Parental alcohol misuse ranks as the most significant factor in serious case reviews and recent data from Doncaster Children’s Trust indicates that parental alcohol misuse is a factor in 58% of child protection plans. The prevalence of PAM has rocketed during the COVID-19 pandemic and is linked to domestic violence, mental health issues and the impact of wider socio-economic changes. Within Doncaster Council’s local authority area, there are a range of agencies providing services and interventions for children and families experiencing parental alcohol misuse, however, in spite of the work of these services, the impact of alcohol misuse on families continues to escalate.

Doncaster public health had recently completed an alcohol health needs assessment which highlighted concerns and scale of the impact on children and felt the need to look deeper. In June 2020 Doncaster Public Health made contact with Annette Haywood (PaRC Yorkshire and Humber) to ask for support in communicating our project brief of commissioning a university to conduct research locally into the impact that parental Alcohol Misuse has on children and how Doncaster could respond more effectively.

We received a good response and held informal interviews with universities to discuss how we could work together.  When meeting with Huddersfield University (The Just Futures Centre for Child, Family and Communities Research), we met Prof Barry Percy-Smith. Barry took the time to understand the brief and asked us in Public Health some useful (sometimes tricky) questions, challenging what we wanted to actually find out and action from commissioning this work.  It was exactly what we needed and a breath of fresh-air to have a critical friend on board for this work.

We in Public Health realised through conversations with Barry that we already had a wealth of knowledge and understanding with regards to the ‘impact’ parental alcohol misuse was having on children, what we needed to explore was how services were working to respond to the need in Doncaster and what already existed.

Prof Barry Percy-Smith added ‘The Just Futures Centre have expertise in using whole systems action inquiry to support innovation and development of public sector systems. This approach to service evaluation and improvement can be especially effective in reorienting services to changing needs of service users. Yet, so often public services eschew this approach in favour of surveys and interviews. Following initial conversations with Doncaster Council Public Health, it was clear that significant knowledge already existed about the extent to which children are impacted by PAM, the challenge appeared to be about how services work together to respond.’

This short commission involved a series of action inquiry workshops engaging key partners in conversation for change to critically assess how child and family needs were going unmet despite high level of expertise in services. Creating this space for dialogue and inquiry provided an opportunity for local professionals and service leads to harness their expertise and ‘think together’ about what was needed, what was working well, where the gaps were and what could be done to improve the local offer for children and families experiencing parental alcohol misuse.

One challenge we didn’t anticipate was to undertake the workshops remotely as we were in the middle of covid so no traditional flip charts, highlighter pens and no coffee and biscuits! The workshops were held via MS Teams with one to one follow up conversations with key stakeholders.

The outcome was a set of recommendations that emerged from dialogue and inquiry with professionals and was in turn submitted to Doncaster Directors of services. These included practice changes and larger strategic change initiatives.

The recommendations were presented at the Doncaster Health & Wellbeing Board and Children’s Safeguarding Partnership for endorsement.

Doncaster Public Health set up a PAM task and finish group with good commitment from partners to address some of the recommendations.  Completed work from this group includes:

  • Recruitment of internal staff in all sectors (list of work areas) becoming alcohol champions.
  • Information sharing pathways introduced such as between the young people’s risk taking behaviours service and A&E (Doncaster Royal Infirmary).
  • Development and commissioning of dedicated Parental Substance Misuse Service within Aspire
  • Improving links with schools – development of educational package happening to be used in school settings.
  • Promotion and re-launch of FMOT (Families Moving On Together programme: a whole family program designed to help parents, carers and children talk more openly about the effects of parental/carer drug and alcohol misuse in a safe space. It helps to develop tools and strategies to move forward in a positive way).
  • Development of a training package to include PAM for all front-line staff within Safeguarding training.
  • Strengthening inter-agency working relationships.

Realising improvements in practice such as these can be challenging in the high-pressured context of public sector service delivery meeting increasing demand with ever-diminishing resources, in which spaces for innovation can feel impossible to find. However, proactively embracing the priorities for change that have emerged as outcomes from this systemic action inquiry with professionals in practice will have positive benefits in preventing demand for services down the line. To that end the recommendations have already been presented to the Health and Well Being Board and follow up action is being negotiated with support from service leads. The issues and challenges surfaced through this work are not specific to one service area. As the recommendations highlighted, action for change needs to involve a cross system multi agency commitment. PAM needs to be on the radars of  all service / stakeholders  and embedded within the work we all do – it is everyone’s responsibility to improve outcomes for children affected by parental drinking.

A collaborative blog, with credit to the following health professionals: 

Dr Annette Haywood, Research Fellow, PaRC Manager, University of Sheffield
Jane Mundin,  Public Health Improvement Coordinator, Doncaster Council
Andy Collins, Public Health Improvement Officer, Doncaster Council
Barry Percy-Smith, Professor of Childhood Youth and Participatory Practice, Huddersfield University