Background to the research

• It is estimated that in the UK there are 5 million children under the age of 16 affected by parental substance misuse. Many of these parents are often experiencing mental health problems too and the compound impact on their children can be extensive.
• Often children take on caring roles, may be exposed to domestic violence and are faced with multiple disadvantage.
• Children living with a substance misusing parent (or living with hidden harm), have multiple needs ranging from understanding what is happening to their parents, feeling safe, helping their carers to seek support and get better, to meeting other children in similar circumstances.
• Many barriers prevent them from accessing support including a mistrust of professionals, fear of being removed from home and loyalty towards the mother or father.
• In Northern Ireland, the government has prioritised developing an appropriate response to the growing problem of parental substance misuse.

The Steps to Cope Intervention

It is accepted that there is a lack of an evidence base for providing support to affected children and young people. This paper describes a new intervention developed for children living with parental substance misuse and/or parental mental health problems - Steps to Cope. Adapted from a brief structured intervention designed for adults, the 5-step method, it adopts a new approach. Rather than viewing the family as dysfunctional or deficient, it instead concentrates on the needs of family members in their own right, a move away from attempting to engage the problem user. It is grounded in a stress and coping theoretical model which considers living with substance misuse akin to coping with other chronic events, for example, living with cancer or other chronic conditions.

The programme consists of 5 building blocks (stress, strain, information, coping, and support) which the practitioner works through with each child, the intervention is manualised and children use a workbook to monitor their progress.

• Step 1: What is living with this like for me?
• Step 2: Information about addiction and mental health problems
• Step 3: Coping with addiction or mental health problems in your family
• Step 4: Using support
• Step 5: Further help

Research approach

A qualitative research investigation was conducted to explore the feasibility of delivering the adapted intervention to children and young people. Based on two separate Steps to Cope projects involving all 5 of the Health and Social Care Trusts in Northern Ireland, it draws on the experience of both children and practitioners involved in the intervention. Data was collected using:

• Professional logs (n=31) which contained background data on each child and a written summary of each session;
• Brief interviews (n=6) and/or a drawing exercise (n=5) and children’s workbooks (n=20);
• Telephone or face-to-face interviews (n=28) and group discussions (n=16) with practitioners;
• Researcher field notes

Best practice guidelines were followed to involve the children and young people in the research. The young people in the sample were aged between 10-17 years and lived with (or had regular contact with) (a) parent(s) with alcohol, drug or mental health problems. Interviews were audio recorded where appropriate.

Main findings

• N=57 practitioners were recruited and trained to deliver the intervention. There was some attrition across the two projects (n=13) which was attributed to health/personal reasons, change of job or ‘inability to deliver the intervention’.
• The research team had some difficulty maintaining contact with some practitioners and were unsure as to why this was.
• The majority of practitioners delivered the intervention on an individual basis, however one group intervention was delivered in each project.
• A total of n=43 children participated across the 2 projects.
• The majority of young people were dealing with maternal alcohol misuse.
• Many of the young people in the sample had been dealing with problems for 10 years or longer.
• A number were dealing with parental substance misuse and parental health problems (namely depression).
• Of the 43 children, n=25 were female and n=18 were male.

Qualitative analysis was conducted on the data collected, and concluded that each stage of the Steps to Cope intervention helped the young people involved:

• Step 1 Helped to tell their stories, explore their feelings and realise that they were not alone.
  Step 2 The young people interviewed found it helpful to ask about their parents’ problems, gain more understanding of their own health needs and realise that it was not their fault.
  Step 3 Taught them how to respond effectively to their problems.
  Step 4 Gave them advice to seek out appropriate support.
  Step 5 Helped them to reflect on what they had achieved and what kind of further help they might need in the future.

The Steps to Cope intervention has the potential to help health professionals provide support to young people affected by parental substance misuse. Relatively easy to train up large numbers of practitioners, those who delivered the intervention found it straightforward to implement and initial findings would suggest that it provides a suitable framework for working with children. Further evidence is required to evaluate its effectiveness, including exploring how resilience in children may be facilitated by this intervention. 

Further information

The work is continuing in Northern Ireland as the result of a significant grant from the Big Lottery.  Currently, Steps to Cope is only available in Northern Ireland and can only be delivered by practitioners who have completed a two day training course.  Further details on Steps to Cope in Northern Ireland - 0800 25 45 123 or aislinn@ascert.biz