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Developing a specialist community based service for adolescent drug users

Topics. Principles of treating young people with substance misuse problemsDevelopment of Project 360BackgroundOrganisationHow are we doing?Conclusions; outstanding issues.. National policy and guidelines. Substance misuse treatmentChild protection and rights of young peopleYoung people and s

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Developing a specialist community based service for adolescent drug users

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

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

    3. National policy and guidelines Substance misuse treatment Child protection and rights of young people Young people and substance misuse: 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).

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

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

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

    7. Development of young persons community drug service, Bolton (Project 360) 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 1998 SS appointed a young persons’ drug co-ordinator, with plans to develop a young persons drug project 2000 establishment of Project 360 in premises run by a voluntary group, that housed various young peoples’ projects.

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

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

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

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

    12. Referrals to P360 by age

    13. Source of referrals

    14. Substance use identified in referral

    15. Health and social problems

    16. Substitute prescribing; prescribed at 21October 2002

    17. Conclusions 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 Some have problematic, regular injecting drug use from a very young age Many have poor physical and mental health Many live in very difficult social circumstances Many are known to YOT/CJS Only a small proportion are prescribed substitute medication.

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

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

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