SAFEguarding children in Substance exPosed fAmilies by supporting the non-using CaregivEr: Safe Space

Context of the research
Drug and/or alcohol misuse by a parent can be harmful to children and wider family members. Because of this, parents who misuse drugs or alcohol often receive health and social care services to help them reduce their misuse and to protect their children. Having another parent or carer who does not misuse drugs or alcohol can be protective for children. However, little is understood about how to best support these parents and carers who are often overlooked regarding support. Our project will work closely with these 'affected' parents/carers and their children as well as with health and social care professionals involved in their care to develop an intervention which specifically supports to the non-substance misusing parent/carer.

Aims and objectives
In our project we will:
- Map what support is currently available for families affected by a parent's drug or alcohol misuse to find out what works well and what does not. We will do this by working in groups with different health and social care professionals across the North East of England.
- We will also ask children who are affected by parental drug or alcohol misuse and their parents/carers who do not misuse drugs or alcohol who they think can provide them with the most useful support, including family members, friends and local volunteer groups.
- We will ask the non drug or alcohol-misusing parents and carers how best to help them support children affected by parental alcohol or drug misuse.
- We will combine what we learnt and share this with parents/carers and health and social care professionals in workshops. We will work in partnership to develop a new way of helping parents and carers in their caregiving role. This will be the 'Safe Space Intervention'.

Potential application and benefits
The Safe Space intervention will be delivered to parents/carers of children aged 0-17 years (inclusive) who live within families affected by parental drug or alcohol misuse. Whilst these families often have a range of health and social care needs, we think that families who receive 'early help' and children's social care services will be the most likely group to receive the intervention as there is greatest need in this population. The Safe Space intervention aims to benefit children (improving their emotional wellbeing); their caregivers (improving their emotional wellbeing, quality of life and awareness of parental drug or alcohol misuse); the family (family functioning) and the professionals that support them (reducing the need for health and social care services including safeguarding services and increased confidence when supporting families affected).

Parental substance misuse is a substantial public health and safeguarding issue. Research in this area typically focuses upon developing and evaluating interventions to reduce substance misuse in the misusing parent. The presence of a non-substance misusing parent/caregiver has been found to offer some protection from harm to children in substance exposed families. Despite this, there is a lack of research examining interventions to support the non-substance misusing parent/caregiver to achieve health and well-being outcomes for themselves and their children.

Our project aims to develop an intervention for this population. Our specific objectives are:
- To understand the real world formal and informal structural, social and individual level systems of care and the impact of these as barriers and facilitators to effective health and social care for dependent age children and families affected by parental substance misuse
- To examine the knowledge, skill and support needs of non-substance misusing parents/caregivers of dependent age children affected by parental substance misuse
- To co-produce an intervention for non-substance misusing parents which seeks to support them and their children.

The methods we will use to achieve our objectives:
- Soft-systems methodology to map out the wide range of formal systems and co-construct social reality maps which capture details of health and social care provision for families affected by parental substance misuse
- Social Network Analysis to explore the formal and informal care networks accessed by children in substance exposed families and the non-substance using parents/caregivers
- In-depth qualitative interviews with non-using parents/caregivers to identify which causal or contextual factors increase the likelihood of harm to the family and which have the greatest scope for change as well as the mechanisms of change
- Co-production workshops with practitioners and non-substance misusing parents/caregivers.

Following the completion of the proposed early phase study, we will produce a manualised Safe Space Intervention, supported by an initial programme theory postulating the generative causal pathways between interventions and impacts. A summary of findings will be provided to all participating parents/caregivers and practitioners who indicate they would like to receive this and a feedback event which will be used to engage practitioners and decision-makers wishing to collaborate in future work. The Safe Space Intervention will then be examined in an externally funded realist evaluation of the intervention, further refining our programme theories, examining acceptability to the non-using parents/caregivers as well as the practitioners delivering it and modifying our intervention accordingly. We will subsequently apply to NIHR Public Health Research for funding to undertake a definitive randomised controlled trial. Ultimately, the Safe Space project aims to impact these families by:
- Making available to children's social care an effective intervention to support families affected by parental substance misuse in order to safeguard the child
- Develop an evidence based for interventions which moves beyond intervening with the substance user to reduce the risk to the family by unifying the informal and formal care systems and intervening with the non-substance using parent/caregiver in substance exposed families with dependent age children.