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Estimating the prevalence of the ‘toxic trio’

Evidence from the Adult Psychiatric Morbidity Survey

This report contains new quantitative analysis by the Children’s Commissioner’s Office (CCO) on the potential numbers of children in England living in households where the ‘toxic trio’ of factors affecting adults may be present. The ‘toxic trio’ is the interaction of:

  • Domestic violence and abuse (DV&A) within the household
  • Parental substance misuse (alcohol or drugs)
  • Parental mental health issues

There is a wide literature showing that each of these issues can have damaging consequences for the wellbeing and outcomes of children; see, for example, Wolfe et al. (2003), Manning and Gregoire (2009), Stanley and Cox (2009), Cleaver et al. (2011), Guy et al. (2014), Harold et al. (2016), and Hedges and Kenny (2018). The ‘toxic trio’ issues – and associated responses of frontline practitioners – have been cited as a major driver of the increases on children’s services caseloads and the numbers of children being taken into care (ADCS, 2016), and have also been frequently cited as a factor in serious case reviews (Sidebotham et al., 2016). Despite this, there is very little recent and representative empirical evidence on the prevalence of these factors, especially their co-occurrence within the same household.