Risk-Taking

Risk taking behaviour is a normal part of adolescent development. Risk taking can be positive and helps shape us, our values and ethics.

Unfortunately young people can and do engage in risk taking behaviours which can have negative consequences on their health and well being, these can include drug and alcohol use, unprotected sex, anti-social behaviour and risky behaviour involving motor vehicles.     

In addition a UNICEF report published in January 2007 found that, young people in the UK are disproportionately engaging in behaviours that risk their health and wellbeing when compared to young people in other OECD (organisation for economic co-operation and development) countries.

Why should we focus on Risk-Taking Behaviours?

Evidence for traditional drug and alcohol prevention approaches is low, by which I mean educational approaches which only focus on the behaviour (e.g Drug taking) and the possible consequences (e.g. health, offending).

We know that this approach is relatively ineffective in changing behaviour in children and young people.

Most young people know you should wear a condom to prevent against STI’s for instance but we know many go on to engage in unprotected sex.

This highlights the reality that it’s relatively easy to change opinions and attitudes, but much harder to change behaviour.

So can we get a better response by focusing on those young people identified as possibly more likely to engage in risk taking behaviour?

I guess the question could be, do young people take Drugs or Risks?

Mark Bowles

The Training Effect

New Contract with Essex County Council

Last week we were informed that we had won a major 6 month contract with Essex County Council to deliver 2 separate training courses to several thousand professionals, really looking forward to it, great for the business and as always a really great opportunity to improve outcomes for children and their families.

A new Prezi intro to The Training Effect

Is the NHS just too important to be controlled by politicians?

The latest policy disaster currently affecting the NHS has put it into sharp focus - not only as institution but as saver of life and national treasure. It has also made me consider more deeply the unique position it occupies in our collective consciousness.

I can tell you a tale of its life saving accomplishments, of selfless nurses and committed doctors. Tales of compassion and hope, of the role it plays in the start of life and the dignity it provides at the end.

But, I can also tell you of the nurses with no time or emotion to spare, of dirty sheets and terrible food. Tales of despair and horror, of mistakes made and the loss of dignity at the end.

This is not unique, and I would imagine most of us have seen the NHS at something approaching its best and its worst. But if your anything like me that doesn’t stop you loving it, for all it can be and all it is, limitations and all. Don’t get me wrong I’m not a fundamentalist, I would like to see reform in some areas but I’m becoming increasingly convinced that politicians are not the correct people to drive that change.

As someone who has worked within the NHS I was always impressed that it worked at all, that it didn’t just all collapse under its own weight, like a patient on the gastric band waiting list.

So whilst the criticism of the NHS by the coalition and the plans to reform it didn’t come as a total shock, it certainly took me by surprise given that they didn’t give any warning like, I don’t know, actually putting it in a manifesto maybe?  No, that would be too easy they must have said, people might not like that, you know what let’s just get elected then just change it all anyway.  

Not long ago Andrew Lansley was lauded as a leader, someone who could drive change and modernise the NHS. The NHS was failing, unsustainable and stifled competition. It was too beauracratic, wasteful and led by the wrong people. GP’s are the people to lead the NHS given that they work on the frontline, let’s give them the money and let them spend it. Get rid of the PCT’s and save the nation a fortune.

What a difference a day makes (or several months) fast forward to the present and Lansley is political death and his reforms lie in tatters. Why? Because it doesn’t appear he did the thing that people usually do when they want to change something.

Ask the people who know about it, will be affected by it and care about it.

On that basis that’s everyone.  

The NHS for me is not like other elements of government, its not transport or highways or overseas aid, it’s not trade and industry or even the military it occupies a different space altogether and one which people are far less likely to go quietly into the night when changes are proposed. We are all heavily invested in its past, present and future and we cannot allow it to be destroyed by those who believe it to be just another public service which can be 'modernised', reformed and used for political capital.

When politicians can prove they have its best interests at heart then I will agree they are the correct people to be custodians of it. What their latest proposed reforms have shown is their inability to understand it, both as service and institution and a lack of respect for those who care about its future direction.

The real irony is that the coalition believe front-line medical practitioners are the correct people to decide how the resources of the NHS are distributed but they can’t help decide or be consulted on the future direction of it as an organisation.

Let’s just hope the coalition listening exercise moves beyond just that and they actually hear what the people of this country are saying.

Mark Bowles

The Training Effect

Young People and Drugs – Defining levels of use

Drug use amongst people of any age can be categorised into three main categories: Experimental, Recreational and Problematic.

For specialist and non-specialist practitioners alike an ability to indentify levels of use and thus act accordingly and in the clients best interests is key to effective intervention. Levels of use can go up and down and what may be recreational use for one young person may well be problematic for another.

The following articles aims to provide a brief outline of the levels of use to provide practitioners with an initial picture of the issues that may be present for clients who find themselves at each stage.

Experimental

It stands to reason but everyone’s initial use of a substance is, by definition experimental. Reasons for use at this stage may include availability, curiosity, peer influence, initiation and anticipation of positive effects.

Experimental drug use amongst adolescents should not be viewed in isolation as it represents a wider desire amongst this group to attempt and try a range of new experiences. Not all experimental drug and alcohol users move on to use substances recreationally.

For adolescents they may remain experimental drug and alcohol users for some time, it should not be viewed as a time limited stage of use. Some adolescents may only choose to use substances when they are available, which may be infrequent. The lack of seeking the drug out, or those using it, can be a further sign of experimental drug or alcohol use.

It is also not true that all experimental drug and alcohol users are adolescents, many adults may also experiment with drugs and our alcohol at any stage of their lives.

Recreational

Those that have experimented with drugs and or alcohol may choose to remain at the experimental stage. They may however move on to become recreational users of a particular substance or substances.

Recreational drug and or alcohol use can be thought about in terms many of us find familiar, given that we may be recreational users of alcohol. Recreational use can be identified by having set patterns to use (evenings and weekends possibly), a motivation to use to relax, pleasure is obtained from the experience and use often does not occur on consecutive days.

The user will also continue to function and complete everyday tasks that are expected (attending school, college, work etc). Often the user has found a drug of choice and has discovered how to enjoy and maximise its positive effects.

Problematic

As the name suggests problematic users of substances have progressed beyond the recreational stage and are now dependent on a particular substance or are now poly drug users.

Their behaviour and use has become problematic and the rules and boundaries which governed their recreational use have rapidly diminished.

Psychical and/or psychological are now present which furthers distinguishes the user from experimental and recreational users of substances. The reasons for use in the recreational stage have significantly altered, the process of obtaining the drug rather than the pleasure and relaxation provided by it has become the key driver. Any pattern of use (evenings and weekends) has vanished and the young person’s use has become more regular and less controlled.

Problematic users who are injecting are commonly exposed to further health implications if injecting equipment is shared. All domains start to be affected in this group: psychical, social, emotional and psychological. This group of young people will often have legal problems, be involved in the criminal justice system and experience worklessness.

Friends, family and former social and recreational activities become less important and the user often becomes isolated from former family and friends.

The information above is intended to provide a brief introduction, the most effective way to further educate yourself or your staff is through outcome focused workforce development programmes which can effectively support staff and equip them with the skills to effectively support young people with substance misuse issues when they first arise.

With better education on substance misuse we can reduce the harm they cause.

Mark Bowles

The Training Effect

Families With Complex Needs – An introduction to Intervention.

Families that have one or more parents with vulnerabilities or problems such as alcohol misuse, drug misuse, mental health problems, domestic abuse or criminal involvement are shown to have poor outcomes for the children as well as the adults. These problems are often overlapping creating complex families that present a challenge for services to deal with effectively. These complex families can cost public services between £250,000 and £350,000 a year to deal with.

Government policy and evidence of effective programmes support a move towards giving greater priority to vulnerable families, and adopting an approach to build their resilience through whole family assessments, whole family care plans and intensive whole family interventions.

If we can see these families coming (by identifying them through services or data) and know that they are not likely to do well in our normal service responses (by acknowledging the evidence of poor outcomes, difficulties in intervening effectively and the resultant high costs to public services), then we have a duty to do something different with them in future. We can intervene early rather than wait for a crisis to happen.

Adults who are parents and have more than one vulnerability is the norm for adult and children’s social care rather than the exception. The prevalence estimates we have generated show that these issues should not be considered to be a “hidden harm” or a specialist issue – these families form the bulk of those who regularly attend key agencies and should be considered a core issue and be afforded greater priority.

A more tailored response is needed from adult services for parents with multiple vulnerabilities as evidence shows that these parents are likely to drop out of standard support services or be hard to engage.

Strategically we should concentrate our resources where it will have the biggest impact, especially during a time of public sector spending cuts.

This means identifying and targeting high cost families with programmes that have been shown to work and save money.

The current set up of services encourages the fragmentation of families into individual members (adults and children) with numbers of individual problems dealt with separately, in spite of research demonstrating how linked these problems are and that parent’s affect the whole family’s outcomes not just those of the individual.

Intergenerational transmission, where many of these parental vulnerabilities mean that their children are significantly more likely to experience similar problems, typified by local case studies we were told about showing 2nd and 3rd generation drug misuser's and children in care, demonstrates the need to adopt a “never too late to intervene” principle to ensure that services do not give up on families or pre-judge their ability to improve.

The evidence shows that you can have success and change the lives of vulnerable families by pro-actively engaging them, building their resilience, reducing their risk factors and strengthening the family to cope by themselves in the long term.

There appears to be an opportunity for a “Win-Win” situation. By developing and building capacity for whole family interventions with families with complex needs, the evidence suggests that it can be better for the outcomes of the children and the adults in that family, whilst also serving to reduce the cost burden on social and health care, and even improving staff recruitment and retention.

In short, now is the right time to look again at families with complex needs and use the evidence and policy direction to change our approach for the better.

The above information was produced by our partner organisation Tonic as part of their work with local authorities and other providers to better support families with complex needs.

Alongside The Training Effect they offer a range of services that can help local authorities and other providers to better support these families, saving money, improving efficiency and improving outcomes for children and families.

For further information please take a look at our websites.

Mark Bowles

Families with Complex Needs – What should Local Authorities do?

The Issue A number of factors for parents impact on their ability to parent well and impact negatively  on their children in terms of both immediate safety and longer-term outcomes, including if a  child is taken into care. Most prominent amongst these vulnerabilities for parents are drug  misuse, alcohol misuse, mental health problems, domestic abuse and offending. These vulnerabilities are often linked, overlapping and mutually reinforcing.  Families with multiple vulnerabilities present challenges for services, cost the local authority  and health services significant amounts of money to respond to, and are difficult for staff to  work with effectively across social care and partner agencies. Policy Context The new Government has committed to helping families with multiple problems.  Nationally, there has been a raft of policies over the last decade placing greater emphasis on  the importance of the family, including Think Family, the Drug Strategy, the Youth Alcohol Action  Plan and Working Together to Safeguard Children guidance. What Works There is a growing evidence base to support the efficacy of whole family interventions that  demonstrate improved outcomes for vulnerable and complex families and provide evidence of  cost savings or cost avoidance for public services. These have been shown to be effective for  families with parental substance misuse, domestic abuse and mental health problems.  These programmes include Westminster Family Recovery Project, Family Intervention Projects,  Strengthening Families Programme, Option 2, M-PACT and Family Drug and Alcohol Courts. Delivery Options Using the evidence of what works and the local needs analysis, we have developed a set of  principles and characteristics of effective programmes that should underpin any future service  development, joint working protocols and training. We have also outlined three delivery models  to take this work forward: 1. A multi-agency joint working protocol 2. A programme of training, support and co-location 3. Adopting an evidence-based programme Identify Conduct an exercise to identify the top 400-600 complex families that cost local authorities the most money to deal with. Pool training resources by bringing together budgets, expertise, venues and  overlapping issues (e.g. parental drugs, alcohol, mental health, domestic violence)  into a single set of training programmes to: (i) help identifying agencies to spot signs  and engage complex families; and (ii) develop whole family working practices across  key agencies. Pool communications resources to ensure that key messages about working  with complex families go to all staff across agencies in a joined up way, spreading  evidence of what works. Commissioning priority should be given for parents with vulnerabilities and complex families,  with commissioners actively ensuring an appropriate response from service providers. Intervene Improve inter-agency working through developing and implementing a specific  protocol to drive improved joint working for complex families. Key agencies need to  sign up, setting out expectations and commitments from each agency in line with  evidence of what works. Consider adopting evidence based programmes to deal with complex families more effectively. Bridge the gap between adult and children’s services by joining up the safeguarding  functions and championing a multi-agency approach to complex families, in line with  evidence based programmes. Consider whether the current use of money for drug testing and substance misuse experts  in child care proceedings could be more effectively used to fund specialist drugs worker  input co-located with children’s social care to joint work these cases. Prevent Address the current gap in support after a child goes into care when parents have  vulnerabilities, by ensuring appropriate family strengthening support and parenting  skills for the parents and specific support for the children who may experience long term problems. Establish self support groups for parents (esp. mothers) going through these issues. The above information was produced by our partner organisation Tonic as part of their  work with local authorities and other providers to better support families with complex needs. Alongside The Training Effect they offer a range of services that can help local authorities  and other providers to better support these families, saving money, improving efficiency  and improving outcomes for children and families. For further information please take a look at our websites. Mark Bowles