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Drug Treatment Services for Young People: A Research Review
CHAPTER 1 INTRODUCTION
This report gives an account of treatment services in Scotland for children and young people who have problems with drug misuse. The research was carried out for the Effective Interventions Unit (EIU) of the Scottish Executive, by a partnership comprising York Consulting Limited (YCL) and The School of Nursing and Midwifery, Dundee University (SNMDU).
The aim of the project was to review existing knowledge about, and current service provision for, the treatment and care of young people with developing or established problems with drugs misuse.
The focus of the review is on children under 16, but it includes consideration of services for 16 to 18 year olds, as there are issues and transition routes which link the two age groups.
Definitions and terminology
'Current service provision' includes all treatment and care services designed to reduce problematic use of drugs, and/or to reduce or alleviate harm as a result of such use. Services designed to educate or advise, to prevent use, or to address the recreational use of drugs, are not covered by this review, unless they also include elements that meet the inclusion criteria. Linked issues and services relating to alcohol are included, but services and themes relevant to alcohol only are not covered.
The descriptions used to refer to children in the study are important both for clarity and in terms of the attitudes or cultural implications they may contain. In common with most practitioners in this area we use the description 'children or young people with drugs misuse problems' to express the fact that drug use is more than merely recreational, and that there are specific problems arising from or associated with it. The term 'misuse' refers to this problematic dimension of use and is not intended to be pejorative.
For clarity, we use 'service' or 'agency' to refer to the organisation delivering treatment or care, and 'intervention' or 'treatment type' to refer to specific types of work undertaken with service users or their families. The exception is where 'intervention' is used in its wider sense to describe early interventions whereby services identify and engage with children at a relatively early stage of misuse.
Project method
This report is based on the results of a mapping survey and subsequent case study fieldwork with selected treatment services, and integrates the results from literature reviews. The various stages of the overall methodology are described briefly below.
Literature reviews
The literature reviews aimed to:
identify, assess, critically appraise and synthesise the existing evidence from the international research literature concerning the effectiveness of treatment and care services for drug using young people under 16;
outline the current statutory framework that affects the provision or take up of drug services for young people in Scotland under the age of 16 years.
Mapping survey
A mapping survey took place between September 2001 and the end of January 2002. The aim of this stage was 'to review existing services in Scotland, identifying significant gaps and specific examples of promising and innovative practice'. The focus was on review and analytical description, rather than assessment and evaluation, although one of the aims was to identify cases that offer useful lessons or models for future practice.
The survey collected information on existing (and planned) services, from Drugs Action Teams (DATs) in Scotland and from other sources. This collection involved:
a review of information contained in DAT plans and similar sources;
a survey of DAT co-ordinators and other potential sources of information on services;
where necessary, more detailed telephone or face to face consultations with these and similar contacts, to collect or clarify details of services.
Case Studies
The second phase of the mapping exercise was a more in-depth look at eight selected cases (or a group of services in one case). In choosing these, the aim was to provide, as far as possible, a selection which represented the variety of services available in Scotland, but which also provided useful illustrations of key themes or issues arising from the earlier mapping work.
Chapter 6 describes in more detail the shortlist and the subsequent selection process by which the final eight case studies were agreed. The case studies were conducted with the following:
services in Aberdeen City;
Bannockburn's Community Alcohol and Drugs Service;
Dundee Youth Drug & Alcohol Service;
Fife Youth Drug Team (YDT);
Glasgow Council's Looked After and Accommodated Children's Team;
the Hype Project in Edinburgh;
Polmont Young Offender's Institution;
the Rushes project, North Lanarkshire.
Most of the case studies focused on one specific service, while exploring their links to others in the area and their place within overall DAT strategies. The Aberdeen study attempted to expand on this by including interviews with both voluntary sector and NHS services and examining how these worked within the overall framework of services in the city.
Treatment Pathways
In the next stage of the research, qualitative, face to face interviews and group discussions were conducted with service managers, operational and delivery staff, and children and young people being treated. These interviews with service users were conducted in five of the eight cases.
Report Structure
The structure of the remainder of the report is as follows:
Chapter 2 describes the characteristics and predicaments of children and young people with problematic drug misuse; this is informed by the case study and treatment pathway work, and integrates some findings from other studies of drug use and related issues.
Chapter 3presents the results of the mapping survey and draws out conclusions on the incidence and nature of relevant services in Scotland.
Chapter 4discusses the evidence available in international literature on the effectiveness of interventions involving children and young people misusing drugs. This evidence is then discussed in the context of the scenario in Scotland identified by the mapping survey;
Chapter 5 outlines the legal framework within which provision in Scotland is set and some issues associated with this.
Chapter 6 reviews the issues arising from the mapping and the literature and legal review, with other issues encountered during the case study work, as they apply to services in Scotland.
Chapter 7 looks at the implications in terms of areas for future development, and poses some questions that might usefully be addressed in further research.
A range of supporting materials, including research instruments and more detailed methodological notes, is provided in separate appendices available on request from the EIU.
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