Sam Cox Deputy Regional Manager NTA London Regional Team

1. Approaches to reducing alcohol harm for children and young peopleYoung People’s Specialist TreatmentLondon Alcohol Practitioners Forum 20th March 2009 Sam Cox Deputy Regional Manager NTA London Regional Team

2. 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

3. 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

4. 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

5. NTA and young people’s specialist treatment • NTA developing a range of guidance to support improvements to national service delivery • Regional performance assurance role – the focus is on improving accessibility, quality and effectiveness of yp treatment provision: • Needs assessment • Treatment planning • Performance data and quarterly progress reviews • Supporting integration of commissioning function into Children’s Trust arrangements • Partnership level and regional governance arrangements

6. 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’

7. 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.

8. 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

9. 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.

10. 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 NDTMS Presentations

11. What does a good substance misuse service look like? • Reflects needs of the population – not based on historical make up of services • Clear protocols and referral pathways into and out of specialist provision • Comprehensive range of interventions offered – all yp specific and evidence based • Holistic approach to the young people’s needs • Local services – accessible both in terms of location and opening hours in appropriate buildings with outreach/satellite services

12. 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….

13. Issues for specialist substance misuse provision in London • 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

14. 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