background - mapping report

Summary

The LSLHA commissioned an exploratory mapping of service responses for substance-using young people to assist them in commissioning services for young people at risk of misusing drugs problematically. The consultancy, educaRI was appointed to undertake the work, which took place in April, May and June 1999. The work was done through: study of background documents; meetings with key people; a postal questionnaire; and face-to-face semi-structured interviews with 28 respondents working in relevant agencies that were identified by the chairs of the borough youth sub-groups. These agencies covered a wide spectrum.

Contents of the Report

The Report includes some discussion of the theoretical background to early intervention. There is some background data on the Health Authority area: its character and levels of drug use. The findings of the mapping are then presented in some detail. The report identifies the expressed training needs of staff in the agencies, the things that they would like to do, and what they thought they would need to do these things. Some key findings address weaknesses in the services though questions based on weaknesses identified by SCODA. Around half the respondents identified ‘poor local co-ordination’ as a weakness. A lack of expertise in drugs work with young people was also seen as a weakness by some projects. Monitoring and evaluation was specifically asked about, and this exposed a further area of weakness in some projects.

An important section of the Report discusses the findings on the user profiles. There were three parts to this: firstly, respondents were asked to provide profiles of the typical young people with drug problems who used their service. A range of profiles was given; these are listed in the Report. Secondly, they were given seven profiles that had been agreed with the Chairs of the Youth Sub-Groups, and asked if these profiles fitted with their experience. In general they did. Thirdly, they were asked to add to these profiles ñ were there other groups of drug-using young people in the Health Authority who were at risk and needed services? They identified a number.

Gaps in Provision

This was one way in which gaps in provision were identified, although further questions also covered this key area. Respondents identified a number of gaps, three of which were particularly notable: services for young children (under 11s) were not adequate and developing drugs problems among this group were not being picked up. Many of these young people would not yet be using drugs but early, pre-drug use intervention was thought to be worthwhile for some members of this group there were substance misuse problems in their family. Several respondents felt that more resources were needed for family work. Particularly within the two areas mentioned, alcohol was an especially significant drug, which needed more specific attention.

There was also concern among some respondents about provision for members of minority groups. There were complex issues here of how such services should be set up and run.

Another way of looking at gaps in provision was through the four tiers of service provision. Respondents tended to see gaps at Tiers 2 and 3, that is, services that were more specialised in drugs work than generic, Tier 1 services, but not the most specialised (Tier 4) sort.

Recommendations

Our recommendations are grouped under several headings for ease of reference: Defining the problem and gathering data. All reports of this kind call for the collection of more information. This is because investigations always uncover gaps in knowledge or things that need following up. In this case, there are a number of gaps: what do the actual and potential service users think about what is available for them? More information is required about the needs of young people There is a need to carry out some in-depth qualitative work with young people to gain information on their expressed needs and perceptions. This work should also focus on particular groups of young people (such as excluded young people) in whom there is particular interest.

We recommend that the DAT commission a project to gather information from representative samples of young people of different age groups, genders, ethnicity etc. living in different areas of the borough, to get more information from young people themselves about what the drug issues are. The survey should include both those who are attached to projects and those who are not.

It would also be useful to have a more accurate view of the level of drugs problems within the Health Authority. One might undertake a more quantitative survey of young people's drug use and needs through a questionnaire administered to school pupils (it would need to take account of those pupils not in school for any reason). It is possible that the work of the DPAS will provide some of this information. For maximum effectiveness, this would need to be longitudinal and linked to any more qualitative work.

A systematic look at available records, for example police cautioning and arrests for drug offences, records related to school exclusions for reasons of drug misuse, and problems among young people looked after by the local authorities might also reveal the extent of problems (we understand that in Lambeth there is such an analysis of school exclusions).

We are concerned about the apparent absence of projects that specifically focus on the needs of ethnic groups in the three boroughs. However, we were not able to investigate this in sufficient detail to give a definitive view on what are the needs of young members of minority groups and how they could be met. We therefore recommend that further investigation of this area be carried out.

If this is done, consideration should be given as to whether it is necessary 'to gain the confidence of some workers' for this to be undertaken by external consultants who have credibility with the black community and with workers who are members of minority groups because monitoring and evaluation appeared to be weak, the flow of information about what agencies are doing and what results they are getting is probably inadequate and certainly haphazard. This needs to be closely examined with a view to systematic development of an information strategy.

Co-ordination and Information Flow

We see the need for more proactive co-ordination from the DAT. This would probably mean the appointment of a full time DAT co-ordinator; evidence from the UK Anti-Drug Co-ordinating Unit shows that DATs with a full time co-ordinator appeared to work better than DATs that did not have one.

Another helpful action to improve co-ordination would be to have a readily up-datable directory of agencies and services, perhaps distributed, say, quarterly on CD-ROM. This perhaps could be combined with a newsletter. Doing this electronically would mean that it could easily be migrated to the internet, once enough services were confidently on-line.As we noted, the different perspectives of the range of agencies involved in the provision of services makes co-ordination complex. It would be worth looking closely at the barriers to information flow (for example, confidentiality requirements).

Monitoring and Evaluation

Currently, a number of new services are starting up or are at the planning stage. It is important that the lessons from these services are identified and fed into the planning process. We recommend process monitoring where appropriate.

More information would need to be gathered on the reasons why monitoring and evaluation was so weak, but we suspect that the two main reasons are the difficulty of doing it ñ it is genuinely complex and time-consuming (and expensive); and agencies do not have sufficiently elaborated guidelines on how to monitor and evaluate. We recommend that thought is given to the best ways of encouraging the development of more elaborated mechanisms, that would not only provide management information, but that would also enable workers to reflect on, and thereby develop, their practice. It should be clear that projects will require both guidelines and time to implement this.

Training and Staff Development

We are not sure how much training has been organised locally on drugs issues, but there did seem to be a lack of awareness about young peopleís drug problems, and, within generic services, an apparent absence of expertise in dealing with these problems. It may be that there have been sufficient drug awareness courses already available. We are aware that courses are being provided across the HA by the CDEP, and we understand that their most well-attended courses are about working with young people. There may be a need for focused specialist drug courses (or practice support meetings) for particular groups of workers, as well as for multidisciplinary courses. These latter also have the effect of helping workers in different agencies and disciplines to meet together and exchange experiences, and to get to know who their counterparts in different organisations are.

There seemed to be some weaknesses in staff supervision and support that need addressing.Iit may be that both these areas could be addressed by greater integration between course preparation, course attendance and follow-up work, involving stronger links between training courses and on-the-job training.

We recognise that there are many staff development pressures on agencies and that drugs issues do not always take top priority. To overcome this, consideration should be given as to how drug-related course content can fit with training about other aspects of professionals' work. We recommend that consideration be given to the feasibility of web-based training and staff development support, which could be a cost-effective solution for getting across basic information.

The range of drugs problems and specific groups with needs. Alcohol misuse by teenagers is a big concern for many projects. This needs to be specifically addressed the need for more family work was expressed by several respondents, and it seems to us to be an appropriate and holistic way of working. We understand that the ART Team will be tackling family issues in a comprehensive way.

There is a need for support for parents worried about their children's drug use, and readily-available advice for parents to help them to know what do if their children have drug problems; there is also a need for parental education about drugs several projects mentioned their concern about young people ‘and some very young children’ in families where there were drug misuse problems. This issue needs looking at further. There are particular concerns with the provision of services for minority groups which need further consideration refugees were identified by some respondents as a potentially vulnerable group: services targeting them should be looked at.

Possible developments in service provision with so many new initiatives in the pipeline, and with a concurrent piece of work on early intervention services being undertaken by us, it is premature to make detailed service provision recommendations however, we recommend for consideration the idea of supporting schools more actively in delivering drug education messages (which can reach a large and ‘pre-problematic drug use’ audience) chools can also be a site for prevention services provided by other agencies there are opportunities for links with many other ongoing initiatives. Particularly significant are, of course, the YOTs, in relation to criminal justice, and the work on social exclusion. The ‘Quality Protects’ programme for Social Services Departments will also be an important development that the HAZ needs to keep close links with.