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4.7.5 Substance Misuse Screening

SCOPE OF THIS CHAPTER

Along with all the chapters relating to looked after children this chapter was added to the manual in June 2011.

AMENDMENT

This chapter was extensively revised updated in April 2017.


Contents

  1. Introduction and Overview
  2. Requirement to Screen Children in Care
  3. What is Screening?
  4. Who Should be Screened?
  5. Who will do the Screening?
  6. When Should a Young Person be Screened?
  7. The Screening Process
  8. Confidentiality and Information Sharing
  9. The Screening Tool and Responses to Screening
  10. What if a Young Person in Need Refuses an Intervention?
  11. Recording
  12. OC2 Return
  13. Glossary of Terms and Definitions
  14. Making a Referral and Sources of Information


1. Introduction and Overview

In 1999 the Government established a set of objectives for Children's Social Services. One of these is 'To ensure that children looked after gain maximum life chance benefits from educational opportunities, health care and social care'. The various outcome indicators provided by the OC2 annual collection help the Government to monitor the extent to which this objective is being achieved by English local authorities. The OC2 return now forms part of the Children Looked After (SSDA903) return.

Substance misuse and associated problems harm children and young people’s welfare and prevent them from achieving their full potential. The strategic guidance document “Every Child Matters: Change for Children - Young People and Drugs" (2005) set out proposals to ensure that every young person with increased vulnerability to developing substance misuse problems is identified early on and receives appropriate service(s) or intervention to prevent the problems escalating.

Drug use among young people aged 10 - 24 years is higher than it is for the rest of the population and, within this group; young people who belong to one or more of the ‘vulnerable groups’ report the highest rates of all.

Vulnerable and disadvantaged under 25s who are at risk of misusing substances include:

  • Those whose family members misuse substances;
  • Those with behavioural, mental health or social problems;
  • Those excluded from school and truants;
  • Young offenders;
  • Looked-after children;
  • Those who are homeless;
  • Those who are being exploited;
  • Those from some black and minority ethnic groups.

See Substance Misuse Interventions for vulnerable under 25s Public Health Guideline PH4 March 2007.

Children and young people who are in Care are four times more likely than their peers to smoke and misuse alcohol and drugs. Addressing the early onset of substance misuse and the underlying causes can prevent problems escalating. Early use of these substances is a recognised risk factor for problem drug use in later life (DfES 2005 and 2007).

The Offending, Crime and Justice Survey (OCJS) survey which looks in detail at drug use and young people, found that whilst young people in vulnerable groups account for less than one third of their sample (28%) they represented nearly two thirds (61%) of the reported Class A drug users in the past year (Becker J and Roe S 2005).

The Public Health Outcomes Framework Healthy Lives, Healthy People: Improving Outcomes and Supporting Transparency, sets out a vision for public health, desired outcomes and the indicators that will help us understand how well public health is being improved and protected. Specific indicators around substance use include drug and alcohol treatment completion and alcohol related admissions to hospital. Public Health England also acknowledge that substance misuse interventions will contribute towards wider determinants of health such as pupil absence, first time entrants to the justice system, reoffending rates and the number of 16-18 year olds not in education, employment or training.


2. Requirement to Screen Children in Care

From 1 October 2005, Local Authorities were asked by the Government to report on the number of children and young people in Care with substance misuse needs. The report is part of the Children looked after return (SSDA903) which consists of data collected on those children and young people aged 11 to 18 who have been In Care.

The information collected is anonymous and asks the following questions:

  1. The number of children in Care for at least 12 months who were identified as having a substance misuse problem during the reporting year;
  2. The number of children and young people who received an intervention for their substance misuse problem during the year;
  3. The number of these children and young people who were offered an intervention but who refused it.


3. What is Screening?

Screening is simply a worker using their skills with young people to highlight a drug or alcohol issue or need and take the appropriate steps to ensure those needs are met. Screening is not a formal assessment – a comprehensive substance use assessment will be carried out if a young person is referred to a specialist substance misuse treatment agency.

Royal College of Psychiatrists (2012) guidance on Practice Standards for Young People with Substance Misuse Problems 1.0 seeks to support the identification of young people not seeking treatment but who may be at risk of substance misuse problems. For young people identification should simply involve brief questioning about substance misuse.

Screening should, wherever possible, take place in an environment in which the young person is comfortable. It would be helpful to have age appropriate information and literature on drugs and alcohol and specialist treatment services to hand. Please see Suggested Resources for advice on resources.

Screening should establish the following:

  • A young person’s knowledge of drugs, alcohol or solvents;
  • If they take drugs, alcohol or solvents and, if so, how often and in what context;
  • If there are any immediate/urgent risks related to substance use;
  • If substance use is part of troubling behaviour - or unusual behaviour for that age group - in relation to their substance misuse;
  • Whether there are any safeguarding issues.


4. Who Should be Screened?

Information on substance misuse should be collected from all Children Looked After regardless of age. However, in line with understanding of treatment data which suggests that substance misuse problems develop from the age of 10 onwards, calculation of the national percentage of children looked after with substance misuse problems will be expressed from the number of Children Looked After aged 10–17, rather than those aged 0–17.

The screening of children of all ages allows for identification of those children who feel affected by substance misuse in their close family or by members of their household. An additional screening tool is available to support this.


5. Who will do the Screening?

It is vital that all Children Looked After with substance misuse needs are identified early, through their health assessment, statutory reviews and care planning processes, and receive support and appropriate interventions as a result. The identification of these needs should be an on-going consideration.

In Cambridgeshire substance misuse screening forms part of the Initial and Review Health Assessments for Children Looked After which are performed by Specialist Nurses, Paediatricians or GPs.

The person undertaking the screening is not expected to have expert knowledge of alcohol and drugs but it will be useful to have an awareness of basic information and where to find it. Please see Section 14, Making a Referral and Sources of Information for more information. If you are in doubt about the level of need that a young person has, or what to do with the information you have received from a young person, you should seek advice; information and guidance from your local drug or alcohol agency (see Section 14, Making a Referral and Sources of Information).

Substance misuse issues are also part of the Early Help Assessment for children and young people, which enables a practitioner’s first assessment of need to pick up on drug misuse issues and lead to effective intervention.


6. When Should a Young Person be Screened?

Initial Health Assessments are normally undertaken within 20 working days after a young person has come into care, thereafter Review Health Assessments take place annually. However, the identification of needs relating to substance misuse should be an on-going process and not a ‘one-off’ assessment.

As part of the completion of work for a young person’s Statutory Review there will be a prompting question about whether the screening has taken place but will not ask for details from the screening. The Statutory Review will, however, address any needs arising from substance misuse, which need to be met through the young person’s Care or Pathway Plan.


7. The Screening Process

Generally, screening can be conducted as part of a conversation with a child or young person. For children and young people who are Looked After the CRAFFT Tool is used:

  • Consider the following before beginning the screening with a young person;
  • Remain calm and supportive even when you hear something potentially alarming;
  • Paraphrase what they tell you - confirm you have understood them;
  • Listen more than you talk;
  • Consider that the young person may ask you questions about drugs/alcohol generally and about your own drug/alcohol use. You will need to be prepared as to how you will respond.


8. Confidentiality and Information Sharing

(Please also refer to the separate chapter on Confidentiality Policy).

There are seven golden rules to information sharing that are highlighted in the Cambridgeshire Information Sharing Framework Guidance:

  1. Remember that the Data Protection Act 1998 and human rights law are not barriers to justified information sharing, but provide a framework to ensure that personal information about living individuals is shared appropriately;
  2. Be open and honest with the individual (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be shared, and seek their agreement, unless it is unsafe or inappropriate to do so;
  3. Seek advice from other practitioners if you are in any doubt about sharing the information concerned, without disclosing the identity of the individual where possible;
  4. Share with informed consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, there is good reason to do so, such as where safety may be at risk. You will need to base your judgement on the facts of the case. When you are sharing or requesting personal information from someone, be certain of the basis upon which you are doing so. Where you have consent, be mindful that an individual might not expect information to be shared;
  5. Consider safety and well-being: Base your information sharing decisions on considerations of the safety and well-being of the individual and others who may be affected by their actions;
  6. Necessary, proportionate, relevant, adequate, accurate, timely and secure: Ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those individuals who need to have it, is accurate and up-to-date, is shared in a timely fashion, and is shared securely (see principles);
  7. Keep a record of your decision and the reasons for it – whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.

Sharing information must be in the best interests of the child or young person. A young person’s discussion of their own drug use or that of their family is not in itself a reason to pass on information to a third party.

In deciding whether there is a need to share information you need to consider your legal obligations including:

  1. Whether the information is confidential; and
  2. If it is confidential, whether there is a public interest sufficient to justify sharing.

Confidentiality and information sharing should be discussed with all young people before any discussion takes place with others. As a general rule, the consequences of the identification of substance misuse should be clearly explained to the young person. This should include informing them about the information you can provide and about any service to which you may want to refer them.

If a child or young person is to be encouraged to approach a service for help, they need to know that their information will not be passed on without their knowledge or consent.

All young people should be encouraged to talk about their substance misuse with their parents, where this is appropriate, or with their carers, as they play an important role in supporting and protecting the young person. Young people who do not want to tell their parents or carers should not have their confidentiality breached unless there is a safeguarding concern.

The circumstances in which sharing confidential information without consent will normally be justified in the public interest are:

  • Where there is evidence that the child is suffering or is at risk of suffering significant harm; or
  • Where there is reasonable cause to believe that a child may be suffering or at risk of significant harm; or
  • To prevent significant harm arising to children and young people or serious harm to adults, including through the prevention, detection and prosecution of serious crime. For the purposes of this guidance, serious crime means any crime which causes or is likely to cause significant harm to a child or young person or serious harm to an adult. (HM Government 2006).


9. The Screening Tool and Responses to Screening

Click here to view the CRAFFT Tool.

Using the CRAFFT Screening Tool with children and young people who are looked after, these are the possible actions (more than one may be appropriate).

No further action required. Child or young person not using substances and has no unmet substance related needs identified.

Further screening conversation and provide brief advice and information.

Further conversation would include supplementary questions to enable staff to enquire about:

  • Whether a young person has used substances;
  • The type used and how it was taken (in what context);
  • How frequently taken (including first and most recent time);
  • Presence of any other risks or concerns (e.g. mental health concerns, safeguarding, use within family, sexual vulnerability);
  • Young person’s view of use and impact on their lives (problems at home, school, with relationships);
  • Their willingness to access a further assessment or help (RCPsych (2012) Practice standards for young people with substance misuse problems).

Personalised feedback given to child or young person on their current substance use choices - consider a FRAMES format and using a motivational interviewing approach. Psycho education given on the effects of alcohol and drugs identified at screening and the most relevant consequences of use/misuse discussed.

Discussion should include current use, risks, harm reduction advice, referral and treatment options, in primary and specialist care, between the professional and the treatment service. Agreement on helpful actions that the professional could undertake/ offer and advice and support the treatment service can offer to the professional.

Referral to local young people’s treatment service, with the young person’s agreement. Use agreed local treatment service referral form.

Young person already engaging with the local young people’s treatment service. Any relevant information shared with the treatment service with the young person’s permission. A request for a report on the current care plan and safety plan for the young person to be shared with professional could be requested with the young person’s permission.


10. What if a Young Person in Need Refuses an Intervention?

Where a young person is in need of an intervention but is unwilling to access it directly you can contact the specialist substance misuse services on a ‘what if?’ or anonymous basis for advice, information and support.

A young person may not have the motivation to address their substance misuse at this stage and cannot be forced. In this case, your role is to provide information to ensure the young person is informed of the risks and how to minimise harm caused by their substance misuse. Continue to monitor the situation and seek opportunities to motivate the young person to change. Consider contacting your local specialist service for advice on how to engage with the young person.

If the young person is considered to be at risk of significant harm, Cambridgeshire’s Local Safeguarding Children Board’s Procedures should be initiated. These can also be found on the Cambridgeshire LSCB website.


11. Recording

Substance use screening undertaken during Health Assessments is documented by Health Professionals in the assessment paperwork based on the Coram BAAF forms and CRAFFT forms are attached to this. These Health Assessments are quality assured by the Named Doctor for Children Looked After.

Confidentiality issues and sharing is discussed with young people at the beginning of assessments. Prior written consent to assessments is obtained from those with parental responsibility for young people <16 years and those >16 years will be asked for their written consent at assessments.


13. OC2 Return

Percentage of young people in care with substance misuse is reported back by the Children Looked After Health Team through the Dashboard to Cambridgeshire and Peterborough CCG.

The Local Authority is required to collect data on numbers of Children Looked After identified as having a substance misuse problem, those that have received an intervention for a substance misuse issue and those who were offered an intervention.

For the purposes of the OC2 return, it will be the responsibility of each of the Area Children’s Social Care and 16+ Adviser Service Teams to ensure that the information given on the outcome sheet at the back of the screening tool is transferred to either the “CLA Spreadsheet” held by Team Business Support Managers or, when implemented, onto “One Vision” (the Integrated Children’s System).

All information regarding screening must be collected by mid-September of each year and numbers returned to the Performance and Quality Assurance Team or entered on “One Vision”.

The information is then collated by the Performance and Quality Assurance Team and reported as a number to the Home Office.


15. Glossary of Terms and Definitions

Click here to view a Glossary of Terms and Definitions.


16. Making a Referral and Sources of Information

Identify the agency to be referred to from the following:

Smoking – CamQUIT Under 18 / Over 18

Alcohol and Drugs
Alcohol and drugs include all legal, prescribed and over the counter medication as well as illegal substances and solvents/volatile substances. It does not include tobacco

Cambridgeshire Child and Adolescent Substance Use Service

Self referrals and professional can contact CASUS by
Telephone: 01480 445315
E-mail: casus@cpft.nhs.uk
Website: www.cpft.nhs.uk/casus

Referrals should be sent to CASUS by
E-mail: casus@cpft.nhs.uk
Fax: 01480 445351 or
Post to: CASUS, Newtown Centre, Nursery Road, Huntingdon, PE29 3RJ.
Website: http://www.cpft.nhs.uk/casus/howtorefer

Inclusion

Inclusion are the commissioned adult (Over 18) alcohol and treatment service in Cambridgeshire. Referrals can be made directly by
Telephone: 0300 555 0101 (local rate)
Website: www.inclusion-cambridgeshire.org.uk

Other sources of information and support include:

Frank - National drugs
Website: www.talktofrank.com
Text: 82111 or t
Telephone: 0300 123 6600

Kooth
Website: www.kooth.com
Free Safe and Anonymous online support for Young People

Youthoria
Website: www.youthoria.org/
Information for 11-19 year olds in Cambridgeshire

Keep Your Head
Website: www.keep-your-head.com/CP-MHS
Information on Mental Health and Wellbeing for Children and Young People across Cambridgeshire and Peterborough

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