Alcohol and Drug Training for Social Workers

Back in April I looked at the number of young people in the care system that were identified as needing treatment for substance misuse.  The bald figures were that 1 in 29 young people in care were identified as needing treatment, which compares to 1 in 240 amongst the general population.

One of the questions I asked was whether the system is good at identifying need and acting on those needs.

A new report from the University of Bedfordshire, published on the Alcohol Research UK website, suggests that social workers aren’t getting the level of training they feel they need in this area.

The key finding seems to be that there is no consistency in how drug and alcohol education is delivered to trainee social workers, with three quarters of respondents saying that they felt there wasn’t sufficient focus on the issue in what was provided.

Looking at the detailed report I can’t find any reference to preventing drug and alcohol misuse though this may be included in the modules that look at how to talk about alcohol and other drugs.  By contrast there are courses that talk about treatment interventions.

In children and family modules the topics that are reported as being covered most often are:

  • Impact on children and families and parenting
  • Identifying problematic alcohol use
  • How to assess risk relating to drug or alcohol issues
  • Working with or referring to specialist alcohol and/or drug workers
  • Reasons people use and misuse substances

The University of Bedford have what look like a number of useful resources on their website including:

Other papers can be downloaded here.

Dame Sally Davis, Chief Medical Officer, calls for more investment in prevention & end to silos

Quote

Two quotes from Dame Sally Davis, the Chief Medical Officer:

The rise of lifestyle diseases and chronic disease means we should probably put any rises of money we get into prevention rather than into more acute care. But we’ll only get that if we build the evidence base while using economic modelling to make the case.

We have absolutely got to build the case for investment, but we have got more economists in the department working on the job and we are commissioning more economics on prevention.

And:

We can, in fact, crack lifestyle diseases. But we need to stop tackling them in silos with a tobacco cessation clinic here, a contraception clinic there and alcohol treatment somewhere else. We need a broader cultural change across society to achieve that, and one that embraces Public Health England, schools and the health care system.

Recommendations for improving the capacity of public health in the UK

Aside

A paper for the EU about the capacity of public health across the continent identifies the following as the recommendations for action:

  • Build competence across all sectors that can contribute to the health of the public within and beyond health care
  • Develop skills and knowledge (competences) in the wider workforce (i.e., those who make an impact on the population’s health through their role but would not necessarily call themselves public health workers e.g., teachers and urban planners. This workforce already exists and needs recognition and awareness-raising of their potential contribution
  • Improve information linking environmental factors and others (e.g., transport, planning) with health outcomes (e.g., to effect behavioural change) 
  • Ensure public health retains its influence across all sectors and at all levels by carrying out health impact analysis on all public policy; ensure that importance and relevance of public health is well understood by all sectors 
  • Strengthen multidisciplinary/multisectoral public health workforce that is adequately resourced to meet the needs of the population
  • Ensure adequate investments in health and well-being
  • Ensure that proposals for developing a new Public Health Service in England lead to enhancement of links with academia to expand capacity, and translate research into practice, and ensure that more undertaken research is informed by service needs
  • Additional research funding in areas such as evidence to support behaviour change

Intriguingly only the UK’s recommendations specifically talk about including teachers in terms of developing the wider workforce.

Anyway sounds like a good list to me.

School Health Services

I’ve been meaning to write about the contribution that school nurses can make to drug prevention and this report from WHO Europe from 2009 that I came across today has prompted me to at least point out some of the things we know.

Across Europe it appears that most school health services have some responsibility for substance misuse prevention.

school nurses

Cross referencing this with the PSHE mapping exercise carried out by researchers from Sheffield Hallam University a few years ago suggests that quite a lot of the drug and alcohol prevention activities that school nurses in England undertake are outside the classroom.  That review found that 17% of schools (both primary and secondary) used school nurses to deliver at least some of their drug education.

Health England when they looked at preventative spending in the NHS were able to show that of the £5 billion being spent on prevention and public health services in 2006/07 £159 million (3%) went to school health services.  They were able to split this down between primary (£44m) and secondary (£115m) prevention, and noted that £17 million could be attributed to the national Health Schools Programme.

Since then the government have issued a new vision for school health services, Getting it right for children, young people and families, which says:

School nurses will be part of teams providing ongoing additional services for vulnerable children, young people and families requiring longer term support for a range of special needs such as disadvantaged children, young people and families or those with a disability, those with mental health or substance mis-use problems and risk taking behaviours. School nursing services also form part of the high intensity multi-agency services for children, young people and families where there are child protection or safeguarding concerns.

There is a useful brief overview of this vision produced by the Department of Health and the LGA aimed at councillors, which can be downloaded here.

Also worth examining is the NICE guidance on school based interventions for alcohol, which makes the following recommendations (identifying school nurses as one of the groups who should take action):

  • alcohol education should be an integral part of the school curriculum and should be tailored for different age groups and different learning needs
  • a ‘whole school’ approach should be adopted, covering everything from policy development and the school environment to staff training and parents and pupils should be involved in developing and supporting this
  • where appropriate, children and young people who are thought to be drinking harmful amounts should be offered one-to-one advice or should be referred to an external service
  • schools should work with a range of local partners to support alcohol education in schools, ensure school interventions are integrated with community activities and to find ways to consult with families about initiatives to reduce alcohol use.

Finally below is a presentation that the Drug Education Forum had at one of the seminars we ran. It describes a multi-agency approach to improving health and wellbeing for young people in Bury, which included school health services.

Policy Précis – Making the link: Youth and health equity

Aside

Drawing on the recommendations of the WHO the Equity Channel website have produced a policy précis about young people and creating health equity:

The health and wellbeing of young people need specific attention from policy-makers. While an integrated and holistic approach is the way forward, a life course approach recognizing the specific characteristics and needs of every stage in life is needed. Addressing the needs, priorities and risk factors of the youth in a realistic manner, while taking into account differences related to age, gender, sexuality, disability, ethnical and cultural backgrounds, makes social and economic sense for now and for the future.

The whole thing can be downloaded here.

What does a public health response to drug prevention look like?

The debate on what a public health approach to drug policy looks like is not only happening here in the UK but is something that Americans are also looking at following the publication of the Obama Administration’s latest drug strategy.

This piece at the ever interesting Alcohol and Drugs History Society’s Points blog asks whether there’s any appetite in the public health community to ‘own’ the issue alongside the many other issues that they have traditionally addressed.  And it points out that public health measures can also mean:

fear-mongering and produce risk, blame and shame in their efforts, identifying “risky” lifestyles and behaviors. At its best, public health projects can address the complex etiology and interactions between individuals and their environments as well as focusing on the “upstream” societal factors—poverty and inequality, to name a couple—that are such important forces in determining one’s life chances.

This concern that drug policy could get lost is (broadly) the same point that Marcus Roberts from DrugScope makes here about the emergence of Public Health England and the local government’s budget decisions when it comes to determining local need.

The article on Points does however link to an attempt to map out what a public health approach may look like.  Developed by the New York Academy of Medicine and the Drug Policy Alliance the Blueprint for a Public Health and Safety Approach to Drug Policy sets out one way that New York might try to tackle issues around illegal drug use.

As you would expect the paper has sections that deal with prevention, treatment and the role of law enforcement.  Readers will I hope understand if I focus on the recommendations for prevention.

They are clear about what they see as prevention:

Effective prevention strategies enable people to make healthy choices and improve health outcomes for themselves and their families. Prevention can delay the initiation of drug use, avert the escalation of use, and diminish engagement in drug related activities that can lead to violence and/or criminal justice involvement. Prevention, here, is conceptualized both in its traditional sense of programs that provide education and skills to avoid or address drug use and, more broadly, to encompass community development strategies that address the root causes of drug use and offer individuals meaningful alternatives to drug use and drug dealing.

chart_1 (21)The first of their findings is that there is a desire to see more funding allocated to effective prevention initiatives.  The paper estimates that only 5.5% of the federal budget for drugs was spent on prevention work.  (It is worth noting that when the UK Focal Point estimated central government spending on drug policy here in the UK they were barely able to identify any spending at all.)

The paper argues:

Research shows that prevention programs can also be cost effective; for each dollar spent on prevention, communities can save up to $10 in drug treatment and counseling costs.  Too often, however, drug prevention programs are underfunded, narrowly defined, and operate in isolation, especially from other health promotion and community development efforts.

They are, however, keen to point out that what they are not calling for is solely investing in education and messaging (though they remain part of the mix) but to extend prevention to tackling the risk factors and building protective communities and environments in which young people can grow and which foster resilience.

The conception of a community prevention strategy is focused on the social determinants of health, particularly by reducing unemployment – which, for the authors, is also linked with providing alternative economic routes for those who may otherwise engage in drug dealing.

Youth Development

It is clear that the consultations that the authors did in drafting the report suggests that drug use by young people, and trying to prevent those harms was a significant issue for communities and professionals.

Prevention programming that facilitates positive youth development not only decreases drug use, but also reduces delinquency, violence, drop-outs, and teen pregnancy. Community members and academics highlight several risk factors for young people that needed to be better addressed in New York communities, including normalization of drug use and other problem behaviors by the media, peers, and, in some cases, parents; academic failure; family conflict; community disorganization; and lack of opportunities for positive involvement with family and community members.

The authors highlight the difficulty of providing positive out of school activities that focus on developing young people as a significant barrier to a good prevention strategy.

Drug education

The paper echoes our experience – see for example the youth led research we did for the London Youth Involvement project – that school drug education isn’t currently meeting the needs of young people.

Several participants, including young people, felt that current education strategies were nonexistent, under-resourced, or ineffective.

They are however able to report that nearly half (47%) of those who received prevention services got an evidence based programme; something we couldn’t claim.

The paper is clear that a a wide health education curriculum is part of what is needed:

According to research, a broad health based curriculum including drug education, along with life skills and decision-making training, can impact the choices young people make on a range of issues (drug use, gang involvement, violence, delinquency, teen pregnancy, etc.).

But the curriculum isn’t enough:

Schools were identified by community members as an important—but missed—opportunity to increase youth engagement, raise achievement expectations and outcomes, and more comprehensively address students’ needs in ways that can prevent drug use and drug dealing. Participants wanted schools to go beyond health education and do more to bolster positive youth development and academic achievement.

And what schools do should be allied to providing parents with the information and skills they need to be able to support school based drug education.

This draft strategy of building skills, supporting positive health behaviours and the protective factors that make risky behaviour less likely allied to a wider prevention push on the social determinants of health is very attractive to me and fits neatly with the UN’s recent prevention standards.  But it requires significant political will to make it happen, and that will be difficult to achieve in a period where resources are tighter than ever.

 

Managing high risk behaviours in adolescents – Ofsted case study

Aside

In December 2007, Ethan, a 14-year-old boy, died as a result of a heroin overdose. Ethan was looked after and being supported by a range of services that were intended to protect him. Following his death, an independent management review was undertaken to establish what lessons could be learnt and what actions needed to be taken to minimise the risks to other young people. 

Ofsted have highlighted Northumberland County Council’s risk management model which seeks to safeguard adolescents who are taking significant risks with their health.  Their briefing “provides an overview of the processes in place in Northumberland and the impact that this way of working is having. It includes information about the risk management framework, a multi-agency partnership approach and engaging young people.”

Fishy figures

nutt letter to times

Professor David Nutt writes to the Times to make a point about the importance of survey design.

As you can see he is pointing out that the way that the study that was reported recruited participants was likely to lead to over reporting of drug use.

When the Home Office last reported on drug use by adults they were able to show prevalence levels by various occupations including those who were full-time students.

What that data shows us is that while full-time students were the most likely to say that they have used drugs compared to other occupations it remains the case that 83.9% don’t report using drugs.

student drug use 2012

This is important as Professor Nutt says because giving the impression that drug use is rife amongst student populations sets a social norm that may be self-fulling in that it sets expectations for future generations of university students.

Public Health Outcomes Framework

I’ve written before about how data is likely to drive decisions in what gets done in public health so it’s useful that there is now a Public Health Outcomes Framework website which provides quite a lot of information at a locality level.

So below is a screen shot of a heat map depicting the number of first time entrants to the youth justice system per hundred thousand of population.

first time youth justice

There’s also regional level data – below are the proportions of pupil absence in the North West.

north west

And the site lets you drill down to council level, below are some of the statistics for Birmingham that relate to the wider determinants of health as measured amongst young people.

birmingham

Users can see the outcome of drug treatment, the vast majority of whom will be adults (as you can see in the heat maps below this is broken down by opiate users and non-opiate users). As yet the alcohol related outcomes don’t appear to be available, nor are the prevalence data for smoking, drinking and drug use by young people, though if this tweet is anything to go by there are plans to keep adding to the data sets.

treatment outcomes