It is difficult to define what is meant by “parental substance misuse”, and almost impossible to be certain about the extent and nature of the phenomenon. However, it is clear that it is an issue in a wide range of family situations, that for some children it can cause serious harm and that very large numbers of children are affected. It is certainly a social problem that has a considerable impact on children’s social services, with most children who come into care being affected by parental substance misuse. Yet until recently there has been little research on the issue and there is limited evidence about what works in helping such families. This presentation considers some of the challenges inherent in such work and outlines key elements involved in effective responses. It then reflects on lessons from 3 recent studies carried out by Dr. Forrester and colleagues. These were a study looking at social work communication skills, one exploring the potential of Motivational Interviewing (MI) for helping families (both funded by the Alcohol Education and Research Council) and one evaluating the impact of an Intensive Family Preservation Service (“Option 2”) that uses MI in serious child protection situations (funded by the Welsh Assembly Government). In conclusion it is argued that understanding what works in helping families affected by parental substance misuse provides an opportunity for radically improving children’s social services in three important ways. Firstly, it provides an opportunity for social work and social care to learn from the research traditions of the substance misuse field. Secondly, it offers promising approaches that work with difficult behaviour change issues that are likely to be of wider usefulness. Thirdly, and most importantly, it offers a new vision for how services and policies should be designed and delivered. This vision focuses on “rehumanising” social work through attention to client/worker relationships and the structures required to support workers to deliver “evidence based” interventions. This is contrasted with the managerial/bureaucratic and market-based visions for social services that currently dominate policy.