Developing a specialist community based service for adolescent drug users Jack Leach Consultant in substance misuse Young persons drug project, Bolton

Topics n Principles of treating young people with substance misuse problems n Development of Project 360 –Background –Organisation n How are we doing? n Conclusions; outstanding issues.

National policy and guidelines n Substance misuse treatment n Child protection and rights of young people n Young people and substance misuse: n Children and young people: –Substance misuse services; the substance of young needs (HAS 1996) –The substance of young needs; review 2001 (HAS 2002) –Assessing local need: planning services for young people (DPAS & DrugScope 2002).

Principles n Child centered and be distinct/separate from adult substance misuse services n Everyone involved in child health responsibility either for prevention of supporting treatment n Co-operation and integration of service provision to meet the needs of the child n Promoting and involving families n Early recognition and interventions crucial.

n Separate/distinct from adult drug services; location,staffing,management n Staff with paediatric/adolescent training and experience n Multi-disciplinary; health,social work, youth and community workers n Provide social, psychological and health interventions.

Underlying assumptions n Children” are different to “adults” in significant ways (uniqueness of childhood?) n So need different treatment to adults n These needs are best met by separate services (contamination by adults?) n Early treatment alters the course of substance use.

Development of young persons community drug service, Bolton (Project 360) n From 1996 two workers at the drug team took responsibility for case-working under 18 year olds. As a small but increasing number were being referred for treatment n 1998 SS appointed a young persons’ drug co- ordinator, with plans to develop a young persons drug project n 2000 establishment of Project 360 in premises run by a voluntary group, that housed various young peoples’ projects.

Staffing n Managed by Children and families department of Bolton Social Services n Team leader (social worker) n Case worker (paediatric nurse) n Case worker (youth and community) n Case worker (social worker) n Family support worker n Secretary.

Medical support n Associate specialist in community paediatrics (one session a week) n Consultant in substance misuse (one session a fortnight) n Consultant in Child and Adolescent Psychiatry (one session a month)

What do we do? n Take referrals from all agencies; particularly YOT and self or family referrals n Advice, information and support to health and social care agencies and to families n Assessment: –Advice, information, support and referral (brief contact) –Care plan n Case work and treatment; range of health and psycho-social interventions, including prescribing substitution medication.

How are we doing? n Number of referrals and source n Substance use n Problems experienced n Substitute prescribing.

Referrals to P360 by age

Source of referrals

Substance use identified in referral

Health and social problems

Substitute prescribing; prescribed at 21October 2002

Conclusions n Only a small number of under 18 year olds are in treatment compared to the number of clients in adult services who say they started their regular use at this age n Some have problematic, regular injecting drug use from a very young age n Many have poor physical and mental health n Many live in very difficult social circumstances n Many are known to YOT/CJS n Only a small proportion are prescribed substitute medication.

Outstanding issues: general n Consent and assessing “competence”; generally has not been a problem n Involving parents; problem at times particularly if the parent has mental illness or is dependent on drugs or alcohol n Needle exchange; to do or not to do? n Sharing records with other agencies and long-term implications of being in treatment n Transition to adult services.

Outstanding issues; prescribing n Keeping youngsters safe; balancing risks and benefits of prescribing in context of psycho-social interventions. n Degree of choice by the young person? n What type of replacement treatment and what dose? n Under what monitoring/constraints? n Duration of replacement treatment?