Children living with parents who use substances are a group of children who are overlooked in legislation, policy and practice. This guide draws on research that puts children’s voices front and centre. Findings from safeguarding practice reviews consistently show clear system failures and a lack of inter-agency communication where parental substance use is identified as the primary factor in the significant injury or death of a child. Through attention to the child’s narrative, this guide will support social workers in their assessment of risk and the protective factors needed by children to buffer against the negative impact of parental substance use.