young people's substance misuse review for hertfordshire
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Hertfordshire Young Peoples Substance Misuse ReviewExecutive Summa
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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
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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
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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
(with 2.7bn cost to NHS)
13.74bnfrom smoking
(with 2.7bn cost to NHS)
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
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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
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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
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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%
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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
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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
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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
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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
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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
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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
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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
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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
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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
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