This page describes newly published policy and guidance documents relating to drug use and prevention. Links to summary tables towards the bottom of the page provide an overview of all recent documents relevant to prevention within the tiered system, and within specific populations.

 Being Healthy: The implications for youth work of Every Child Matters.

The National Youth Agency has produced this briefing paper for senior youth work policy makers and practitioners. It discusses the contribution of youth work to the Every Child Matters Outcomes.

All the other outcomes of Every Child Matters are underpinned by being healthy. This briefing paper states that healthy young people are more likely to enjoy, achieve and contribute and, hence, to achieve economic wellbeing. This suggests that unless physical and emotional wellbeing are met, people do not achieve academically and do not strive towards self actualisation.

This paper outlines the policy context for being healthy, discusses different perspectives on young peoples’ risk – taking and looks at the four key areas of health identified in government papers: Being physically healthy; Being mentally and emotionally healthy; Being sexually healthy and Making healthy lifestyle (drug use) choices. The current state of young people’s health is outlined under each of these headings along with government concerns and initiatives; and the contribution that youth work can and does make.

The following list suggests that senior youth work policy makers and practitioners need to be:

· aware of government initiatives, while also being able to critically review them, deciding when to comply, and how best to act in the interests of the young people they serve in any locality;
· aware of the facts, while also being aware of the limitations of official data and the potential for misinterpreting different perceptions of “risky” health behaviours; and
· clear about the value of youth work  and its potential contribution to the health strand of Every Child Matters in general and to each of its five main aims.

The policy context for Being Healthy

Government policy is aimed at raising health standards overall and reducing the significant inequalities that exist. Good health can enrich and prolong lives but the government also has other concerns and considerations: the costs to individuals, the NHS and other public services and to the economy, through work absence when people fail to take care of their health; the significant inequalities that still exist between different social groupings and between regions despite increased national prosperity, wider opportunity and improving health over the last 20 years; and the cycle of health inequalities by which poor health is passed down from one generation to another.

A range of approaches has been identified by the government to address health concerns including strategies that focus on education and prevention, as well as treatment: addressing inequalities through targeted provision whilst also aiming to raise the nation’s health through improved and more accessible universal services; recognising that health inequalities are tied up with housing, employment and the physical environment necessitating joined-up working and holistic approaches; and recognising that services need to be organised around the needs of the people that they serve and encouraging those user groups to be actively involved in design, delivery and evaluation of provision.

The main health concerns are the same for young people as for adults and tackling inequality is also a priority.

The main Be Healthy aims in the Every Child Matters Outcomes Framework are that children should be: physically healthy (with targets for obesity); mentally and emotionally healthy; sexually healthy; living healthy lifestyles (alcohol, smoking and healthy eating); choosing not to take illegal drugs. The teenage pregnancy rate is decreasing (though still higher than comparable EU countries and although some STIs rates are increasing, others are falling; alcohol and smoking rates are not decreasing but class A drug use has stabilised.

Perspectives on young people’s risk-taking

The government has recognised structural forces at work for example with significant investment in poorer neighbourhoods but there is also a tendency to emphasise personal responsibility in young people’s risky health behaviours. Youth workers may worry about promoting the “right” choices as opposed to making personal well-informed choices.

The main reason why young people take drugs is because they like them. Personal reasons also include youthful curiosity and experimentation and rebellion against adult restrictions. Drugs or alcohol might also be used to escape from difficult circumstances. From the structural perspective, choices are shaped by social circumstances.

Being physically healthy: The current state of young people’s physical health

The main target for physical health in the Every Child Matters Outcomes Framework is reducing obesity. This is often linked in government reports with healthy eating and physical activity. Among boys and girls aged 2 to 15, the proportion who were obese increased between 1995 and 2004. Nineteen per cent of boys and 22 per cent of girls will be obese by 2010 if no action is taken (Information Centre for Health and Social are, 2006).

Targets have not been met for healthy eating and over half of students in years 7, 9, and11 failed to take the recommended level of exercise: at least one hour a day, five times a week. In 2003 just over half of young men aged 16 to 24 achieved the recommended level of physical activity compared to a third of young women.

Government concerns and initiatives

The government expresses concerns about health and about costs to the economy and there are four main programmes in place to halt the increase in childhood obesity by 2010, the target for which is jointly owned by the Department of Health (DoH); the Department for Education and Skills (DfES); and the Department for Culture, Media and Sport (DCMS). They are responsible for the following initiatives: The DfES/DCMS School Sport Strategy; The DCMS programme for children’s play; The DfES programme for improving school meals; and the DH/DfES National Healthy Schools Programme. These four programmes also mesh with broader programmes to achieve cleaner, safer and greener public spaces, which increase opportunities for children and young people to be active.

The contribution that youth work can make

Three of the four programmes outlined above are school based but much of young people’s physical activity occurs outside school. Traditionally, youth work has included a variety of sporting activities. Dance, theatre, games and outdoor education are also part of the youth work repertoire, which get young people moving.

Being mentally and emotionally healthy

The current state of young people’s mental health

The main targets within Every Child Matters are reductions in the death rates from suicides and undetermined injury along with improvements in access to Child and Adolescent Mental Health Services (CAMHS). The main worries for 14 to 15 year olds are: school work problems, health problems, the way they look, career problems, family problems, problems with friends, puberty and growing up, and bullying, with some being worried about their sexuality. One in 15 young people aged 11 to 25 has self harmed. Around 19,000 young people aged 15 to 24 attempt suicide every year with around 700 dying as a result and the suicide rate for young men aged 15 to 24 was higher than for young women of the same age in 2004. Tiers 2 to 4 employ increasingly specialised mental health professionals for children who have increasingly severe mental health problems. Every Child Matters is seeking to make access to services easier and to make them more user friendly and to ensure that mental health professionals are supporting non-specialists at Tier 1.

The contribution that youth work can make

At Tier 1: youth workers use activities and conversations to enable young people to have fun; learn from experience; build mutually satisfying relationships; engage in well informed problem solving and decision making, resulting in young people gaining the confidence and self esteem that provide resilience in dealing with adversity.

At Tier 2: youth workers are also able to recognise when the problem is something that needs professional mental health support and who might provide it.
 
Being Sexually Healthy

The current state of young people’s sexual health

The teenage pregnancy rates have fallen since the launch of the Teenage Pregnancy Strategy and they are currently at their lowest since the 1980s. However, the rates are higher than in comparable EU countries. There is some way to go to the target of halving the teenage pregnancy rate by 2010 and according to the DfES, nearly every local authority has at least one neighbourhood where more than six per cent of girls aged 15 to 17 become pregnant every year.

Chlamydia is the fastest growing STI in young people aged 16-24 but rates of gonorrhoea diagnosis fell by 17 per cent between 2004-2005. More young people than over 25s take up voluntary, confidential testing.

Government concerns and initiatives

Teenage pregnancy rates are important for teenage mothers (finishing education early, damaging employment prospects and potentially excluding themselves from mainstream society); their children (infant mortality is higher among babies born to teenage mothers and teenage mothers are more liable to physical and mental health problems; to smoke; to choose bottle feeding over breast feeding and to experience poverty and housing problems); and the economy (benefit payments). There are similar concerns with STIs.

The Teenage Pregnancy Strategy represents the first coordinated attempt to tackle the causes and consequences of teenage pregnancy. The strategy has two main targets: halving the under-18 conception rate by 2010 and establishing a firm downward trend in the under 16 rate; and increasing the participation rates of teenage parents in education, training and employment, to reduce the risk of long-term social exclusion. The Strategy has four broad themes: Joined-up action, a national media campaign, prevention and support for teenage parents.

The contribution that youth work can make

The Government identified seven key factors in areas that were successful in reducing teenage pregnancy rates during reviews of statistically similar areas with contrasting rates of progress in 2005 and three of these mention youth work specifically. The study also showed that Primary Care Trusts were making good use of youth work skills and contacts, to promote sexual health education among young people.

Making healthy lifestyle (drug use) choices

The current state of teenage drug use

There is a distinction between legal and illegal drug use within the Every Child Matters main aims for Being Healthy, whereas the National Healthy Schools standards groups them together (along with sexual health) under the topic of PSHE (Personal, Social and Health Education). This briefing adopts the latter strategy in discussing drug use/misuse.

The fourth key aim of the Be Healthy Every Child Matters outcomes Framework, for children and young people to live healthy lifestyles, is linked to targets for reductions in the percentages of children and young people who consume alcohol and smoke.

For the fifth key aim: that children and young people will choose not to take illegal drugs, the related targets and indicators are reductions in the harm caused by illegal drugs, and in the use of Class A drugs.

With the exception of cigarette smoking by boys, the use of tobacco, alcohol and cannabis among 15 year olds in the UK is amongst the highest in Europe. Among the 6.8 million 16 to 24 year olds in the UK: almost a third are daily smokers; nearly 30 per cent drink more than twice the recommended daily alcohol limit at once a week; one million have used an illegal drug in the past month; and multiple drug use is common for all ages. Young smokers are much more likely to use illegal drugs than non smokers.
 
Links between different forms of “risky behaviour”

More than a quarter of those who drank at least once a week had taken drugs in the last month compared with only 8 per cent of those who drank one to three times a month and 1 per cent of those who had not drunk alcohol in the previous year. 43 per cent of those who drank once a week reported smoking regularly compared with 2 per cent of non-drinkers.

After drinking alcohol, one in seven young people reported having unsafe sex and one in ten had drunk so much that they could not remember if they had had sex or not.

More offences were committed by those who reported drinking alcohol in the last week than those who drank less often. 39 per cent of those who drank at least once a week reported violent offences compared with 26 per cent of those who drank one to three times a month. For those who had not drunk at all in the previous year, 11 per cent reported committing violent offences.

Drug users may commit “acquisitive” crimes such as burglary and robbery to feed their habit. They may commit violent offences while under the influence of drugs or be involved in “gangland” rivalries (according to DrugScope). For young women, a drug “habit” might lead to prostitution as a way of raising the money to buy drugs.

Government concerns and initiatives

Legal and illegal drug taking can cause problems for young people themselves and cause a burden on the NHS, partly from the direct effects of drugs; partly (in the case of illegal drugs) because of the links with HIV infection; partly because of the increased likelihood of damage to self and others while under the influence of drugs and partly because of links with other aspects of health.

Every Child Matters indicates that the aims of reducing drug use among young people are to be achieved by ensuring that: a full range of substance misuse work, from education through prevention and treatment, are embedded in mainstream services; and all professionals working with children and young people are able to identify, assess and undertake appropriate action for addressing substance misuse issues. (2.37)

The government’s Drugs Strategy involves joint working between the Home Office, the DfES and the DoH and has a four pronged approach: information (mainly through schools) with “teachernet” guidance on how drugs education should be delivered; easy access to advice and information on drugs and services for young people and their families (approaches based around the FRANK helpline and website; prevention (direct access to core health, education, housing and family support services; and prompt access to specialist young people’s services when needed) and social inclusion programmes such as the Positive Future programme.

Other government initiatives include The Alcohol Harm Reduction Strategy (2004); The Every Child Matters: Change for Children programme on Young People and drugs (DfES, 2005) and the National Healthy School Standards.

The contribution that youth work can make

Youth work organisations are often in contact with vulnerable young people who may not attend school to receive the National Healthy School Standards programmes. This puts youth workers in a good position to affect the factors that protect young people from problematic drug use. These protective factors include: strong bonds with the local community; a supportive relationship with at least one adult and clear boundaries for acceptable behaviour. Other protective factors include strong family bonds and family involvement in the lives of children. This raises the question about the extent to which youth workers should also work with the parents of young people. 

Conclusion

The government has invested heavily in PSHE in schools as part of the national Healthy Schools Programme, but there are questions about its effectiveness. Although many young people know the risks of STIs and drug misuse, it does not necessarily influence their behaviour. Youth work offers a wealth of experience in promoting informed decision-making and opening up services to the needs and interests of young people and thereby can provide a complementary forum and methodology for effective PSHE especially where disengaged young people are concerned. The Briefing paper indicates a variety of ways in which youth work can contribute to different elements of Being Healthy.

Link to full document

Policy review of children and young people. A discussion paper

The Government is committed to improving the life chances of children and young people.The Review of Children and Young People is assessing progress made to improve outcomes and what further action needs to be taken as part of the 2007 Comprehensive Spending Review and beyond. This document presents evidence the Review has collected to date.

Fulfilling the potential of all children

Preventing problems or intervening as soon as they are identified is essential to sustain children’s life chances. Positive outcomes are self-reinforcing, that is they are likely to lead to even better outcomes later or improve a child’s resilience against poor outcomes. A preventative approach therefore needs to develop the full potential in all children. Analysis produced for this review shows that while a small number of children remain at risk of poor outcomes throughout their childhood many develop poor outcomes later. This suggests that support needs to be available at all ages of childhood – and that universal services such as schools and health services need to play a key role to monitor and identify children who are at risk of or begin to develop problems.

The Review has examined how well public services currently operate towards providing support that is prioritised towards prevention. Every child matters, the Government’s
programme of reform of services for children, is bringing about significant improvements, and the Review identifies a number of areas where more can be done:

• the framework in which public services operate could place more emphasis than it does currently on rewarding or incentivising support which is preventative; in particular

• more could be done to build children’s resilience to poor outcomes in key areas, including enhancing educational attainment and building social and emotional skills; and

• parents and communities are vital to create a supportive environment in which children and young people can develop; more can be done to build their capacity to fulfil this role.

Young people continue to be exposed to new or changing influences as they develop towards adulthood. Experiences outside of formal learning, particularly participation in
positive activities are important for young people’s development. Youth Matters set out the Government’s priorities to support young people outside of schools, including action to give young people more say about how their needs are met.

This Review identifies a number of areas where further progress needs to be made to achieve more participation from young people in activities which boost their resilience to poor outcomes, including:

• continued work to reduce barriers that currently stop some young people participating in any positive activities;

• raising the standards and consistency in the quality of what is made available at local level; and

• building on existing good practice, to involve young people in the design and decision-making processes behind their provision, working with adults and communities.

Supporting vulnerable groups

Some groups of children tend to be particularly vulnerable to poor outcomes. The Review is considering in more depth progress made and remaining challenges for policy in relation to two groups: disabled children; and families caught in a cycle of low achievement.

Disabled children are diverse in their characteristics. Many disabled children experience more than one disability. On average, they experience poorer outcomes compared to their non-disabled peers, such as fewer qualifications. The Review has found many approaches, both national and local, which are improving the support available for disabled children and their families. For example, the provision of key workers and allowing greater control by disabled children and their families over the purchase of services is helping to create services that respond to need. However, responsiveness to need is not a universal experience, good practice needs to be spread, and more needs to be done to:

• develop a clearer and more coherent understanding of the disabled children population at local level, combined with a stronger evidence base on interventions to improve outcomes for disabled children. In particular the role of earlier intervention to prevent outcomes from deteriorating;

• allow disabled children and their families to influence the way services are delivered in their local area; and

• ensure public services cooperate appropriately at local level to deliver effective packages of support.

Families caught in a cycle of low achievement

Research carried out for this Review identifies a small minority of families with multiple problems leading to particularly harmful outcomes for the children in the family, family members and potentially the wider community. It is essential to support them on a sustained basis, if services are ultimately to shift resources and focus to a more
preventative approach. It is also important if the Government is to break the cycle of disadvantage across generations. The Review has found that there are often barriers and challenges that prevent effective support for these families. Key challenges identified include:

• improving coordination of public services, particularly links between services for children and for adults, to address the root causes of problems in these families;

• ensuring services are able to engage effectively with these families through building their trust, where this is a barrier to engagement, and ensuring services can balance support and sanctions to gain optimum engagement; and

• providing sufficient support and motivation to front-line professionals to engage in what are often extremely challenging circumstances.

The Review has drawn on a wide range of evidence including a public Call for Evidence, which received responses from many interested organisations and individuals, as well as consultation events. The Review will continue to build on the analysis set out in this document. The Review will report in spring 2007 with recommendations to inform and influence the outcome of the 2007 Comprehensive Spending Review.

Link to full report

School Nurse: Practice Development Resource Pack

The Department of Health has just published its School Nurse: Practice Development Resource Pack which offers a framework for practitioners, their colleagues, managers, and commisioners to support the development of a modern school nurse role. It identifies key national policies that are currently shaping developments in children's services and sets out a child centred public health approach for school nursing teams. The pack assumes that the reader already has an understanding of the theory and practice of school nursing.

Alcohol and drugs are discussed and the Home Office/DfES PSA - Reduce Class A drug use by young people. Reduce the frequency of any illicit drug among all young people under the age of 25, especially by the most vulnerable - is emphasised. The key role of school nurses in the development of school based prevention programmes is highlighted. Nurses should give advice and identify those who might be or are at risk of developing problems. School nurses are encouraged to ensure that they are up to date with latest drug and alcohol information, including legal consequences; use health promotion strategies; identify at risk groups; offer practical choices and information about where to seek help; use individual health plans and health surveys to identify and address drug related behaviour; and work with others to establish extended school activities.

Link to full text

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