Types and timing of testing FDAC is an abstinence-based model and the team work intensively with parents to achieve this. Given that parents often enter the process with chaotic and chronic levels of drug and/or alcohol use, the first phase of the FDAC process focuses on safety and stabilisation. The aim is to help parents shift to a position where they are ready to engage in more psychosocial treatment.
‘FDAC, it's like the last-chance-saloon. It was “do you want to be a drug addict, or do you want to be a mother?” So I decided, that's it, I want to be a mum.’
A hair strand test is taken at the start of the FDAC process, as part of understanding the parent’s chemical profile prior to proceedings, as well as to establish a baseline for subsequent evidence. Further hair strand testing, to measure and evidence a parent’s changed behaviour in relation to substance misuse, is taken towards week 18 in the proceedings. This is the point at which the FDAC team carry out a further parenting assessment and make recommendations to the court about whether parents have demonstrated capacity to change within the child’s timescales.
Depending on case specifics and other indicators of use and/or abstinence, it is expected that parents will be tested via oral mouth swab or urine screens once or twice a week. This gives parents an opportunity to provide evidence of their chemical status, including change in their pattern of use. It also ensures that treatment sessions take account of where parents have got to on their recovery journey. In addition, regular testing supports clinical safety management, particularly where substitute prescribing may be in place. As testing forms part of the treatment journey, it is done inhouse by the FDAC team as part of the treatment package.
The FDAC model is one of continuous and iterative assessment, treatment and support. Testing in the FDAC model is not used in isolation – it forms part of FDAC’s holistic therapeutic approach with families, and it supports other forms of evidence that the team present to the court each fortnight.
How testing helps bring about positive change
Alongside weekly keywork sessions, targeted intervention sessions, and fortnightly non-lawyer reviews, testing provides parents with a regular opportunity to demonstrate the change they are achieving. Parents often talk about testing as being a significant motivator for them during their FDAC journey.
The process of regular testing also supports transparency when working with professionals. Parents are encouraged to disclose any use of substances prior to testing and this honesty in proceedings is promoted by the FDAC team as well as the judge. It facilitates the process of change for parents who have previously sought to hide the nature of their substance use because of the fear of repercussion and stigma.
A recovery process often includes lapses and relapses and a parent’s response to these episodes provides critical information when making a prognosis for the future. If parents are able to disclose the nature of their lapse as quickly as possible after the event, despite their feelings of guilt and failure, and if they are willing to undertake drug testing to corroborate their self-reports, these are markers of the cognitive and behavioural change that are needed. This information can then be used in targeted interventions to increase their insight into the events preceding their lapse or relapse (triggers, unhelpful thinking styles) and, more importantly, to identify strategies that can help establish firmer recovery foundations for the future. Some parents find it helpful to ask for an increase in testing over a short period of time, to motivate them when emotional resources are depleted. The aim of the team is always to reduce the extent to which testing is relied upon as an agent of change, and to move from this to a parent’s increased use of internal resilience and effective coping strategies.
Complexities of testing
Testing is fraught with complexity. Different methods have different detection windows, different cut-off levels, and – arguably – some can be more open than others to adulteration and/or being affected by environmental factors. Moreover, there has been considerable publicity recently about unreliable forensic toxicology results from two laboratories and these are no longer in operation.
Testing is not a marker of abstinence. It is possible that parents can infrequently use low amounts of illicit substances that are either below cut-off detection levels or not within the testing detection windows. It is possible, too, that false positives and false negatives can be present in samples, and some results cannot determine levels or frequency of use accurately. Hair strand test results can sometimes include the presence of substances from a time prior to the testing window, either because the hair has stopped growing in the months before the test (a resting hair phase) or because the rate of growth has been variable. Breathalyser results only reveal alcohol present in the system at the time of testing, not at any other time, and other forms of alcohol testing, including hair strand and blood analysis, only reflect whether there are any biological markers that support chronic excessive alcohol use. The variability of how alcohol is used and the impact this has on the safe care of children is far more complex than simply whether or not levels of use reach what is considered to be a chronic and excessive level.
Testing can also be something of a red herring at times. An over focus on test results can divert attention away from other risky and relevant issues for families, such as domestic abuse or poor mental health.
A fair trial for change
While there are undoubtedly complexities regarding the use of testing it does have a place within care proceedings where parental alcohol and/or drug misuse feature. In FDAC, testing is used to complement the iterative assessment and intensive intervention process.
Testing should be proportionate. Testing that is too frequent, and doesn’t meet the clinical needs of the case, doesn’t support a therapeutic process and undermines a parent’s belief that change can be seen in other areas of their behaviour. On the other hand, an under focus on testing can lead to gaps in evidence at a later stage.
Testing is a necessary part of gathering information: it helps provides a fuller understanding of the issues underlying the dependence on alcohol and/or other drugs, as well as of the impact this has on parents’ care of their children. It should be viewed as part of a more substantive assessment that takes account of the interplay between other inter- and intra- personal factors.
After all, recovery for our parents is not about providing drug free tests, but about achieving a different way of life. This is about a life of new thought processes, child-centred lifestyles, financial stability, a pro-social social network, better time management, improved family functioning and better ways of dealing with life’s challenges. Change and evidence of change are aspects of the broader context of recovery and, ultimately, the most reliable markers of sustainable recovery are often overwhelmingly evident in the parents and children themselves.
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