Young People's Substance Misuse Review for Hertfordshire

7/25/2019 Young People's Substance Misuse Review for Hertfordshire

1/17

Hertfordshire Young Peoples Substance Misuse ReviewExecutive Summa


2/17

The Challenge

The Brief

Hertfordshire County Council(HCC) commission drugs, alcohol and

tobacco education, prevention and

treatment services for children and

young people

HCC want an effective whole system

approach to reducing harm from

childrens substance misuse

To help achieve this, HCCcommissioned TONIC to review

existing drug and alcohol services,

including the role played by specialist

and universal services for young

people and their families

Our Approach

We engaged over

2users, young peopleproviders and partnworkshops, intervie

We also:

Conducted a li

find evidence o

Collated releva

conducted ana

needs assessm

Developed a p

system approa

Carried out a c

of our proposa


3/17

Amongst 11-15 year olds in England

5%are regular smokers

8%drink regularly

6%have taken an illegal drug (mostly cannabis) in the l

The National Picture

Young peoples use of drugs alcohol and tobacco - is a rapidly changi

different service models being developed across the UK, and no overa

whole system approach

Although overall prevalence of alcohol, drug and tobacco use by youn

falling, these population-level figures mask:

Increased use among certain vulnerable groups

A comparatively high prevalence level compared with other develop

High costs of related harm

Changing patterns of substance use that include e-cigarettes and


4/17

Some young people face increased risks of developing

alcohol including those truanting or excluded from sc

young offenders, those at risk of involvement in crime a

with mental health problems, and whose parents misus

vulnerable groups need targeted support to prevent su

early intervention when problems first arise

The National Picture

Drinking too much, too young is a

significant risk to young peoples healthand development

16,000Ambulance call outs for under 18 drinking

13,000Hospital admissions linked to young peoples

drinking each year

15.4bnfor drug misuse

(with 0.5bn cost to NHS)

18-25bnfrom alcohol misuse


13.74bnfrom smoking


42.5mAnnual cost of children in care

because of substance misusing parent

INCREASED

RISK

Substance use affectsyoung people in the

short term and long term

Tobacco use is the

preventable death

smokers and the pe

through secondhan

Last year over

18,00young people acces

misuse treatment

86%fo51%fo

The annual costof substancemisuse to UKsociety is high

HARM


5/17

Universal Prevention

Should incorporate a mixture of life skills,

motivational work, social norms and social

competence components

Unplugged and Good Behaviour Game are

programmes that should be further considered

Generic programmes show as much promise as

specific programmes Substance: Several programmes that have

largely been evaluated outside of the UK have

tried to assimilate core components of these

models which are then essentially marketed

under differing brand names

Resilience, communication skills, coping

strategies, motivation, clarification over social

norms, assertiveness skills, and access to

services are all vital components irrespective of

the particular programme chosen

Targeted Prevention

Programmes show

higher risk groups

Consideration shou

programmes for BM

them culturally sensconsideration to ge

Treatment

No single interventi

more effective than

all shown positive o

in combination or in

young persons pres

Treatment should b

possible, involve scyoung person

Enforcement

Partnership working

is critical in disrupti

e.g. working with ret

schools and religiou

Targeted policing a

beneficial than swe

simply increasing po

Positive Youth Outcomes

Evidence of What Works

Effective prevention does not mean doing

more - it means refocusing resources on what

has been shown to work. It also means working

collaboratively across sectors and settings,

recognising that positive youth outcomes

are most likely when prevention efforts areintegrated and sustained


6/17

Positive Youth Outcomes

Evidence of What Works

Must Do Actions

Ensure facilitators and practitioners are

adequately trained and motivated

Involve family where possible and appropriate in

both treatment and prevention

Be part of an holistic classroom/school

environment approach to ensure young people

feel valued

Target social norms and influences as part of

universal prevention

Use an approach that has multiple components

Provide a booster/follow-up session

Make interventions interactive and dynamic; e.g.

role plays, active discussion

Be responsive to gender and ethnicity

Should Do Actions

Use Motivational Interviewing techniques or

interventions

Use cognitive based / problem-solving

interventions

Use interventions that draw on a range of

theoretical models

Target high risk gro

Target early childho

cognitive and probl

general curriculum

Offer group and 1:1

Offer young people

practice skills learnt

Activities should be

informal settings to

Design school polic

stakeholders inclu

partner agencies

Things to Avoid

Use of scare tactics

Delivering drug info

Focusing solely on s

Using ex-users or p

deliver intervention

whole school appro

and consistency of

Undermining parent

interventions

Target social

norms andinfluences as

part of universalprevention


7/17

Comparing latest national and local data shows prevalence rates for

Hertfordshire are generally lower than, or similar to, the national pictu

Applying prevalence data from the local HRBQ survey to Hertfordshir

population, suggests there may be:

Needs Assessment: Hertfordshire

14,000Young people who with over 2,500of these being regular smoke

12,000Young people who alcoholic drink during the last week, with over

being regular drinkers

5,000Young people who havewith over 2,500of these being regular drug us

21%

18%

8%


8/17

419Young people aged 18 or under ar(Downfrom 532 in 2013-14 & 597 in 2012-13)

223Alcohol Offenders aged 12-18(Downfrom 315 in 2013-14)371Young Offenders with substancemisuse needs identified in their assessment

110Drug-related hospital admissions185Alcohol-related admissions75Young people set a date to quit smoking,of which 18 were successful

35Alcohol-related attendees by under 18s atthe A&Es of Watford and Lister hospitals (5% of the total)

No referrals were made to treatment by A&E

109Fixed term school exclusions fordrug or alcohol related reasons (Upfrom 95 in 2013-14)

10Permanent school exclusions fordrug or alcohol related reasons (Upfrom 3 in 2013-14)

97Started substance misuse treatment (Downfrom 107 in 2013-14)

Needs Assessment

In 2014-15, some direct indicators of

substance misuse by young people include:

Our district-level analysis

indicators and prevalence

revealed that Stevenage

priority districts. Howeve

exercise and gaps in our

discussions with agencie

this area should also be c

28NEET young people identified by YouthConnections as having substance misuse issues

25Children Looked After identified with s


9/17

Investment

Specific funding (exc. smoking & locally

funded projects) has declined by 36%since 2009-10

With a 21%reduction for treatment Local levels of investment were 40%

lower per person aged 12-17than in the

comparator areas

Declining investment has led to the service

being potentially unsustainable at this level

Demand

Numbers entering treatment have fallen by

26%over this period 97young people entered treatment last

year, from over 240referrals receivedby the service

Based on comparator areas & national

averages, estimated demand for

treatment is likely to be around 240

young people per year

Young Adults

Comparing data

that for young ad

up in need

Agencies apeople toldabout a cliat transitio

We recommend e

for a transitional

aged 18-21 or up

Treatment Review

22450

45

40

35

30

25

20

15

10

5

0


10/17

Treatment Review

Impact

Looking at comparator areas & national

averages, reveals that in Hertfordshire:

Unit costs per person in treatment were similar

Unit costs for planned treatment

completions they were 27%higher 30%shorter duration of treatment

than the national average

20% lower rate of planned treatmentcompletions than the national average

16%completed treatment drug free half the national average 32% Representation to the service was higher

13%than nationally 6% althoughthis was based on small numbers

Significantly lower than national average

performance for reductions in cannabis,

alcohol and smoking on exit

Quality

We heard absuccessful cand received

feedback abfrom serviceagencies - gmile to help

This was balance

the treatment pro

too clinical, some

applied restrictiv

showed inflexibil

needs of some vu

they did not expr

part in treatment

Contracting Arrang

The contract for

now requires a co

process to be un

16% completedtreatment drugfree half thenational average


11/17

Young people identified the need for:

Co-ordination between services

Promotion of available support services for young peo

Range of support options - inc. groups, therapeutic sp

Transitional arrangements into adult services

Use of social media as a resource to promote service

health-based messages

Use of peers to create a climate of safe disclosure wh

use of substances is not stigmatisedYoung and parents already involved with A-DASH were happy with the servic

young people and some agencies were unaware of this provision

Agencies and young people felt prevention should be timed appropriately, co

life-span, delivered by someone other than a teacher, be interactive and sho

negative elements of substances

Emphasis was placed on the need for integrated delivery and commissioning

children, young people and public health provision given the crossover of prio

What young people, parents and agen


12/17

YOUNG PEOPLE WITH SUBSTANCE

MISUSE PROBLEMS &THEIR FAMILIES / CARERS

PRIORITYVULNERABLEGROUPS

ALL YOUNGPEOPLE &PARENTS

FOR

Investinbuilding

capability

inSchools

Group &IndividualOptions

Ensure drugs, alcohol & tobaccoincluded in evidence-based programmes:

Primary, Secondary, FE & AlternativeParenting Campaigns:

Role Modelling, Influence & AccessParenting Courses -

Childrens Centre S o c i a l n o r m s , L i f e s k i l l s & R e s i l i e n c e

Unplugged

Enforcement limiting access: Licensing, Police, Trading Standards

Good Behaviour Game Penn Resilience Programme

Screening & Early IDMeasure Impact by HRBQ

Screening & Response

Specialist Workers

Embedded in Key Teams

Inte

grat

edCom

mis

sionin

g&Pe

rforman

ceMonito

ring

Settin

gprio

ritie

s&

strate

gy,m

easu

ringim

pact

,influ

encing

wid

erage

nda

SpecialistServiceP

rovision

Workingtoastrategicde

liveryplan

Proposed Model

Key Teams:YJS, GUM, CLA,NEET / PRU / Excluded, A&E,Care Leavers, Children of SMP,Parents/carers of YPSM

Better pathways into future support

Measure impact by NDTMS & YPOR

Range of evidence based structuredInterventions

Specialist smokingcessation

Deliver diversionaryprogrammes for low-leveldrug or alcohol incidents inschools, childrens homes,

foster care, police

Deliverbrief

interventions:IBA / EIBA

CBT MI

Family

MST

Integrate Delivery CAMHS Transform

YJS- Youth Justice ServicePRU- Pupil Referral UnitYPSM- Young Peoples Substance MisuseSMP- Substance Misusing ParentsIBA- Interventions & Brief AdviceEIBA- Extended Interventions & Brief AdviceCBT- Cognitive Behavioural TherapyMST- Multi-Systemic Therapy

MI- Motivational InterviewingNDTMS- National Drug Treatment Monitoring SystemYPOR- Young People Outcome RecordGUM- Genito Urinary MedicineNEET- Not in Employment, Education or TrainingCAMHS- Child and Adolescent Mental Health ServicesID- IdentificationHRBQ- Health Related Behaviour Questionnaire

A&E- Accident and Emergency


13/17

Universal Prevention

Adopting a broader approach that will:

Ensure a focus on the root causes of why young

people misuse substances, e.g. lack of self

esteem, peer pressure, as a coping mechanism

Equip children and young people with the skills

needed to manage situations and their emotions

Provide all young people with the lifeskills,resilience and emotional wellbeing to prevent

them from experiencing substance misuse

related harms in their future lives

Achieving this by taking a triple-track approach:

Building Resilience and Lifeskills:By investing

in and supporting generic, evidence-based

programmes already being run in Hertfordshire.

Ensuring they delive

tobacco elements. T

within all primary an

programmes across

children and young

rather than being de

attend

Nurturing Wellbeinpartnership with CA

for universal preven

Empowering Paren

are aware of the im

the opportunity for

model (e.g. through

activities conducte

Key Elements of the Proposed Model

Although the overall picture was of relatively low need and an adequa

apparent that improvements could be made to increase the reach and

better use of the dedicated budget and existing partnerships

We propose adopting a whole system approach, using a life-course

service delivery, governance and commissioning function at its core


14/17

Key Elements of the Proposed Model

Interventions, Treatment & Targeted Prevention

Maximising opportunities to identify young people

with smoking, drug, alcohol or NPS related issues -

acting early and intervening effectively with a focus

on priority vulnerable groups by:

Ensuring diversion is used as a response for the

management of drug and alcohol and tobacco

incidents with police, childrens homes, foster

carers and education providers

Training and supporting key agencies to screen

more effectively using a fit for purpose tool and

to deliver specific evidence based interventions

(e.g. IBA)

Ensuring timely access to age-appropriate

smoking cessation inc. for those in treatment,

online service promotion, self-help tools and

information

More co-ordinated support for parents who are

struggling with difficult teenagers using substances

and children of substance misusing parents

Ensuring substance misuse is considered

alongside wider multi-agency responses for late

teens requiring transition to adult services

Developing online self-care tools for young

people and parents

Meeting the needs of

related problems, by:

Increasing funding f

widening its scope t

and increasing capa

Embedding special

working with key vu

barriers to accessin

those most in need

Enforcement & Availa

Limiting availability

solvents and NPS to

Ensuring appropriat

taken to address sp

underage sales, He

Governance

Ensuring young peo

and drugs is fully int

issues through joine

and performance m

relevant public heal

Pool funding used b

reach overlapping p

potential impact & s

those with multiple

Specialisttreatment shouldbe accessible,matched tolocal need andNICE-compliant Public Health England


15/17

The Business Case for Change

Return on Investment

Up to

5.3min savings

Invest

590,000in Direct Provision

40,000contribution to build

capacity in wider universal

education evidence-based

resilience programmes e.g. as part of CAMHS

Transformation

550,000to commission an

integrated specialist interventions,

treatment & Targeted Prevention Service

2.5m - 4.6mlifetime return on treatmentinvestment in reduced crime

education and social costs

wo

wit

6ret

Res

COST BENEFITVS


16/17

Where will the money come from?

The majority of funding to this proposal

comes from a re-focusing of current

specific funding:

By changing from grant giving for a

range of small, short-term projects,

to a concentrated commissioning of

specialist treatment, interventions and

targeted prevention services from a

single provider

This dedicated funding comes from a

range of sources including Public Health,

Childrens Services, Youth Justice, andthe Police and Crime Commissioner and

this will require their approval

Efficiencies and additional funding to

increase capacity and scope may come

from a range of potential sources identified

in our report including extending the age

limit to improve transitions and additional

funding for CAMHS Transformation

Making it Happen

An initial delivery

needed to put th

This now requires

formal adoption b

Wellbeing and Ch

The competitive t

services provides

deliver much of th

does the CAMHS

The Business Case for Change

Re-focusing ofcurrent specific

funding


17/17

Follow usCompany Details

Company Registration Number06141892 VAT Registration Number971257702 D-U-N-S Number219603037Registered AddressGothic House Avenue Road, Herne Bay, Kent, CT6 8TG

Email [email protected]

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Young People's Substance Misuse Review for Hertfordshire

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