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SERVICES FOR YOUNG PEOPLE WITH PROBLEMATIC DRUG MISUSE: A GUIDE TO PRINCIPLES AND PRACTICE
Chapter 2: Young people's needs and rights
The Effective Interventions Unit's
Integrated Care for Drug Users: Principles and Practice highlighted the importance of addressing
the needs of the whole person. Similarly, effective support for young people who are developing serious problems with drugs cannot address the 'drug use' in isolation. Both the research reviews and the consultation with service providers reported that drug misuse problems are rarely the only problem experienced by a young person and they are often not the problem that provokes the involvement of services.
Participants at the consultation event highlighted that young people are not
mini-adults, they have a
variety of needs and are
sensitive to stigma. |
As highlighted above, problematic drug use may be associated with homelessness, prostitution, criminal behaviour or poor attendance and under achievement at school. The Health Advisory Service report (2001) also highlights that many of those young people engaged in the heaviest substance use are likely to experience significant behavioural disorders. These may have hampered their development since early childhood and can take the form of anxiety or depression.
When planning provision for young people with substance misuse problems, DATs and partner agencies will need to consider the spectrum of needs (as identified in the needs assessment) and the type and range of provision appropriate to meet those needs
How do the needs of young people differ from those of adults?
'Young people have needs that are distinct from adults. …Not only are young people vulnerable to exploitation, or misjudgement, adults have a responsibility of care that they may not have to the same extent for adult clients or patients.' The Substance of Young Needs, Health Advisory Service 2001 |
In many respects, the needs of young people are the same as those of adults. Both young people and adults require flexible services that respond to their needs and for both the impact of drug misuse will reach into many areas of their psychological, social and economic lives. However, there are also
important differences that will have an impact on the services required. These include:
Social impact: The consequences of missing or under-performing at school can have a negative impact on later life chances that may be, or appear to be, irreversible. A chaotic lifestyle may seem acceptable and normal to a young person because they have fewer immediate responsibilities such as childcare, or maintaining housing or employment. However, involvement as a juvenile with a negative and anti-social peer group, particularly where this leads to offending, has been found to be a strong predictor of adult behaviour.
Vulnerability: Young people involved in problematic drug misuse are highly vulnerable. In addition to the risks to their future prospects and the likelihood of later involvement in crime, they are at increased risk of victimisation and exploitation by others, particularly sexual exploitation.
Physical impact: Most young people will have been using drugs for a shorter period than adults who present to drug agencies. This tends to mean that the negative health effects of an abusive lifestyle - such as injecting related injuries or blood borne viruses - are less likely to be evident amongst either themselves or their peer group. However, the wider
health needs of this group - particularly around mental wellbeing - should not be under-estimated.
Methods of use: The ways in which young people take drugs may differ from adults. There is likely to be a higher degree of poly-drug use, with the young person taking whatever is available - including solvents, prescribed or illegal drugs - rather than pursuing one specific drug of choice. Drug use may change from week to week. Binge use of alcohol and other drugs often features with little understanding or awareness of the consequences.
Circumstances of use: The circumstances in which young people misuse drugs may differ from those of adults. Their lack of independence can mean that the drug use takes place in environments that may bring additional risks, such as outdoors or in the company of a much older peer group.
Perceptions of risk: Young people can consider themselves 'immortal' and death or a serious deterioration in their ability to function can seem unimaginably distant. Many young people will not see their drug use as problematic and they may not make connections between the drug use and other issues in their lives. None of the young people involved in the Melrose and Brodie (2000) research felt that the experience of being looked after, excluded or offending were related to their drug use. The positive and enjoyable aspects of drug use may still appear paramount.
What are the rights of children and young people?
DATs need to ensure that services uphold children's rights and that they operate within the sprit and intentions of the law as well as the fact of the existing legal framework.
2 The
Children (Scotland) Act 1995, the
United Nations Convention on the Rights of the Child 1989 and the
Age of Legal Capacity Act (Scotland) 1991 are the central pieces of legislation in relation to the care and welfare of children in Scotland.
The key themes relevant here are:
The child's views should be taken into account where major decisions are to be made about his or her future.
Each child who can form a view on matters affecting himself or herself has the right to express those views if he or she so wishes;
Each child has the right to protection from all forms of abuse, neglect or exploitation;
Any intervention by a public authority in the life of a child must be properly justified and should be supported by services from all relevant agencies working in collaboration.
The literature review highlighted potential problems in implementing the framework in four key areas:
Upholding children's right to health and health care
Upholding children's right to participate in decisions
Upholding children's right to consent to medical treatment
Sharing of information
To overcome these issues, DATs and their partner agencies will need to consider carefully how they ensure that the rights of children are maintained. Information is available from organisations such as the
Scottish Child Law Centre, which provides independent, free legal advice to children, and
Who Cares? Scotland, which provides independent advocacy for children cared for by local authorities.
Involving parents/carers
An intervention with a young person will be more effective if there is support from a parent, family or carer. The building or maintenance of a supportive relationship with a caring adult is important for the young person. As well as a support role the parent may also have a
legal need to consent to treatment. However, there will be cases where the parents have contributed to the young person's problems and may be unlikely or unwilling to offer any support to the young person. Some young people may need services to support them to mature and develop so they are able to survive independent from their family.
It is incumbent upon health professionals to check with a child, on an ongoing basis, whether sharing information with their parents is an option. (Harding-Price 1993) |
Care must be taken at the time of assessment, and throughout the care process, to establish the possible role of
parents/carers. The young person's views should inform this process. Support to families and carers is also essential in order to limit the damaging effects that coping with a relative's drug use can have upon others. The EIU review
Supporting the Families and Carers of Drug Users (November 2002) addresses this issue.
Sharing of information is a potential source of tension between parents and health and social care professionals. Although agencies share information on a 'need to know' basis, parents may be refused access to this information on the grounds of maintaining a child's confidentiality (Cleland and Sutherland 2001). The
Children (Scotland) Act 1995 gives parent's responsibility for their child's welfare, but not necessarily the legal right to access confidential health information about their child. Only if workers involved in the child's care consider it necessary to inform parents, in order for them to carry out their caring responsibilities, will information be shared against a child's wishes. Furthermore, since complex legal relationships exist within many extended families, ascertaining who can consent and who has the right to information may not be straightforward.
It is suggested that under the principles applied to the '
Gillick Case', treatment without parental consent might be justified where health professionals are satisfied that:
The young person, although under 16 years of age, will
understand the advice.
The young person
cannot be persuaded to inform parents or to allow someone else to inform their parents that the young person is seeking drugs advice.
The young person is likely to
begin or continue using drugs with or without drugs treatment.
Unless the young person receives drugs advice or treatment the young person's
physical or mental health or both are likely to suffer.
The young person's
best interests require health professionals to give the young person drug advice or treatment or both without parental consent (Goodsir 1991; Harding-Price 1993).
If practitioners have concerns about issues of confidentiality,
legal advice should be sought.
NEEDS AND RIGHTS CHECKLIST |
When planning future service provision DATs should: Make
key stakeholders such as health, education and social care professionals aware of the legislative framework so that they fully recognise and uphold the rights of children and young people. Realise that
children and young people's knowledge of the current statutory framework is likely to be limited and that this will undermine their capacity to demand the comprehensive services set out by the law. Services will need to build in capacity to develop this understanding using appropriate methods. Understand that most
parents and carers will have limited knowledge of the current statutory framework in which services are provided. This will need to be overcome so that they are able to take valuable opportunities to work with professionals in upholding their children's rights.
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