Hertfordshire Young People s Substance Misuse Strategic Plan 2014 15 1
1. Introduction and context Young people misusing substances can cause harm to our communities through crime and antisocial behaviour, and they can also cause harm to their own mental and physical health. By reducing levels of substance misuse, we can reduce these negative impacts, as well as reducing the public funding required to manage them. Substance misuse is linked to many other health inequalities and risk taking behaviours in vulnerable young people. By reducing substance misuse, we will also impact on reducing mental health problems, unsafe sex and teenage pregnancies, general health and wellbeing, educational attendance and achievement. Finally, substance misuse interventions for young people contribute towards outcomes measured within the Public Health framework, and Drug and Alcohol Harm is a priority of Hertfordshire s Health and Wellbeing board. 2. Scope of this Plan This plan links to several other local strategies, importantly the Hertfordshire Children s Services Plan, Youth Justice Plan, Drug Strategy, Alcohol Plan, Tobacco Control Strategy, Public Health Strategy, and Health and Wellbeing Strategy. This is an action focussed plan which aims to: Prevent young people in Hertfordshire from taking drugs, drinking alcohol or smoking. Minimise the potential harm experienced by young people in Hertfordshire who may be taking drugs, drinking alcohol or smoking, as well as the harm they may cause to the wider community. Treat young people in Hertfordshire who have a problem with drugs, alcohol or smoking. The plan is a partnership document, owned by the Young People s Substance Misuse Joint Commissioning Group, who is responsible for setting an annual action plan and monitoring performance against it. The scope of the plan includes drugs, alcohol and smoking and defines young people as those under the age of 25. 2
3. Mapping young people s substance misuse in Hertfordshire summary of needs assessment A full needs assessment using 2012-13 data revealed the following key findings: General trends: The number of under-18s in Hertfordshire engaged with the A-DASH (Adolescent Drug and Alcohol Service Hertfordshire) specialist service during 2012-13 was 182. This is a decrease of 5% from 2011-12 (192). This decline in under 18s accessing specialist treatment follows a trend that started in 2009-10 nationally and supports the fall in the number of young people who report using substances currently. Evidence collected from the Health Related Behaviour Survey 2012 supports the treatment data which suggests that drug and alcohol use among young people in Hertfordshire is falling. Young people in Hertfordshire had a rate of 21.2 hospital admissions per 100,000 population due to alcohol and 11.47 due to drugs compared with regional rates of 30.9 and 15.31 respectively. The rate of hospital admissions for alcohol has dropped significantly since 2006/07 and is the lowest rate in the region. However, there is still a lack of robust, reliable data collected from Accident and Emergency departments on the number of drug and/or alcohol related admissions for young people. In 2012-13 18% of Common Assessments (CAFs) identified substance misuse issues, of which; 83 were for the young persons drug and/or alcohol use and 106 for parental substance use. Treatment population and referrals: 50% of Hertfordshire s population aged 9-17 are male compared with 64% of the young people in treatment with A-DASH. Young people resident in North Herts, Stevenage and East Herts accounted for over half of all clients accessing specialist treatment in 2012-13. Referrals from Broxbourne remain the lowest in the county, which is reflected in the number of those accessing treatment. The main sources of referral to A-DASH in 2012-13 were from Youth Justice and Children and Family services. 3
Substances used: As with previous years, the majority of young people are receiving help for problems associated with cannabis and/or alcohol. Together these drugs account for nine out of ten of all cases of young people receiving help during the year. Proportionally, the percentage receiving help for primary cannabis use has gone up in the past year. In 2012-13, 77% of young people were engaged in treatment for primary cannabis use. For the first time in three years, cocaine was cited as a primary drug. 1 young person presented to treatment services with cocaine as their main drug. Cocaine remains the second most popular secondary/tertiary drug of choice (26%, n=48) after alcohol (35% n=64). This continues to reflect the current national trend of increased recreational cocaine use by young people. The use of New Psychoactive Substances (NPS) among young people in Hertfordshire remains a significant concern with anecdotal evidence suggesting its use is on the increase. The number of under-18s treated for problem drug use associated with the use of heroin and crack remains low. In 2012-13 there was only one young person in treatment for secondary heroin use and two for crack cocaine use. 31% of young people in Hertfordshire say they smoke now or have smoked in the past, and 9% of year 8 and 10 students report having smoked at least one cigarette in the last week (HRBQ, 2012) Treatment process The majority of young people accessing services in 2012-13 received harm-reduction support to address the impact of substance misuse on their physical, sexual and mental health. Psychosocial and Family interventions were also used to address the underlying causes and consequences of their substance misuse. The length of time that young people are in treatment for in Hertfordshire is slightly less than the national position, with the average length of time in services being 18 weeks compared to 22 weeks nationally. The number of planned exits has increased significantly since 2011-12 and is now in line with the national figure; however, the number of unplanned exits has remained at around 1 in 4. Those who left in an unplanned way were more likely to be a poly drug user, have started using substances earlier and be involved in offending. 4
Most young people entering specialist substance misuse services in Hertfordshire have not been using alcohol and/or drugs for long. When they do use, some are using heavily and experiencing physical or psychological problems along with behavioural problems associated with increased risk-taking, such as exclusion from school, family breakdown and offending. TOP Outcomes data shows that young people s physical health is not following treatment in line with national levels. In addition, of the 10 young people who stated they were practising unsafe sex at treatment start, 8 (80%) said they were still practising unsafe sex at treatment exit; an additional two young people also said that they were engaging in unsafe sex at treatment exit but were not at the start of their treatment Vulnerable groups In 2012-13 4% (n=188) of recorded drug offences in Hertfordshire were attributable to under 18 s. 1 in 5 drug related offences by under 18 s were recorded as occurring in Dacorum. According to NEET (Not (In) Education, Employment or Training) figures collected during 2012-13 18% of 16-18 year olds had a substance misuse issue. In the same period 36% of A-DASH clients aged 16-17 were not in Education and/or Employment. In 2012-13, 21% (n=37) of young people in treatment with A-DASH were looked after, however the data shows that referrals directly from CLA teams only accounted for 2 of the young people in treatment during the year. Compared to national figures, in 2012-13, Hertfordshire had higher proportion of young people with 4 to 7 risk indicators (24% Hertfordshire, 17% national) and lower proportion of young people with 1 to 3 risk indicators (74% Hertfordshire. 4. Strategic Priorities for 2014-17(in additional to ongoing core work) The following priorities have been agreed for 2014-15. They are in addition to ongoing work to address young people s substance misuse. 1. Targeting treatment and support services: at those who are most vulnerable and/or who are not accessing help. The needs assessment demonstrates that certain groups are more at risk of substance issue problems and may not be accessing services, particularly care leavers and children looked after. Certain localities, 5
particularly Broxbourne, also have low referral rates to treatment, suggesting that further exploration as to reasons is required. 2. Cocaine: a focus on reducing the use of cocaine in young people. Local data shows that use of cocaine is increasing, in line with national trends, and is the second most common popular secondary drug of choice. 3. Holistic treatment: ensuring that young people receiving treatment and support from A-DASH, receive holistic assessment and support around their wider health and wellbeing. Local TOP outcomes data shows that young people are not improving their physical health following treatment. 4. Alcohol: a focus on reducing drinking among young people. This will help to deliver the Health and Wellbeing Priority for 'Reducing the harm from alcohol' across all ages. Local data indicates that in 2012 around 16,000 young people aged between 9 and 15 drank alcohol in the last week 5. Age thresholds of treatment services: considering how service provision can support vulnerable young people over the age of 18. Local reports indicate that the management of transition to adult services could be improved. 6. Novel Psychoactive Substances (NPS): a focus on reducing use of, and minimising the harm of, NPS (legal highs) which we have evidence are becoming more popular among our young people, with a recent survey of students indicating 50% had either tried or knew someone who had tried these drugs. Local data shows that 50% of university students had tried or knew someone who had tried an NPS. 7. Parental awareness and parental substance misuse: helping parents to understand their role in reducing take-up and minimising the harm of drugs, alcohol and smoking in their children. Helping to reduce the impact of substance misusing parents on children. Local data shows that 72% of primary school pupils said they would like their parents/carers to talk to them about drugs, and in 201213 there were 106 CAFs relating to parental substance misuse 8. Emotional wellbeing: a focus on addressing emotional wellbeing in young people and the link to alcohol, drugs and smoking, including dual diagnosis and self harm. 6
National data indicates that there is a very strong link between these two areas. For more information regarding the action plan please contact: Ruth Fennemore, Health Inequalities Manager, Services for Young People Tel: 01438 844417 Email: ruth.fennemore@hertfordshire.gov.uk 7
5. 2014/15 Action Plan Theme Objective Action or activity Outcome measure and monitoring Targeted 15 awareness sessions Prevention taken place in target areas Targeted Prevention Help parents to be more aware of their role in preventing their children from misusing substances, including drugs, alcohol and tobacco Help to reduce the impact of substance misusing parents on children 1. Commission parental awareness sessions through schools, materials, and a parental reference group. 2. Explore how existing parenting programmes can incorporate drugs, smoking and alcohol elements 3. Implement the recommendations of the HCC report Impact of substance misusing parents on families Toolkit produced for schools to run further sessions Feedback from existing programmes Report against recommendations Resources 4,000 Tobacco Control Manager Officer - HM Secondary Health and Social Care Commissioni ng Team Accountability / Secondary Health and Social Care Commissioning Team Targeted Prevention Target young people at risk of substance misuse with specific preventative 4. Seek and fund innovative projects that impact on substance misuse, through the Partnership Fund Evaluation report of projects showing numbers of young people involved and positive outcomes. 20,000 8
Theme Objective Action or activity Outcome measure and monitoring interventions and support, and find ways to mainstream successful projects 5. Commission programmes working with at risk groups in Broxbourne around substance misuse, and demonstrate impact with a view to securing sustainable funding for future years. Programmes to focus promoting emotional wellbeing and physical activity. Evaluation report of projects showing numbers of young people involved and positive outcomes. Report considering sustainability of programmes. Resources Officer - CK 25,000 Accountability 6. Provide counselling support to young people in the Targeted Youth Support Service, by commissioning the Counselling in Schools service (HCC service), and explore how this work could be mainstreamed from 2015. Outcomes monitoring showing impact on substance misuse 30,000 Specialist Services Manager 9
Theme Objective Action or activity Outcome measure and monitoring Targeted Campaign evaluation Prevention report Develop creative ways of getting preventative messages out about drugs and alcohol to young people 7. Run a digital campaign around alcohol and prom night, aimed at both parents and young people Resources Alcohol campaigns budget, CCSU Officers JM and HM Accountability Alcohol Campaigns Group 8. Run a campaign around NPS and use at music festivals 9. Ensure high quality resources and information on NPS, cocaine, alcohol, club drugs and other substances are available and shared Campaign evaluation report Report on available resources and their usage Police budget 2,000 CCSU Police Communicatio ns Drug Education Forum 10. Facilitate a youth led campaign around substance misuse issues through a school or college (linked to action in teenage pregnancy plan half the group will work on a teenage pregnancy campaign) 1,000 Officer - JM 10
Theme Objective Action or activity Outcome measure and monitoring Resources Accountability Targeted Prevention Integrate the five ways to wellbeing into delivery of services to young people, as a way of improving emotional wellbeing and reducing the risk of substance misuse Support schools to prevent substance misuse among their students 11. Run a conference to promote usage of the five ways to wellbeing among the young people s workforce, and produce and publish toolkits 12. Provide targeted support surgeries for teachers delivering drug education in schools in Broxbourne, Watford and Stevenage or who are identified as requiring support based on HRBQ data. 13. Produce a model smoking policy for schools on preventing smoking and how to deal with students caught smoking Feedback from conference and usage of toolkits Evaluation demonstrating impact on young people Confirmation that the majority of schools involved have not previously been in receipt of similar support. Policy available on the Grid for Learning Positive feedback from schools 7,000 Officer - HM 4,000 Herts for Learning Drug Education Forum Head of How to Thrive / Health Inequalities Manager Stop Smoking Service Team 11
Theme Objective Action or activity Outcome measure and monitoring Minimising harm Provide support to children in care and care leavers who are engaged in substance misuse 14. Develop and implement a plan to increase the number of children in care and care leavers receiving harm reduction information. Increase the numbers of direct contacts that children in care and care leavers have with A-DASH and monitor the number successfully entering into treatment. Resources Young People s CLA workers, CLA Nurses A-DASH, CLA CAMHS Service Accountability A-DASH 15. Provide support programmes to children s residential homes around cannabis use Feedback from residential homes 2,000 Officer JM Increase support available in Broxbourne Gather more data on who is most vulnerable 16. Set up a locally led task and finish group to increase the referrals to treatment services from Broxbourne 17. Gather intelligence from voluntary agencies, CRAFFT data, schools and CLA pathway plans, including youth crime in Dacorum and links to Increase in referrals from Broxbourne A-DASH Data report Services for Young People Research Manager 12
Theme Objective Action or activity Outcome measure and monitoring substance misuse. Ensure young people 18. Set up protocol for risk Feedback from Risk in targeted youth management panels to Panels support and the youth consider substance misuse justice system receive and crime issues as routine support around substance misuse Encourage housing associations to deliver support around substance misuse Train the children s workforce on the latest substance misuse issues, particularly alcohol, cocaine and NPS 19. Provide training and information leaflets to housing association staff and ensure links to A-DASH and other partners are efficient 20. Identify training needs and commission a suite of training courses Feedback from housing associations Evaluation report on training programme, including feedback and numbers attended Resources Accountability Services for Young People Manager (Nick Smith) Officer - JM 7,000 Learning and Development Team Evaluate existing projects addressing emotional wellbeing and substance misuse together, to inform future commissioning decisions 21. Evaluate the impact of the mentoring service on substance misuse and groups vulnerable to substance misuse Final report with recommendations 10,000 Specialist Services Manager 13
Theme Objective Action or activity Outcome measure and monitoring Treatment Provide an efficient 22. Commission an adolescent Contract management and holistic treatment drug and alcohol treatment and annual work plan service for young service, and ensure the people service provided looks at the holistic needs of young people, including their wider Consider whether existing treatment services should work with vulnerable young people aged over 18 Support Spectrum to be more young people friendly health and wellbeing 23. Set up a task and finish group to consider this issue 24. Support Spectrum hubs to become You re Welcome accredited Recommendations and plan for implementation Resources 374,000 (TBC) Three hubs accredited Health Improvement Manager Officer - JM Accountability Specialist Services Manager Secondary Health and Social Care Commissioning Team Obtain improved qualitative data on young people in treatment, regarding dual diagnosis and 25. Identify national good practice in adult services for 18 24 year olds 26. A-DASH to monitor transitions of young people to Adult Services, and dual diagnosis prevalence Report produced and disseminated Officer - JM Data report A-DASH A-DASH 14
Theme Objective Action or activity Outcome measure and monitoring transitions Ensure young people 27. A- DASH to set up protocols Protocols in place. who visit A&E as a with A&E departments. Feedback from A&E staff. result of alcohol or drug problems are referred into treatment services Ensure young people who need help but do not agree to treatment are supported 25. A-DASH to manage provision of informal engagement appointments, to ensure outcomes are monitored Feedback on outcomes from engagement appointments TOTAL (excl treatment) ESTIMATED BUDGET (excl treatment) Resources A-DASH A-DASH 112,000 123,000 Accountability A-DASH A-DASH 6. Vital services contributing to reducing young people s substance misuse Spectrum Thriving Families Programme How to Thrive programme Hertfordshire s Adult Drug Treatment Service, which treats older young people and parents Provides support to families with substance misuse problems through its own drug workers and referrals to Spectrum and A-DASH Provides resilience training to young people through Hertfordshire s schools and to targeted groups and individuals 15
Targeted Youth Support Service Youth Offending and Enhanced Restorative Justice Resolution Programme Targeted Youth Support Service Targeted Advice Service (Interface workers) Herts for Learning Youth Connexions Local voluntary organisations Schools Trading standards Operation Crystal Stop Smoking Service Provides support to young people who have substance misuse issues and works in partnership with A- DASH Provides support to young people who have substance misuse issues and works in partnership with A-DASH Has a dedicated drug and alcohol worker linking adult and children s services provision Provide support for PHSE leads around substance misuse Provide diversionary activities for vulnerable young people, support programmes around substance misuse as part of youth projects and also provide a suite of traded packages for schools Provide support, diversionary and training programmes to parents and young people, including through schools Provide drug, smoking and alcohol education as part of PHSE lessons Conducts test purchasing of tobacco and alcohol and monitors head shops where NPS and other drugs may be supplied Identifies trends in drug use Provides stop smoking support to young people 16