Approaches to reducing alcohol harm for children and young people Young Peoples Specialist Treatment

1
Approaches to reducing alcohol harm for children
and young peopleYoung Peoples Specialist
Treatment London Alcohol Practitioners Forum
20th March 2009

• Sam Cox
• Deputy Regional Manager
• NTA London Regional Team

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Overview

• This presentation will cover
• The role of the NTA in young persons specialist
  treatment centrally and regionally
• The policy context for specialist treatment
• Guidance to support the commissioning and
  delivery of specialist treatment
• Alcohol provision within specialist substance
  misuse treatment
• What makes a good specialist treatment service

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Role of the NTA

• Improvements required in the availability,
  capacity and effectiveness of treatment for drug
  misuse in England
• Pooled Treatment Budget
• Monitoring the performance of DATs in the
  commissioning and developing of treatment
  services
• Reviewing compliance at DAT level with advice and
  guidance issued to support best practice
• Overseeing appropriate use of the PTB
• Less clearly defined role around yp treatment
  until Memorandum of Understanding between DCSF
  and NTA in 2007 which definitively outlined roles
  in relation to delivery assurance
• PTB contribution to yp specialist treatment
• A minimum range of service delivery available in
  each partnership area

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Putting this into context the developing agenda

• 1998 First 10 year drug strategy (updated 2002)
• 2004 HO PSA Target To reduce the use of Class A
  drugs and the frequent use of any illicit drug
  amongst all yp under the age of 25, especially
  the most vulnerable young people
• 2005 DCSF publish Every Child Matters Change for
  Children Young People and Drugs
• 2008 DCSF PSA 14 Increase the number of children
  and young people on the path to success
• Increasing participation and resilience and
  tackling negative outcomes
• NI 115 Reduce the proportion of young people
  frequently using illicit drugs, alcohol or
  volatile substances

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NTA and young peoples specialist treatment

• NTA developing a range of guidance to support
  improvements to national service delivery
• Regional performance assurance role the focus
  is on improving accessibility, quality and
  effectiveness of yp treatment provision
• Needs assessment
• Treatment planning
• Performance data and quarterly progress reviews
• Supporting integration of commissioning function
  into Childrens Trust arrangements
• Partnership level and regional governance
  arrangements

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Treatment Definition

• Young peoples specialist substance misuse
  treatment is a care planned medical, psychosocial
  or harm reduction intervention aimed at
  alleviating current harm caused by a persons
  substance misuse

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Guidance to support quality improvements

• NTA is developing a range of guidance to support
  improvements in young people's substance misuse
  treatment services across England.
• Young Peoples Specialist Substance Misuse
  Treatment Commissioning Guidance
• Young Peoples Specialist Substance Misuse
  Treatment Exploring the Evidence
• Young Peoples Specialist Substance Misuse
  Treatment The Role of CAMHS and addiction
  psychiatry in adolescent substance misuse
  services
• Further guidance planned around prescribing
  practice in the secure estate (YJB led) followed
  by guidance around prescribing practice in a
  community based setting.

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The extent of drug and alcohol use among young
people

• The number of young people in England using
  alcohol and drugs is not increasing
• Drug Use, Smoking and Drinking by young people
  in England 2007 revealed that among 8000 young
  people aged between 11 15
• Those who stated they had never drunk alcohol was
  up from 39 in 2001 to 46 in 2007
• In terms of drug use 25 stated they had tried a
  substance was at 25 in 2007 down from 29 in
  2001
• TellUs3 survey undertaken in 2008
• 86 of the 13 15 year olds indicated there had
  never been any drug use compared with 80 in
  TellUs2 survey in 2007
• Reporting of being drunk in previous 4 weeks fell
  from 19 to 16 in 2008

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Alcohol related trends

• Although regionally it appears that both alcohol
  consumption and drug use among young people is
  lower than the national average it has been noted
  there has been a sharp increase in the amount of
  alcohol consumed by those who do drink and the
  frequency of consumption has also increased,
  resulting in more negative outcomes
• Average weekly consumption up from 5 units in
  1990 to 11 units in 2006
• Increases in amount of drinking to get drunk -
  up to 35 of the 11 to 15 cohort had done this
  when drinking in previous 4 weeks, and 56 of
  15/16 year olds reported having drunk heavily in
  the last 30 days
• Alcohol related hospital admissions in London
  increased for the 11 18 age group from 1,171 in
  2002/03 to 1,769 in 2006/07
• There has been a 57 in increase in
  alcohol-related deaths amongst young people aged
  1534 between 1991 and 2006.

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NDTMS Presentations

• 06/07 Presentations
• Of the young people presenting into specialist
  treatment in 2006/07 10,824 (52) were treated
  primarily for cannabis use and 7,039 (34) for
  alcohol use. This contrasts with the 9,043
  primary cannabis users (55) and 4,886 (30) who
  required treatment for the use of alcohol in
  2005/06

• 07/08 Presentations
• Of the young people presenting into specialist
  treatment in 2007/08 12,021 (51) were treated
  primarily for cannabis use and 8,589 (36) for
  alcohol use
• A further 4,672 used cannabis as an additional
  substance and 6,652 used alcohol 35 and 50
  respectively of all those who reported use of
  additional substances

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What does a good substance misuse service look
like?

• Reflects needs of the population not based on
  historical make up of services
• Clear protocols and referral pathways into and
  out of specialist provision
• Comprehensive range of interventions offered
  all yp specific and evidence based
• Holistic approach to the young peoples needs
• Local services accessible both in terms of
  location and opening hours in appropriate
  buildings with outreach/satellite services

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A good treatment service

• Routinely involves young users and their parents
  and carers in evaluation and responds to the
  feedback
• Monitors clinical outcomes routinely
• Develops good transition protocols and
  relationships with adult providers, CMHTs and
  Probation
• Responds swiftly and addresses crisis
• Waiting times are low
• Delivers effectively against the NTA key
  treatment quality measures
• Ensures the workforce is supported by regular
  clinical supervision, and clear governance
  structures. Training and consultation available
  to generic staff based in targeted settings
• Pathways and protocols to address the
  unexpected.

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Issues for specialist substance misuse provision
in London

• Variable levels of provision and investment
• Screening to identify need is not routinely
  implemented
• Uncertainty/mixed practice in applying threshold
  for specialist treatment
• Demands on time and resources of specialist
  workforce to support generic staff
• Workforce development difficulties, high churn
• Variable commissioning especially around
  residential/inpatient services and
  pharmacological interventions
• Variable waiting times
• Difficulties with transitions

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Improving provision

• Opportunities for joint working as substance
  misuse agenda is increasingly embedded in
  childrens commissioning structures and linked
  operationally with generic provision
• Benefits from emerging evidence base to inform
  practice
• Revisions to NDTMS YP core data set wef 01/04/09
  will support robust needs assessment in future
  and then impact on quality of treatment planning
• Commitment cited within Youth Alcohol Action Plan
  for DCSF and NTA to review young peoples
  specialist treatment plans and to develop
  additional guidance on basis of findings of review