Transcript NTA and young people`s specialist treatment

Approaches to reducing alcohol harm for children and
young people
Young People’s Specialist Treatment
London Alcohol Practitioners Forum
20th March 2009
Sam Cox
Deputy Regional Manager
NTA London Regional Team
Overview
This presentation will cover:
 The role of the NTA in young person’s specialist treatment –
centrally and regionally
 The policy context for specialist treatment
 Guidance to support the commissioning and delivery of
specialist treatment
 Alcohol provision within specialist substance misuse treatment
 What makes a good specialist treatment service
Role of the NTA
 Improvements required in the availability, capacity and effectiveness of
treatment for drug misuse in England
 Pooled Treatment Budget
 Monitoring the performance of DATs in the commissioning and developing of
treatment services
 Reviewing compliance at DAT level with advice and guidance issued to
support best practice
 Overseeing appropriate use of the PTB
 Less clearly defined role around yp treatment until Memorandum of
Understanding between DCSF and NTA in 2007 which definitively outlined roles
in relation to delivery assurance
• PTB contribution to yp specialist treatment
• A minimum range of service delivery available in each partnership area
Putting this into context – the developing agenda
 1998 First 10 year drug strategy (updated 2002)
 2004 HO PSA Target: To reduce the use of Class A drugs and the
frequent use of any illicit drug amongst all yp under the age of 25,
especially the most vulnerable young people
 2005 DCSF publish Every Child Matters: Change for Children: Young
People and Drugs
 2008 DCSF PSA 14: Increase the number of children and young people
on the path to success
• Increasing participation and resilience and tackling negative outcomes
• NI 115: Reduce the proportion of young people frequently using illicit
drugs, alcohol or volatile substances
NTA and young people’s specialist treatment
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NTA developing a range of guidance to support improvements to
national service delivery
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Regional performance assurance role – the focus is on improving
accessibility, quality and effectiveness of yp treatment provision:
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Needs assessment
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Treatment planning
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Performance data and quarterly progress reviews
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Supporting integration of commissioning function into Children’s Trust
arrangements
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Partnership level and regional governance arrangements
Treatment Definition
 Young people’s specialist substance misuse
treatment is a care planned medical, psychosocial
or harm reduction intervention aimed at alleviating
current harm caused by a person’s substance
misuse’
Guidance to support quality improvements:
NTA is developing a range of guidance to support improvements in
young people's substance misuse treatment services across England.
Young People’s Specialist Substance Misuse Treatment:
Commissioning Guidance
Young People’s Specialist Substance Misuse Treatment: Exploring
the Evidence
Young People’s Specialist Substance Misuse Treatment: The Role of
CAMHS and addiction psychiatry in adolescent substance misuse
services
Further guidance planned around prescribing practice in the secure
estate (YJB led) followed by guidance around prescribing practice in a
community based setting.
The extent of drug and alcohol use among young people
The number of young people in England using alcohol and drugs is not
increasing
‘Drug Use, Smoking and Drinking by young people in England 2007’
revealed that among 8000 young people aged between 11 – 15
Those who stated they had never drunk alcohol was up from 39% in 2001 to
46% in 2007
In terms of drug use 25% stated they had tried a substance was at 25% in
2007 down from 29% in 2001
TellUs3 survey undertaken in 2008:
86% of the 13 + 15 year olds indicated there had never been any drug use
compared with 80% in TellUs2 survey in 2007
Reporting of being drunk in previous 4 weeks fell from 19% to 16% in 2008
Alcohol related trends
Although regionally it appears that both alcohol consumption and drug
use among young people is lower than the national average it has been
noted there has been a sharp increase in the amount of alcohol
consumed by those who do drink and the frequency of consumption
has also increased, resulting in more negative outcomes
 Average weekly consumption up from 5 units in 1990 to 11 units in 2006
 Increases in amount of ‘drinking to get drunk’ - up to 35% of the 11 to
15 cohort had done this when drinking in previous 4 weeks, and 56% of
15/16 year olds reported having drunk heavily in the last 30 days
 Alcohol related hospital admissions in London increased for the 11 – 18
age group from 1,171 in 2002/03 to 1,769 in 2006/07
 There has been a 57% in increase in alcohol-related deaths amongst
young people aged 15–34 between 1991 and 2006.
NDTMS Presentations
06/07 Presentations
Of the young people presenting into
specialist treatment in 2006/07
10,824 (52%) were treated primarily
for cannabis use and 7,039 (34%) for
alcohol use. This contrasts with the
9,043 primary cannabis users (55%)
and 4,886 (30%) who required
treatment for the use of alcohol in
2005/06
07/08 Presentations
Of the young people presenting into
specialist treatment in 2007/08
12,021 (51%) were treated primarily
for cannabis use and 8,589 (36%) for
alcohol use
A further 4,672 used cannabis as an
additional substance and 6,652 used
alcohol; 35% and 50% respectively of
all those who reported use of
additional substances
What does a good substance misuse service look like?
1. Reflects needs of the population – not based on historical make up
of services
2. Clear protocols and referral pathways into and out of specialist
provision
3. Comprehensive range of interventions offered – all yp specific and
evidence based
4. Holistic approach to the young people’s needs
5. Local services – accessible both in terms of location and opening
hours in appropriate buildings with outreach/satellite services
A good treatment service
 Routinely involves young users and their parents and carers in
evaluation and responds to the feedback
 Monitors clinical outcomes routinely
 Develops good transition protocols and relationships with adult
providers, CMHTs and Probation
 Responds swiftly and addresses crisis
 Waiting times are low
 Delivers effectively against the NTA key treatment quality measures
 Ensures the workforce is supported by regular clinical supervision, and
clear governance structures. Training and consultation available to
generic staff based in targeted settings
 Pathways and protocols to address the unexpected….
Issues for specialist substance misuse provision in London
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Variable levels of provision and investment
Screening to identify need is not routinely implemented
Uncertainty/mixed practice in applying threshold for specialist treatment
Demands on time and resources of specialist workforce to support
generic staff
Workforce development difficulties, high churn
Variable commissioning especially around residential/inpatient services
and pharmacological interventions
Variable waiting times
Difficulties with transitions
Improving provision
 Opportunities for joint working as substance misuse agenda is
increasingly embedded in children’s commissioning structures and
linked operationally with generic provision
 Benefits from emerging evidence base to inform practice
 Revisions to NDTMS YP core data set wef 01/04/09 will support robust
needs assessment in future and then impact on quality of treatment
planning
 Commitment cited within Youth Alcohol Action Plan for DCSF and NTA
to review young people’s specialist treatment plans and to develop
additional guidance on basis of findings of review