YJB Health, Mental Health and Substance Misuse Development Projects Past Present Future Louise Cromp

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YJB Health, Mental Health and Substance Misuse
Development Projects Past Present FutureLouise
Crompton YJB-NTAMarch 2008
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Project Drivers

• Previous research including Galahad (2004)
  indicated
• high prevalence of health, mental health and
  substance misuse issues amongst young people
  entering custody
• reported levels of health, mental health and
  substance misuse issues lower than anticipated
  based on research prevalence
• variable patterns of provision for health, mental
  health and substance misuse
• Research recommendations
• improved screening and assessment procedures
• need for evidence based interventions
• Improved targeting of services to meet need

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Health and Substance Misuse Development Projects

• Project 2
• Development of a Model for Screening and
  Assessment of Health, Mental Health and Substance
  Misuse.
• Screening and Assessment Project

• Project 1
• Development of a Model Approach to Detoxification
  and Related Clinical Management of Substance
  Misuse for Under 18s in the Secure Estate.
• Clinical Management Project

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Project Stages
Estate wide Implementation
Pilot Stage Development Implementation Evaluatio
n
Sign Off and Planning
2004 2005 2006 2007 2008
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CHANGE MANAGEMENTNUMBER 8 WIRE APPROACHThis
is an approach to problem solving using resources
at hand
All this was created or repaired with number 8
wire
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Characteristics of a number 8 wire approach

• the idea that nothing is impossible
• a staged or transitional approach to creating a
  desired situation
• finding new ways to solve old problems
• giving it a go
• innovative and lateral thinking
• commitment to an idea

Pilot sites have used innovative approaches to
implement the projects which we can learn from to
inform further roll out.
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Overall Project Team
Pilot Sites Screening and Assessment Clinical
Management
Research Team Screening and Assessment
Research Team Clinical Management
Experts
Experts
YJB Strategy
Health and Substance Misuse Interdepartmental
Working Group
YJB
NTA
DH
Prison Service
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Role of Interdepartmental Government Working Group

• Trouble shooting across pilot sites
• Consistency in policy and practice
• Links to other cross government developments
• Development of implementation plans

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Research Team and Expert GroupClinical Management

• Jill Britton
• Eilish Gilvarry
• Colin Drummond
• Mike Farrell
• Paul McArdle
• Claire Gerada
• Jan Palmer
• Tom Aldridge
• Dr Linda Harris

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Research Team and Expert GroupScreening and
Assessment

• Dr Sue Bailey Professor of Forensic Child and
  Adolescent Psychiatry, University of Central
  Lancashire
• Dr Ilana Crome Professor of Addiction Studies and
  Academic Registrar, University of Keele
• Dr Justin Lawson Clinical Director,
  Northumberland NHS Care Trust Healthcare
  Development at HMPYOI Castington and Specialist
  GP in Community Substance Misuse team, Blyth
• Dr Heather Payne Consultant Paediatrician, Gwent
  NHS Trust
• Dr Jenny Shaw Consultant Forensic Psychiatrist
  and Senior Lecturer, Manchester University
• Joe Sheppard Senior Manager, Substance Misuse
  Services, HMPS
• Paul Tarbuck Director, BSTMHT
• Dr Jonathan Tripp Consultant Paediatrician and
  Senior Lecturer, University of Exeter
• Dr Stephen West Consultant Psychologist, NWLMHT
  and Feltham YOI
• Dr Richard Williams Professor, University of
  Glamorgan

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Role of Research Teams

• Development of new products based on existing
  research and informed by current practice
• Supporting pilot sites to implement products
• Evaluation of implementation process
• Evaluation of products
• Revision of products following evaluation process
• Report and recommendations following development,
  implementation, evaluation and review

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Pilot Sites
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Role of Pilot Sites

• Involvement of relevant local partners
• Developing Action Plans to guide implementation
• Staff training
• Equipment
• Policy and procedures
• Implementing products and necessary processes
• Enabling data collection and providing data
• Input to development process via Research Teams
  and Multiple Pilot Site Events and Consultation
  Processes

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Aims Clinical Management

• To develop guidance for the substance misuse
  detoxification and related clinical management of
  young people within the secure juvenile estate
  which includes identification of those requiring
  medication and management of pharmacological
  interventions as well as the role of clinical
  staff in the integrated care pathway
• Consult with staff to ensure fit with staff and
  young people within the secure juvenile estate
• To pilot the guidance staff and young people to
  ensure suitability and effectiveness
• To trial implementation of the guidance across
  additional sites.

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Clinical Management Progress to Date

• Recruitment of Stage 1 Pilot Sites
• Pre Review of Individual Medical Records
• Development of Clinical Management Guidance
• Stage 1 Sites Implemented Clinical Management
  Guidance
• Recruitment of Stage 2 Pilot Sites
• Stage 2 Sites Implemented Clinical Management
  Guidance
• Evaluation across all sites
• young people - interviews
• Staff - interviews
• Research sheets
• Review of guidance based on evaluation process

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Mid project ImplementationReport - Clinical
Management

• Varied structures re clinical management across
  sites
• Important to have clear leads with clear role
  expectations
• PCT Relationship
• Placement Role

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What next?Clinical Management

• Final stages of development project
• Report
• Guidance
• Development of Clinical Management Guidance for
  Substance Misuse for Under 18s in Community
  Settings
• Department of Health Gateway Approval
• Finalisation of Cross Government Plans to
  implement the instrument
• Resources
• Implementation models
• Timeline

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Aims Screening Assessment

• To develop a combined identification and
  assessment method for mental and physical health
  and substance misuse suitable for young people
  and use by staff across the secure juvenile
  estate
• To develop a manual to accompany the
  identification and assessment method including
  guidance for use and staff roles and competencies
• To determine the effectiveness of the
  identification and assessment method as it is
  used across the secure juvenile estate.
• To develop effective training and implementation
  methods for ensuring staff across the secure
  juvenile estate have competencies for
  implementing the identification and assessment
  methods.

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Screening Assessment Progress to Date

• Survey of Current Practice Across the Estate
• Development of instrument
• Recruitment of Pilot Sites
• Pre Review of Individual Medical Records
• Sites implemented pilot Screening and Assessment
  process
• Post Review of Individual Medical Records
• Commencement of Gold Standard evaluation
• Review of instrument based on evaluation process

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Mid Project Implementation Report - Screening and
Assessment

• Current status of service provision
• Historical factors location, resourcing,
  workforce issues
• Contemporary factors establishment type, work
  load, culture
• Geography of site impact on multi-disciplinary
  working
• Current status of multi-disciplinary working and
  information sharing
• Involvement with other initiatives
• PCT Developments
• Site approach to change

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What next?Screening and Assessment

• Final stages of development project
• Report
• Instrument
• Department of Health Gateway Approval
• Finalisation of Cross Government Plans to
  implement the guidance
• Resources
• Implementation models
• Timeline

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Transition

• Young people experience stress and anxiety when
  leaving residential substance misuse and changing
  treatment intensity. (Ref 77)
• When leaving residential treatment young people
  were concerned about leaving the supportive
  environment of residential care, returning to
  difficult family situations and meeting former
  friends who still use substances. These concerns
  were borne out when they did come home where they
  often found it hard to readjust, as their
  families had not necessarily changed, or
  recognise the changes in their child (Duroy et
  al, 2003).
• High proportion of young offenders who report
  problematic substance misuse in custody report
  parents with substance misuse problems
• Before the end of treatment the transitional
  process should be planned and should include the
  young person, their family and identify the
  services they need. Wood et al (2002)
• Young people need support during transition for
  at least three months. (Ref 78 79)

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Drug Strategy

• Preventing harm to children, young people and
  families
• Making improvements to treatment systems for
  young people
• Improve the transition between secure settings
  and the community for young people in the
  treatment system by
• Issuing a revised National Specification for
  Young Peoples Substance Misuse Services in Secure
  Settings
• Wider implementation of NTA Guidance
• Ensuring better integration with health care
• DH YJB DCSF MOJ