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Drug Treatment Services for Young People: A Research Review
CHAPTER 7 FURTHER DEVELOPMENT AND RESEARCH
This study has presented an overview of drug misuse treatment and care services for children and young people in Scotland and the planning and operational issues they face. It has not aimed to produce direct recommendations for the further development and implementation of these services. An informed and detailed set of key issues for the implementation of services is presented in 'Review 2001: The Substance of Young Needs (Health Advisory Service, 2001), though this is set mainly in the English context. We do not aim to duplicate or directly complement that review here.
This section briefly summarises the implications of the study findings for further development work, and makes some recommendations for future research themes.
Areas for Further Development Work
The findings point to a number of areas where further work will be required in order to meet the policy aim of providing access to treatment and care services for children and young people. In summary these are:
Establishing the scale of need: there are indications from the qualitative research that some children and young people are in need of services, but are not accessing them either because of lack of availability, lack of awareness, or lack of a stimulus to seek help with misuse issues. It may be that the potential scale of such services is significantly larger than their current size. Much work is in hand to meet this need for information.
Filling service gaps: these may relate to service access, in rural areas; or there may be a need to give additional groups access to services; or there may be limited availability of specific treatment or intervention types (such as specialist residential rehabilitation facilities). There may also be a need to consider the mix of earlier interventions for lower risk groups, and services for higher risk groups.
Promoting awareness and understanding of rights and responsibilities: in particular, overcoming delays or problems in service implementation associated with the legal and practical issues involved.
Planning and implementing multi-agency working: this includes providing consistent delivery to service users irrespective of their entry point to the system; providing for effective shared assessment and information exchange; establishing clear roles and responsibilities; and organising effective transitions at 16 and beyond.
Supporting effectiveness in service delivery: the study findings emphasise the value of targeted, well resourced, and sustainable interventions, with clear aims and objectives and appropriate monitoring and assessment methods, supported by well trained staff.
DAT partners are researching and developing strategies for provision for under-16s, and many have implemented or are about to implement services in this area. However DATs are facing a range of strategic demands and opportunities, including those relating to the development of employability initiatives and of work with families affected by drug misuse. With their very limited resources, they can be hard pressed to co-ordinate and progress work on all these fronts. Although we have shown that much good practice is being developed and implemented at local level, DATs and DAT partners will continue to face time and resource issues in attempting to deal with these. The policy task is to prioritise and facilitate this work within the overall strategy for drugs service development in Scotland.
Further Research
Areas where further research would be helpful include the following:
Further assessments of need and potential demand - local results could be drawn together, where available. In general these will be unpublished and not accessible via literature reviews - some have been collected for this study, and later studies may be available on further investigation. Further research could be undertaken nationally and/or in areas where less information is available. This work should complement existing studies such as the Scottish Crime Survey and more specific surveys of children and young people. Lessons should be derived from the methodological approaches adopted to date and the issues encountered;
Prevalence/needs studies of this type should be repeated at appropriate intervals so that trends can be identified;
The Scottish Drugs Misuse Database collects information about those presenting to drugs treatment and care services, based on birth date rather than by age band. This presents an opportunity to undertake analyses focusing on children and those under 18, and to track numbers in treatment in these groups over time;
The provision of records to the SDMD from all those delivering drugs services to these groups is important to facilitate this. Liaison between services should be undertaken to avoid duplicating individual records;
The attitudes of GPs and their practice in relation to young drugs users presenting within primary care settings might usefully be explored further. Although we saw relatively little referral from GPs, one might feel that they would be well placed to identify issues and, at least, signpost and encourage young people towards suitable provision;
At present it is difficult to be specific about the nature and extent of successful outcomes from treatment, partly because there is little opportunity to track the progress of individuals as they move through agencies and into adulthood. A longitudinal study, looking at treatment pathways beyond 18 where relevant, and at a range of outcomes, from relapse to cessation of use and/or employment, would be of benefit in assessing the value and effectiveness of treatment and care services for under-16s and 16-18s;
International experience suggests that it would be worthwhile to establish a better understanding of the nature and potential role of family therapies, links with schools, and other interventions which appear to have been effective in other countries. Evaluation of the work being done with families as part of the Changing Children's Services Fund and Lloyds TSB Foundation Partnership Drugs Initiative projects may be able to make a valuable contribution.
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