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Nottingham City Safeguarding Children’s Board Procedures Manual
Nottingham City Safeguarding Children’s Board Procedures Manual Nottingham City Safeguarding Children’s Board Procedures Manual
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6.17 Substance Misuse (Foster Care)


Promoting the well-being of children in foster care using prescribed drugs, illicit drugs, alcohol and volatile substances.

This chapter was added to the manual in February 2012.


  1. Aim
  2. Introduction
  3. Information, Advice and Education
  4. Support, Treatment and Care Planning
  5. Confidentiality
  6. Consent to Treatment
  7. Children/ Young People Leaving Care
  8. Children of Substance Misusers
  9. Health and Safety
  10. Use of Strategy Meetings in Response to Concerns
  11. Training/Support

1. Aim

To ensure that foster carers and social workers are aware of good practice and procedures relating to children/young people in foster care using prescribed drugs, illicit drugs, alcohol and volatile substances.

2. Introduction

Children/young people looked after have been identified as particularly vulnerable in terms of substance misuse within the National Drugs Strategy. It is therefore essential that procedures for children in foster care address issues of substance misuse (in this context referring to all drugs including alcohol and volatile substances) informing foster carers and social workers of agreed principles within Nottingham.

3. Information, Advice and Education

  • All children and young people are entitled to age appropriate advice relating to substance misuse. As children/young people looked after are particularly vulnerable there is a key role for all foster carers/social workers in being involved in drug and alcohol education in the home. It is important that a proactive approach is taken to drugs education, i.e. it is everyone’s responsibility;
  • Within Nottingham a resource pack has been developed by the Hidden Harm Implementation Manager for Children’s Services. The pack is available to all foster care support workers and is available to foster carers on request;
  • Additionally, foster carers/social workers will receive basic drugs awareness training, which will include support and guidance on talking about alcohol and other drugs with children and young people (see section on Training/Support);
  • Young people looked after may also receive education relating to substance misuse through education (school or non-school based), youth and leisure services, Children Looked After health team etc.

4. Support, Treatment and Care Planning

Assessments/Identification of Needs

If a child to be placed in foster care has a substance misuse problem this will be identified as part of the pre-placement assessment and the foster carer will be informed. It is unlikely within Nottingham that a child/young person with a serious substance misuse issue will be placed in foster care.

In order to support workers to identify areas of substance related need and offer appropriate interventions Nottingham City Children’s Services have developed ‘Ngage’, an interactive assessment screening tool which includes drugs and alcohol. It is proposed that all looked after children aged ten plus will be offered the opportunity to discuss any substance use issues via Ngage at the looked after health assessment. If this does not occur, screening should be the responsibility of the social worker. Children under the age of ten can be screened where there are particular concerns about substance use. Follow up actions will be identified on the subsequent health plan.

Throughout a foster care placement substance misuse issues will be monitored/identified as part of the overall healthcare assessment and be reviewed at the Looked After Review.

Recording of Significant Health Incidents

An incidence of substance misuse will need to be recorded as a ‘significant health incident’ in line with departmental policy. This means that the Looked After Service and Adoption Service will need to be informed. A ‘significant health event’ form should be completed by the foster carer and given to the social worker, who in turn will send a copy to the Looked After and Adoption Service. Usual principles of handling confidential information should apply. Information/advice will be provided for foster carers in relation to this process within induction and training packages.


If a substance misuse issue is identified relating to a child/young person looked after, the Adoption and Looked After Children Service should be notified and the health records updated. It is the responsibility of the child’s social worker to ensure that any follow up actions are carried out. Risk factors will need to be identified in terms of the young person’s behaviour. A Strategy Meeting may be called if the social worker is significantly concerned about the issue. Alternatively, discussions between the social worker, foster carer and child/young person may suffice. There is a designated Compass Young Peoples Drug and Alcohol worker for looked after children, offering direct support to young people.

If there are significant concerns about a young person’s substance misuse the child/young person may need treatment from a specialist agency (see section on Consent to Treatment). Information will be provided to foster carers/social carers regarding access to specialist drug treatment services for children/young people. These services will adhere to strict confidentiality policies in terms of sharing information. They will also, however, have child protection policies in place.

How Concerns May Arise

Concerns that a child/young person is using a substance may be triggered in a variety of ways. These include:

  • Physical symptoms and the appearance of the child/young person;
  • Behavioural Changes;
  • Discovery of substances or paraphernalia related to substance misuse; and
  • Information from a third party including disclosures from another child or young person.

5. Confidentiality

Confidentiality is essential in terms of respecting a child’s/young person’s privacy and building and maintaining a trusting, supportive relationship with them. Foster carers/social workers need to balance this with their duties and responsibilities to protect children and ensure that they are acting in their best interests.

If a foster carer suspects that a child is misusing substances, best practice would be to discuss concerns with the child/young person in the first instance. It may not be possible to do this if:

  • The child/young person is absent from the foster home; or
  • The child/young person is intoxicated and/or likely to respond in an aggressive manner.

Following a discussion with the child/young person their consent should be gained to share this information with other parties. It should be made clear that this will be done on a ‘need to know’ basis in the child/young person’s best interests.

A child’s social worker and the Adoption and Looked After Service will need to be informed if there are concerns regarding substance misuse, so that an effective care plan can be developed.

6. Consent to Treatment

Consideration should be given to the ability of a child/young person to give informed consent to any planned, structured interventions to address substance misuse issues. The child/young person’s social worker would usually address this. Fraser guidelines apply

It is good practice to consult and keep informed all those who carry parental responsibility unless there are good reasons for not doing so.

7. Children/Young People Leaving Care

Young people leaving care with an identified drug misuse issue should have it addressed as part of their pathway plan. It is the responsibility of the child/young person’s social worker/leaving care worker to ensure that this is in place.

8. Children of Substance Misusers

It is well documented (Hidden Harm 2003) that children of substance misusers may experience a range of difficulties including behavioural and other psychological problems, early substance misuse in their own lives, offending behaviour and low educational achievement.

It is essential that children known to have parents that are substance misusers receive adequate support. In Nottingham there is a specific project addressing this issue known as the STARS project. Information can be obtained from social workers in relation to services/support available. Information will also be provided in foster carers training.

The Screening tool Ngage is aimed at identifying a range of related needs including young people affected ay another person’s substance use.

9. Health and Safety

Foster carers will receive training in relation to basic health and safety procedures within the home. There are some particular areas to consider in relation to substance misuse:

  • Threat to health/well-being requiring an immediate response;
  • Foster carers should call an ambulance if a child/young person;
  • Has lost consciousness or is having difficulty in remaining conscious;
  • Is extremely lethargic;
  • Has difficulty in breathing;
  • Is extremely agitated or distressed;
  • Is having a fit;
  • Has become violent following suspected drug misuse;
  • Has disclosed high risk use.

Children/young people should be accompanied in an ambulance when it is practicable to do so. Ambulance crews need to be given as much information as possible on arrival. Children/young people should never be transported in foster carers/social workers cars when substance misuse is confirmed or suspected.

Child/young person’s social worker must be informed. Social worker must inform the Adoption and Looked After Service and those with parental responsibility, unless clear reason for not doing so.

Concern regarding health/well-being in relation to substance misuse that does not require immediate medical attention.

  • If a child/young person is behaving erratically, threateningly or in any other way causing concerns and substance misuse is suspected foster carers should apply normal techniques for containing the behaviour and safeguarding others;
  • Children and young people should be kept as calm and quiet as possible. If they fall asleep they should be monitored every 5-10 minutes. An ambulance should be called if there is any perceived deterioration in their condition;
  • The child’s social worker needs to be informed so that they can carry out a risk assessment and support the child/young person with any necessary interventions.

Disposal of Substances or Paraphernalia

Foster carers will receive training in the safe handling and disposal of needles and associated paraphernalia as part of substance misuse awareness training.

The police should be called as early as possible to remove and dispose of any discovered illicit substances. Foster carers need to record the incident number given by the police and the name of the officers removing the substances along with the date and time.

Storage and Management of Medicines

In occasional circumstances a young person may have a prescribed drug as part of their treatment. If this occurs for a child/young person in foster care the foster carer will be informed (unless a young person is considered Fraser competent and has arranged treatment without informing parents/carers). Foster carers will then be given guidance in terms of the storage/management of the particular medicine.

10. Use of Strategy Meetings in Response to Concerns

Child/Young Person Placed in Foster Care Suspected of Using Drugs on the Premises

Follow procedure above in terms of health and safety and confidentiality. Inform child/young person’s social worker who will:

  • Carry out a risk assessment; and
  • Decide whether or not to involve the police. Strategy meeting may be convened.

Another Child/Young Person/Adult Suspected of Using Drugs on the Premises

Strategy meeting may be called if there are significant risk factors.

Under Section 8 of the Misuse of Drugs Act, the owner or manager of a premises has legal responsibility for illegal drug use that takes place on their premises, and they must show that they have taken reasonable steps if they know or suspect that drug use is taking place.

Foster carer suspected of using drugs on the premises.

Strategy meeting likely to be called and disciplinary action considered.

NB Strategy meetings are sometimes chaired by team managers and sometimes by Independent Reviewing Officers, depending on the levels of complexity within the case (for example issues relating to the safeguarding of the child/young person).

11. Training/Support

Training in substance misuse awareness should ideally be provided to all foster carers and social workers involved in fostering/adoption. Where this is not possible due to time/resource allocations it will be provided to all those caring for children of 10 and over.

Information packs relating to support services around substance misuse will be available to all foster carers through their support workers.

In addition to basic awareness (e.g. knowledge of drugs and support services available) substance misuse training should include information relating to basic health and safety and advice on supporting young people whose parents are misusers. It should address all substances including alcohol and volatile substances.

Some issues are strongly linked to substance misuse, for example domestic violence, mental health, teenage pregnancy and risky behaviours including unsafe sex. Training will be linked to other risk taking behaviours.

Training will be available in relation to particular developments, for example the new screening tool referred to within this procedure.

Support for foster carers can be accessed through their support workers and/or directly from a specialist drug misuse agency. Regents House, within the Carers Federation, provides a support service for carers of people with drug misuse issues.