26. Parents in alcohol treatment services
Source: gov.uk (2025-11-28)

How alcohol treatment services can support parents and their children, including safeguarding responsibilities, working with children's social care and assessment and making referrals.

26.1 Main points

Adult alcohol treatment services and practitioners should help parents and their children to access support, and if required, protection.

Adult and children and young people’s alcohol treatment services and practitioners have a statutory responsibility to safeguard and promote the welfare of the children.

Services should have arrangements in place to safeguard children, including policies and procedures and a designated safeguarding practitioner or safeguarding lead.

Alcohol treatment services are responsible for making sure their staff have training at the right level for their role, supervision and appropriate competencies to carry out their safeguarding responsibilities.

Alcohol treatment services should provide training for their staff so they understand the various ways parental problem alcohol use can affect children and the importance of their role in helping parents and their children access appropriate support.

Services and practitioners should work to reduce organisational and personal barriers for parents to engage in treatment.

Assessment should identify and practitioners must act on or escalate any child safeguarding concerns. Assessment and review should be ongoing. Practitioners should reassess risk to children as the circumstances of the person and the family change.

Alcohol treatment services and practitioners should consider the needs of parents and children whether or not there are current safeguarding concerns. Helping a parent and their children to access universal services or targeted early help (support for vulnerable children and families) is more effective than reacting later.

Parents may want to consider goals around their parenting or family life as part of their treatment and recovery plan.

Alcohol treatment practitioners should contribute to multi-agency assessments, plans and reviews for children in need and child protection and early help.

Appropriate and timely information sharing between services is essential to safeguard children and promote their welfare. Alcohol treatment services should have information sharing policies that specify information sharing processes, as well as having information sharing agreements with children’s social care and other relevant agencies.

Adult alcohol treatment commissioners and services should work in partnership with local organisations with statutory responsibility for child safeguarding at a strategic level to agree joint working arrangements. This includes referral pathways and information sharing agreements.

26.2 Introduction

This chapter provides guidance on how adult alcohol treatment services and practitioners can support parents or carers and help their children to access support, and if required, protection. Direct work with children and families requires specialist skills and is outside the scope of these guidelines.

Throughout the chapter we will use the term ‘parents’ to include anyone caring for a child.

You can find guidance on pregnancy and the perinatal period in chapter 24 and guidance on supporting adult family members in section 4.9.16 in chapter 4 on assessment and treatment and recovery planning and in section 5.8 in chapter 5 on psychosocial interventions.

Services and practitioners must work within their national legislation and guidance on child safeguarding. Annex 1 summarises this legislation and guidance for each UK nation.

26.3 Impact of parental problem alcohol use on children

Not all children of parents or carers with an alcohol problem will experience harm, but they are at a greater risk of doing so. Parental problem alcohol use is a common factor in cases of child abuse, neglect and deaths.

An analysis of serious case reviews between 2014 and 2017 found that parental alcohol use was recorded as present in over a third of the cases (Brandon and others, 2020). Parental problem alcohol use is often associated with other problems, such as parental mental health conditions or domestic abuse (Cleaver and others, 2011; Brandon and others, 2020). And children often face other adverse experiences and associated negative behavioural, health and social outcomes in adulthood (Hughes and others, 2017).

The quality of care received by children is an important determinant of their future development and wellbeing (Pajulo and others, 2006). Problem alcohol use can reduce parenting capacity, sensitivity and attachment (Canfield and others, 2017). Parents or carers with problem alcohol use have often experienced childhood trauma, maltreatment, and adversity themselves and this can also affect their parenting capacity and ability to form attachments with their children (Stith and others, 2009).

26.4 A child-centred approach to safeguarding

Although most adult alcohol treatment services will not have direct contact with the children of adults in treatment, they have statutory responsibilities to safeguard and promote the welfare of children.

26.4.1 Organisational safeguarding arrangements

All alcohol treatment services should have comprehensive child safeguarding policies and procedures. Child safeguarding policies and procedures should include:
- an outline of relevant legislation and statutory guidance
- accountability and governance arrangements
- provision of training
- procedures for acting on and escalating safeguarding concerns
- procedures for learning from incidents and near misses
- safer recruiting processes
- responding to allegations of child abuse against staff members
As described in Working together to safeguard children 2023 (https://www.gov.uk/government/publications/working-together-to-safeguard-children--2) (England), section 11 of the Children Act 2004 states:

Places duties on a range of organisations, agencies and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children.

There is equivalent child safeguarding legislation and guidance across all UK nations. Alcohol treatment commissioners and services should be aware of the arrangements they should have in place. You can find information on child safeguarding legislation for each UK nation in annex 1.

26.4.2 Training, supervision and support

Service providers are responsible for ensuring their staff are competent to carry out their responsibilities for safeguarding and promoting a child’s welfare. They should also create an environment where staff feel they can raise concerns and are supported in their safeguarding role. They should provide staff with:
- access to appropriate training and supervision in child safeguarding
- an induction to familiarise them with child protection responsibilities and the procedures they must follow
26.4.3 Safeguarding leads or designated practitioners

Organisations and agencies specialising in providing alcohol treatment should have a senior board level member with appropriate competencies to act as lead responsible for organisational safeguarding arrangements.

The statutory guidance ‘Working together to safeguard children 2023’ (England) and equivalent national statutory safeguarding guidance makes it clear that there should be a designated practitioner for child safeguarding in the organisation. The role of the designated practitioner includes support for other colleagues to recognise the needs of children, including protecting them from possible abuse, neglect and exploitation. It also says the role of safeguarding leads should always be clearly defined in job descriptions and to fulfil their responsibilities effectively, organisations should give them enough:
- time
- funding
- supervision
- support
26.5 How adult alcohol treatment services can support children affected by parental alcohol use

Practitioners must refer children to children’s social care where they have concerns about a child’s welfare or safety, but their role in supporting parents and children should be wider than that.

If parents stop or reduce their alcohol use, this is likely to benefit their children. However, this is often not enough on its own to meet the needs of vulnerable children affected by parental alcohol use and other problems.

Alcohol treatment services should make sure their staff are trained to understand the various ways that parental problem alcohol use can affect children. They should also understand the important role they can play in improving outcomes for children by helping parents and children to access support. This could include:
- making a safeguarding (child protection) referral
- working with children’s social care, contributing to child in need and child protection assessments and plans
- using a trauma informed approach and building a trusting relationship (while maintaining professional curiosity) so that parents feel able to discuss their concerns about their parenting or their children
- helping parents and their children to access early help from universal services (open to all) or targeted services (for families with complex needs)
- supporting parents to achieve their parenting goals as part of treatment and recovery planning
- helping parents to access practical support that impacts on the family, for example housing support, welfare rights support and employment support
For practitioners helping parents and their children to access early help services, this could include:
- parenting programmes or support from parenting professionals
- direct support or therapeutic interventions for their children or family
- universal services (open to all) such as children’s centres and youth projects
26.6 Addressing barriers to engaging in treatment

Parents and carers can face significant barriers that prevent them from accessing or engaging in alcohol treatment. All services should consider ways to help remove these barriers. They could:
- offer appointment times that take account of a person’s childcare responsibilities
- make arrangements with regulated childcare providers so children can be looked after while a parent attends treatment appointments
- offer accessible alcohol treatment and support outside of the usual setting (for example, home visits or at targeted early help services)
- make sure that practitioners understand about stigma (and the resulting fear and shame that parents may experience) and respond empathically
- address parents’ fears of involvement from children’s social care by providing information on the circumstances in which a practitioner would make a safeguarding referral and the role of social workers
- offer support through partnerships with children’s services or family nurse partnerships for young parents (for example, an alcohol treatment practitioner co-located in a children and families service on a regular basis, or participating in joint visits to a family)
- offer the option of a women only space to provide emotional safety for women
- make arrangements so that victims do not have to attend a service attended by an abusive partner or ex-partner
- encourage peer support from parents who are further on in recovery, including those who have experienced intervention from children’s social care, which is no longer necessary
- involve parents, and where appropriate children and young people, in planning and developing services
26.7 Identifying the needs of parents, children and families

Chapter 4 on assessment and treatment and recovery planning provides guidance on comprehensive assessment. Comprehensive assessment in alcohol treatment services should always include assessment of the need of parents for parenting support and the needs of their children.

26.7.1 Introducing the conversation about children

Parents are often worried that children’s social care services will become involved with their family or that their children will be taken into care. Assessors should not avoid asking questions because of this, but they need to approach the conversation about children sensitively and thoughtfully. It may be helpful to explain that as part of their safeguarding responsibility as a service, they routinely ask questions to all parents or people living with children.

26.7.2 Recording details at initial assessment

At initial assessment, the assessor should record details of the person’s children and those they are in contact with and identify any child safeguarding risks. Section 4.8 in chapter 4 on assessment and treatment and recovery planning sets out what details an assessor should record at initial assessment.

26.7.3 Identifying potential safeguarding (child protection) risks

As part of comprehensive assessment, the assessor should identify any concerns about the welfare of the child and whether there is reasonable cause to suspect a child is suffering or likely to suffer significant harm (see definition of significant harm in the glossary). This includes considering both risk and resilience factors.

The assessor should use a trauma-informed and non-judgemental approach when asking about parenting and children and they should also maintain professional curiosity. This means they should be aware that for various reasons including fears that children may be removed, the parent may not share all information about their family situation. Where possible, they should speak to other services the family is involved with to gain a fuller picture.

Identifying the impact of the parent’s alcohol use on the safety and wellbeing of children

When assessing whether a child may be at risk, assessors should consider the effect of alcohol use on parental functioning. This includes:
- how much the parent (or parents) is drinking and the pattern of their drinking
- hangovers or withdrawal symptoms or complications
- any additional drug use
- whether both parents or other adults in the household have alcohol or drug problems
Assessors should consider the effect of the parent’s alcohol use on their ability to:
- supervise and adequately protect children and young people from danger
- attend to children’s basic needs for food, clothing, housing, health appointments and any medical needs
- protect children and young people from contact with potentially inappropriate adults (who may also be intoxicated)
- notice signs that children and young people are being drawn into anti-social or criminal behaviour, including involvement with gangs or organised crime groups, being sexually exploited, abused on-line or drawn into radicalisation
- maintain family routines, for example getting children to school on time
- maintain age-appropriate boundaries for children and young people
- manage the family’s essential income, such as whether their income is being spent on alcohol
- be emotionally available for their children and their ability to show emotional warmth
- provide emotional stability, such as whether their children are subjected to a parent’s unpredictable mood swings if the parent drinks episodically or experiences withdrawal symptoms
Assessors should also consider any other potential impacts on parenting and family life likely to result from individual circumstances.

The assessor should also consider whether a child is a young carer. This means they have caring roles, either for the parent or for other family members, which would normally be carried out by an adult.

Identifying other risk factors

Problem alcohol use often occurs alongside other problems which can cause harm to the child.

Examples of other problems that can cause harm to a child include:
- the impact of the parent’s mental health (known to be a particular issue in cases affecting serious injury and mortality of vulnerable infants aged 2 and under) or physical health on parenting
- any risks from the other parent or adult members of the household
- the impact of any parental conflict on parenting, the family environment and children’s wellbeing
- domestic abuse (see below for more information)
- possible physical or sexual abuse
- possible exploitation by people outside the family
- any concerns about a child or young person’s development, wellbeing or mental health
- other people supporting the child, for example family members and their fitness to provide that support
- frequent changes in partners living in the household
Seeing, hearing or experiencing the effects of domestic abuse causes significant harm. Safeguarding legislation in all 4 UK nations takes full account of the effects of domestic abuse. In England and Wales, the Domestic Abuse Act 2021 recognises affected children as victims of domestic abuse in their own right.

See annex 1 for legislation and guidance on domestic abuse across the UK.

The assessor should also ask about potential protective factors. This can include:
- effective strategies the parent has for mitigating the impact of their alcohol use on their child (for example, limiting heavy alcohol use to times when children are cared for elsewhere)
- qualities or coping skills the child or young person has
- strengths in parenting and family life, such as stable routines and emotional warmth towards children
- family members or close friends who can provide appropriate care
- other support the parent may have (for example, from their local community)
- any professional support for the parent or the child that is already in place
- support networks or activities that the child or young person is involved in
- a supportive adult that the child can talk to (for example, a teacher)
- supportive, positive friendships for the child or young person
26.8 Acting on concerns about the welfare of a child

26.8.1 Making a child safeguarding referral to children’s social care

If the practitioner has concerns about a child’s welfare, they should make a referral to local authority children’s social care. They should do this immediately if there is a concern that the child is suffering significant harm or is likely to do so. The practitioner should follow organisational procedure and consult with the relevant accountable person in their organisation. Practitioners who make a referral should always follow up their concerns if they are not satisfied with the response. The service should have policies to escalate concerns within the organisation and with other agencies if safeguarding concerns are not addressed.

Services should make sure that all staff know how to:
- identify risk factors
- follow organisational child safeguarding procedures
- make a safeguarding referral and are familiar with the referral processes in their local area
26.8.2 Informing the parent

The assessor should inform the parent that they will be making a referral to children’s social care. They should do this unless they think informing the parent would put a child at further risk or impede a police investigation. It is important that the practitioner uses an empathic approach while being clear about their concerns for the child and the reasons for the referral. They should allow space for the parent to respond to this information.

It is preferable if the parent gives consent to make the referral, but their consent is not necessary if a child is experiencing or at risk of experiencing significant harm.

This is likely to be an anxious time for parents and they may not know what to expect. Practitioners should explain what will happen after the referral and offer them support as they go through the process of referral and any assessment. Practitioners should make every attempt to keep in contact with the parent, offering another appointment and following up with a friendly text or call if the parent or carer does not attend.

26.9 Young carers

Where a child or young person is identified as a young carer, they should have access to a formal young carer’s assessment if they have support needs or they or their parent request one. Community alcohol treatment services should know how to refer young people for formal young carer’s assessments and encourage the parent to discuss this with the child. The young carer might benefit from support from young carer’s services or activities and in some areas there are specialist services for young carers of parents with problem alcohol or drug use. These services can help young carers to feel less alone and less stigmatised.

You can find more information on carers (including young carers) in annex 1 on relevant legislation and guidance.

26.10 Early help

Practitioners should still consider children’s potential support needs even if they find no risks that meet the threshold for a safeguarding (child protection) referral.

The statutory guidance ‘Working together to safeguard children 2023’ notes the importance of intervening at an early stage:

Early help is a system of support which aims to support children and families as soon as problems emerge. Some early help support is described as ‘targeted early help’ and is provided to children and families who are identified by practitioners to have multiple or complex needs requiring a specialist and/or multi-agency response but where statutory intervention is not needed.

Based on individual needs, children and young people can benefit from direct support, for example psychotherapeutic support or involvement with activity-based support services. Children and young people may also benefit from interventions that support the relationship between the parents and child.

Support from parenting professionals or programmes can help parents gain parenting skills and this can also support their alcohol use goals. A review of the effectiveness of psychosocial treatment found that interventions that incorporated parenting skills into the treatment programme had the most effect on reducing parental alcohol (or drug) use (McGovern and others, 2021).

If a child has been diagnosed with, or suspected of having, fetal alcohol spectrum disorder (FASD), they should receive specialist assessment and support through the local FASD diagnostic and support pathways. Typically, these pathways are for children with neurodevelopmental disorders. If specialist pathways are unavailable locally, you can refer children to the national (UK) clinic for FASD (https://www.fasdclinic.com/).

In some areas, there are specialist services for children and families affected by problem parental alcohol (and drug) use. These services can provide specialist interventions and help children and families affected by parental problem alcohol (or drug) use feel they are not alone.

Adult alcohol treatment services should make sure their staff:
- are aware of locally determined thresholds for levels of need in children and families
- know how to refer children and families to appropriate services
- know how to contribute to early help assessments
Where the threshold for a safeguarding referral outlined in statutory guidance is not met, the parent’s consent is required for a referral to children’s services or another agency for early intervention and support.

26.11 Ongoing assessment

Assessing for child safeguarding risks or support needs for children and young people is not a one-off event. Assessment should be an ongoing process. Risks may escalate or decrease as the parent’s or the family’s circumstances change. The alcohol treatment practitioner working with the parent, supported by the multidisciplinary team, should regularly review their assessment and monitor risks. They should share information on any potential increase in risk with children’s social care and other agencies involved.

26.12 Including goals around parenting and family life in the parent’s treatment and recovery plan

Practitioners working with all parents, whether or not there are safeguarding concerns, should ask them about any goals or aspirations they have about their children or family life when agreeing a treatment and recovery plan. A parent’s concerns for their children can often be a motivating factor to make changes in their alcohol use. They can also consider what sort of support they might need to manage some of the challenges of parenting. Agreeing a treatment and recovery plan is also an opportunity to identify parenting strengths so that risks or needs are not the only focus.

Services should have information on universal children’s services (open to all) and targeted services (for children and families with multiple or complex needs) for parents to consider.

26.13 Multi-agency working with children’s social care and other services

26.13.1 Contributing to multi-agency assessments and plans

A core principle of ‘Working Together to Safeguard children’ is that safeguarding is everybody’s responsibility. Alcohol treatment services and practitioners should be aware of and follow the published arrangements set out by the organisations responsible for safeguarding in the local area. This is so they can collaborate effectively with other services.

Practitioners in alcohol treatment services should contribute to:
- multi-agency assessments
- child in need and child protection plans
- reviews led by children’s social care services
- early help assessments, plans and reviews
If children’s social care services are already working with a parent who needs to be referred to the alcohol treatment service, the referral should be considered a priority, due to the risks to the children.

26.13.2 Information sharing

Effective information sharing between practitioners and local organisations and agencies is essential for early identification of need, assessment and service provision to keep children safe.

Serious case reviews (Sidebotham and others, 2016) have highlighted that missed opportunities to record, understand the significance and share information in a timely way can have severe consequences for the safety and welfare of children. This applies when problems are first emerging or identified and when children are already known to children’s social care.

Alcohol treatment services should develop agreements with other local agencies outlining why, how and when it is appropriate to share information, as well as on how data will be handled once it is shared.

‘Working together to safeguard children 2023’ provides statutory guidance on information sharing.

Information sharing advice for safeguarding practitioners (https://www.gov.uk/government/publications/safeguarding-practitioners-information-sharing-advice) is non-statutory guidance for people who provide safeguarding services to children, young people, parents and carers (in England only).

26.13.3 Strategic partnerships

Alcohol treatment commissioners and service providers should work with organisations responsible for safeguarding across systems in the local authority.

Local areas need strong leadership and strategic partnerships so that practitioners can work well together across organisations and systems. There should be agreed working arrangements between children and family services and adult and young people’s service and other relevant services. Muti-agency working arrangements are best supported by a written protocol. In England, the local safeguarding partnership provides multi-agency governance arrangements and data sharing arrangements for the system.

Agreements can be about:
- the role of alcohol treatment services (adult and young people) in local safeguarding arrangements
- information and data sharing
- the process for early help assessments and interventions for parents with alcohol problems
- the process and thresholds for referrals to children’s social care where there are safeguarding concerns
- the process for referrals into alcohol treatment services from children’s services
- multi-agency safeguarding training
- governance and evaluation
In some areas, services may be commissioned or agree to provide services in partnership. For example, this might include an alcohol treatment practitioner based for part of the week in children’s social care, or a local authority social worker providing regular consultation to staff in alcohol treatment services.

26.14 Resources

Families affected by drug and alcohol use in Scotland (https://www.gov.scot/publications/improving-holistic-family-support-towards-whole-family-approach-family-inclusive-practice-drug-alcohol-services/) is a framework for holistic family approaches and family inclusive practice for working with families affected by parental alcohol and drug use.

26.15 References

Brandon M, Sidebotham P, Belderson P, Cleaver H, Dickens J, Garstang J, Harris J, Sorensen P and Wate R. Complexity and challenge: a triennial analysis of serious case reviews 2014 to 2017 (https://www.gov.uk/government/publications/analysis-of-serious-case-reviews-2014-to-2017). Department for Education, 2020.

Canfield M, Radcliffe P, Marlow S, Boreham M and Gilchrist G. Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care (https://www.sciencedirect.com/science/article/pii/S0145213417302016?via%3Dihub). Child Abuse and Neglect 2017: volume 70, pages 11 to 27.

Cleaver H, Unell I and Aldgate J. Children’s needs - parenting capacity. Child abuse: parental mental illness, learning disability, substance misuse, and domestic violence. Second edition (https://www.gov.uk/government/publications/childrens-needs-parenting-capacity-second-edition). Department for Education, 2011.

Hughes K, Bellis M, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L and Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30118-4/fulltext). The Lancet Public Health 2017: volume 2, issue 8, pages e356 to e366.

Pajulo M, Suchman N, Kalland M and Mayes L. Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: focus on maternal reflective functioning and mother-child relationship (https://onlinelibrary.wiley.com/doi/10.1002/imhj.20100). Infant Mental Health Journal 2006: volume 27, issue 5, pages 448 to 465 (registration and subscription required for full article).

Sidebotham P, Brandon M, Bailey S, Belderson P, Dodsworth J, Garstang J, Harrison E, Retzer A and Sorensen P. Pathways to harm, pathways to protection: a triennial analysis of serious case reviews, 2011 to 2014 (https://www.gov.uk/government/publications/analysis-of-serious-case-reviews-2011-to-2014). Department for Education, 2016.

Stith S, Liu T, Davies L, Boykin EL, Alder MC, Harris J, Som A, Mcpherson M and Dees JJ. Risk factors in child maltreatment: a meta-analytic review of the literature (https://www.sciencedirect.com/science/article/abs/pii/S1359178908000608?via%3Dihub). Aggression and Violent Behavior 2009: volume 14, issue 1, pages 13 to 29 (registration and subscription required for full article).

McGovern R, Newham JJ, Addison MT, Hickman M and Kaner EFS. Effectiveness of psychosocial interventions for reducing parental substance misuse (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012823.pub2/full). Cochrane Database of Systematic Reviews, 2021.