ALCOHOL RELATED ATTENDANCES IN CHILDREN

1. ALCOHOL RELATED ATTENDANCES IN CHILDREN KIM WILLIAMS LEAD NURSE, EMERGENCY DEPARTMENT Alder Hey Children’s NHS Foundation TRUST

2. BACKGROUND • Total 60,000 new attendances year • 0-16 years • 150 – 200 patients a day

3. Background • Childrens NSF • National Alcohol Harm Reduction Strategy • Every Child Matters • Local Concerns

4. BACKGROUND • Increasing number of alcohol related attendances Audit 2004 • Inconsistent management • Poor follow up & support

5. WHAT COULD WE DO?

6. WHAT COULD WE DO? • Clinical care pathway • Standardise medical assessment/treatment • Standardise information given to patients • Offer Brief intervention clinic follow up • Establish links with existing support services

7. ALCOHOL PATHWAY

8. WHAT COULD WE DO? • Links with education • School nurses • Identify high use schools • Healthy schools co-ordinator • Links with police • Hot spots of activity • Alcohol suppliers • Links with MRAS

9. Information pack

10. Brief intervention clinic • Nurse Led • Training – motivational interviewing • Once only – 30 -40 mins • Information pack prior to attendance • Seen within a week of event

11. BIC • ‘Its all about you’- social history • Reflection – Morning after leaflet • Explore knowledge • Personal safety • Risk taking behaviours • Screening tool – young people at risk • Referral as appropriate.

12. DESIRED OUTCOMES • Change in behaviour • No re-attendance to AED • Early identification of substance misuse • Referrals to specialist services in appropriate areas • Collaborative working with schools • Collaborative working with police • Data collection to add to national database

13. Pathway Audit Jan 05 to May 09 743 alcohol related attendances 67% Female 70% aged 14 – 16yrs 18% admitted to hospital.

14. AGE RANGE - ALCOHOL 120 100 80 60 No of patients 40 20 0 Under 11 12 13 14 15 16 Over 10 16 Age

15. What are they drinking?

16. Alcohol audit • About half are drinking in streets/parks • With friends, few alone • Alcohol bought from shops (20%) • Co-ingestion in 15% • Paracetamol, cannabis, caffeine • Ecstacy, amphetamines, cocaine and heroin • 17% found by Police/Stranger • 40% associated injuries

17. Is this the first time? • Sometimes - 38% • Regular - 16% • Never - 14% • Not recorded - 32%

18. Case 2What lies beneath • 14yr old girl • Hand laceration – day after • Fallen whilst drunk • Admitted to drinking Vodka Friday nights • Alcohol from off license • Drinks with 1 friend mostly

19. BIC • Drinks half bottle of vodka and cider • Has been drinking for 2 yrs • Has events that she can’t remember • Truants from school • Trouble with the police once • Father died tragically 3yrs previous • No bereavement counselling • Visits grave almost every day

20. BIC • Recognised problem • Wanted to give up • Referral to specialist services

21. Group Therapy • 13yr old girl, drinking vodka in park • 5 friends + group of boys • Vodka obtained by boys • 2 ‘drunk’ 2 sober 1 semi conscious • Explored event from different perspectives • Feelings/concerns/shared experience

22. Group Therapy • Discussion • Risk taking • Future strategies • Experimentation

23. WHAT EFFECT ARE WE HAVING? • Early referral to appropriate services • Recognition of vulnerability of these young people • Opportunity for exploration of underlying issues – depression/anxiety/anger

24. What we have learned? • Local alcohol and substance misuse services • Lots around at Tier 2 and 3 • Real need at Tier 1 provision • Need for “joined up working” • Education, Social Care and other Healthcare providers • Adolescent issues

25. QUESTIONS

26. Thank you If you are young and you drink a great deal it will spoil your health, slow your mind, make you fat - in other words, turn you into an adult. P.J. O'Rourke