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.”

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Substance misuse amongst looked after children

We know that being in care is a risk factor for substance misuse so I’ve been looking at the  DfE figures on outcomes for looked after children, which (if I’ve read them properly) suggest that:

  • 1 in 20 of those young people who got a drug treatment was a Looked After Child.

The last figures that the NTA released on youth substance misuse treatment numbers reported that 20,688 under 18s accessed specialist support in 2011/12, of whom 1,030 were Looked After Children between the ages of 10 and 18 years.

Doing some (very rough) maths I figure that there is a ratio of 1:240 10 to 18 year olds (in the general population) accessing a treatment service; in the looked after population this ratio falls to 1:29.

The DfE report that of the 1,880 assessed as needing an intervention 1030 received one, 580 refusing treatment and 270 cases where the outcome isn’t recorded.

What this data can’t tells us is:

  • Whether earlier interventions were tried
  • Why 30% refused an intervention (and the outcome for 14% is unrecorded)
  • Whether the system is good at identifying young people needing treatment

Marking the government’s drug strategy from a children’s rights perspective

crae - 2012The Children’s Rights Alliance for England in their review of government action on the meeting the Convention on the Rights of the Child mark the government as having overseen a “significant deterioration in law or policy in the past year” in two of the three sections on drugs and alcohol.

They say that there has been a worsening of the position in relation to:

  • providing accurate and objective information on drugs and alcohol to young people; and
  • ensuring support is given to those attempting to end dependency on toxic substances

They also say there has been no significant no significant change in law or policy in the past year when it comes to studying the causes of substance misuse in order to provide targeted preventative measures.

Of particular concern to the authors is the impact of the increasing number of academies on health education.  They say:

The deregulation of education means that increasing numbers of academies and free schools are not under an obligation to, for example, teach key aspects of the curriculum in relation to sex and relationships, drugs and alcohol and citizenship. It also means that schools are subject to weaker accountability and oversight mechanisms.

The report quotes the evidence that we gave to the Home Affairs Select Committee on drug education and prevention.

The National Treatment Agency has an interesting paper out about club drugs which is the increasingly generic term for a range of substances that are heavily associated clubbing culture.

The drugs include ecstasy, GBH and GBL, Ketamine, Methamphetamine, and Mephedrone.

The data that the agency presents shows that the numbers of young people being treated for these substances has remained relatively stable over the last few years, but digging deeper it is apparent that there have been quite big changes in the individual drugs that have led to the need for treatment.

Talking with Dr Own Boden Jones who runs the Westminster Club Drug Clinic, and who is quoted in the NTA paper, he’s told me that the experience they’ve had is that club drug users don’t consider themselves to be the sort of drug user that could or should access traditional drug treatment clinics.

This, if true, may mean that the numbers of people in trouble with these drugs are higher than the NTA figures suggest, and that it takes them longer to access treatment.

From our point of view the paper Claire wrote for the Drug Education Forum on Legal Highs earlier this year sets out our best understanding of how to tackle these drugs in terms of education and prevention.

See here for a summary of Mentor’s views on Legal Highs.

Numbers of Young People Accessing Treatment Services Comes Down

 

The National Treatment Agency (NTA) have produced their annual review of specialist services for young people and report that the numbers accessing treatment have fallen for the third year in a row.

The NTA say that they believe that this fall is a genuine fall in demand which if true is very welcome indeed.

My sense is that while there are some reasons to believe that this may be the case we really don’t have enough information to be sure.

On the side of there having been a reduction in demand for drug services is the consistent falls in drug and alcohol use by young people and young adults.  With the significant falls in prevalence we might reasonably expect the numbers going on to need treatment to also fall.

But, it seems just as likely that the changes in general population prevalence levels are taken from those who were least likely to need specialist services.

It is also worth thinking about whether budget pressures – central government’s budget for young people’s services has been flat for the last few years – and changes to what services are being measured to provide may be responsible for where we are today.  As I understand it under the last government drug services were judged on the number of people entering treatment until the terms of the debate changed and the focus switched to the numbers leaving treatment having completed it successfully.

Also worth noting is the costs.  Research for the Department for Education suggests that in 2008-09 the cost of substance misuse services for young people was £62.2m.  Next year the Department report that councils expect to spend £36.8m.

What I can’t tell is whether this is comparing like for like, so the reduction may be less than this implies, but there is little doubt that these budgets are falling, as I pointed out a few weeks ago next year’s figure is a fall of 16% on this year.

Took and Treated

As part of the thinking we’re doing about the future of Street Talk I was prompted to look at the difference between the numbers of young people who took drugs in the last year and the numbers that were treated for substance misuse problems.

The visualisation above describes the position in England based on an amalgamation of two data sources, the Home Office’s Drug Misuse Declared – which has data about young adult drug use – and the last Smoking, drinking and drug use among young people in England (SDD).

The treatment figures are from the NTA’s last report on young people’s substance misuse.

To get to the figure of 660,000 drug users I’ve had to do a bit of estimating based on the two surveys that measure prevalence.  Here are my workings:

  • According to the DfE there are about 600,000 young people in any given age.
  • SDD tells us that 8.2% of young people between 11 and 15 years old took drugs last year.  600,000 x 5 x 8.2% = 246,000
  • Drug Misuse Declared suggests that 23% of 16 to 19 year olds took a drug last year. 600,000 x 3 x 23% = 414,000

Both of these surveys will publish new results in the next few weeks, and if the positive trends in terms of prevalence continue we should see slightly fewer young people in the group that took drugs last year.  Nevertheless, the difference in size between the groups is a useful reminder of just how few drug using young people enter treatment.

Social Determinants of Health

If you’re having some difficulty in understanding the concept of the social determinants of health, the “causes of the cause’s” of ill-health, the National Social Marketing Centre have produced a few films that are case studies of how particular communities and projects are trying to come at the things that make us less well.

This one is about treating young people for their drug and alcohol problems in Copenhagen.

Public Health in Local Government in England

The Department of Health have a factsheet which sets out the role of public health in local government in England.

The document describes which services will be mandatory and those that are not going to be prescribed by the Secretary of State.

Those that will be mandatory will be:

  • appropriate access to sexual health services
  • steps to be taken to protect the health of the population, in particular, giving the local authority a duty to ensure there are plans in place to protect the health of the population
  • ensuring NHS commissioners receive the public health advice they need
  • the National Child Measurement Programme
  • NHS Health Check assessment

As you’ll notice drug and alcohol services, whether for adults or young people, aren’t on that list. The document tries to suggest that being non-prescribed doesn’t make services less important it may help explain why alcohol services are already under some strain.