London Identification and Brief Advice Practitioner’s Network

Over the last few months I’ve been pleased to be part of the advisory group for the Identification and Brief Advice (IBA) Network.

IBA is an evidence based, effective intervention to identify and intervene with individuals drinking at levels above recommended guidelines.  I wanted to support the network in part because of our experience on the Street Talk project where we found that this sort of approach fitted well with young people who were already taking risks with their health.

The network isn’t for drug and alcohol specialists rather it aims to support staff, practitioners and clinicians working in London to deliver what is quite a simple but effective approach to reducing harm.  If you’ve had training in this area, or want to be more effective in how your organisation can support those at risk then the network could be a way of supporting you.

You can find out about the IBA network by clicking on this link. You will be able to find out about the aims and download the latest newsletters. The network provides support, information, advice, resources and updates on the most recent research in this area.

Membership is free and it’s very easy to sign up. If you would like to join the network or come along to our next meeting on 20th June at Guildhall in London please email fizz@alcoholacademy.net

Key messages from EMCDDA Brief Interventions and Motivational Interviewing meeting

emcdda bi eventReaders may remember that I was one of a number of speakers at an EMCDDA seminar earlier in the year.

They have now published the minute of the event and some of the presentations.  The minutes include the following key messages:

  • ‘Early intervention’ is a term that should be treated with caution (e.g. in quotation marks) as it does originally not refer to intervening early in drug use trajectories, but early in lifetime and is not necessarily related to substance use.
  • More useful in this environment is the term ‘brief interventions”. These interventions have, often with a motivational interviewing element, been applied to a number of settings. 
  • Most of the literature on BI and MI is about adults, alcohol and primary health care. Implementation and effectiveness research on cannabis, other illicit drugs, young people and other-than-health-care settings is scarce.
  • Effectiveness: Brief Interventions and motivational interviewing are effective, at least in primary health care for alcohol. Also the evidence on cannabis use is very promising; as well for computerised interventions (Carey et al., 2009; Khadjesari et al., 2011; Moreira et al., 2009; Rooke et al., 2010). It seems not to matter much who delivers the interventions, in terms of basic professional training, provided they have sufficient dedicated training and motivation.
  • Roll-out: Brief interventions with a motivational interviewing are feasible to be applied in primary health care, particularly in National Health System. Experiences in UK and Spain have shown that. There are also promising experiences with young people and in street work settings. Better coordinating and streamlining existing different services (‘bust the silos’) might be an option in austerity times in order to achieve positive outcomes on health, social and substance use behaviours.
  • To implement BI in public health systems, it needs to be backed with proper specialist referral systems and training systems for front line professionals: they need to know where to send people with special needs and have sources of support and skills development.

EMCDDA | European exchange on Brief Interventions and Motivational Interviewing for people using drugs.

Policing young people – use of stop and search for drugs and how feeling drunk affects the relationship

Police by Dave Pearson from Flickr

The Police Foundation have produced an interesting report about the policing of young adults, which has many echoes of the things we found in the focus group work that our youth advisors recently completed in London with a slightly younger age group.

The young people our youth advisors spoke to talked about the poor relationship between young people and the police, a point the Police Foundation report reiterates:

Negative stereotyping by young adults of police and vice versa leads to negative encounters and outcomes and can even become a self-fulfilling prophecy. Young adults resent yet another stop, and do not listen properly to the reasons given. Police know that some young adults are prolific offenders and may be carrying weapons, illegal drugs or stolen goods; so they see stopping and searching them as rational. It also allows them to do something. If nothing is found, this does not stop the police feeling suspicious next time; if something is found, it simply confirms their negative perceptions.

This struck home to me as I took a look again at the figures for stop and search for drugs in London.  As you’ll see over half of stop and search’s that took place in the capital in 2011 were for drugs, but relatively few arrests followed.  Indeed if I’ve done my maths right for every arrest for drugs 38 searches were carried out.

For those under 18 years over 126,000 were stopped by the police in that year, and whilst the data isn’t broken down as to the reason given we do have a breakdown of arrests; where the proportion for drugs is even smaller than it was for the overall population.

If we turn to look at the data that’s available for how young people are in contact with the police you’ll see that about a quarter said that they had been in touch with the police for one reason or another over the last year.  But those who had felt drunk in the last year appear to have been twice as likely to have had contact compared to those who hadn’t been drunk.  And that having felt drunk is correlated with feeling less positive about the police.

Our youth advisors are considering three recommendations which will be finalised over the next few months.  They are:

  • Police and trading standards should liaise more closely to enforce ID policies around alcohol sales.
  • There should be a more visible police presence in areas and at times where there is a high number of drinkers, drug users and drug dealers. 
  • Ways to increase and improve communication between young people and the police should be identified and put into practice, for example:
    • training;
    • close work with schools to enable Schools Liaison Officers to have more opportunities for positive communication with students;
    • improved relationships between local youth clubs and organisations and community police officers;
    • identification of ways to feed back to young people how the police are making their area safer for them.

#LDNprev conference

“Inspiring, interesting and informative”, the three words most used to describe Mentor’s youth advisors #LDNprev conference to discuss helping young Londoners to be safer when it comes to drugs and alcohol.

LYIP feedback

The conference included sessions on school drug and alcohol education, the skills that parents need to discuss these issues with their children, and on community safety.  These were based on research that our youth advisors had carried out with over 1,000 young people, experts, and policy makers and have been written up into three short papers published on our website.

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EMCDDA meeting on Brief Interventions and Motivational Interviewing

emcdda bi eventHaving been invited to make a presentation to an expert meeting at the EMCDDA I’ve returned feeling that I’ve learnt as much as I’ve contributed.

My presentation described what Mentor and Addaction did as part of our Street Talk project last year.

As anyone who was following my Tweets from the event would have seen I was preceded by contributions from Spain, Poland, Germany and Jim McCambridge from the UK.

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Police in England and Wales arrest a child every two and a half minutes

The Howard League for Penal Reform sent out a press release yesterday which points out that the police in England and Wales arrested a child every two and a half minutes last year.

But looking at the detail in the release what is clear is that there have been significantly fewer children being arrested than there were a few years ago.  In fact the numbers being arrested have fallen by a third in that time.

Child arrests in England and Wales 2009 - 11

The CEO of the Howard League, Frances Crook, argues:

Only a handful of children are involved in more serious incidents and they usually suffer from neglect, abuse or mental health issues.  A commitment to public safety means treating them as vulnerable children and making sure they get the help they need to mature into law-abiding citizens.

I thought this may be of interest to us because of the work we’re doing with Alcohol Concern about entry into the criminal justice system as a result of alcohol misuse in London.  The London figures (below) show a similar downward trend (if less pronounced) in the use of arrest.

Arrests in London 2008-11

What isn’t clear is what alternatives to arrest are being used by authorities to deal with those at risk of entering the criminal justice system, or whether there have been the sorts of drops in criminality that these figures suggest, or whether the changes to the performance management regime mean that the police are no longer incentivised to arrest young people.

LYIP Focus Group Findings on Parents and Prevention

Merton 3The Youth Advisors have been working hard over the last few weeks on focus group research. They devised a  set of questions to try and capture information from other young Londoners about the role of parents in prevention. The next step was to meet with their peers across the capital and discover their views. To date, over 70 young people have taken part.

We have had fantastic responses which have allowed the LYIP develop some recommendations. What’s been especially fascinating is the level of consistency in responses. An overview of what we’ve discovered so far will give you a sense of how well the group has been doing.

There was an overwhelming belief amongst young Londoners we spoke to that parents do have a role in educating their children about drugs and alcohol.

Their children have the right to know that their parents are […] looking out for it. […] The fact that they do say something about it sort of shows that they do take responsibility.

Young people believe that parents’ responsibility for drug education should be seen as one aspect of a well-rounded approach which includes school and the wider community, “from schools to government to extra-curricular activities to parents”.

There are, however, a number of ‘buts’.  Many young people report not talking to their parents about drugs and alcohol and they offered a number of suggestions as to why this is the case.

Lack of knowledge:

My parents don’t know about drugs and alcohol.

They don’t want to say anything just in case they say something wrong and mess it up.

Cultural barriers:

[Parents from some cultures], shy away from it or don’t mention it at all, ‘cause you’re taught it’s wrong. Full stop.

You just know – culture-wise […] I’ve never had that conversation, but it’s just one of those things you don’t.

An unwillingness to acknowledge drugs and alcohol may ever be an issue for their children:

Maybe they know, but they just don’t wanna believe it, ‘No, my child’s not taking drugs’ sort of thing. They just don’t want to talk about it because they do think it’s an awkward situation.

The uncomfortable nature of holding a conversation about drugs and alcohol:

Not a lot of parents feel comfortable to actually talk about it

It depends on what kind of parents people have. Some people are comfortable talking to their parents and some people are not

Parental knowledge around drugs and alcohol was discussed in depth. There was not an expectation amongst young people we spoke to that parents should have a comprehensive knowledge of drugs and alcohol. However, the majority of young people did believe that they should have at least a basic knowledge and were clear that simply saying ‘no’ was not enough. Young people want to know why.

Being youth, you’re more intrigued to know about everything.

If they’re actually educated enough that they know all the risks and all the perks as well, then they’ll be able to weigh it up themselves.

They can say, ‘Oh yeah, it’s not good,’ but then kids will probably go on and think, ‘Oh, that’s all they know, they haven’t really told me enough information so obviously they don’t know enough and nor do I’.

Some young people spoke of a contradiction between a non-negotiable ‘no’ message coupled with scare tactics from parents and the experiences they saw for themselves at parties or with friends. Without a more rounded discussion, this may make children more likely overlook a parent’s message given the wide gulf between what they hear from them and what they have actually seen.

Young people were also concerned that without enough knowledge, parents may give them wrong information:

I […] do not believe that parents always have the right advice because they might not always be, like, fluent in the sort of stuff.

It could go the wrong way […] if parents don’t know how to handle it.

Basic knowledge, together with clear messages about decision-making, were considered important by many of the young people we spoke to.

Young people were also clear that talking about drugs and alcohol to your children should start early. The majority of participants suggested that conversations should begin before children become teenagers, either at the end of primary school or the beginning of secondary school. Young people clarified that conversations often only occur too late or “after the event” and believed parents have a role in pre-empting this.

I think sometimes, the younger age, people tend not to think about it […] but by the time they do decide that they’re going to talk about it, there’s been a lot of outside influences.

Overwhelmingly, focus group participants said that conversations should be open, relaxed and recurrent. ‘Sit down’ talks were considered awkward.

It should just be an open dialogue. It shouldn’t be a sit down conversation that’s going to be really awkward. It should just be […] brought up casually and not really made a big deal ‘cause otherwise it will just […] feel really weird afterwards.

There was a sense that this would be much easier for some parents than for others. Those who had open relationships with their children anyway should carry that openness into conversations around drugs and alcohol. Young people also spoke at using stimuli in order to begin conversations, in particular responding to news stories, documentaries or other television programmes.

Parents who adopted an authoritative as opposed to authoritarian parenting style were thought by many young people to be in a good position to help prevent young people from using drugs and alcohol. Young people were not opposed to boundaries being put in place by their parents, but they did want them to be reasonable and to be open to discussion.

I understand why they give you a curfew and at this point I don’t really mind.

We live in London – they’re looking out for me [by setting a curfew].

If you don’t set boundaries then you have no boundaries.

Parents need to be understanding of their children. They can’t just expect them to be perfect all the time […] work with them.

There was a strong theme of overly-strict parenting leading to rebellion.

They’re more sneaky if their parents are more strict.

They’re more likely to rebound due to those boundaries because they feel […] suppressed.

They [children] might find it bullying sometimes maybe and intimidating, that they’re saying, like, they don’t trust their children that much and they [the children] just, like, want to revenge or something.

Recommendations

The group met on Saturday 1st December to look through their research findings and have developed a set of draft recommendations.

  • Parents must play a part in educating their children about drugs and alcohol.
  • Parents should have opportunities to improve their knowledge about drugs and alcohol. This could be in a school setting and should offer the opportunity for parents to work together on determining their roles and responsibilities.
  • Parents should ensure that conversations about drugs are recurrent, relaxed and open.
  • Conversations about drugs and alcohol should begin before children become teenagers.
  • Children are less likely to rebel and more likely to talk to their parents if they adopt an authoritative as opposed to authoritarian style of parenting.

Could the Internet help deliver health information to young people who have been through the prison system?

This intriguing paper from the US looks at whether the internet might be a good way of delivering health information to young people on release from prison.

Admittedly it is a small survey – only 79 people – but it suggests in that community at least that there are high levels of access to the internet outside of prison and that accessing health information online could be seen as a positive way of engaging with personal health information.

It would be interesting to think about whether the young people we’re working with in the Breaking Out project expect to have access to the internet once they leave Polmont, and whether an online service might be one of the ways we could support their health behaviours once they are released.

Any thoughts?

Substance Misuse Prevention and Mental Health Prevention

I’ve been asked to give a talk at a conference in November in a session on the links between substance misuse and mental health and looking at practical things that schools might do to prevent problems across these interlinked areas.

The causal effect of substance use and mental health problems are complex and contested, but what is more clear is that there are some programmes that seem to effect both substance misuse and mental health outcomes.

Yesterday Claire sent me a link to a presentation about the Good Behaviour Game – a primary school strategy which is particularly good at protecting vulnerable boys from early school failure and subsequent drug and alcohol misuse.

There is a very telling slide [above] on the effects the programme has on the idealisations and attempts of suicide that makes it clear just what an effect the programme can have on mental health.

And today I’ve come across a paper which looks at a depression prevention programme and describes the secondary benefits the programme appears to have for substance misuse.

The programme that was being tested was an indicated prevention programme – one that works with young people who are already at risk for depression because of the presence of elevated depressive symptoms.

The trial randomised over 300 high school students who were judged to be at risk into one of four groups, a group that received the programme, one that had a “supportive-expressive group intervention”, cognitive–behavioural (CB) bibliotherapy, or receiving an educational brochure as a control group.

The researchers found that:

Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants.

As you’ll appreciate being able to show an effect over that sort of period of time is potentially quite important.

Healthy Endings

Never underestimate the power of youth work.  It’s a way of working with young people that, at its core, is about meaningful relationships, relationships defined by clear boundaries, which seek to engage, motivate and inspire.

ImageI have been priveleged to work with The London Youth Involvement Project for the last year with a group of remarkable young people.  Sadly, that work is coming to an end as the permananent project officer is returning to to take over, the fantastic Nicola.  We often fail to recognise the importance of “healthy” endings.  With this in mind our ending of this phase of the project was to have a day out enjoying each other’s company and challenging ourselves with some exciting activities including the dreaded “Leap of Faith”.  We shared a bbq and  each young person chose a card at random to keep to remind them of our time working together, along the following lines.  “Fun, your guidance is to take time to enjoy yourself.  Relax and find your sense of humour.  Treat things lightly.  Fun brings lightness of spirit, and the most difficult situations can be eased if you see the funny side of things, so cultivate a sense of the ridiculous.

The work has reminded me of the value of frames of reference.  And a vital one is to have an understanding of the importance of healthy attachments including the making and ending of them.  Bowlby has written widely on this and it is a key theoretical component of “That Can Be Me”.

Remember the importance of, and pay attention to, positive endings.

Si