This section of the website provides an overview of research and practice underway across the ENCARE countries. More detail can be found in the websites and written materials sections of the website, or via your national website.
At the moment there is a lot of information on this page but we hope to review this page soon so that it is easier to navigate around.
The Austrian national ENCARE website will provide much more detail on interventions available for children, and research that is underway in the country. In terms of summary for this website a few examples of things underway in Austria include:
- A group for the 'children of alcoholics' aged 13-19 years. The group offers alcohol-related information and discussion with other children. The group takes places once a month in an inpatient treatment centre, and is free of charge.
- Onysos-chat: a round-the-clock chat room for 'children of alcoholics'. Twice a week the group is moderated by a therapist.
- Onysos-play: a play group for children from aged 10, with accompanying material for teachers that includes alcohol-related information.
- A forum for questions from 'children of alcoholics' run by AKIS (Alkohol-Koordinations-und Informationsstelle).
- The Alcohol Treatment Unit of the Anton-Proksch-Institute (API) in Vienna runs an inpatient programme for women alcoholics; their children may stay with them.
The VAD, a Dutch acronym for “Association for alcohol and other drug problems” gave the “Broeders Alexianen Tienen ” the opportunity to develop a group program for children of alcoholics, called 'Families under influence - influencetial families'. The overall goal of the program is to enhance childrens' abilities to cope with the problems arising from parental problem drinking. Additionally, the program aims to identify the most vulnberable children and refer them to more appropriate help. The parents are familiar with the children's program and are supported as educators.
The program has 4 core elements, based on evidence and clinical experience: psycho education, cognitive and social skill training, coping with stress and mixed feelings and looking after yourself. The children's program involves two workbooks, each aimed a specific age group - a junior workbook for 8-12 year olds and a teen workbook for 12-18 year olds. The program is in two parts - an information part about alcohol problems and the effect that they can have on families, and a training part that explore coping and which is age-specific. In the latter part of the program, various methods are drawn upon to help the children deal with the stress that they experience. A manual has also been developed for the therapists. After the program had been designed it was piloted and evaluated (supported by Professor Byttebier at the University of Leuven). More recently, junior, teen and parent groups have been formed.
The most recent part of the program is the development of a Flemish website for the children, their parents and the therapists.
The most common form of alcohol treatment is found in alcohol clinics; some of these are public whilst others are private establishements. during the least few years children and families have become more widely recognised as important issues. Several clinics offer support to partners, and some to children. However, most of the work with children is not a routine part of practice and is dependent on specific monies. AA and Al-Anon are known in Denmark, but are perhaps not so widely used as in other EU countries.
In Denmark there are several rather old associations and organisations that work with people with alcohol problems. Some also work with families e.g. Laenken (The Link), Blue Cross and the YMCA, for example by organising 'get-togethers' and offering support for parents and children to holiday together.
Working with children and families as part of statutory health and social care, and having specific services to children and families, are undeveloped areas of work in Denmark. However, new initiative are being established so it is hoped quite soon that this picture will change.
There is at least one children's telephone helpline (Bornetelefonen) but this is quite small scale and is for all sorts of problems that children might encounter, not just where there are alcohol problems in the family. Specialised generic counselling (paedagogisk psykologisk radgivning) is available through the school system.
A lot of the research in this area in Denmark has been undertaken at the Danish National Institute of Social Research. The results from these studies have been widely used and greatly added to the evidence base in this area.
Professor Dr Michael Klein, one of the Germany ENCARE partners, has written a paper for this website on the situation in Germany with regard to children affected by parental alcohol problems. This paper will be available here in pdf format as soon as possible.
A website for the children of those affected by drinking problems has also been developed in Germany - it is called Kidkit.
The Fragile Childhood Activity: Led by the A-Clinic Foundation has been running since 1986. Its main aims are to raise awareness amongst professionals, the public and policymakers of the plight of children living in families where there are alcohol problems. This leads to training, co-operating and networking to meet the needs of these children, to develop services, work practices and materials, to provide information on the nature and extent of the problem, to identify gaps in knowledge, skills and training, and to get policymakers to recognise the problems faced by such families. The activity's website is at www.lasinenlapsuus.fi
The work of the Trimbos Institute: The drankjewel website is an initiative of the Trimbos Institute. It is for children (12-18) and adult children (18+) who have a parent with an alcohol problem.
Trimbos has also developed two handbooks for organising group interventions for children with parents who have addiction or psychiatric problems. One handbook focuses on organising groups for children aged 8-12 years; the other focuses on chidlren aged 13-15 years. Details can be found on the publications page of this website.
Finally, Trimbos has developed a self-help guide for adults who grew up with a parent with an alcohol problem. Details can be found on the publications page of this website.
KIPIZIVERO is a Dutch campaign for and about children with parents who have addiction or psychiatric problems. For this campaign a series of brochures and posters were developed, for children of different ages, as well as for parents and professionals, to provide information, advice and addresses for further help.
Several of the regional institutes for addiction care offer group interventions for children of parents with alcohol problems. These include: Tactus, Jellinek, Parnassia, Kentron and CAD Limburg. There are also regional Dutch institutes for mental health care that organise group interventions for children of parents who have addiction or psychiatric problems. Finally, Alateen is also active in the Netherlands and organises self-help groups for children under the age of 19 years who have a parent with an alcohol problem.
Socidrogalcohol - Program Alfil:Program Alfil has been running in Spain since 1997. It was initiated by Sociodrogalcohol, a Spanish non-governmental organisation, and is a multisite research project, funding by the National Plan about Drugs, aimed at the adolescent children of alcoholics who are at risk of problematic behaviour. There are two main parts to the study – epidemiological research and an evaluation of a preventive intervention. The theoretical basis of the work inorporates cognitive and social learning and the family alcoholism vulnerability model. Targets for change include family interactions, issues related to alcoholism, parenting practices, youth knowledge, attitudes and expectations around alcohol and addiction, coping/social skills training, development and problem behaviours. Parents attend session to look at parenting, communication and social skills and how to get a good drug prevention message across to their children. The young people also attend a number of group sessions to provide education around alcohol & drugs and social support/reinforcement for drug-free attitudes and activities as well as a focus on decision making and coping skills. Further information on the sessions is given below:
Suggested group sessions with parents:
- Youth opinions about alcohol and its effects.
- Objective information about alcohol and its effects (myths and reality).
- Alcoholism, a disease with a treatment.
- Why young people start drinking: Group pressure and publicity (alcohol beverages commercials).
- Why young people start drinking: emotional distress.
- Why young people start drinking: facilitation of social relationships.
- Alcoholism as a family disease: consequences in the family environment, typical roles, genetic and environmental factors.
- Initial symptoms of alcohol problems in youth.
- Leave-taking. Evaluation questionnaires. Party with parents (if possible).
Suggested group sessions with children and adolescents (8-18):
- Educate children for prevention: a difficult task. Adolescence, what a marvellous stage!
- Alcohol and youth: a dangerous 'cocktail'. New tendencies in alcohol consumption. Why young people start drinking? How they cope with risk factors?
- Specific risk and protective factors in children from families with alcohol problems. Genetics and environment.
- Sessions 4-6. Preventive strategies in the family: healthy and pro-social values; norms, rules and boundaries; more liberty, more responsibility; healthy use of free time (alternatives to alcohol); conflict solving at home (negotiation); communication at home.
- How to react if your children use alcohol or other drugs. Problems and solutions.
- How to talk with children about their own experience with alcohol (if you have had alcohol problems).
- Leave-taking. Evaluation questionnaire. Party with children (if possible).
The materials of the ALFIL program (group sessions manual, booklets for children and for the whole family) are available from the Socidrogalcohol website in pdf format. In addition a guide outlining this work is being prepared and will be available through the ENCARE and Socidrogalcohol websites as soon as possible (Guía de actuación preventiva en niños y jóvenes de familias con problemas de alcohol" [Díaz, R]- Socidrogalcohol - Governmental Delegation for the National Plan about Drugs).
Ersta hospital in Stockholm offers education to professionals in how to set-up support groups for children who have parents with addiction problems, as well as other problems such as domestic violence and mental health problems.
Ersta also runs a group approach, called Children are People (CAP) for children who have parents with alcohol problems. It is based on the AA 12-step model. Another method used is a programme introduced by the Save the Children Organisation, which used a model based on cognitive and psychodynamic methods.
Bris is a telephone helpline for children who are having problems at home.
In 2000, there were 69 group programmes in Sweden that offered help to children who have parents with an alcohol problem.
Ala-teen is also active in Sweden and organises self-help groups for children under the age of 19 years who have a parent with an alcohol problem. Ala-tooth offers help to younger children.
Addiction centres in Malmoe and Gothenburg also run support groups for children. In Gothenburg a video has been made to demonstrate how the CAP (see above) approach works.
Recently, the Swedish government has allocated 2 million Swedish crones to communities to provide help and support to children who have a parent with an alcohol problem.
There are studies in Sweden that have been conducted to look at the impact of alcohol problems on children, adult children and other relatives. Some references are given in the publications section of this website. Examples of this work include (not all involve younger children and adolescents but may still be of interest):
- Prevention Program för University Students who are Adult Children or Relatives of people with alcohol problems; A randomised controlled study. Helena Hansson, Ulla Zetterlind, Jenny Cederfjäll and Mats Berglund. (The results from the study have not yet been published). Department of Clinical Alcohol Research, Lund University
- An Implementation Study for Students at Luleå University. Drinking pattern and exposure to stress: One Part of this Study concerns Students who have Relatives with Alcohol Problems. Kent Johnson et al. (The study is still continuing and results are not published yet) Department of Clinical Alcohol research, Lund University
- Group Treatment for Children of Parents with Alcohol and Drug problems. A follow-up Study. Ulla Zetterlind & Helena Ekdahl (The study is still continuing) Department of Clinical Alcohol research, Lund University and Children and Adolescent psychiatry, Malmoe University Hospital.
- Thomas Lindstein has been conducting a 10-year follow-up study of children who have been part of the Ersta Hospital group programme for children who have parents with alcohol problems.
- Kerstin Stromland has been undertaking research into fetal alcohol syndrome.
In June 2004 the UK ENCARE network held a conference to hear about the ENCARE project, and to share work underway in the UK. Extracts from some of the presentations that were given are summarised here.
Children & Families (national) Forum:
The Forum is part of Alcohol Concern's Networking Distant Neighbours project. The overarching aim of the Forum is to “improve the lives of children and families affected by alcohol misuse” by “highlighting gaps and making differences” in four main areas of policy, research, practice and funding. The Forum is producing a literature review discussing children and families affected by alcohol misuse, has conducted a small qualitative study to explore how various health and social care systems respond to need in this area and has recently obtained funding from the AERC (Alcohol Education and Research Council) to conduct a national mapping exercise of service provision to children and families affected by alcohol misuse.Another piece of work, linked also to the Department of Health, will be producing a series of Toolkits to help specific professional groups respond to the needs of children and families affected by alcohol misuse.
Alcohol, Drugs and the Family Research Programme: The Alcohol, Drugs and the Family (ADF) Research Group is a national collaboration (mainly between academic and NHS organisations in Bath and Birmingham, including Richard Velleman, Jim Orford, Alex Copello and Lorna Templeton) that has been undertaking specific research in this area for many years. The ADF group has extensive experience in exploratory research to investigate the experiences of family members living with a relative with an alcohol (or drug) problems. This has lead to developmental research to develop and test interventions for use by a range of professional groups. The group has also been involved in service evaluation, and is involved in local, national and international collaborations (including the ENCARE network). Two recent projects, funded by the AERC (Alcohol Education and Research Council), will be supporting primary care and specialist services to integrate work with families as part of routine service provision, and developing a broad based Toolkit to support those who wish to develop or extend service to respond to the needs of children and families affecteby by alcohol misuse.
One of the bases of the ADF Group is the Mental Health Research and Development Unit at the University of Bath. A website summarising the work of the Group is under construction and will be available later in 2004.
Family Alcohol Service: Launched in 2002, the Family Alcohol Service (FAS) is a partnership between the NSPCC (National Society for the Protection of Cruelty to Children) and AWP (Alcohol Recovery Project). Its multi-disciplinary team works at some length with families affected by alcohol misuse, focussing particularly on the needs of the children. An independent evaluation of the first year of the service was conducted by the Mental Health Research & Development Unit (click here for more details), concluding that the service had been positively received by families and referrers, with positive outcomes in terms of engaging families, relationships and family dynamics, coping, support, resilience building in children, and drinking behaviour.
Option 2: In preparation for an ENCARE conference held in the UK, one of the Option 2 therapists, Mark Hamer, wrote the following:
Option 2 works with families where the parents have problematic drug or alcohol use and where childcare social workers are seriously considering the need to remove the children. We use a crisis intervention model working with the whole family for a brief but intensive period, usually 4 – 6 weeks during which contact with the family is limited only by the families requirements. In practice this usually means we work with a family for around 2 – 3 hours per day, 5-6 days a week. Sometimes visits with families have been as long as 9 hours and a 5 hour visit is not unusual. We are on call to client families 24 hours a day, they have their therapists mobile telephone number.
Using tools drawn from Solution Focussed Brief Therapy, Family Therapy and crisis intervention, we explore values, goals, hopes and family and social strengths. We work to the clients agenda, bring it into clear focus and develop an action plan. Goal setting and scaling is vital. Each family member may set his or her own goals and this gives us our treatment plan for the course of the intervention. Our aim is to identify and build on strengths and resilience within the family and to develop new skills and resources that will enable a family to keep the children at home. We find ourselves routinely teaching skills like: anger management, communication, and relaxation skills. Working with families where there is depression, anxiety, domestic violence and of course problematic drug or alcohol use.
As you may imagine with so much time spent with families in their homes, we quickly build some very close relationships and a good working understanding of what daily life is like inside that family. The core of our work is with families but we spend a great deal of time working with other agencies, particularly negotiating realistic outcomes with childcare teams, liaising with treatment agencies and attending Child Protection Case Conferences and Core Groups.
Our target is to keep 75% of families together. At the moment over 80% of the families we work with still have the children at home 12 months later.
Option 2 won the Child Protection category of the Community Care magazine's Community Care Awards in 2001.
Clouds House is a residential substance misuse treatment centre. Families Plus offers community interventions for family members, offering a range of services to family members, including a residential programme and support groups. Aat present there is no separate ‘programme' for children. However, they may be included in Family Therapy, with their parent(s) and also in Family Conferences when the relative is receiving treatment at Clouds House. Consideration is being given to providing a combined service to parents and children in a partnership initiative with the Young Persons service.
Child Protection Research: Hedy Cleaver, Sukey Tarr and colleagues are engaged in a number of projects emerging from the finding thathigh number of social worker cases involve parental alcohol misuse (also drug problems, mental health problems and domestic violence).
The study has three core aims (to explore how social services respond to families where problems require the intervention by both adult and children's services; to identify the factors that enable different agencies to successfully work together at the various stages of assessment, planning, service delivery and review; and to explore children and parent's experiences of professional interventions – what factors do they find most supportive) and will be carried out within six councils and involve social services, and agencies working with domestic violence or parental substance misuse. The study will include three parts - to identify working practices, to explore how referrals are dealt with and to ilicit the views of families.