Safer Bristol - Young People's Substance Misuse Treatment Plan 2009/10
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Young People’s Substance Misuse Treatment Plan 2009/10 P Prroodduucceedd bbyy M Maarrttiinn S Siiddddoorrnn –– Y Yoouunngg P Peeooppllee’’ss S Suubbssttaannccee M Miissuussee M Maannaaggeerr
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Part 1 Strategic Overview and Key Priorities
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The Overall Direction of the Strategy This plan will evidence the work that will be undertaken in Bristol during 2009/10 to contribute to achieving the ambitions of key governmental drivers regarding young people’s substance misuse. This work will specifically contribute to PSA 25, reducing the harm caused by alcohol and drugs, and PSA 14, increasing the number of young people on the path to success. It will evidence actions towards achieving contributions to national indicator 40, which records the increase in numbers of drug users in effective treatment and national indicator 115substance misuse by young people, which is included as a priority within Bristol’s Local Area Agreement. The Drug Strategy Team (DST) and Safer Bristol are committed to delivering a full range of substance misuse treatment, targeted prevention and universal services to young people regarding this issue. This provision is strategically planned and commissioned by the Young People’s Delivery Group (YPDG). This has close links with Children and Young People’s Strategic Commissioning Group within Bristol City Council. The YPDG is informed by the Young People’s Manager’s Meeting (YPMM) and Worker’s Forums consisting of partners, providers and other stakeholders from across the city. There are also service user consultation groups within commissioned agencies that further advise regarding the commissioning and planning processes. Through this commissioning structure we endeavour to commission and provide support to Bristol’s young people’s substance misuse agencies in line with the NTA’s Essential Elements Guidance. This year’s strategy aims to further build on these commissioning arrangements to ensure that Bristol has integrated, needs led, outcomes focussed commissioning arrangements in place to meet the identified needs of young people in the city. These commissioning arrangements have led to the development of what are now clearly established and integrated young people’s substance misuse agencies in the city. This year’s needs assessment evidences how the establishment and development of these services and the development of strong strategic links with universal young people’s services has led to a significant increase in the number of young people engaged by specialist services across the city. In order for these services to be further integrated into wider children and young people’s provision it is a priority to build on the challenge of PSA 14 to further develop how specialist services fit with Bristol’s Youth Matters agenda, Children and Young People’s Services commissioning and Locality Governance planning, and Common Assessment Framework Locality Panels.
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The Overall Direction of the Strategy contd. The DST recognizes that accurate and timely performance data is crucial to demonstrate the effectiveness of our treatment system. We will strive to improve data quality, specifically NDTMS, and ensure our systems are fit for purpose. This will ensure appropriate data is available to key stakeholders such as NTA, NHS Bristol, Children and Young People’s Services as well as building on the emerging picture of need demonstrated in this year’s treatment plan. This will allow for further investigation of diversity, geographic breakdown of need and changes in ‘drug of choice’ profiles as highlighted in this years assessment. A key challenge for the forthcoming year will be the integration of all targeted and treatment young people’s substance misuse services in Bristol under one common name. This will allow for clearer branding of services, afford an excellent opportunity for re-launching and re-publicising services and facilitate the substance misuse services being incorporated under the Integrated Youth Support banner. This will also give a banner under which practitioners, managers, service users and commissioners can meet at ‘Big Team Meeting’ days, ‘Cutting Edge’ conferences, ‘Workers Forums’ and ‘Service User Consultation’ panels. This should facilitate better communication between all stakeholders and ensure easier identification of services for young people. Much has been achieved in recent years to target vulnerable young people and to engage them in treatment services. However, more work is required regarding specific groups such as children in care, homeless young people, those leaving the secure estate for community services and a wider review of all young people who are outside of mainstream education. A particular focus is also required on some BME groups, particularly those who are highlighted in the needs assessment. Also, work needs to be done to further integrate this agenda with the work of groups engaging with gangs, group offending and dangerous weapons agendas. Following on from the lead in the new National Drug Strategy there is a clear need to improve awareness and provision of services for families of substance misusers. This will involve some key partnership working with Bristol Safeguarding Board, with a particular focus on the issue of Hidden Harm. In order to facilitate effective referrals into treatment services further work is required to develop the provision of in school education. The Bristol Early Intervention Service is a key source of referrals into treatment services and these referral pathways need to be further reviewed and strengthened. By establishing an effective workforce strategy, generalist agencies can be skilled in substance misuse matters and referrals into specialist services further encouraged and monitored This is a particular priority regarding work with Police, Youth and Play Service, Connexions and Accident and Emergency departments.
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The Overall Direction of the Strategy contd. Bristol DST has a clear commitment to hearing the views of all its stakeholders to inform the commissioning and strategic planning processes. Service User consultation groups are established in a number of specialist services. This year we will build on this to establish a DST service user forum that will feed directly into the Delivery Group. We will also establish members of the adult UFO group, who have an experience of adolescent substance misuse, onto both the Managers and Delivery Groups. Further work with service users carers will be undertaken to ensure their representation in this process. Improving transitional arrangements for young people leaving young people’s services for adult services will be key piece of work this year. This will involve the recruitment of a specialist transitions worker in adult services and completion of a scoping exercise for a discreet service for 18 to 25’s for the city.
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The Likely Demand for Specialist Treatment Interventions for Young People
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The needs assessment shows that 10 young people received pharmacological interventions in 08/09. It seems likely that demand will continue at a similar level this coming year. Work has been done with universal services and targeted prevention services to ensure that any young person thought to require such an intervention is referred immediately into Young People’s Drug Treatment service for full assessment.
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The needs assessment showed that 313 young people engaged with specialist treatment services for psychosocial interventions. It is estimated that this number will increase in the forthcoming year. This will primarily be due to the increased targeting of specific vulnerable groups such as those young people outside of mainstream education, children in care and those who are homeless/inadequately housed.
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This document identifies the further assessment and provision of family interventions as a key priority. Particular emphasis will be given to monitoring and increasing provision for Hidden Harm groups and working with Children and Young People’s Safeguarding Board to ensure a more integrated approach to planning and commissioning.
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A working group has been established to review provision of specialist harm reduction provision for young people. A common health screen is now used across all treatment services to establish need and plan a coordinated response regarding blood born viruses, safer injecting etc.
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No young people were identified as being in need of residential placements regarding substance misuse issues in 08/09. However there is a clear mechanism in place for identified need to be raised with the Delivery Group.
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The needs assessment clearly demonstrates changing need in the city in regards to diversity issues. It is a priority in this document to improve outreach, identification and engagement of specific BME groups of young people into the treatment provision. Similarly the past year has seen a shift in the gender profile engaging with services and work needs to be done to ensure that we are adequately engaging young males in specialist services.
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The Key Findings of the Current Needs Assessment
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Overall this year has seen an increase in activity from the young people’s substance misuse services in Bristol. Early Intervention Service, Youth Offending Team and Drugs & Young People Project have all shown an increase in young people accessing their services.
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As regards treatment outcomes, within the young people’s substance misuse services planned discharges have decreased, but more young people are currently in treatment, whilst unplanned discharges have reduced. These will be monitored through out the year.
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There has been a significant increase in young people presenting to services with alcohol as their primary drug of choice. This has been due to more effective targeting of young people with alcohol problems and the shifting of emphasis at specialist services to respond to this need. These trends will be reviewed through out the year.
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Changing trends of drug use by young people have been noted. Encouragingly crack and heroin use amongst young people has decreased. However new drugs of choice are emerging amongst young people, such as ketamine, that will need investigating. Further work also needs to be done on new drug profiles emerging amongst young people. For example, based on national research, steroid use and tanning drugs are increasingly being used but have not been identified within this year’s needs assessment data.
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Young people in Bristol appear to be following the profile of ACCE’rs(Alcohol, Cannabis, Cocaine & Ecstasy) when looking at poly drug use. In addition to this the majority of young people are aged 17 and over in the young people’s services. This provides further evidence of the need for a ‘transitional’ service that caters for young adults with different needs to those of adults in adult drug treatment services.
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Through out the young people’s substance misuse services there has been an increase in accessing vulnerable groups of young people. However further action is required to target these groups. This work will ensure we have a clearer picture of any unmet need amongst these groups•
Hidden Harm-There is a need for a greater service provision to meet identified need.
•
Truants/excludees- A review of ‘out of school provision’ is taking place.
•
Children in care- Increased targeting especially by D&YPP. 7
The Key Findings of the Current Needs Assessment contd.
•
Criminal Justice- Increased targeting at YOT, a review of young people who are being released from the secure estate needs to take place.
•
Homeless/inadequately housed- More work done in hostels/dropins.
•
At risk of sexual exploitation- Through the BASE service.
•
Teenage mothers- more links established with maternity services and the teenage pregnancy agenda.
•
NEETS(Not in Education, Employment or Training)- established links with out of school provisions/Connexions.
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In terms of ethnic minority groups accessing young people’s services, ‘Mixed: White & Black Caribbean’s represent a much higher % to that of Bristol’s overall % for this group, this will require further research. In addition to this, work will need to be done on how we can engage young people from ‘newly arrived communities’ in Bristol, such as Somalians or Eastern Europeans.
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This year’s needs assessment has seen an increase in females accessing young people’s services. A further review will need to be done to ensure we are still effectively engaging males in young people’s services.
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We will review the postal districts of the young people accessing services. Postal areas which have either a high or low entry in to the young people’s substance misuse services will be investigated and the reasons behind this.
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Recently published data for Bristol(TellUs3 and Every Child Matters surveys) has informed us that, overall, drug use amongst young people is above the national average(however the sample in Bristol contained more older young people compared to the national average).
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These 2 surveys explained that young people in Bristol are more satisfied with the advice and information received compared to the national average. However there is a still a significant number of young people who are unsure whether they have a local drug service available to them. This supports the work that has started in Bristol to integrate the young people’s services and have a common branding for the services to make them more identifiable to young people.
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The Key Findings of the Current Needs Assessment contd.
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The release of Dataset F next year will increase the young people’s data that is uploaded on to NDTMS. This will enable us to produce a more detailed needs assessment, with a focus on young people’s entries and exits in to the treatment system, next year.
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More work needs to be done to identify the points of attrition for young people from the treatment system. Cases of young people who are leaving the treatment system in an unplanned way need to be reviewed in order to ensure that similar drop outs from treatment will be avoided in future cohorts where at all possible.
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The improvements to be made in relation to the impact of treatment in terms of its outcomes
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NDTMS data will be closely monitored to assess the effectiveness of our treatment system for young people. With the aim of delivering improvements in individuals health and social functioning. We will continue to incorporate monitoring of TOP’s completions in our quarterly performance monitoring meetings.
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The completion of the Early Intervention Service evaluation, in partnership with John Moore’s University, will also inform review of the effectiveness of the referral pathways into treatment services.
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Key priorities for developing specialist young people substance misuse treatment interventions In order to further to develop this work the Delivery Group has identified four priorities for the Treatment plan for 09/10. These priorities were developed based upon the findings of the needs assessment and consultation with key stakeholder groups such as service users, managers and practitioner’s. These four priorities are: 1) We need to improve transitional arrangements for young people moving from young people’s specialist services into adult services. 2) We need to review and improve access to whole families work. Within this there needs to be a focus on work with children who are living with adult substance misuse. 3) We need to build on this year’s service Integration work to ensure that young people’s substance misuse services are delivered under a common branding to respond to the needs of young people in their localities. 4) We need to further review the work we are doing to target the most vulnerable groups. We need to have a strong focus on targeting those BME young people who are particularly vulnerable. In order to meet these priorities key actions have been identified: Priority 1: Transitional Arrangements
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Development of and recruitment to specialist transitions worker in adult services.
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Referral pathways between young people’s services and adult specialist services to be formalised.
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Review of transitional needs of young people with emerging mental health/ substance misuse dual diagnosis issues.
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Develop and cost a model of an 18-25 service. Developed in consultation with young people’s and adult’s services and service users.
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Present to DST Joint Commissioning Group and Young people’s Delivery Group proposals for new service.
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Priority 2: Families Work
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Carry out a mapping exercise of services for families of drug service users in Bristol, including relevant national services.
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Review gaps in this provision, including an emphasis on support for parents of young substance misusers. Present findings to commissioning groups.
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Work with Bristol City Council Safeguarding Board to prioritise work with young people affected by parental substance misuse.
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Draw together a database of services available and promote this.
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Establish close links with Anti Social Behaviour and Child Poverty Family Intervention Projects.
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Complete a detailed needs assessment of Hidden Harm needs across the city.
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Endeavour to ensure the continuation, development and strategic linking of Hidden Harm provision in targeted and specialist services.
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Review provision of training for key staff working with Hidden Harm issues eg social workers, health visitors, staff in children’s centres.
Priority 3: Service Integration
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Services launched under common branding. Publicised using leaflets, websites etc. Service re launch day to be organised and publicised.
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Current arrangements for Big Team Meeting, Cutting Edge Days, Worker’s Forums and Service User Consultation Panels to continue.
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Membership of Locality Governance Groups to be established.
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Early Intervention Service staff to link into Children and Young People’s Services Common Assessment Framework Practice Panels.
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EIS staff to link in with Locality Integrated Youth Support Teams. Providing substance misuse expertise in each locality and facilitating referral from locality teams into EIS and treatment services.
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Common practice protocols to be agreed and implemented.
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Closer linking with Teenage Pregnancy agenda as part of IYSD.
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Progress with all of the above to be regularly reviewed and monitored.
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Priority 4: Targeting Vulnerable Groups
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Continued targeting of Children in Care to encourage referral into Drugs and Young People’s Project. Review training available for social workers working with this group.
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Targeting of homeless/inadequately housed young people by links into hostels/drop-ins.
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Review arrangements for young people moving from secure estate into community substance misuse services.
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Review provision for young people who are out of mainstream education. Review service availability with PSA 14 Group. Map current delivery against available provision.
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Use DCSF Equality and Diversity Audit Tool for Commissioning to produce a diversity and equality action plan.
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Establish closer links with key BME groups eg Asylum Dispersal Centre, Somalian Youth Groups etc.
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Continue to link Nilaari young people’s service in with other provision.
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Review links with socially excluded groups through groups working with gangs, group offending and dangerous weapons agendas.
The intended outcomes for these actions is a young people’s substance misuse service that can be clearly marketed and publicised, in close collaboration with other Integrated Youth Support Services in the city. This service would be able to provide much improved transitional arrangements for young people post 18 years. There would be a clearer idea of current provision and need regarding whole families interventions, particularly for those young people living with adult substance misuse. Finally, specifically identified vulnerable groups would be further engaged by specialist services, building on work that has been started over recent years. This will increase the engagement of Bristol’s young people with specialist services, building on the increased engagement identified in this year’s need assessment. This will improve the engagement of those small numbers of young people requiring specialist treatment interventions who can be more clearly identified from a number of strongly developed referral routes.
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Part 2 Treatment Planning Grids
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Key to Abbreviated Job Titles/Responsibilities
YPM - Young People’s Manager (Safer Bristol) YPDG - Young People’s Delivery Group (Multi agency) SHPS - Senior Health Promotion Specialist (PCT) NTA - National Treatment Agency CPO - Commissioning Projects Officer (Young People, Safer Bristol) WDM - Workforce Development Manager (Based at Safer Bristol) TPSL - Teenage Pregnancy Strategy Lead (PCT) ADPH - Associate Director of Public Health (PCT) YPDTS - Young People’s Drug Treatment Service (Senior Manager) DYPP - Drugs and Young People’s Project (Senior Manager) BASE - Barnardo’s BASE (Senior Manager) SMC - Substance Misuse Consultant (LEA) DSUC - Drug Service User Co-ordinator (Safer Bristol)
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1. Commissioning and Systems Objective 1
Ensure further integration into mainstream Children and Young People’s Services (C&YPS) commissioning, planning and delivery
By when: September ‘09
Actions
Membership of Strategic Commissioning Group, and linked into Young People’s Substance Misuse (YPSM) Delivery Group
YPM
Review YP substance Misuse, as priority in Children’s Plan, Annual Performance Assessment (APA), needs assessment documents/refreshers.
YPDG
Review Delivery Group Terms of Reference, membership of Group and relationship with other commissioning groups/functions YPDG to ensure that there is a comprehensive system for commissioning young people’s specialist substance misuse services. This to ensure effective provision of pharmacological and psychosocial interventions. Close monitoring of data to ensure that at least 90%of young people requiring specialist treatment are catered for in a young people’s service. YPDG to monitor that all five treatment elements as identified in Essential Elements are offered. YPDG to monitor that at least 20% of referrals to specialist substance misuse treatment are from Children and Families services. Continue to commission Young People’s Drug Treatment Service to target young people with mental health needs. Further develop their role in providing consultation and training to colleagues in CAMHS working with this group.
YPDG YPDG
YPDG YPDG YPDG YPM
Expected outcomes: Integrated, needs led, outcomes focussed commissioning to meet the identified needs of young people in Bristol regarding substance misuse.
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Objective 2
Ensure further integration with C&YPS Locality Planning and IYSD provision.
By when: June ‘09
Actions
Membership to be established on emerging Locality Commissioning/Governance Groups.
YPM
Re-organisation of Early Intervention Service (EIS) provision according to C&YPS locality planning model and Integrated Youth Support (IYS). Ongoing monitoring of links with IYSD provision in order to establish model of joint working.
YPM
Service Integration Plan to be completed March 09. Ongoing review required of new service developments.
YPM
Monitor referrals to EIS from CAF panels
SHPS
Link into new positive activities agenda / other outreach
YPM
Attendance at PSA 14 & IYSD Stakeholder Groups
YPM
Improve links with Teenage pregnancy agenda (inc joint training through PCT)
YPM
Expected outcomes: Young People’s substance misuse agenda represented in locality commissioning and Common Assessment Framework planning. Integrated YP substance misuse service developed and launched.
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Objective 3
Ensure YP substance misuse performance is accurately entered into LAA data sets against key indicators.
By when: September ‘09
Actions
Ensure EIS data is accurately reported into key data sets (Sparnet, Be Healthy Quarterly Report Cards etc)
YPM
Ensure accurate NDTMS data for treatment services is similarly recorded and entered Develop agreed targets from 08/09 baseline for 09/10 and 10/11 for LAA.
YPM
Ongoing monitoring of TellUS3 data and Every Child Matters survey to assess performance against indicators. Ongoing monitoring of OC2 data to monitor performance regarding looked after children
YPM YPM
Expected outcomes: Accurate data reported into key datasets in a timely way.
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Objective 4
Building on 08/09 Needs Assessment exercise
By when: June ‘09
Actions
Include issues arising from this year’s exercise including diversity, geographic breakdown, changes in drugs of choice, etc
YPM
Quarterly review of service performance to ensure increases/reductions in service activity.
YPM
Quarterly review of data to monitor changes in patterns of ‘drug of choice’ to map emerging patterns of use amongst this cohort.
YPM
Quarterly review of ethnicity data to review engagement with BME groups, with particular focus on identified groups such as newly arrived Eastern Europeans and Somalians.
YPM
Quarterly review of age profile of those young people being engaged by services.
YPM
Quarterly review of data illustrating gender breakdown of young people being engaged by services.
YPM
Quarterly review of sources of referrals into services with particular focus on CAF panels, housing support services and self/parental referral.
YPM
Review Bristol’s performance against national data sets, comparative cities, etc
YPM
Expected outcomes: Clearer picture of emerging need established.
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Objective 5
Review YP substance misuse data collection/quality
By when: September ‘09
Actions
Review link with C&YPS and IYSD data systems
YPM
Review with DST Manager processes for YP data collection in relation to other DST data sets.
YPM
Ensure completion of cleansing of National Drug Treatment Monitoring System (NDTMS) data and all new data entered successfully and up to date.
YPM
Data set F training rolled out and adherence to submission requirements confirmed by April 2009
YPM
Ongoing monitoring of NDTMS accuracy
YPM and NTA
Expected outcomes: Accurate and timely data collected and reported to commissioning Group and key partners.
Objective 6
All key Service Level Agreements (SLAs) to be written/reviewed
By when: September ‘09
Actions
Ensure all SLAs are reviewed and up-to-date
YPM
Ensure quarterly review of commissioned services against key performance indicators in refreshed SLAs, focussing on key outcomes achieved.
YPM
Expected outcomes: More effective performance management to inform service development and commissioning 20
processes.
Objective 7
Ensure effective communication of work done by the services to service users, carers, partner agencies and media.
By when: June ‘09
Actions
New name for services to be agreed in early 09 followed by service relaunch.
YPM
Youngb people to be consulted and involved in the rebranding and remarketing of services.
YPM
New service information, leaflets etc published as part of re launch.
YPM
Write and publish information for Youth Offer/IYSD website
YPM
Expected outcomes: Key stakeholders including young people and carers are aware of newly launched integrated service.
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Objective 8
Ensure links with/completion of key strategies
By when: June ‘09
Actions
Link into PCT/ NHS Bristol Training Plan. Attend steering Group
CPO
Implementation of DST workforce strategy including website, degree development, etc
WDM
Workforce competence to be monitored in line with 2007 clinical guidelines.
WDM
Link to alcohol strategy and task groups
YPM
Continue with Safer Bristol Induction sessions
YPM
Increased training for PCSOs/ Police officers via YP Induction and SUST training.
YPM
Link in with youth work provision in Fire & Rescue Service
YPM
Expected outcomes: YP Substance Misuse delivery linked in with other key strategic planning.
Objective 9
Completion of Early Intervention Service evaluation exercise and act on findings
By when: August ‘09
Actions
Evaluation to be completed with John Moores University. Findings to be reviewed at Delivery Group and action plan developed.
SHPS
Action plan to be implemented and monitored to ensure service delivered in line with best practice recommendations.
SHPS
Outcomes focussed approach to be utilised for ongoing review of service.
SHPS 22
Expected outcomes: Evaluation used to inform EIS service development.
Objective 10
Review YP substance misuse services link to Black and Minority Ethnic (BME) groups
By when: August ‘09
Actions
Establish closer links with those working with Key vulnerable BME groups. Eg Asylum Dispersal Centre , Somalian Youth Groups, Right Track etc
YPM
Review Needs Assessment data re ethnicity to inform review of current performance
YPM
Amend data collection tools to collect data re engagement of key groups. Eg Somalian, newly arrived Eastern European groups.
CPO
Continued work to link Nilaari BME YP Team in with other service provision. Use DCSF Equality and Diversity Audit Tool for Commissioning to produce a diversity and equality action plan Staff access to annual equality and diversity training
SHPS YPM YPM
Expected outcomes: Increased access to specialist YP substance misuse services for vulnerable BME groups.
Objective 11
Review membership, effectiveness, communication between stakeholder groups
By when: June 09
Actions
Ongoing review of stakeholder meetings in line with new meeting structure including Big Team Meeting, Worker’s Forum, Cutting Edge and service user consultation groups.
YPM
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Expected outcomes: Service users, practitioners, service managers better linked into commissioning process, best practice and other key stakeholders.
Objective 12
Establish links with Child Death Review Panel
By when: Sept 2009
Ensure membership and actions on recommendations from Local Safeguarding Children Board regarding Child Death Review Panel
Service Director, Safer Bristol
Expected outcomes: Responsive responses to Child Death panel Review findings to inform better practice.
Objective 13
Link in to newly recommissioned CAMHS service.
By when: September 2009
Ensure YPDTS is able to continue to practice under agreed model commissioned by Safer Bristol. Engage in negotiations re key issues. E.g. premises etc.
YPM
YPDTS link into CAMHS to offer substance use expert advice and training.
YPM
Expected outcomes: YPDTS continuing to offer excellent service under new provider.
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2. Access and Engagement Objective 1
Improve levels of support and consultation with families and carers
By when: September ‘09
Actions
Carer consultation to be included in ‘user involvement’ work
CPO
Carry out a mapping exercise of services for families of drug service users in Bristol and relevant national services.
Adult CPO
Review need for specialist young people’s parental support provision.
Adult CPO/CPO
Draw together a centralised data base of services available and relevant advertising material.
Adult CPO
Ensure that relevant assessment forms (START/ CAF) are reviewed in line with best practice DST Families Group within CYPS. Review provision for supervision for those providing families based interventions. YPM Review Bristol’s Parenting Strategy to identify suitable parenting classes/ services within the YPM city. Ensure close links continue with Anti Social Behaviour and Child Poverty Family Intervention YPM Projects Expected outcomes: Improved awareness and provision of services for families of substance misusers.
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Objective 2
Review services targeting vulnerable groups
By when: Sept ‘09
Actions
Review services not currently being targeted by EIS who work with vulnerable groups
SHPS
Work with PSA 14 Group to develop service directory for ‘out of school’ provision
YPM
Work with PSA 14 Group to further review correlations between vulnerabilities and protective factors across related agendas eg teenage pregnancy, youth crime, poor attainment etc.
YPM
Review EIS targeting of truants/excludes/other vulnerable groups
SHPS
Review targeting of Looked After Children (LACs), including those in privately run homes. Further work to encourage Social Workers to refer this vulnerable group to specialist services.
DYPP
Review EIS links with socially excluded groups through gangs, group offending, dangerous weapons
SHPS
All of above in line with EIS evaluation work
SHPS
Work with Barnardos BASE to increase targeting of runaways/ those at risk of sexual exploitation.
BASE
Closer links with partner agencies,IYSD/Connexions to identify and engage NEETS. Review Accident and Emergency Pilot. Link into Early Intervention Service. Increase availability of prevention resources e.g. FRANK/Alcohol Concern literature to vulnerable groups across city. Review provision for homeless/ inadequately house young people through links with hostels/ housing provider drop ins etc Develop closer links with smoking cessation agenda
YPM YPM CPO
SHPS YPM
Expected outcomes: Services more accessible to targeted vulnerable groups. 26
Objective 3
Review future development of EIS work outside main SLA
By when: October ‘09
Actions
Development of new Comic Relief funded post in ARA to further target EIS work outside of mainstream provision.
SHPS
Review out of school provision across the city and map EIS activity to ensure best engagement with vulnerable groups.
YPM
Expected outcomes: Development of further EIS work to target specific groups e.g. over 16s
27
Objective 4
Further develop the quality of drug/alcohol education in schools
By when: September ‘09
Actions
Work with Healthy Schools Plus team to review target for completion of Personal, Social and Health Education (PSHE) certificate with drug/alcohol specialisation
SMC
Development of new scheme of work for teacher’s delivering drug education.
SMC
Review provision of support for parents of substance misusing young people in school settings
YPM
Review provision for independent sector schools
SMC
Review provision for independent sector schools becoming academies
SMC
Expected outcomes: Improved quality of substance misuse education in schools
Objective 5
Increase the number of referrals from generalist/Tier 1 agencies into early intervention By when: September service ‘09
Actions
Work with key partner agencies—Youth and Play Service, Connexions, Police, A&E, etc—to facilitate training and onward referral to EIS and linked with teenage pregnancy agenda.
SHPS
Expected outcomes: Increased referral from partner agencies into early Intervention Service.
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Objective 6
Increase the level of user consultation/involvement in service planning
By when: September 09
Actions
Continue to link in with individual service user groups.
CPO
Develop DST YP service user consultation Group
CPO
Review consultation of YP issues with User Feedback Organisation (UFO) group
DSUC
Review service user (UFO) input into Delivery Group and commissioning process
YPM
Require services to report on service user consultation activity in quarterly reports/ performance management meetings.
YPM
Expected outcomes: Service users having an increased voice in service planning and provision.
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Objective 7
Increase the provision for young people affected by adult substance misuse
By when: September 09
Actions
Review HAWKS Primary School Hidden Harm Project (awaiting bids re future funding)
SHPS
More detailed needs assessment completed of Hidden Harm needs.
CPO
Hidden Harm issues to be reviewed in DST families Action Group.
YPDG
Ensure hidden harm is represented in the updated CYPS safeguarding plan and Bristol’s parenting strategy. Ensure continued membership of Local Safeguarding Children’s Board to promote this agenda.
YPM
Ensure continuation of hidden harm provision and further development across targeted and specialist services
YPDG
Targeting of YP involved in dealing, drug running. BDP mentoring work linked in with other provision Training needs of health visitors/staff in children’s centres reviewed and training offered. Need to ensure closer links with Hidden Harm work and adult focussed interventions/ families work. Training needs of CYPS Social workers to deliver consistent reponse to child protection issues regarding children of drug misusing parents.
YPM YPM SHPS YPM SHPS
Expected outcomes: Greater understanding of need regarding Hidden Harm and increased coordination of response to this need.
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Objective 8
Increase the numbers of appropriate referrals from EIS into treatment services
By when: April ‘09
Actions
Continue to review with EIS staff service users appropriate fro referral to specialist treatment. SHPS Coordinator to meet with EIS staff on monthly basis to identify appropriate treatment referrals.
SHPS
Monitor passage of YP into treatment services, encourage joint working and engagement of this cohort.
SHPS
Review prevalence of emerging drugs of choice. Monitor national data re steroids etc.
YPM
Expected outcomes: More appropriate young people accessing relevant treatment services.
31
3. Treatment Services Objective 1
Ensure acceptable waiting times and numbers of unplanned discharges are achieved by all treatment agencies
By when: September ‘09
Actions
Waiting times to be monitored from local data and NDTMS
YPM
Close monitoring to ensure that all young people have a comprehensive assessment undertaken within 5 working days of referral to specialist treatment.
YPM
Close monitoring to ensure that all young people assessed as requiring treatment to commence treatment within 10 working days of the comprehensive assessment.
YPM
Close monitoring to ensure that all young people in treatment have a care plan specifically related to their treatment needs.
YPM
Numbers of unplanned discharges to be monitored from local data and NDTMS
YPM
Close monitoring to ensure that 65% of young people leave treatment in an agreed and planned way.
YPM
Introduction of exception reporting for long waiting and unplanned discharges
YPM
Expected outcomes: Clearer monitoring of outcomes for young people in specialist treatment services
32
Objective 2
Review harm reduction strategy for YP
By when: September ‘09
Actions
Produce YP Harm Reduction Strategy
YPM
Review provision of health assessments for all YP engaged in treatment
YPDTS
Review provision of BBV advice, testing and treatment/ Needle exchange
YPDTS
Close monitoring to ensure that all young people with a history of injecting or are at risk of injecting are offered a personal Hepatitis C test with pre and post test counselling.
YPDTS
Develop locally agreed pathways of care for the management of BBVs
YPDTS
Develop local protocols that clearly define clinical responsibility for the management of BBVs
YPDTS
Expected outcomes: Implementation of strategy to reduce harm to young substance misusers
Objective 3
Review provision/need for residential treatment
By when: September ‘09
Actions
Regularly review local needs with team managers
YPM
Present findings to Delivery Group
YPM
33
Expected outcomes: Clear mechanism established for review of residential need.
Objective 4
Review provision for YP being released from secure estate
By when: September ‘09
Actions
Work with Ashfield YOI to establish closer links with specialist Bristol Services.
YPM
Review referral pathways from custodial establishments are consistent with YJB/NTA guidance.
YPM
Expected outcomes: Clearer referral pathways for young people leaving custody.
Objective 5
Develop a means of clear outcome monitoring
By when: June ‘09
Actions
Monitor completion of Treatment Outcomes Profile (TOP) from providers. To be used at the start of treatment and in care plan reviews for those over 16 years.
YPM
Development of EIS outcome monitoring tool
SHPS
Monitor completion of tool
SHPS
34
Expected outcomes: Clearer monitoring of outcomes for young people in substance misuse services
Objective 6
Develop clear information sharing protocols for EIS
By when: August ‘09
Action
EIS Info sharing/ confidentiality policy to be developed in line with IYSD policy
YPM
Clear protocols to be developed in line with C&YPS/ IYS policies
YPM
Expected outcomes: Consistent information sharing between substance misuse services and key partners.
Objective 7
Review need and develop provision for specialist counselling modality
By when: September ‘09
Actions
Review/monitor need from Tier 2 & 3 providers
CPO
Work with SWAN Project to develop YP focused counselling service
YPM
35
Expected outcomes: Counselling modality developed and linked with other provision.
Objective 8
Ensure effective model of practice governance is introduced
By when: August ‘09
YP representative attendance at DST practice governance meetings
YPDTS
Implement forthcoming NTA YP Governance Guidance.
YPM
Actions Review all clinical governance and audit arrangements to ensure that they are in line with guidance. Ensure monitoring is in place to demonstrate that practice is in line with 2007 Clinical Guidelines.
YPDG YPM
Expected outcomes: Effective practice governance for young people’s services is in place.
36
4. Young People Leaving Treatment Objective 1
Develop provision for effective transitions for young people moving into adult services
By when: September ‘09
Actions
Transitions sub-group to work on action plan to meet estimated need
Adult CPO
Development and recruitment to specialist transitions worker post placed in adult services.
Adult CPO
Review prioritisation of YP by adult services
Adult CPO
Referral Pathways to be formalised between all young people’s specialist substance misuse treatment services and adult drug and alcohol services.
Adult CPO
Conduct a review of the transitional needs of young people with emerging dual diagnosis needs including issues relating to capacity and thresholds of adult mental health services.
YPM
Develop and cost a model for an 18-25 transitions service. Developed in consultation with young people’s and adults services and service users.
YPM/Adult CPO
Present to adult Joint Commissioning Group and YP Delivery Group proposals for new service.
YPM/Adult CPO
Expected outcomes: Effective transitions between young people’s and adult services planned and delivered.
37
Objective 2
Review provision of services for 18–25 age group
By when: April ‘10
Actions
Work with DST adult commissioning team to review need, and plan for targeted service provision for this group. Develop service spec/ tendering process.
Adult commissioning team
Expected outcomes: New service planned and commissioned for commencing April 2010
38
1
Part 1 Strategic Overview and Key Priorities
2
The Overall Direction of the Strategy This plan will evidence the work that will be undertaken in Bristol during 2009/10 to contribute to achieving the ambitions of key governmental drivers regarding young people’s substance misuse. This work will specifically contribute to PSA 25, reducing the harm caused by alcohol and drugs, and PSA 14, increasing the number of young people on the path to success. It will evidence actions towards achieving contributions to national indicator 40, which records the increase in numbers of drug users in effective treatment and national indicator 115substance misuse by young people, which is included as a priority within Bristol’s Local Area Agreement. The Drug Strategy Team (DST) and Safer Bristol are committed to delivering a full range of substance misuse treatment, targeted prevention and universal services to young people regarding this issue. This provision is strategically planned and commissioned by the Young People’s Delivery Group (YPDG). This has close links with Children and Young People’s Strategic Commissioning Group within Bristol City Council. The YPDG is informed by the Young People’s Manager’s Meeting (YPMM) and Worker’s Forums consisting of partners, providers and other stakeholders from across the city. There are also service user consultation groups within commissioned agencies that further advise regarding the commissioning and planning processes. Through this commissioning structure we endeavour to commission and provide support to Bristol’s young people’s substance misuse agencies in line with the NTA’s Essential Elements Guidance. This year’s strategy aims to further build on these commissioning arrangements to ensure that Bristol has integrated, needs led, outcomes focussed commissioning arrangements in place to meet the identified needs of young people in the city. These commissioning arrangements have led to the development of what are now clearly established and integrated young people’s substance misuse agencies in the city. This year’s needs assessment evidences how the establishment and development of these services and the development of strong strategic links with universal young people’s services has led to a significant increase in the number of young people engaged by specialist services across the city. In order for these services to be further integrated into wider children and young people’s provision it is a priority to build on the challenge of PSA 14 to further develop how specialist services fit with Bristol’s Youth Matters agenda, Children and Young People’s Services commissioning and Locality Governance planning, and Common Assessment Framework Locality Panels.
3
The Overall Direction of the Strategy contd. The DST recognizes that accurate and timely performance data is crucial to demonstrate the effectiveness of our treatment system. We will strive to improve data quality, specifically NDTMS, and ensure our systems are fit for purpose. This will ensure appropriate data is available to key stakeholders such as NTA, NHS Bristol, Children and Young People’s Services as well as building on the emerging picture of need demonstrated in this year’s treatment plan. This will allow for further investigation of diversity, geographic breakdown of need and changes in ‘drug of choice’ profiles as highlighted in this years assessment. A key challenge for the forthcoming year will be the integration of all targeted and treatment young people’s substance misuse services in Bristol under one common name. This will allow for clearer branding of services, afford an excellent opportunity for re-launching and re-publicising services and facilitate the substance misuse services being incorporated under the Integrated Youth Support banner. This will also give a banner under which practitioners, managers, service users and commissioners can meet at ‘Big Team Meeting’ days, ‘Cutting Edge’ conferences, ‘Workers Forums’ and ‘Service User Consultation’ panels. This should facilitate better communication between all stakeholders and ensure easier identification of services for young people. Much has been achieved in recent years to target vulnerable young people and to engage them in treatment services. However, more work is required regarding specific groups such as children in care, homeless young people, those leaving the secure estate for community services and a wider review of all young people who are outside of mainstream education. A particular focus is also required on some BME groups, particularly those who are highlighted in the needs assessment. Also, work needs to be done to further integrate this agenda with the work of groups engaging with gangs, group offending and dangerous weapons agendas. Following on from the lead in the new National Drug Strategy there is a clear need to improve awareness and provision of services for families of substance misusers. This will involve some key partnership working with Bristol Safeguarding Board, with a particular focus on the issue of Hidden Harm. In order to facilitate effective referrals into treatment services further work is required to develop the provision of in school education. The Bristol Early Intervention Service is a key source of referrals into treatment services and these referral pathways need to be further reviewed and strengthened. By establishing an effective workforce strategy, generalist agencies can be skilled in substance misuse matters and referrals into specialist services further encouraged and monitored This is a particular priority regarding work with Police, Youth and Play Service, Connexions and Accident and Emergency departments.
4
The Overall Direction of the Strategy contd. Bristol DST has a clear commitment to hearing the views of all its stakeholders to inform the commissioning and strategic planning processes. Service User consultation groups are established in a number of specialist services. This year we will build on this to establish a DST service user forum that will feed directly into the Delivery Group. We will also establish members of the adult UFO group, who have an experience of adolescent substance misuse, onto both the Managers and Delivery Groups. Further work with service users carers will be undertaken to ensure their representation in this process. Improving transitional arrangements for young people leaving young people’s services for adult services will be key piece of work this year. This will involve the recruitment of a specialist transitions worker in adult services and completion of a scoping exercise for a discreet service for 18 to 25’s for the city.
5
The Likely Demand for Specialist Treatment Interventions for Young People
►
The needs assessment shows that 10 young people received pharmacological interventions in 08/09. It seems likely that demand will continue at a similar level this coming year. Work has been done with universal services and targeted prevention services to ensure that any young person thought to require such an intervention is referred immediately into Young People’s Drug Treatment service for full assessment.
►
The needs assessment showed that 313 young people engaged with specialist treatment services for psychosocial interventions. It is estimated that this number will increase in the forthcoming year. This will primarily be due to the increased targeting of specific vulnerable groups such as those young people outside of mainstream education, children in care and those who are homeless/inadequately housed.
►
This document identifies the further assessment and provision of family interventions as a key priority. Particular emphasis will be given to monitoring and increasing provision for Hidden Harm groups and working with Children and Young People’s Safeguarding Board to ensure a more integrated approach to planning and commissioning.
►
A working group has been established to review provision of specialist harm reduction provision for young people. A common health screen is now used across all treatment services to establish need and plan a coordinated response regarding blood born viruses, safer injecting etc.
►
No young people were identified as being in need of residential placements regarding substance misuse issues in 08/09. However there is a clear mechanism in place for identified need to be raised with the Delivery Group.
►
The needs assessment clearly demonstrates changing need in the city in regards to diversity issues. It is a priority in this document to improve outreach, identification and engagement of specific BME groups of young people into the treatment provision. Similarly the past year has seen a shift in the gender profile engaging with services and work needs to be done to ensure that we are adequately engaging young males in specialist services.
6
The Key Findings of the Current Needs Assessment
►
Overall this year has seen an increase in activity from the young people’s substance misuse services in Bristol. Early Intervention Service, Youth Offending Team and Drugs & Young People Project have all shown an increase in young people accessing their services.
►
As regards treatment outcomes, within the young people’s substance misuse services planned discharges have decreased, but more young people are currently in treatment, whilst unplanned discharges have reduced. These will be monitored through out the year.
►
There has been a significant increase in young people presenting to services with alcohol as their primary drug of choice. This has been due to more effective targeting of young people with alcohol problems and the shifting of emphasis at specialist services to respond to this need. These trends will be reviewed through out the year.
►
Changing trends of drug use by young people have been noted. Encouragingly crack and heroin use amongst young people has decreased. However new drugs of choice are emerging amongst young people, such as ketamine, that will need investigating. Further work also needs to be done on new drug profiles emerging amongst young people. For example, based on national research, steroid use and tanning drugs are increasingly being used but have not been identified within this year’s needs assessment data.
►
Young people in Bristol appear to be following the profile of ACCE’rs(Alcohol, Cannabis, Cocaine & Ecstasy) when looking at poly drug use. In addition to this the majority of young people are aged 17 and over in the young people’s services. This provides further evidence of the need for a ‘transitional’ service that caters for young adults with different needs to those of adults in adult drug treatment services.
►
Through out the young people’s substance misuse services there has been an increase in accessing vulnerable groups of young people. However further action is required to target these groups. This work will ensure we have a clearer picture of any unmet need amongst these groups•
Hidden Harm-There is a need for a greater service provision to meet identified need.
•
Truants/excludees- A review of ‘out of school provision’ is taking place.
•
Children in care- Increased targeting especially by D&YPP. 7
The Key Findings of the Current Needs Assessment contd.
•
Criminal Justice- Increased targeting at YOT, a review of young people who are being released from the secure estate needs to take place.
•
Homeless/inadequately housed- More work done in hostels/dropins.
•
At risk of sexual exploitation- Through the BASE service.
•
Teenage mothers- more links established with maternity services and the teenage pregnancy agenda.
•
NEETS(Not in Education, Employment or Training)- established links with out of school provisions/Connexions.
►
In terms of ethnic minority groups accessing young people’s services, ‘Mixed: White & Black Caribbean’s represent a much higher % to that of Bristol’s overall % for this group, this will require further research. In addition to this, work will need to be done on how we can engage young people from ‘newly arrived communities’ in Bristol, such as Somalians or Eastern Europeans.
►
This year’s needs assessment has seen an increase in females accessing young people’s services. A further review will need to be done to ensure we are still effectively engaging males in young people’s services.
►
We will review the postal districts of the young people accessing services. Postal areas which have either a high or low entry in to the young people’s substance misuse services will be investigated and the reasons behind this.
►
Recently published data for Bristol(TellUs3 and Every Child Matters surveys) has informed us that, overall, drug use amongst young people is above the national average(however the sample in Bristol contained more older young people compared to the national average).
►
These 2 surveys explained that young people in Bristol are more satisfied with the advice and information received compared to the national average. However there is a still a significant number of young people who are unsure whether they have a local drug service available to them. This supports the work that has started in Bristol to integrate the young people’s services and have a common branding for the services to make them more identifiable to young people.
8
The Key Findings of the Current Needs Assessment contd.
►
The release of Dataset F next year will increase the young people’s data that is uploaded on to NDTMS. This will enable us to produce a more detailed needs assessment, with a focus on young people’s entries and exits in to the treatment system, next year.
►
More work needs to be done to identify the points of attrition for young people from the treatment system. Cases of young people who are leaving the treatment system in an unplanned way need to be reviewed in order to ensure that similar drop outs from treatment will be avoided in future cohorts where at all possible.
9
The improvements to be made in relation to the impact of treatment in terms of its outcomes
►
NDTMS data will be closely monitored to assess the effectiveness of our treatment system for young people. With the aim of delivering improvements in individuals health and social functioning. We will continue to incorporate monitoring of TOP’s completions in our quarterly performance monitoring meetings.
►
The completion of the Early Intervention Service evaluation, in partnership with John Moore’s University, will also inform review of the effectiveness of the referral pathways into treatment services.
10
Key priorities for developing specialist young people substance misuse treatment interventions In order to further to develop this work the Delivery Group has identified four priorities for the Treatment plan for 09/10. These priorities were developed based upon the findings of the needs assessment and consultation with key stakeholder groups such as service users, managers and practitioner’s. These four priorities are: 1) We need to improve transitional arrangements for young people moving from young people’s specialist services into adult services. 2) We need to review and improve access to whole families work. Within this there needs to be a focus on work with children who are living with adult substance misuse. 3) We need to build on this year’s service Integration work to ensure that young people’s substance misuse services are delivered under a common branding to respond to the needs of young people in their localities. 4) We need to further review the work we are doing to target the most vulnerable groups. We need to have a strong focus on targeting those BME young people who are particularly vulnerable. In order to meet these priorities key actions have been identified: Priority 1: Transitional Arrangements
►
Development of and recruitment to specialist transitions worker in adult services.
►
Referral pathways between young people’s services and adult specialist services to be formalised.
►
Review of transitional needs of young people with emerging mental health/ substance misuse dual diagnosis issues.
►
Develop and cost a model of an 18-25 service. Developed in consultation with young people’s and adult’s services and service users.
►
Present to DST Joint Commissioning Group and Young people’s Delivery Group proposals for new service.
11
Priority 2: Families Work
►
Carry out a mapping exercise of services for families of drug service users in Bristol, including relevant national services.
►
Review gaps in this provision, including an emphasis on support for parents of young substance misusers. Present findings to commissioning groups.
►
Work with Bristol City Council Safeguarding Board to prioritise work with young people affected by parental substance misuse.
►
Draw together a database of services available and promote this.
►
Establish close links with Anti Social Behaviour and Child Poverty Family Intervention Projects.
►
Complete a detailed needs assessment of Hidden Harm needs across the city.
►
Endeavour to ensure the continuation, development and strategic linking of Hidden Harm provision in targeted and specialist services.
►
Review provision of training for key staff working with Hidden Harm issues eg social workers, health visitors, staff in children’s centres.
Priority 3: Service Integration
►
Services launched under common branding. Publicised using leaflets, websites etc. Service re launch day to be organised and publicised.
►
Current arrangements for Big Team Meeting, Cutting Edge Days, Worker’s Forums and Service User Consultation Panels to continue.
►
Membership of Locality Governance Groups to be established.
►
Early Intervention Service staff to link into Children and Young People’s Services Common Assessment Framework Practice Panels.
►
EIS staff to link in with Locality Integrated Youth Support Teams. Providing substance misuse expertise in each locality and facilitating referral from locality teams into EIS and treatment services.
►
Common practice protocols to be agreed and implemented.
►
Closer linking with Teenage Pregnancy agenda as part of IYSD.
►
Progress with all of the above to be regularly reviewed and monitored.
12
Priority 4: Targeting Vulnerable Groups
►
Continued targeting of Children in Care to encourage referral into Drugs and Young People’s Project. Review training available for social workers working with this group.
►
Targeting of homeless/inadequately housed young people by links into hostels/drop-ins.
►
Review arrangements for young people moving from secure estate into community substance misuse services.
►
Review provision for young people who are out of mainstream education. Review service availability with PSA 14 Group. Map current delivery against available provision.
►
Use DCSF Equality and Diversity Audit Tool for Commissioning to produce a diversity and equality action plan.
►
Establish closer links with key BME groups eg Asylum Dispersal Centre, Somalian Youth Groups etc.
►
Continue to link Nilaari young people’s service in with other provision.
►
Review links with socially excluded groups through groups working with gangs, group offending and dangerous weapons agendas.
The intended outcomes for these actions is a young people’s substance misuse service that can be clearly marketed and publicised, in close collaboration with other Integrated Youth Support Services in the city. This service would be able to provide much improved transitional arrangements for young people post 18 years. There would be a clearer idea of current provision and need regarding whole families interventions, particularly for those young people living with adult substance misuse. Finally, specifically identified vulnerable groups would be further engaged by specialist services, building on work that has been started over recent years. This will increase the engagement of Bristol’s young people with specialist services, building on the increased engagement identified in this year’s need assessment. This will improve the engagement of those small numbers of young people requiring specialist treatment interventions who can be more clearly identified from a number of strongly developed referral routes.
13
Part 2 Treatment Planning Grids
14
Key to Abbreviated Job Titles/Responsibilities
YPM - Young People’s Manager (Safer Bristol) YPDG - Young People’s Delivery Group (Multi agency) SHPS - Senior Health Promotion Specialist (PCT) NTA - National Treatment Agency CPO - Commissioning Projects Officer (Young People, Safer Bristol) WDM - Workforce Development Manager (Based at Safer Bristol) TPSL - Teenage Pregnancy Strategy Lead (PCT) ADPH - Associate Director of Public Health (PCT) YPDTS - Young People’s Drug Treatment Service (Senior Manager) DYPP - Drugs and Young People’s Project (Senior Manager) BASE - Barnardo’s BASE (Senior Manager) SMC - Substance Misuse Consultant (LEA) DSUC - Drug Service User Co-ordinator (Safer Bristol)
15
1. Commissioning and Systems Objective 1
Ensure further integration into mainstream Children and Young People’s Services (C&YPS) commissioning, planning and delivery
By when: September ‘09
Actions
Membership of Strategic Commissioning Group, and linked into Young People’s Substance Misuse (YPSM) Delivery Group
YPM
Review YP substance Misuse, as priority in Children’s Plan, Annual Performance Assessment (APA), needs assessment documents/refreshers.
YPDG
Review Delivery Group Terms of Reference, membership of Group and relationship with other commissioning groups/functions YPDG to ensure that there is a comprehensive system for commissioning young people’s specialist substance misuse services. This to ensure effective provision of pharmacological and psychosocial interventions. Close monitoring of data to ensure that at least 90%of young people requiring specialist treatment are catered for in a young people’s service. YPDG to monitor that all five treatment elements as identified in Essential Elements are offered. YPDG to monitor that at least 20% of referrals to specialist substance misuse treatment are from Children and Families services. Continue to commission Young People’s Drug Treatment Service to target young people with mental health needs. Further develop their role in providing consultation and training to colleagues in CAMHS working with this group.
YPDG YPDG
YPDG YPDG YPDG YPM
Expected outcomes: Integrated, needs led, outcomes focussed commissioning to meet the identified needs of young people in Bristol regarding substance misuse.
16
Objective 2
Ensure further integration with C&YPS Locality Planning and IYSD provision.
By when: June ‘09
Actions
Membership to be established on emerging Locality Commissioning/Governance Groups.
YPM
Re-organisation of Early Intervention Service (EIS) provision according to C&YPS locality planning model and Integrated Youth Support (IYS). Ongoing monitoring of links with IYSD provision in order to establish model of joint working.
YPM
Service Integration Plan to be completed March 09. Ongoing review required of new service developments.
YPM
Monitor referrals to EIS from CAF panels
SHPS
Link into new positive activities agenda / other outreach
YPM
Attendance at PSA 14 & IYSD Stakeholder Groups
YPM
Improve links with Teenage pregnancy agenda (inc joint training through PCT)
YPM
Expected outcomes: Young People’s substance misuse agenda represented in locality commissioning and Common Assessment Framework planning. Integrated YP substance misuse service developed and launched.
17
Objective 3
Ensure YP substance misuse performance is accurately entered into LAA data sets against key indicators.
By when: September ‘09
Actions
Ensure EIS data is accurately reported into key data sets (Sparnet, Be Healthy Quarterly Report Cards etc)
YPM
Ensure accurate NDTMS data for treatment services is similarly recorded and entered Develop agreed targets from 08/09 baseline for 09/10 and 10/11 for LAA.
YPM
Ongoing monitoring of TellUS3 data and Every Child Matters survey to assess performance against indicators. Ongoing monitoring of OC2 data to monitor performance regarding looked after children
YPM YPM
Expected outcomes: Accurate data reported into key datasets in a timely way.
18
Objective 4
Building on 08/09 Needs Assessment exercise
By when: June ‘09
Actions
Include issues arising from this year’s exercise including diversity, geographic breakdown, changes in drugs of choice, etc
YPM
Quarterly review of service performance to ensure increases/reductions in service activity.
YPM
Quarterly review of data to monitor changes in patterns of ‘drug of choice’ to map emerging patterns of use amongst this cohort.
YPM
Quarterly review of ethnicity data to review engagement with BME groups, with particular focus on identified groups such as newly arrived Eastern Europeans and Somalians.
YPM
Quarterly review of age profile of those young people being engaged by services.
YPM
Quarterly review of data illustrating gender breakdown of young people being engaged by services.
YPM
Quarterly review of sources of referrals into services with particular focus on CAF panels, housing support services and self/parental referral.
YPM
Review Bristol’s performance against national data sets, comparative cities, etc
YPM
Expected outcomes: Clearer picture of emerging need established.
19
Objective 5
Review YP substance misuse data collection/quality
By when: September ‘09
Actions
Review link with C&YPS and IYSD data systems
YPM
Review with DST Manager processes for YP data collection in relation to other DST data sets.
YPM
Ensure completion of cleansing of National Drug Treatment Monitoring System (NDTMS) data and all new data entered successfully and up to date.
YPM
Data set F training rolled out and adherence to submission requirements confirmed by April 2009
YPM
Ongoing monitoring of NDTMS accuracy
YPM and NTA
Expected outcomes: Accurate and timely data collected and reported to commissioning Group and key partners.
Objective 6
All key Service Level Agreements (SLAs) to be written/reviewed
By when: September ‘09
Actions
Ensure all SLAs are reviewed and up-to-date
YPM
Ensure quarterly review of commissioned services against key performance indicators in refreshed SLAs, focussing on key outcomes achieved.
YPM
Expected outcomes: More effective performance management to inform service development and commissioning 20
processes.
Objective 7
Ensure effective communication of work done by the services to service users, carers, partner agencies and media.
By when: June ‘09
Actions
New name for services to be agreed in early 09 followed by service relaunch.
YPM
Youngb people to be consulted and involved in the rebranding and remarketing of services.
YPM
New service information, leaflets etc published as part of re launch.
YPM
Write and publish information for Youth Offer/IYSD website
YPM
Expected outcomes: Key stakeholders including young people and carers are aware of newly launched integrated service.
21
Objective 8
Ensure links with/completion of key strategies
By when: June ‘09
Actions
Link into PCT/ NHS Bristol Training Plan. Attend steering Group
CPO
Implementation of DST workforce strategy including website, degree development, etc
WDM
Workforce competence to be monitored in line with 2007 clinical guidelines.
WDM
Link to alcohol strategy and task groups
YPM
Continue with Safer Bristol Induction sessions
YPM
Increased training for PCSOs/ Police officers via YP Induction and SUST training.
YPM
Link in with youth work provision in Fire & Rescue Service
YPM
Expected outcomes: YP Substance Misuse delivery linked in with other key strategic planning.
Objective 9
Completion of Early Intervention Service evaluation exercise and act on findings
By when: August ‘09
Actions
Evaluation to be completed with John Moores University. Findings to be reviewed at Delivery Group and action plan developed.
SHPS
Action plan to be implemented and monitored to ensure service delivered in line with best practice recommendations.
SHPS
Outcomes focussed approach to be utilised for ongoing review of service.
SHPS 22
Expected outcomes: Evaluation used to inform EIS service development.
Objective 10
Review YP substance misuse services link to Black and Minority Ethnic (BME) groups
By when: August ‘09
Actions
Establish closer links with those working with Key vulnerable BME groups. Eg Asylum Dispersal Centre , Somalian Youth Groups, Right Track etc
YPM
Review Needs Assessment data re ethnicity to inform review of current performance
YPM
Amend data collection tools to collect data re engagement of key groups. Eg Somalian, newly arrived Eastern European groups.
CPO
Continued work to link Nilaari BME YP Team in with other service provision. Use DCSF Equality and Diversity Audit Tool for Commissioning to produce a diversity and equality action plan Staff access to annual equality and diversity training
SHPS YPM YPM
Expected outcomes: Increased access to specialist YP substance misuse services for vulnerable BME groups.
Objective 11
Review membership, effectiveness, communication between stakeholder groups
By when: June 09
Actions
Ongoing review of stakeholder meetings in line with new meeting structure including Big Team Meeting, Worker’s Forum, Cutting Edge and service user consultation groups.
YPM
23
Expected outcomes: Service users, practitioners, service managers better linked into commissioning process, best practice and other key stakeholders.
Objective 12
Establish links with Child Death Review Panel
By when: Sept 2009
Ensure membership and actions on recommendations from Local Safeguarding Children Board regarding Child Death Review Panel
Service Director, Safer Bristol
Expected outcomes: Responsive responses to Child Death panel Review findings to inform better practice.
Objective 13
Link in to newly recommissioned CAMHS service.
By when: September 2009
Ensure YPDTS is able to continue to practice under agreed model commissioned by Safer Bristol. Engage in negotiations re key issues. E.g. premises etc.
YPM
YPDTS link into CAMHS to offer substance use expert advice and training.
YPM
Expected outcomes: YPDTS continuing to offer excellent service under new provider.
24
2. Access and Engagement Objective 1
Improve levels of support and consultation with families and carers
By when: September ‘09
Actions
Carer consultation to be included in ‘user involvement’ work
CPO
Carry out a mapping exercise of services for families of drug service users in Bristol and relevant national services.
Adult CPO
Review need for specialist young people’s parental support provision.
Adult CPO/CPO
Draw together a centralised data base of services available and relevant advertising material.
Adult CPO
Ensure that relevant assessment forms (START/ CAF) are reviewed in line with best practice DST Families Group within CYPS. Review provision for supervision for those providing families based interventions. YPM Review Bristol’s Parenting Strategy to identify suitable parenting classes/ services within the YPM city. Ensure close links continue with Anti Social Behaviour and Child Poverty Family Intervention YPM Projects Expected outcomes: Improved awareness and provision of services for families of substance misusers.
25
Objective 2
Review services targeting vulnerable groups
By when: Sept ‘09
Actions
Review services not currently being targeted by EIS who work with vulnerable groups
SHPS
Work with PSA 14 Group to develop service directory for ‘out of school’ provision
YPM
Work with PSA 14 Group to further review correlations between vulnerabilities and protective factors across related agendas eg teenage pregnancy, youth crime, poor attainment etc.
YPM
Review EIS targeting of truants/excludes/other vulnerable groups
SHPS
Review targeting of Looked After Children (LACs), including those in privately run homes. Further work to encourage Social Workers to refer this vulnerable group to specialist services.
DYPP
Review EIS links with socially excluded groups through gangs, group offending, dangerous weapons
SHPS
All of above in line with EIS evaluation work
SHPS
Work with Barnardos BASE to increase targeting of runaways/ those at risk of sexual exploitation.
BASE
Closer links with partner agencies,IYSD/Connexions to identify and engage NEETS. Review Accident and Emergency Pilot. Link into Early Intervention Service. Increase availability of prevention resources e.g. FRANK/Alcohol Concern literature to vulnerable groups across city. Review provision for homeless/ inadequately house young people through links with hostels/ housing provider drop ins etc Develop closer links with smoking cessation agenda
YPM YPM CPO
SHPS YPM
Expected outcomes: Services more accessible to targeted vulnerable groups. 26
Objective 3
Review future development of EIS work outside main SLA
By when: October ‘09
Actions
Development of new Comic Relief funded post in ARA to further target EIS work outside of mainstream provision.
SHPS
Review out of school provision across the city and map EIS activity to ensure best engagement with vulnerable groups.
YPM
Expected outcomes: Development of further EIS work to target specific groups e.g. over 16s
27
Objective 4
Further develop the quality of drug/alcohol education in schools
By when: September ‘09
Actions
Work with Healthy Schools Plus team to review target for completion of Personal, Social and Health Education (PSHE) certificate with drug/alcohol specialisation
SMC
Development of new scheme of work for teacher’s delivering drug education.
SMC
Review provision of support for parents of substance misusing young people in school settings
YPM
Review provision for independent sector schools
SMC
Review provision for independent sector schools becoming academies
SMC
Expected outcomes: Improved quality of substance misuse education in schools
Objective 5
Increase the number of referrals from generalist/Tier 1 agencies into early intervention By when: September service ‘09
Actions
Work with key partner agencies—Youth and Play Service, Connexions, Police, A&E, etc—to facilitate training and onward referral to EIS and linked with teenage pregnancy agenda.
SHPS
Expected outcomes: Increased referral from partner agencies into early Intervention Service.
28
Objective 6
Increase the level of user consultation/involvement in service planning
By when: September 09
Actions
Continue to link in with individual service user groups.
CPO
Develop DST YP service user consultation Group
CPO
Review consultation of YP issues with User Feedback Organisation (UFO) group
DSUC
Review service user (UFO) input into Delivery Group and commissioning process
YPM
Require services to report on service user consultation activity in quarterly reports/ performance management meetings.
YPM
Expected outcomes: Service users having an increased voice in service planning and provision.
29
Objective 7
Increase the provision for young people affected by adult substance misuse
By when: September 09
Actions
Review HAWKS Primary School Hidden Harm Project (awaiting bids re future funding)
SHPS
More detailed needs assessment completed of Hidden Harm needs.
CPO
Hidden Harm issues to be reviewed in DST families Action Group.
YPDG
Ensure hidden harm is represented in the updated CYPS safeguarding plan and Bristol’s parenting strategy. Ensure continued membership of Local Safeguarding Children’s Board to promote this agenda.
YPM
Ensure continuation of hidden harm provision and further development across targeted and specialist services
YPDG
Targeting of YP involved in dealing, drug running. BDP mentoring work linked in with other provision Training needs of health visitors/staff in children’s centres reviewed and training offered. Need to ensure closer links with Hidden Harm work and adult focussed interventions/ families work. Training needs of CYPS Social workers to deliver consistent reponse to child protection issues regarding children of drug misusing parents.
YPM YPM SHPS YPM SHPS
Expected outcomes: Greater understanding of need regarding Hidden Harm and increased coordination of response to this need.
30
Objective 8
Increase the numbers of appropriate referrals from EIS into treatment services
By when: April ‘09
Actions
Continue to review with EIS staff service users appropriate fro referral to specialist treatment. SHPS Coordinator to meet with EIS staff on monthly basis to identify appropriate treatment referrals.
SHPS
Monitor passage of YP into treatment services, encourage joint working and engagement of this cohort.
SHPS
Review prevalence of emerging drugs of choice. Monitor national data re steroids etc.
YPM
Expected outcomes: More appropriate young people accessing relevant treatment services.
31
3. Treatment Services Objective 1
Ensure acceptable waiting times and numbers of unplanned discharges are achieved by all treatment agencies
By when: September ‘09
Actions
Waiting times to be monitored from local data and NDTMS
YPM
Close monitoring to ensure that all young people have a comprehensive assessment undertaken within 5 working days of referral to specialist treatment.
YPM
Close monitoring to ensure that all young people assessed as requiring treatment to commence treatment within 10 working days of the comprehensive assessment.
YPM
Close monitoring to ensure that all young people in treatment have a care plan specifically related to their treatment needs.
YPM
Numbers of unplanned discharges to be monitored from local data and NDTMS
YPM
Close monitoring to ensure that 65% of young people leave treatment in an agreed and planned way.
YPM
Introduction of exception reporting for long waiting and unplanned discharges
YPM
Expected outcomes: Clearer monitoring of outcomes for young people in specialist treatment services
32
Objective 2
Review harm reduction strategy for YP
By when: September ‘09
Actions
Produce YP Harm Reduction Strategy
YPM
Review provision of health assessments for all YP engaged in treatment
YPDTS
Review provision of BBV advice, testing and treatment/ Needle exchange
YPDTS
Close monitoring to ensure that all young people with a history of injecting or are at risk of injecting are offered a personal Hepatitis C test with pre and post test counselling.
YPDTS
Develop locally agreed pathways of care for the management of BBVs
YPDTS
Develop local protocols that clearly define clinical responsibility for the management of BBVs
YPDTS
Expected outcomes: Implementation of strategy to reduce harm to young substance misusers
Objective 3
Review provision/need for residential treatment
By when: September ‘09
Actions
Regularly review local needs with team managers
YPM
Present findings to Delivery Group
YPM
33
Expected outcomes: Clear mechanism established for review of residential need.
Objective 4
Review provision for YP being released from secure estate
By when: September ‘09
Actions
Work with Ashfield YOI to establish closer links with specialist Bristol Services.
YPM
Review referral pathways from custodial establishments are consistent with YJB/NTA guidance.
YPM
Expected outcomes: Clearer referral pathways for young people leaving custody.
Objective 5
Develop a means of clear outcome monitoring
By when: June ‘09
Actions
Monitor completion of Treatment Outcomes Profile (TOP) from providers. To be used at the start of treatment and in care plan reviews for those over 16 years.
YPM
Development of EIS outcome monitoring tool
SHPS
Monitor completion of tool
SHPS
34
Expected outcomes: Clearer monitoring of outcomes for young people in substance misuse services
Objective 6
Develop clear information sharing protocols for EIS
By when: August ‘09
Action
EIS Info sharing/ confidentiality policy to be developed in line with IYSD policy
YPM
Clear protocols to be developed in line with C&YPS/ IYS policies
YPM
Expected outcomes: Consistent information sharing between substance misuse services and key partners.
Objective 7
Review need and develop provision for specialist counselling modality
By when: September ‘09
Actions
Review/monitor need from Tier 2 & 3 providers
CPO
Work with SWAN Project to develop YP focused counselling service
YPM
35
Expected outcomes: Counselling modality developed and linked with other provision.
Objective 8
Ensure effective model of practice governance is introduced
By when: August ‘09
YP representative attendance at DST practice governance meetings
YPDTS
Implement forthcoming NTA YP Governance Guidance.
YPM
Actions Review all clinical governance and audit arrangements to ensure that they are in line with guidance. Ensure monitoring is in place to demonstrate that practice is in line with 2007 Clinical Guidelines.
YPDG YPM
Expected outcomes: Effective practice governance for young people’s services is in place.
36
4. Young People Leaving Treatment Objective 1
Develop provision for effective transitions for young people moving into adult services
By when: September ‘09
Actions
Transitions sub-group to work on action plan to meet estimated need
Adult CPO
Development and recruitment to specialist transitions worker post placed in adult services.
Adult CPO
Review prioritisation of YP by adult services
Adult CPO
Referral Pathways to be formalised between all young people’s specialist substance misuse treatment services and adult drug and alcohol services.
Adult CPO
Conduct a review of the transitional needs of young people with emerging dual diagnosis needs including issues relating to capacity and thresholds of adult mental health services.
YPM
Develop and cost a model for an 18-25 transitions service. Developed in consultation with young people’s and adults services and service users.
YPM/Adult CPO
Present to adult Joint Commissioning Group and YP Delivery Group proposals for new service.
YPM/Adult CPO
Expected outcomes: Effective transitions between young people’s and adult services planned and delivered.
37
Objective 2
Review provision of services for 18–25 age group
By when: April ‘10
Actions
Work with DST adult commissioning team to review need, and plan for targeted service provision for this group. Develop service spec/ tendering process.
Adult commissioning team
Expected outcomes: New service planned and commissioned for commencing April 2010
38
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