AGENDA ITEM 4

BOROUGH OF POOLE

CHILDREN AND YOUNG PEOPLE OVERVIEW AND SCRUTINY COMMITTEE

18TH MAY 2010

YOUNG PEOPLE’S SUBSTANCE MISUSE SERVICES: REPORT OF THE HEAD OF CHILDREN AND YOUNG PEOPLE’S SOCIAL CARE

  1. PURPOSE OF REPORT

1.1To report on the governance arrangements and current provision of substance misuse services for young people.

1.2To outline commissioning strategies and priorities in relation to substance misuse services and proposals for future models of service delivery.

1.3To advise and inform members of the future policy direction and commissioning priorities in relation to substance misuse services.

  1. BACKGROUND

2.1Government policy aims to continue to reduce the level of substance misuse by young people through local delivery of education, prevention, treatment and enforcement programmes as set out in both the new ten-year Drug strategy and the Youth Alcohol Action Plan. The Government has signalled its commitment to tackling substance misuse with a new national indicator (NI 115 Substance misuse by young people) in the Public Service Agreement 14: to increase the number of children and young people on the path to success. The ten- year Drug Strategy2008 – 2018, prioritisefamilies for the first time and outlines actions to reduce the harm that children experience from either their own or their parent’s use of drugs, alcohol and volatile substances (glue, gas, solvents etc)

These include:

  • Taking a long-term view of prevention by intervening early with families at risk, improving treatment for parents with drug problems and protecting their children during and after the treatment period
  • Improving drugs education and strengthening the role of schools and children’s services in identifying problems and intervening earlier
  • Integrating substance misuse service provision within mainstream children’s services and targeted youth support, improving access to positiveactivities and ensuring effective specialist treatment for under-18s.

The delivery of the above key policy objectives and local performance in achieving agreed outcomes is overseen and monitored by the National Treatment Agency for Substance Misuse (NTA). This is underpinned by an annual Young People’s Specialist Treatment Plan produced by all local authorities which has clear linkages into priorities in Poole Children’s and Young People’s Plan and the LSCB Business Plan in relation to vulnerable young people and substance misuse.

2.2Local governance around Young People’s Substance Misuse Services is now located within the Children’s Trust. Commissioning of service is via a Young People’s Commissioning Group which reports to both the Children’s Trust structure and the Drug and Alcohol Action Team (DAAT) Executive Board.

2.3Following an external Commissioning Review in 2008/9 a Young People’s Commissioning Strategy has been developed which will inform a process to agree future commissioning arrangements through the Children’s Trust. As a result of changes to funding arrangements, universal service funding will in future be drawn from mainstream and Area Based Grant funding. The DAAT will, in future, only receive funding to commission high level treatment services as defined by the National Treatment Agency and this funding has reduced in 2010/11 and is likely to further reduce in 2001/12. This will result in significant challenges to partner agencies across Children’s Services in maintaining services in this important area of work.

3.CURRENT SERVICE DELIVERY MODEL

3.1The current service (Young Adults Drug and Alcohol Service) delivery model has grown around a core service provided by YADAS commissioned jointly with Bournemouth Borough Council. The model is best described by considering tiers of provision as follows:

Tier 1 - Prevention and Early identification - focused on universal service provision
Includes:

  • Education, Prevention and Advice in schools and other universal settings. Focussed work with Pupil Referral Unit
  • Drug and Alcohol Awareness training provided to all Children’s Services staff by YADAS
  • Role of Safe Schools and Communities team in drug and alcohol, education and awareness.
  • Drop-in service and group work activity linked with Poole Youth Service
  • Use of the CAF Common Assessment Framework to identify early substance misuse including use of SUST (Substance Misuse Screening Tool).

Tier 2 – Brief Intervention Provision – focused on ‘experimental’ and/or occasional substance misuse.

  • Located within the specialist YADAS service and providing time limited community based interventions or programmes with clear referral criteria and pathways with a specific aim to reduce the risk of repeat or more serious substance misuse. In Poole this service has been focussed primarily around alcohol misuse (identified locally as the most significant area of need) and has established close links with Poole Hospital A & E and the Police custody suite. Alcohol misuse work with young people is an LAA target and has received time limited LAA funding.

Tiers 3 and 4 – Specialist treatment – focussed on ‘problematic’ and ‘dependent’ substance misuse.

  • A fully integrated multi-agency specialist drug service, primarily for problematic drug/alcohol users. Referrals are predominantly for alcohol and cannabis use, however, there are a number of young people presenting as chaotic users with a range of needs that require high intensity support.

The service provides:-

- psychosocial interventions

- pharmacological support

- family support

- harm reduction

- community detoxification

- through are support

- aftercare to support a relapse prevention approach

A Carers’ Support Service is also provided for young people with substance misusing parents and for parents with young people with substance misuse needs.

3.2 The current staffing resource within YADAS (currently operating across tiers2, 3 and 4)is:-

2 fte YADAS key workers

2 fte social workers

1 fte YOT YADAS worker (joint post with Bournemouth BC)

Child and Adolescent Psychiatrist

4 SUBSTANCE MISUSE SERVICE REVIEW AND COMMISSIONING STRATEGY
4.1 An independent commissioning review of substance misuse services

was undertaken in 2008/9 by Alcohol Concern. The key messages from this review and the 2009/10 needs assessment and Treatment Plan are:-

  • Alcohol and cannabis are the predominant types of substance misuse locally.
  • There appears to be a high number of alcohol related hospital admissions in Poole compared to the national average.
  • In 2008/9 2 young people received treatment as problematic drug users (defined as users of opiates and/or crack cocaine). Very few young people require access to prescribing, inpatient or residential services.
  • Evidence of correlation between local geographical hotspots for drug and alcohol misuse and concentrations of number of children with high levels of need and poor outcomes. Geographical areas identified are Alderney, Turlin Moor, Newtown, Poole Town Centre and Canford Heath.
  • Prevention and early intervention strategies were judged as positive by the Review particularly in relation to education in schools.
  • An identified need to strengthen the link between the Common Assessment Framework and the use of the specialist screening tool in order to further improve early identification amongst agencies.
  • Further clarity required between tiers of provision and referral pathways into services.
  • In 2008/9 there were 202 referrals into the YADAS service. (116 alcohol, 86 drugs (predominantly cannabis). Of these, 123 continued into treatment.
  • Treatment outcomes are positive. A high proportion of young people who commenced treatment had either a planned discharge or continued in treatment (102 out of 123-83%).

4.2The key commissioning priorities emerging from the review and now forming part of the 2010/11 Young People’s Specialist Treatment Plan are to:-

  • provide early identification though the CAF and effective screening;
  • ensure that the specialist tier three service is targeted at young people with the most complex needs;
  • ensure that there is a robust care pathway in place which delivers for young people a holistic service at the level appropriate for their needs;
  • integrate the drug and alcohol services for young people with other targeted youth services, as part of the Integrated Youth Services developments;
  • provide effective brief interventions for young people misusing alcohol at the point where these interventions will be most effective;
  • ensure that the drug and alcohol services in Poole are able to meet identified need within the resources available and in the most effective way and in line with best practice.
  • build capacity in early intervention and prevention services focused on those most at risk of developing substance misuse problems to ensure a reduction in the risk of escalation;
  • ensure that there is a competent and appropriately trained workforce in place that supports the capability of universal and targeted services to deliver effective substance misuse education and intervention
  • maintain robust and high quality data recording;

4.3The above priorities are complemented by the Poole Alcohol Harm Reduction Strategy which has a specific priority objective around Alcohol and Young People- Tackling Parent and proxy supply. Helping young people to address the consequences of alcohol misuse. The strategy includes a number of specific actions and outcome measures which cross reference with the substance misuse commissioning strategy outlined above.

5.Funding Information

5.1 The funding of substance misuse services is complex and has historically been drawn from a number of sources. In addition the process of review and developmentof clear commissioning priorities based on identified types and levels of local need is taking place within the context of reducing central funding year on year. The current available budget for 2010/11 is £258,321 as follows:-

£ / Source
72,074 / Area Based Grant
16,299 / Substance misuse grant paid via Youth Justice Board
60,502 / Young Peoples substance misuse treatment grant
45,000 / LAA funding (Alcohol BIT targets)
29,121 / Adult treatment budget contribution
17,425 / PCT mainstream funding
17,900 / Children Services mainstream funding
Total / £258,321

The above budget funds the YADAS service outlined in section 3 above and in addition two family support workers posts within the Adult Treatment Service supporting children and young people in families with substance misusing parents.

5.2 Significant reductions in the Young Peoples substance misuse treatment grant and in the historical subsidy from the Adult Service Treatment budget has resulted in the loss of 2.5fte posts within the YADAS service for 2010/11. Detailed work has been undertaken with the service to consider the impact of this reduction in staffing. As a result of identification of some duplication of work and review of allocation systems across Poole and Bournemouth caseloads YADAS is able to maintain appropriate levels of service for Poole young people at Tiers 3 and 4 and therefore absorb the impact of staff reductions. This position will be kept under close review through quarterly monitoring meetings with the service provider.

5.3 The current and future budgetprofile will require that available treatment monies are focussed on provision of specialist treatment services i.e. primarily tiers 3 and 4 which will continue to be commissioned jointly with Bournemouth Borough Council.. This model of delivery is consistent with the intention to ensure that an appropriate level of Tier 1 and 2 services are delivered locally within Poole as part of Integrated Targeted Youth Support Services and extended schools provision.

The Integrated Targeted Youth Support Programme involves the development of service now underway and including member involvement models which would bring drug and alcohol expertise around prevention and early identification into an Integrated Targetted Youth Support Service. Detailed work is now underway within this programme to ensure appropriate local staffing and resources for substance misuse services.

6.SUMMARY

6.1In summary, the key actions within the delivery plan for the Young Peoples substance misuse strategy are to:-

  • continue to provide comprehensive drug and alcohol education information and awareness programmes in all Poole Schools and other universal settings.
  • mainstream and integrate the tier 2 drug and alcohol service for young people with other targeted youth services, as part of the Poole Integrated Targeted Youth Services development programme.
  • develop a revised specification for tier 3 and 4 young peoples specialist treatment services in line with an agreed budget for 2011-12 and beyond. This service will be commissioned jointly with Bournemouth Borough Council via formal tendering process.
  • ensure that relevant data systems continue to inform future strategic needs analysis and strategic planning, particularly on relation to equality and diversity and improved identification of geographic ‘hot spots’ for targeted intervention.

Gerry Moore

Head of Children and Young Peoples Social Care

Tel: 01202 714745 e-mail

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