Alcohol, Drugs and Smoking

Government guidance on the consumption of alcohol by children and young people, based on scientific and medical evidence, makes it clear that the consumption of alcohol by children and young people is detrimental to their health and development, both in the short and long term, and that an alcohol-free childhood is the healthiest and best option (see Alcohol consumption by children and young people - GOV.UK).

There is also clear evidence that parents and carers can influence young people's alcohol use. Children are less likely to drink, or drink less, when parents and carers have strict rules on young people's drinking and show their disapproval of underage drinking rather than adopt a tolerant attitude and supervise and manage young people's behaviour.

Children in care are particularly vulnerable to the health risks associated with alcohol consumption. Evidence from studies suggested that the physical and mental health of children in care is often poor in comparison to that of their peers. Evidence also suggests that children in care are four times more likely than their peers to smoke, use alcohol and misuse drugs. In addition, children coming into care may have experienced strict discipline, family conflict and a family history of alcoholism which have been associated with an increased risk of higher levels of alcohol consumption by children and young people.

Foster carers should ensure that young people are educated about alcohol. It is accepted that the more that young people know, the more likely they are to make good decisions about how to deal with smoking, drinking and the inappropriate use of drugs. It is good to talk about this subject so that you can give out the right messages and information.

Changing the way that people behave with alcohol and drugs is partly dependent on persuasion, so it is important that channels of communication are kept open. This does not mean that you approve of what the young person might be doing.

Carers need to demonstrate a responsible attitude to alcohol. You must also bear in mind any possible previous experiences for the child in placement relating to alcohol use. They may have come from a household where alcohol was misused and was a precursor to domestic violence.

The carer's response to underage drinking must be clear and consistent, and any breaches of the law relating to supplying alcohol to children should be reported to the police. There are serious health risks to children who drink, and alcohol can reduce inhibitions and impair judgement, which may make children vulnerable to behaving in a dangerous manner or being exploited.

For children in care addressing drinking issues is the shared responsibility of everyone involved in the child's life, including the child's family, carer and social worker, health and education professionals, and specialist drug and alcohol services. The young person's Health Assessment should address their health needs, including any needs in relation to drinking and alcohol misuse. Services should be identified that will meet the young person's assessed needs.

Carers should work closely with the child's social worker, children in care nurse and any specialist services working with the young person to address their drinking issues.

Practice Guidance for foster carers in relation to young people and alcohol

• Carers should actively promote, encourage, and emphasise the advantages of, an alcohol free childhood;
• Carers should not adopt a permissive/tolerant approach to the consumption of alcohol by children and young people placed in their care;
• Carers should talk openly with young people about alcohol and give guidance, or help young people access information and guidance, about the specific harms linked to drinking at a young age, including how risks change with age and the frequency and quantity of alcohol they consume. Carers should help young people make sensible drinking decisions and understand that delaying drinking alcohol until they are aged 18, or at least until they are over 15, will reduce health risks;
• Carers are responsible for ensuring children and young people are not at risk from any alcohol kept in their home. Alcohol in a foster home should be kept out of children's reach or stored safely. Carers should monitor the alcohol in their home to ensure they are aware if any has been taken by a young person in their care without their permission;
• Carers' behaviour management strategies should include incentives for young people not to consume alcohol;
• Carers should prepare young people for an adult environment dominated by alcohol by discussing responsible drinking and the dangers associated with drinking and alcohol misuse;
• Carers should set boundaries for drinking by discussing responsible drinking and ensuring that young people are aware of the types and strengths of different alcohol and recommended adult alcohol limits;
• Carers have a critical role to play in showing children and young people how to drink responsibly. Children and young people should not witness drunkenness or binge drinking within their foster placement;
• Carers must ensure that while caring for a foster child their parenting capacity is not impaired by alcohol;
• Carers should be aware that many children and young people in care have had negative experiences of alcohol, including violence and abuse. Carers therefore need to be sensitive to the young person's perceptions of adults drinking and how this might vary from theirs and their own children's experiences;
• Carers should talk to other parents, when children and young people are visiting or staying with friends, to ensure the rules they have in place regarding alcohol are followed;
• Carers should monitor young people's access to alcohol for example being aware how much money children have at their disposal and what they are spending it on;
• Fostered young people 16 years and older may under the supervision of their foster carer be permitted to consume one light alcoholic drink at significant family events, such as birthdays or festivities. This must be agreed as a part of the foster carers' delegated authority arrangements agreed by the young person's Social Worker and parent where appropriate. Any decision to permit the consumption of a small amount of alcohol must have regard to the individual circumstances of the young person;
• Carers should seek advice from the child's social worker, Dedicated LAC Health Team, Family Placement Worker or any specialist services if they are aware, or are concerned, that the young person in their care is drinking. Clear strategies for managing the young person's alcohol consumption should be agreed and recorded in the child's Placement Plan/Health Care Plan.

Current legislation in relation to young people and alcohol consumption

• It is illegal for anyone under the age of 18 to purchase alcohol in licensed premises (Licensing Act (Young Persons) Act 2000);
• It is illegal under the age of 14 to be alone in a place licensed purely for the sale of alcohol. It is legal over the age of 14 with the permission of the licensee;
• 16 and 17 year olds can consume alcohol purchased by an adult (beer, cider and wine) on a licensed premises while eating a meal if an adult is present;
• It is illegal to give alcohol, unless under medical supervision, to anyone under the age of 5;
• While it is not illegal for parents to give their children over 5 alcohol in a private place it is a criminal and civil offence to cause a young person to suffer or likely to suffer harm through supplying / consuming alcohol (Children Act 1989);
• If a young person under 18 year old is found in a public place consuming or intending to consume alcohol the police have the right to confiscate it.

Foster carers do not need to know everything about drugs and substances to respond appropriately and competently to young people that they are caring for.

All young people can be tempted to experiment with drugs, no matter where they come from or their background. Some children and young people will be in foster care because of substance misuse in their family and this may inform how they feel about drugs and their knowledge.

Substances are any substances, whether restricted or prohibited, which may have a harmful effect upon a child, such as:

Aerosols, Gas, Glue, Magic Mushrooms (Amanita), Petrol, Solvents and Amphetamines, Barbiturates, Cannabis, Cocaine, Hallucinogens, Nitrous Oxide (NOS) Hashish and Heroin. This can also include alcohol, cigarettes and tobacco.

Young people often have access to a range of domestic products that are harmful and potentially fatal to them when inhaled. You need to be vigilant with young people around aerosol products, nail varnish, corrective fluid, glues etc.

It also includes psychoactive substances which can cause a very similar range of problems to the drugs which they mimic, including a risk of dependence developing with repeated use. Some appear to be more dangerous even than the traditional drugs they mimic.

See also:

• Frank - New Psychoactive Substances;
• Frank - Drugs A-Z;
• Frank regarding drugs and the law.

It is often difficult to tell if a young person is using drugs, particularly when a child/ young person first takes drugs or only takes them occasionally.

Some possible indications of drug abuse are:

• Sudden changes of mood;
• Irritability;
• Loss of appetite;
• Increased appetite - possible want sweet things more;
• Drowsiness or sleepiness;
• Evidence of telling lies;
• Unexplained loss of money or belongings;
• Unusual smells, stains or marks on the body, clothes or around the house.

Many of these signs are easily confused with normal growing up. It is vital that you do not make it a taboo subject but perhaps use opportunities such as stories in the media and on TV to start conversations.

It is important not to jump to the wrong conclusion, but speak to the child's social worker or your Supervising Social Worker if you are concerned. Further specialist training is available on drug and alcohol misuse and there are people who specialise in working with young people on these issues. Access to these services should be done in conjunction with the child's social worker.

You could be held responsible for any illegal drugs that are kept in your home so having clear boundaries about drug use is important and all reasonable measures must be taken to reduce or prevent children from obtaining drugs or substances which may harm them.

If it is known or suspected that a child is at risk of participating in drug or substances misuse activities, such as using or dealing, consideration should be given to the following:

• Providing information, guidance and advice to help reduce or prevent risks;
• Developing a strategy for managing risk;
• Making a referral to relevant specialists for support, guidance and treatment;
• Consulting or involving the police.

Share your concerns with your supervising social worker in the first instance, to seek advice and support.

All supervising social workers are expected to advise foster carers and new applicants about the dangers to babies, children and young people of passive smoking. We are now committed to reducing the level of smoking in the county and protecting non-smokers from the damaging effects of second-hand smoke. One important aspect of this, is to encourage and support smokers who want to give up and to promote local 'stop smoking' services.

Carers who smoke are damaging their own health and potentially compromising their ability to actively parent the child. This is of particular concern for a limited number of foster carers who are providing a permanent home for the child. Children who have experienced many losses in their lives may be faced with the premature loss of another parent figure as a result of smoking related disease, disability or death.

You might think that smoking at work – if you're still allowed to do it – deals with the second-hand smoking issue. However, the smoke on your clothes that you take back into the home, still contains poisonous chemicals which can affect the health of those who breathe it in. It is impossible to cancel out the damaging effect of smoke which hangs around on your clothes, or drifts into the house or another room.

And, of course, in all these situations the risk to your own health is still present.

As a foster carer, you may be advised to restrict your smoking to certain areas of your home, preferably outdoors, to ensure that children play, eat and sleep in smoke-free environments. Carers also have a responsibility to ensure that children are not exposed to smoke when they visit relatives and friends of carers. This guidance applies to the use of tobacco and e-cigarettes.

The Fostering and Adoption Services are committed to ensuring that no Looked After Child, and particularly a child under 5 years, are placed within a smoking or vaping household unless exceptional circumstances apply. Not only will this improve the health of children, but it will also protect agencies from potential legal action in the future. Please see  Nottinghamshire Children’s Social Care Service Procedures Manual, Protecting Children from the Harmful Effects of Second-hand Smoke (Prospective Adopters) Procedure for further information.

"Exceptional circumstances" refers to a situation where the child's other identified needs are well met and there is no alternative family available. A decision to place a child in a smoking household must be ratified by t senior managers.

The Fostering or Adoption Panel will need to see evidence that the Smoking Exemption has been signed (the Smoking Exemption can be located on the case file and is a Mosaic episode) and have confidence that the family will honour the terms contained therein.

Children with respiratory or cardiac conditions, middle ear problems or a disability such as Down's syndrome or Cystic Fibrosis will not be placed with a smoking family unless there are exceptional circumstances.

All older children, who can express a view, must be given a choice to be placed with a non-smoking family wherever possible

See Nottinghamshire Children’s Social Care Service Procedures Manual, Protecting Children from the Harmful Effects of Second-hand Smoke (Prospective Adopters) for further information.

In addition, if the child was born prematurely, or the mother smoked during pregnancy, or there is a family history or of asthma, for example, it would be considered inappropriate to place the child within a smoking household.

Passive smoking is linked to respiratory diseases such as asthma and bronchitis, sudden infant death syndrome and middle ear problems. No child should have to live in a smoking environment.

Adult carers act as role models for their children. Children who live with smokers are much more likely to become smokers themselves, with all the health risks that this poses. Smoking is a difficult habit to break, so it is important to encourage children never to start.

Not all young people will smoke/vape and some may have a period of just trying it but they can quite quickly become hooked. Remember, this guidance applies to the use of tobacco and e-cigarettes.

Some children/young people placed with you may already have a smoking/vaping habit. You should support and encourage young people to reduce or stop smoking/vaping. You can get support from the Looked After Children's Nurse or the young person's GP, including where a young person indicates that they would like to try e-cigarettes as a way of giving up smoking. Make sure the rules about smoking are very clear – for instance, smoking in the bedroom can be an additional fire risk and should never be allowed. Young people should not smoke inside the foster home and should be advised that if they must smoke, they have to go outside.

Remember:

• It is against the law for retailers to sell cigarettes/cigarette papers, tobacco, electronic cigarettes (e-cigarettes) or e-liquids to someone under 18;
• Rules about when, where and by who is allowed to smoke/vape should be clear;
• To be a positive role model to children/young people;
• To raise awareness of the effects of smoking/vaping and tobacco use and how to live a healthy lifestyle.

Your role is to:

• Consider your own health, your family and fostered children. If you are offered smoking cessation support, you have a duty to consider taking up the service;
• Be mindful that your behaviour provides a role model for the children in your care and consider the effect of smoking/vaping on children;
• Never buy cigarettes or materials used for smoking or vaping, for children/young people in your care and cigarettes must never be used as a reward for good behaviour;
• Put in place household rules about smoking/vaping, making these clear to young people (appropriate age) placed with you.

It is illegal to smoke in your car when carrying someone who is under 18 (see GOV.UK, Smoking in vehicles). This applies when people have the windows down or the sunroof open, or are sitting in the open doorway of a car. This does not apply to e-cigarettes (vaping) or a convertible car with the roof completely down. However, as the effects of this are unknown, the fostering service views this in the same way as smoking and would recommend you do not do this with children present.

For further advice on smoking cessation there are some helpful resources below

• NHS Smoking Helpline  
  0300 123 1044 (freephone);
• Quit smoking (NHS);
• NHS Asian Tobacco Helpline
  0800 169 0 881 (Urdu)
  0800 169 0 882 (Punjabi)
  0800 169 0 883 (Hindi)
  0800 169 0 884 (Gujarati)
  0800 169 0 885 (Bengali);
• Text GIVE UP with your full postcode to: 88088.

NHS "Stop Smoking" Services across Nottinghamshire:
FREE support for smokers who want to stop.

• Bassetlaw Stop Smoking Service
  "Do you want to kick the habit?"
  0800 328 8553 or 07968 016256
• New Leaf Stop Smoking Service
  (covers Ashfield, Mansfield, Newark and Sherwood. This service offers FREE nicotine replacement therapy to those registered with GPs in this area)
  0800 389 7712
  Text LEAF to 80800
• Nottingham New Leaf City Stop Smoking Service
  (covers Nottingham City, Gedling, Rushcliffe, Broxtowe and Hucknall)
  0800 561 2121
  Text NEW to 80800