Helping parents who misuse substances meet the developmental needs of their children is a complex issue. In addition to the challenge of parenting a child that may have special developmental needs as a result of in utero exposure to substances, the parent may face the adverse influences associated with a drug-using lifestyle. The case of Jane presented in Box 19.1 (overleaf) highlights many of the issues facing women who misuse drugs and/or alcohol. Clearly, any intervention aimed at improving her parenting will need to be comprehensive, and raises the question of whether programmes targeting substance-misusing parents can be effective. The case study also raises issues concerning the safeguarding of her children. What are the responsibilities of GPs concerning this mother's capacity to parent her 5-year-old son and the prevention of potential risks to her unborn child?