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Introduction

Young people’s drug misuse is markedly different to that of adults, and so is the combination of treatment and support they receive. Interactions and interventions must be appropriate to the age, maturity and level of development of the individual child or young person.

Substance misuse among young people also needs to be seen in the context of the family environment, social pressures and emotional issues, to which young people are especially vulnerable. When young people struggle to come to terms with such factors, they can resort to drugs and alcohol.


Definition

Substance use can include: alcohol, volatile substances, legal, prescribed, over-the-counter drugs, and illegal drugs.


Identification

All staff in contact with children and young people have a key role to play in identifying and supporting young people, this includes being able to identify and respond to any substance related needs. Often young people are asked ‘Do you use drugs?’ however, in order to get a better understanding of a young person’s needs around substances, more open ended questions should be used. The conversation with the young person has to provide enough information to be able to judge the following:

  • A young person’s knowledge of substances;
  • If the young person uses substances;
  • If the young person misuse substances;
  • If the young person is in immediate danger;
  • Is substance use is part of complex or troubling behaviour; and
  • Signs of unusual behaviour for that age group in relation to their substance use.

The aim of the identification process is not to police a young person’s substance use but to support the young person, e.g. by providing information or more targeted work. Identification of substance related needs should not stigmatise or ostracise a young person.

There are a number of situations when professionals explore whether a young person has any substance related needs:

  • Following actual, or suspicion of, substance use;
  • Where a young person seeks drug or alcohol related advice and information;
  • When a drug or alcohol related incident occurs; or
  • When young people vulnerable to substance misuse comes into contact with your service.

It is good practice for all universal, targeted and specialist services to incorporate the process of identifying substance related needs as part of their own assessment process.


Child Protection Concerns

The Standing Conference on Drug Abuse (SCODA) recommends using the following four parameters when determining whether confidential information given by a young person in relation to substance use should be disclosed to Children’s Social Care or the Police because of concerns that a child may be suffering, or likely to suffer Significant Harm:

  1. The age and maturity of the child and young person - As a general rule, the younger the child, the more problematic it is to guarantee or maintain confidentiality. There is no age limit in law below which a child cannot enter a confidential relationship, but given the problem of establishing competence, and therefore capacity to consent, it is difficult to envisage children being offered treatment and support without parental consent or parental involvement under the age of 13;
  2. The degree of seriousness of drug and alcohol misuse - The more serious the substance misuse the more likely it is that disclosure of confidential information to other agencies will have to be considered. In deciding whether or not to disclose, the service must take into account the level of substance use and the risk involved. The supply source of the young person’s drugs may also be an important factor particularly if the young person in question is open to exploitation;
  3. Whether harm or risk is continuing or increasing - Harm from substance use needs to be considered in relation to past, present and potential future behaviour. If there is a clear risk to the child or young person arising from present behaviour or evidence of escalated risk to an unacceptable level, it is important that agencies take steps to ensure the future safety of the child or young person;
  4. General context in which drug taking is set - Where a child or young person has multiple problems, it is likely that other agencies or professionals will need to be involved to resolve these problems or reduce the vulnerability and risk to the child or young person.

Response

When practitioners identify a young person’s substance misuse it can be useful to consider the stage of use that the young person is at.

The Stages of Substance Use model (see below) can help practitioners working with children and young people to explore possible motives behind use, the potential impact on emotional well-being and functioning, and the most appropriate intervention to support the identified stage of use.

Click here to see Stages of Substance Use And Suggested Interventions.

Parental Consent

Where a young person is aged 16 years or over and has severely diminished ability to understand the above, or where they are aged under 16 years and have not been assessed as Fraser Competent, consent will be sought from their parent, carer or other person with Parental Responsibility.

Consultation

Even where a young person does not consent to working with ReFRESH (the Young People’s Drug and Alcohol Service), support and consultation can still be provided to practitioners. A practitioner who is already supporting the young person is often well placed to deliver work as they will already have a good relationship with the young person. By contacting ReFRESH, substance misuse practitioners can then support the practitioner to use consultation toolkits containing drug education and harm minimisation information, and to explore the young person’s motivation to address their substance use. Practitioners are able to work through the tool kits with the young person following which they may consent to a referral to ReFRESH. ReFRESH has consultation tool kits on cannabis, alcohol and mephedrone (m-cat).

CRAFFT

Local agencies can use the CRAFFT questionnaire to identify young people who may be at risk. If concerns are identified in young people aged under 15 then it is recommended to refer into ReFRESH for a comprehensive substance misuse assessment to assess health, education and social care needs. For those young people over 15 years, practitioners can complete the CRAFFT screening tool by following the instructions on the CRAFFT form.

Click here to access the CRAFFT Screening Tool (found in the Documents Library section of this manual).

The screening tool looks at substance use over the last 12 months and will indicate whether a referral into ReFRESH should be made. If the CRAFFT screen is negative and indicates that a referral to ReFRESH is unnecessary but the practitioner/young person would still like information/support from ReFRESH then they are still encouraged to contact ReFRESH directly.

If the CRAFFT screen is positive then, with the young person’s consent, the practitioner or if the young person prefers, they themselves, or their parents/ carers should make a referral to ReFRESH via telephone: 01482 331059, by email: ReFRESH@hullcc.gov.uk using the ReFRESH referral form or by dropping into ReFRESH during duty times 12.30 - 2pm Monday – Friday to make a referral.

Training and support is available to staff and agencies in using the CRAFFT and tool kits – please contact ReFRESH to arrange.

If a young person is under 15 years of age, is from an ‘at risk’ group or in an ‘at risk’ situation (refer to pathway) a referral, with the young person’s consent refresh should be made as already outlined.

To download the ReFRESH referral form, please see the Documents Library.

Referrals are discussed at the weekly Multi Discipline Team (MDT) meeting. At this stage the ReFRESH team will decide whether the referral requires an initial assessment, following a CRAFFT screen, or a comprehensive assessment for those young people ‘at risk’ and under fifteen years old. The referral will be allocated to a worker who will make contact with the referrer and young person within 5 working days. If all ReFRESH practitioners’ caseloads are full then the referral will be placed on a waiting list, with the referrer and young person being notified. If support is required in the meantime for that young person the practitioner and/or young person should access ReFRESH’s duty service.

Once a young person has been allocated a ReFRESH worker a range of interventions, depending on the stage of use, are offered and utilised. This can include but is not limited to psychosocial interventions; motivational interviewing, cognitive behavioural therapy, relationship building, relapse prevention, and access to counselling, and pharmacological interventions; detoxification, withdrawal management, substitute prescribing, harm reduction including Blood Bourne Virus and Sexual Health screenings, access to clean equipment.

ReFRESH offers a multi-agency package of care supported by both universal and specialist services such as education, supported housing, Child and Adolescent Mental Health Services (CAMHS) Targeted Youth Support, and Hull Youth Justice Service (HYJS) to promote the young person’s physical, emotional and social well-being.

The young person’s package of care is reviewed at ReFRESH’s MDT, at least every six weeks. Once the young person’s goals have been met the case is presented at ReFRESH’s MDT where treatment complete is agreed. The young person and referrer will both receive a closure letter outlining the work undertaken. If the young person has previously consented they will be contacted soon after their discharge to obtain service user feedback.

Training

For those practitioners wishing to increase their knowledge and skill base, ReFRESH delivers level one drug awareness, level one alcohol awareness and Screening and Identification Briefing Training as part of the Hull Safeguarding Children Board training pathway.

For further information on training, please see the Hull Safeguarding Children Board website.


Further Information

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