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Many professionals will already have substantial training and experience in talking to children about their problems. What follows are some general ideas for those who are coming to this area fresh. More specific ideas for working with children (and families) can be found in the part of the website for professionals working with children at risk, in the websites and written materials sections or via your national website and other organisations in your country.
One of the most common issues faced by professionals who work with or come into contact with children from families where there are parental alcohol problems is how to assess risk, and to know how and at what level to intervene. This dilemma can prevent many professionals from feeling able to support these children. It is a dilemma that is viewed differently in different countries.
For example. a recent publication (Hetherington et al. [2003] The children of parents with mental illness: learning frmo inter-country comparisons. Chichester: Wiley) found inter-country comparisons between UK and other European countries, in how to manage risk when working with the children of parents with mental illness.
Similar issues could arise when responding to parental alcohol problems. An expert paper is being written on this issue in the UK, and details will be made available via this website as they become available, as there may be much in this paper of use to professionals across Europe. In the meantime, we will give an overview of how professionals can support children in families where there are parental alcohol problems.
The most important thing is to create an environment and the circumstances which allows a child to trust you and hence to start to discuss in more detail what their problems are. This is often the most difficult part of any level of intervention that you will make with the child, partly because children often find it difficult to believe that adults do want to hear what they have to say, and partly because of their specific experiences within their families, where they are often neglected or abused.
The best ways of creating this trusting relationship are by providing uninterrupted time, concentrating on the child and not doing other things, maintaining a set of warm and friendly facial and vocal expressions, maintaining appropriate eye contact and allowing the child to see that you are offering the basic necessities of warmth, empathy, genuineness and being non-judgemental.
Once this trusting relationship is developed further tasks are to:
A key question is whether or not the issues discussed with the child should be raised with one or more parents (for example as a teacher should you ask to see one or more of the parents to discuss the issues that the child is raising or that you have raised with the child). It is impossible to give a definitive answer to this question, because it will depend on the context (for example is there a non-problem drinking parent who is open about the situation at home).
However, the most important thing here is the safety of the child and it is vital not to take any action that might call that safety into question. The child is trusting you with potentially dangerous information, telling you things which, if the drinking parent were to know that they were being discussed, might make that drinking parent very defensive and very angry.
It is important therefore that the child's confidentiality is respected (within clear professional and legislative limitations) and that other family members are only involved after consultation with the child and under almost all circumstances with the child's permission.
The same principles outlined above apply when talking about the specifics of alcohol. In addition, it's important to approach the topic of parental drinking in an unembarrassed fashion, and where the issue is named and not skirted around.
If the child raises the problem of parental drinking directly on their own it is important to continue that conversation using the same terms as the child is using. If the child is just talking generally about problems at home and you suspect that alcohol may be a feature it's good to raise the topic specifically although not too abruptly.
Some possibilities might include, “I wonder if anyone in the family ever drinks a lot”, or “I wonder if some of these problems you've talked about seem to occur more often if Mummy or Daddy has been drinking”.
We said above that it's important to let the child know that you are available for them to talk to you and for them to come back and tell you how they get on with some of the things that they try, but it is important that you do not offer more than you can or more than is appropriate. Most generalist professionals would not feel that they were able into an in-depth or long-term counselling relationship with the child, and it is important to ensure that the limits of what you're offering are clear to the child.
Allowing the child to think that you are offering more than you can will lead to that child becoming disappointed and disillusioned that yet another adult has let them down, which is likely to exacerbate any problems that the child may have in the first place because of their risky family environment.
As well as the personal limits on what is possible to be offered, there may well be institutional or professional limits. The organisation within which you work may have policies, procedures, and boundaries within which they expect their employees to work and it is important that these are not over-stepped.
There is a wide range of interventions and therapies that might be used. Such interventions can work directly with children (with or without other family members) but it is important to recognise that if it is not possible to intervene with a child or young person, that they can be helped indirectly through intervention with adult family members, including the drinking and non drinking parents.
Many of these interventions are very individualistic, and with these it is likely that other family members would not be involved. However, others work more holistically and with these it is very likely that other family members will take part in the intervention.
General approaches that can be used with children, young people and other family members include counselling, individual work, art/play therapy, work that particularly focuses on resilience, 12-step approaches, systemic/family work, solution-focused approaches, motivational work, education, family group conferences, child support groups etc. These interventions can be attempted on various levels by a wide range of generic or more specialist professionals (including alcohol workers, child-care workers and social workers).
It is important that generalist professionals in these circumstances familiarise themselves with referral routes and procedures into available services in their localities and countries. Details of referral procedures will clearly differ from place to place, even within countries and therefore cannot be listed here.
Even if a referral is made and a more specialist agency becomes involved, it is likely that there will still be a role for you as the generalist professional who is likely to have a longer-standing relationship with a child, and to see them on a day to day basis.
A research project in the UK has trained professionals to deliver a brief intervention to a family member concerned by the alcohol or drug use of a relative. The training of the professionals included a section on identification of a family member; some of this information is summarised here as it may be useful to you in your contact with children (and families) dealing with parental alcohol misuse:
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