Is the provision of information enough to reduce risky behaviours in young people?

Drugs Kill, photo by Flikr user Randy Edwards

The government’s drug strategy talks about ensuring schools provide accurate information on drugs and alcohol through drug education as a core element in its attempts to reduce drug use, but is does the evidence suggest that information provision will work?

The Department for Education have commissioned the Centre for Understanding Behaviour Change to produce a review looking at research focused on raising awareness of the consequences of risk taking behaviours and studies using a social norms approach.

The report finds that focusing on providing information is more successful at changing knowledge and perceptions than changing actual behaviour, and this is particularly true on programmes that focus on the consequences approach.

This is something we’ve been clear about for some time, we consistently point out that emphasising knowledge and health harms (particularly extreme harms) without building up protective factors, skills and values  and reducing risk factors have a history of being ineffective. Continue reading

Children and Young People’s Health Outcomes – implications for drug and alcohol issues

The Department of Health have published their response to the Children and Young People’s Health Outcomes Forum setting out what they propose to do to strengthen the accountability framework for the health and wellbeing of children and young people.

My reading is that we’ve made some progress towards what Mentor was asking for in our response to the consultation carried out in May last year. Continue reading

They’re under the bed…

There’s an excellent post about the use of vivid imagery and provoking fear through public health advertising over on the Brief Addiction Science Information Service blog.

As they say:

Using provocative and disturbing imagery as part of anti-drug advertisements might be unwarranted if it has not been demonstrated to be effective. More research needs to determine whether these kinds of advertisements are successful in preventing harmful drug use and promoting treatment-seeking behavior. Absent careful evaluation demonstrating the efficacy of prevention efforts, the potential for unintended consequences is great. Consequently, vigilance and careful evaluations are key components of effective interventions for addiction.

Health Outcomes for Young People

The Children and Young People’s Health Outcome Forum have reported to the Department of Health.  This report will inform a strategy for young people’s health that the DH have said they will produce this summer.

In our area the Forum have recognised the point that we made in our submission about the lack of local data on drug and alcohol misuse and recommend that a population based children and young people’s survey is developed including indicators which will allow local policy makers to judge the prevalence of substance misuse.  More broadly they see the need for this data to draw in other stakeholders:

Effective delivery of public health services requires the commitment of staff and organisations which are outside the direct control of the health system but are core partners to it. The new health and wellbeing boards bring tremendous potential – to connect schools, the environment, housing and safeguarding services for example, all to improve health outcomes.

In relation to commissioning services the Forum make the following point:

The World Health Organization (WHO) has developed the concept of youth friendly services, emphasising that services that provide young people with good experiences are more likely to be effective and used. Based upon this, clear quality criteria for adolescent-friendly health services were developed, validated and published by the DH in 2007 – You’re Welcome.

Local authority commissioned drug, alcohol and sexual health services also need to be youth friendly and sensitive to the needs of both young men and women. This means being confidential, in the right place, open at accessible times and well publicised to reduce the stigma of asking for help and encourage young people to seek early advice. Involving young people in the JSNA (such as through Healthwatch, chapter 2) will help local authorities design services around how young people in their areas live their lives, rather than around professional boundaries, and provide a more coordinated approach to prevention and support. The duty on local authorities to provide services and activities to improve young people’s well-being provides another opportunity to integrate health advice into youth settings and other services young people trust.

The Forum recommends that the NHS CB, all clinical commissioning groups and LA commissioners of public health services, commission services in a way that ensures that teenagers are managed in age-appropriate services – either in paediatrics, adult services or dedicated young people’s services – and that a measure of this is included in the NHS Outcomes Framework. All services for teenagers should be commissioned using the quality criteria outlined in You’re Welcome.

From where I stand if these recommendations are taken up by Ministers then young people will be in a much stronger position when it comes to the proper development of effective preventative drug services.

Directors of Public Health report loss of resources

Aside

The Association of Directors of Public Health have been surveying their members.  Asking about resources they found that since November 2011 over half had lost resources:

We asked whether there had been a loss of PH capacity since November 2011 (our last transition survey).

  • Loss of DsPH and / or Deputy or Assistant DPH = 12 (16%)
  • Loss of Consultant in PH = 13 (17%)
  • Loss of other Specialists = 12 (16%)
  • Loss of other staff = 29 (38%)
  • Loss of programme funding = 10 (13%)
  • 33 (43%) did not report a loss of capacity

Healthy Places Councils leading on public health

The New Local Government Network have produced an interesting report looking at the new powers around public health that local authorities are to assume in full from April next year.

A lot of the policy discussions I’m having increasingly see the reform of public health as offering a singular opportunity to see preventative services to gain resources that are otherwise very scarce.

The NLGN paper offers some challenges to this easy assumption. They argue:

If local authorities are to succeed in reducing demand for acute services, they will need to shift resources to prioritise preventative measures. However there is often a lack of preparedness to use budgets differently and additional incentives will be needed to promote pooling of budgets between HWB [Health and Wellbeing Board] members.

They report that in 42 per cent of authorities, the newly appointed Director of Public Health (DPH) will be a subordinate to the Director of Adult Social Services or reporting to a ‘super-director’.  There might then be a challenge to get attention to children and young people’s prevention interventions.

The report also makes clear that the relationship with the centre will continue to be important.  Talking about Public Health England (PHE), which takes over from the National Treatment Agency (NTA) and the Health Protection Agency, they say:

PHE will work with partners to provide evidence and analysis to enable local government, the NHS, voluntary and other sectors to invest in prevention, health promotion and protection. For the time being, the nature of the relationship between DPHs and PHE remains uncertain.

For us I think this suggests that we need to develop relationships with Public Health England in ways that we only sporadically were able to manage with the NTA.

The majority of respondents to the NLGN survey do not yet have plans in place to assess performance in achieving public health outcomes or in improving service delivery. Through the interviews HWB members report there is often a lack of clear responsibility for the identified outcomes.

One of the areas where the change of government in 2010 has led to some uncertainty is about what mechanisms will be used to achieve accountability for outcomes, we’ve seen ‘armchair auditors‘ and ‘open data’  touted as an alternative to the Labour government’s reliance on National Indicators.  But there are clearly problems with this approach:

Nevertheless, there seems to be a fair amount of optimism at a local level that the HWBs will make a difference, with pooled budgets and training leading the way in making that happen.  The report argues that for health economies to be made there will need to be a focus on prevention, but acknowledges this won’t be easy to achieve:

For resources to be shifted away from reactive services to preventative services, local authorities and the NHS will need to work together to work out decommissioning priorities, a transition plan and a clear message to the public about the benefits of the decision. These priorities will need to extend beyond the remit of HWB members and into the wider local authority commissioning powers.

To support these decisions the report suggests that PHE and NICE will be critical in providing the evidence base that can be relied on to support the debates that will take place.  Talking about NICE briefings the report suggests:

The briefings will not be in the form of ‘must dos’ for local authorities but rather consist of a menu of cost effective and evidence based actions which local could be used depending on the local priorities and on the needs of local communities. The approach provides clear and concise information about ‘what good looks like’ i.e what works, how it can be achieved and how to demonstrate progress.

As a final note the report is quite gloomy about engaging schools, recognising that pull of education policy towards more autonomous schools and even more focus on academic qualifications may make their commitment to the health of their pupils weaker:

Other health services provided at school might also be at risk if they are not seen as a necessary part of education. These include those aimed at reducing teenage pregnancy, childhood obesity and substance abuse, all indicators outlined by the Public Health Outcomes Framework. Although children and young people are entitled to the universal offer of public health, it is up to the school whether the universal offer is available through schools.

There are several reasons for schools not to engage with public health initiatives. First of all, certain religious schools might find initiatives such as sexual health advice contrary to their beliefs. Second, some schools might not consider health as the key priority of their establishment and do not directly reap the benefits from such initiatives. Some governing bodies would like minimum distractions to the schools day have the space available.