In Reviews of Serious Case Reviews Ofsted Noted That

Toxic / Complex Trio

In reviews of Serious Case Reviews Ofsted noted that:

The most common issues [relating to the children’s families] were domestic violence, mental ill-health and drug and alcohol misuse. As Working Together notes these issues rarely exist in isolation. There is a complex interaction between the three issues (often referred to as the toxic trio). In one situation domestic violence may be the result of women who use drugs being more likely to be in relationships with volatile men. In another situation maternal drug misuse may be a consequence of their experience of domestic violence. Maternal mental ill health may be a result of violence or abuse that they have experienced or depression may lead a parent to misuse drugs or alcohol.

Definition of Domestic Violence

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

• psychological
• physical
• sexual
• financial
• emotional

Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.”*

*This definition includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

This definition recognises that past legal and cultural understanding of domestic abuse has been too narrowly focused on single physically violent incidents rather than complex and controlling patterns of behaviour.

It is recognised that the desire to exert power and control in family, domestic and intimate relationships underpins the majority of domestic abuse which takes place, and that abuse is usually inflicted to achieve this end.

Measurement of the prevalence of domestic violence and abuse is difficult, and there are a range of sources of measurement, all of which have substantial weaknesses. However, the wide range of available sources all point in the same direction, indicating that domestic violence and abuse is widespread.

You can read more about the new definition on the Domestic Violence policy page on the Home Office website.

Definition of Mental ill Health & Substance Misuse

Working Together (pp. 265 - 266) describes the wide range of conditions covered by the term mental ill-health, including:

Depression and anxiety, and psychotic illnesses such as schizophrenia or bipolar disorder… Mental illness may also be associated with alcohol or drug use, personality disorder and significant physical illness.

NICE (p. 5) describe substance misuse as:

Intoxication by/ or regular excessive consumption of and/or dependence on psychoactive substances, leading to social, psychological, physical or legal problems. It includes problematic use of both legal ( includingprescription drugs) and illegal drugs (including alcohol when used in combination with other substances).

What works with these children, young people and families?

Work has been undertaken locally to improve early identification, recording, information sharing and service pathways for the toxic trio. Current Independent Domestic Violence Advocate (IDVA) provision will support people who are experiencing substance misuse and/or mental ill-health but there is recognition that the support required is different from the general IDVA service, and a funding application has been summited to support a wider remit.

The Council has begun a piece of work to develop a better understanding of the support and safeguarding being provided to B&NES families with children where at least one parent/carer present these issues. The aim is that this information will identify strengths and weaknesses within the system to help develop more effective, coordinated and targeted support and interventions. This is in line with Ofsted requirements and the Local Safeguarding Children’s Board’s (LSCB) commitment to keep children in B&NES safe.

The following references provide some evidence for working with children and families where domestic violence, parental mental ill-health and parental substance misuse are present.

Children

Options for supporting children of substance misusing parents identified as being in need to remain at home might include:

• Providing occasions for the safe and contained expression of their own ideas and feelings; enabling them to have fun, arranging attendance at nursery, providing special educational support, providing access to health care and other services and arranging assessments e.g. CAF ( or another Early Help assessment )and treatment of emotional and behavioural problems.

• Particular attention should be given to developing programmes designed to enrich the experiences of neglected children and to address issues such as delayed speech and language development and aggressive behaviour that are likely to impact on the stability of placements and jeopardise children’s chances of making progress at school.

Parents

Identifying problems:

• Practitioners need to be prepared to raise the issues of domestic violence or substance misuse on more than one occasion. Approaches which avoid passing judgements on parents’ behaviour, while emphasising children’s needs, are required. It will usually be more productive to focus on the child’s needs for routine, boundaries, support, stimulation and a safe environment than to highlight the damaging nature of the parental behaviour. Practitioners should adopt attitudes to families that are sympathetic and encouraging rather than blaming or punishing.

• Initial questions to ask women about domestic violence:

How are things at home?

How are arguments settled?

How are decision reached?

What happens when you argue or disagree?

What happens when your partner/husband gets angry?

Have you ever felt frightened of your partner/husband?

Have you ever felt threatened by your partner/husband?

• Thought will need to be given as to what information is shared with whom. This is particularly important for the safety of those who have left an abusive household, as their whereabouts can be inadvertently leaked to the abusive partner.

• Information gathering and analysis:

While mothers’ parenting appears to be adversely affected by domestic violence, there is evidence that their parenting can recover once they are no longer living with domestic violence

Cassell and Coleman (1995) suggest that, when assessing the risks of harm for children posed by a parent with mental health needs, practitioners should consider the following factors:

• The warmth of the parent-child relationship
• The parent’s responsiveness to the child’s needs
• The content of any delusional thinking
• The parent’s history of anger management
• The availability of another responsible adult

The research suggests that when statutory agencies come into contact with families with alcohol or drug problems, learning disability or poor mental health, parents may experience difficulties in understanding what is said to them or what is happening. These problems may also impact on parents’ ability to remember and recall key information. Line managers should support workers in planning sufficient time to explain things to parents at the first encounter, and to revisit them when necessary to ensure that information has been understood and retained.

A caring partner, spouse or relative who does not use drugs can provide essential support and continuity of care for the child. Other protective factors include drug treatment, wider family and primary health care services providing support, the children’s attendance at nursery or day care, sufficient income and good physical standards in the home.

Assessing parental progress

All but one of the parents who made sufficient changes did so before the babywas six months old.

The slight progress made by other parents around the baby’s birth provedunsustainable if major change had not occurred by the time the child was sixmonths old.

Written agreements were often broken with no adverse consequences.

Partnership working

The findings from the study indicate that workers rarely consult orcollaborate with services for substance misuse and domestic violence incarrying out assessments or planning. Collaboration should be given greaterpriority because practitioners in domestic violence units and alcohol and drugservices will have a better understanding of how these issues impact on adultfamily members and family functioning. The expertise of practitioners in thesespecialist services should be used to inform the social work assessments,judgements and planning.

In Bath and North East Somerset Council area, we would recommend that all families with the Toxic Trio present have an assessment and work to a SMART, multi-agency plan to ensure the right services are in place to meet these complex needs

Training available from LSCB

A specialist inter-agency course regarding the ‘Complex / Toxic Trio’ is provided through the LSCB training programme. The course is aimed at members of the workforce who have completed the advanced inter-agency child protection course or who have a specific role within their agency related to the subject. Participants are supported to extend their knowledge and skills through exploring evidence based practice, children’s experiences, and information on local services and referral pathways.

It is recognised that the detailed information covered within this course is not suitable for the entire workforce, although it is of fundamental importance that an awareness of the topic is held due to the ‘Complex / Toxic Trio’ being key indicators of increased risk of harm to children and young people. Consequently a half day introductory course is currently under development to meet this identified need. The ‘Complex / Toxic Trio’ and how to work with those affected by the issues is also considered on every standard and advanced child protection course, which take place monthly.

The LSCB training programme also offers Domestic Abuse, Safeguarding and Child Protection training and Parental Substance Misuse, Safeguarding and Child Protection training. These specialist courses are designed for those looking to refresh and build on their knowledge and skills to support children and families living in environments with high levels of domestic abuse or living in environments where parents or carers use of alcohol or drugs impacts on their parental capacity.

Courses or E–learning packages are also available which focus on wider issues of violence which affect young people including Modern Slavery and Human Trafficking, Child Sexual Exploitation, Female Genital Mutilation, Ending Violence against Women and Girls and Forced Marriage.

Information and online bookings for all Children's Workforce Training can be accessed through the Learning Pool or further information can be gained from the team on 01225 394210.

References:

Department for Children Schools and Families (2010) Working Together to

Safeguard Children, London: TSO

Home Office (2009) What is Domestic Violence? London: Home Office

NICE (2007) Interventions to reduce substance misuse among vulnerable

young people: guidance, London: NICE

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