SCOPING REPORT ON DRUGS AND ALCOHOL SERVICES IN BELFAST
Transcript of SCOPING REPORT ON DRUGS AND ALCOHOL SERVICES IN BELFAST
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SCOPING REPORT ON DRUGS AND ALCOHOL SERVICES IN BELFAST
Based on information and views gathered by the Belfast Drug and Alcohol Working Groupbetween June 2010 and March 2011.
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Contents
Page
1. FOREWORD 5
2. INTRODUCTION 7
3. FUNDINGOFDRUGSANDALCOHOLSERVICESINBELFAST 11 3.1 Treatmentandsupportfunding 12 3.2 Preventionandeducationfunding 12
3.3 Communitydevelopmentandsupportfunding 123.4 Workforcedevelopmentfunding 123.5 BelfastRegenerationOfficefunding 133.6 BelfastCommunitySafetyPartnershipfunding 133.7 Costsofalcoholmisuse(NI) 13
4. INFORMATIONANDAWARENESS-RAISING 15 4.1 Whatdoestheevidencesay? 16
4.2 What’sinplace? 164.3 Gaps/Issues 18
4.4 Recommendations 18
5. EDUCATIONANDPREVENTION 21 5.1 Whatdoestheevidencesay? 22 5.2 Scaleoftheproblem 22 5.3 What’sinplace? 24 5.4 Gaps/Issues 25 5.5 Recommendations 26 6. TREATMENTANDSUPPORT 29 6.1 Whatdoestheevidencesay? 30 6.2 Scaleoftheproblem 31 6.3 What’sinplace? 36 6.4 Gaps/Issues 39 6.5 Recommendations 40
7. SPECIFICSERVICESFORVULNERABLEGROUPS 41 7.1 Whatdoestheevidencesay? 42 7.2 Scaleoftheproblem 43 7.3 What’sinplace? 44 7.4 Gaps/Issues 45
7.5 Recommendations 46
8. WORKFORCEDEVELOPMENT 478.1 What’sinplace? 48
8.2 Gaps/Issues 49 8.3 Recommendations 50
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9. SKILLINGUPOFANDSUPPORTINGCOMMUNITIES 51 9.1 Whatdoestheevidencesay? 52 9.2 Scaleoftheproblem 52 9.3 What’sinplace? 54 9.4 Gaps/Issues 54 9.5 Recommendations 55
10. REDUCINGAVAILABILITY 57 10.1 Whatdoestheevidencesay? 58 10.2 Scaleoftheproblem 58 10.3 What’sinplace? 59 10.4 Gaps/Issues 59 10.5 Recommendations 60
11. TACKLINGSUBSTANCERELATEDCRIME/VIOLENCE 61 11.1 Whatdoestheevidencesay? 62 11.2 Scaleoftheproblem 62 11.3 What’sinplace? 65 11.4 Gaps/Issues 66 11.5 Recommendations 66
12. COORDINATIONANDINFORMATIONSHARING 67 12.1 What’sinplace? 68 12.2 Gaps/Issues 69
12.3 Recommendations 69
13 SUMMARYOFRECOMMENDATIONS 71
14 CONCLUSIONS 81
REFERENCES 83
APPENDIX1: Thefourtiermodel 88
APPENDIX2: Listofabbreviationsusedinthetext 90
APPENDIX3: MembershipofBDAWG 94
APPENDIX4: OverviewofservicesinBelfastcurrentlyfundedby 95EDACT/PublicHealthAgency
FOREWORD
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1 ForewordThisreportpresentsasubstantialinsightintothecurrentsituationinrelationtodrugsandalcoholuseandmoreimportantly,itgivesanoverviewofserviceprovisioncurrentlyinplacetotacklesubstancemisuseintheBelfastarea.
Thedrivebehindthisscopingreportbeganinlate2009whenanumberofcommunityandstatutorysectorindividualscametogethertovoicetheirconcerns,especiallyinaNorthBelfastcontext,arounddrugandalcoholissuesimpactingonlocalcommunitiesandtheneedforamoreBelfast-focussedco-ordinatedapproach.ThissmallgroupfeltitwastimelytotakeaninnovativeBelfast-wideapproachtothisareaofwork.
InitialmeetingswereheldwithJohnMcGeown,AssistantDirectorofMentalHealthServicesintheBelfastHealthandSocialCareTrust;BillyHutchinsonofMountVernonCommunityDevelopmentAssociation;FrancesBlackandBrianAllenoftheRISEFoundationandMaryBlack,AssistantDirectorofPublicHealth,HealthandSocialWellbeingImprovementinthePublicHealthAgencyalongwithIreneSherryfromtheBridgeofHopeinordertoconsidertheissuesfacingagenciesinBelfast.However,itsoonbecameclearthatmorestakeholdersshouldbeinvitedtoparticipateinordertoensureafullyinclusivecollectiveapproachwasadopted.
Throughout2010representativesfromanumberofkeystatutoryorganisationsandcommunity/voluntaryprovidersmettoundertakeaninitialscopingexercise.Fromthisinitialanalysis,itwasclearthattherewasalotofworkbeingfundedorcommissionedbutthatawarenessofservicesand,moreimportantly,linkingupofserviceprovisionwasnotalwaysinplaceoraseffectiveasitneededtobe.Withthisinmindthegroupagreedthatitwouldbeworthwhiletospendsometimelookingatthegapsandissueslocallyandanalysethesituationwithaviewtocreatinganoverviewreportwithrecommendationsforconsideration,primarilybythePublicHealthAgencyandtheEasternDrugsandAlcoholCoordinationTeam,butalsobyotherstatutoryagencieswitharesponsibilityfor,orinterestin,addressingdrugsandalcoholmisuse.
ThisreportistheresultofalltheirhardworkandwewishtoacknowledgethecommitmentoftheBelfastDrugandAlcoholWorkingGroupmembers,whetheronbehalfoforganisationsorasindividuals,inworkingtogetherinpartnershipwiththesinglefocusofsupportingindividualsandfamilieswhoareexperiencingdrugandalcoholproblems.
Ourrecommendationsfocusonlongertermplanningandmorecohesivepartnershipworkingaswellassimplifyingaccesstoandparticipationinexistingserviceprovision.Itisacknowledgedthatwhilstmanyagenciesaredeliveringservicesinthisarea,thereisalackofawarenessofprovisionbothwithinthehealthandsocialcaresectoritselfandoutsideinthewidercommunity/voluntarysector.
Asaresultofourcollaborativeapproachandthesuccesswehavehadinworkingtogether,otherareashaveadopted,orintendtoadopt,thismodelwhenlookingattheirissuesspecifictotheirlocalities.ThetaskhasbeenchallengingbutwebelievethisreportsetsthetoneforthecreationofamoreeffectivedrugandalcoholsectorworkingacrossBelfastinwhatiswidelyregardedasadifficulthealthfieldbutwhichcanyielduntoldbenefitsforindividualsandtheirfamilies.
IreneSherry OwenO’NeillCo-chairofBDAWG Co-chairofBDAWGBridgeofHope/AshtonCommunityTrust PublicHealthAgency
INTRODUCTION
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2 IntroductionTheNewStrategicDirectionforAlcoholandDrugs(NSDAD)hasbeeninplacesince2006.TheDHSSPSiscurrentlyundertakingareviewoftheNSDADwiththeaimofproducingarevised5-yearstrategy(2011-2016)inmidtolate2011.
Themulti-sectoralDrugandAlcoholCoordinationTeamsarerequiredtodeveloplocalactionplanstosupportthestrategyandtoguidetheworkandfundingprioritiesoftheTeams/PublicHealthAgency(PHA).TheEasternDrugsandAlcoholCoordinationTeam(EDACT)coversboththeBelfastandSouthEasternHealthandSocialCareTrustareas.
GiventhechangesasaresultoftheReviewofPublicAdministration(BelfastHSCTrustandSouthEasternHSCTrustfocusratherthananEasternareafocus)andfollowingonfrommeetingsthePHAhadchairedwithconcernedNorthBelfastcommunityrepresentatives,itwasagreedthataDrugsandAlcoholWorkingGroupshouldbeestablishedandsupportedineachTrustlocality.
Thefollowingorganisationswereinvitedtoattend/participateintheBelfastDrugandAlcoholWorkingGroup(BDAWG):BelfastCityCouncilBelfastCommunitySafetyPartnership(ledbyBelfastCityCouncil)BelfastEducationandLibraryBoardBelfastHealthandSocialCareTrust(AddictionServicesandHealthPromotion)BelfastHealthDevelopmentUnitBelfastRegenerationOfficeCommunityOrganisationsDrugsandAlcoholVoluntarySector(fourrepresentatives)EDACTChairpersonNorthernIrelandHousingExecutiveAreaPartnershipBoards(tworepresentingthe5boardsacrossBelfast)PoliceServiceforNorthernIrelandProbationBoardforNorthernIrelandPublicHealthAgencyYouthJusticeAgency
On24thJune2010thegrouphaditsinitialmeetingwhereallinattendanceagreed,onbehalfoftheirorganisations/partnerships,toadoptthefollowingTermsofReference:Toengageandconsultwithorganisationswithaninterestinreducingdrugandalcoholrelated
harmatanindividual,familyandcommunitylevel;ToconsidertheinformationcompiledbyPHA/EDACTinrelationto:
o Assessmentofneedo Goodpracticeandtheevidencebaseforparticularapproaches,projectsor serviceso Monitoringandevaluationdataregardingtheimpactofservicescurrently funded;
ToprovideadviceandsupporttoPHA/EDACT,localandcentralgovernmentandotherrelevantorganisationsandpartnershipsonhowtoimprovethecoordination,designanddeliveryofdrugandalcoholserviceswithinBelfast;
Topromotelinkageswithotherrelevantstrategies;andToco-optmembersasappropriate.
ThegroupelectedIreneSherryoftheAshtonCentreandOwenO’NeillofthePublicHealthAgencyasCo-chairs.
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Thisreportistheculminationofaseriesofmeetingsandworkshops(fromJunetoNovember2010)wheremembersconsideredalloftheavailableinformationinthecontextofwhatthey,andtheorganisationstheyrepresent,considertobethegapsandareaswhichcouldbeimproveduponforEDACT/PHAtoconsiderwhendevelopingEDACT’sActionPlanfor2011-2016.
Thereporttakesasystematicapproachtoscopingandcompilingevidenceon:fundingofdrugandalcoholservices;informationandawareness-raising;educationandprevention;treatmentandsupport;servicesforvulnerablegroups;workforcedevelopment;skillingupandsupportingofcommunities;reducingavailability;tacklingsubstancerelatedcrime;andcoordinationandinformationsharing.Eachsectionofthereportendswithananalysisofthegapsandrecommendationsforaction,withalloftherecommendationspresentedinatabularformatinSection13.
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FUNDING OF DRUGS AND ALCOHOL SERVICES IN BELFAST
3.1 Treatment and support funding3.2 Prevention and education funding 3.3 Community development and support funding3.4 Workforce development funding3.5 Belfast Regeneration Office funding3.6 Belfast Community Safety Partnership funding3.7 Costs of alcohol misuse (NI)
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FUNDING OF DRUGS AND ALCOHOL SERVICES IN BELFAST
3.1 Treatment and support funding3.2 Prevention and education funding 3.3 Community development and support funding3.4 Workforce development funding3.5 Belfast Regeneration Office funding3.6 Belfast Community Safety Partnership funding3.7 Costs of alcohol misuse (NI)
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3 FundingofDrugandAlcoholServicesInBelfast
Subsections3.1to3.6belowgiveanoutlineofthemaintypesofservicesavailableinBelfastaswellaswhoisresponsibleforcommissioning/fundingthemandtowhatamount.Itisbynomeansanexhaustivelist–forexampletherearemanycharitableorganisationsandtrustswhichwouldalsogiveshorttomediumtermfundingtoorganisationstodevelopanddeliverdrugandalcoholservicesorprojects.ItisenvisagedthatwhentheTotalPlaceinitiativeistakenforwardbytheBelfastHealthDevelopmentUnit(onbehalfoftheBelfastStrategicPartnership)thatamorecomprehensivereviewofthefinancialinvestmentbeingmadebyallrelevantcommissioningandfundingbodies(certainlyintacklingalcohol-relatedissues)willbeundertakenasoneofthefirststepsintheprocess.
3.1 TreatmentandsupportTotalfundingawardedin2008/09amountedto£3,333,243BelfastHealthandSocialCareTrust(BHSCT)invested£1,699,743(recurrent)instatutory
addictionservicesBHSCTalsoinvested£700,050(recurrent)inthevoluntary/communitysectordelivering
preventativeandtreatmentservices(CarlisleHouse,FASA,DunleweySubstanceAdviceCentreandFallsCommunityCouncil).
BHSCTreceived£247,000ofnon-recurrentfundingfromEDACTfortwoservices(prescribedmedicationanddrugoutreach).
BHSCTalsoreceived£212,000non-recurrentfundingfromtheNorthernIrelandOfficeinrespectoftheDrugArrestReferralScheme(DARS).
Thevoluntarysectorreceived£685,500ofnon-recurrentfundingfromEDACT(ASCERT/OpportunityYouth,Barnardos,AddictionNI[formerlyNICAS]andExtern)
3.2 PreventionandeducationTotalfundingawardedin2009/10amountedto£144,141LisburnYMCAreceived£50,696fromEDACTtodelivertheSchoolHealthAlcoholHarm
ReductionProgrammeinpost-primaryschoolsintheBelfastarea;ASCERTandOpportunityYouth£88,937todeliveryouthtargetededucationprogrammes;andLisburnYMCA£4,508toco-ordinatetheTalkingtoyourChildrenaboutToughIssues(TATI)programme.
3.3 CommunitydevelopmentandsupportTotalfundingawardedin2009/10amountedto£166,833.10FASAreceived£83,476fromEDACTtorecruit,houseandsupporttwodrugsandalcohol
communitysupportworkersforBelfast;andtheEasternDrugandAlcoholConsortium(ASCERT,FASAandFallsCommunityCouncil)£47,896todelivercommunitydrugawarenesstrainingcourses(bespokeandaccredited).
EDACTalsoawardedcommunitygroupsandorganisationsinBelfastatotalof£35,461.10insmallgrantstotakeforwarddrugandalcoholinitiatives.
3.4 WorkforcedevelopmentTotalfundingawardedin2009/10amountedto£122,211.29ASCERTreceived£49,760.29fromEDACTtoprovideworkforcedevelopmenttraining
(bespokeandaccredited)targetedatTier1and2serviceproviders;theCouncilfortheHomelessNI£34,394todelivertrainingtothoseworkinginthehomelessandaddictionsectors;andASCERT£7,905todelivertheTakingtheLidOfftrainingprogrammeforthoseworkingwithfamiliesaffectedbysubstancemisuse.
EDACTalsoawardedASCERT,CarlisleHouse,BHSCTandAddictionNI(inpartnershipwithFASA)workforcedevelopmentgrantstotalling£30,152totrainstaffworkingatTier3/4levelwithintheseorganisations.
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3.5 BelfastRegenerationOfficeawardedatotalof£393,085.15in2009/10toanumberofcommunity/voluntaryorganisationstotakeforwarddrugandalcoholwork/initiatives.
3.6 BelfastCommunitySafetyPartnership(ledbyBelfastCityCouncil)spendsapproximately£230,000perannumaddressingalcoholrelatedharm.Thisamountincludesthecostsofafulltime*ProjectOfficerforGetHomeSafe,an*AlcoholMisuseWorker,50%oftheoftheCommunitySafetyCo-ordinator(for‘Reducingalcohol-fuelledviolentcrime’)salaryandprojectcoststotakeforwardinitiativessuchastheoff-licencecodeofpracticeandstafftraining,barstafftraining,theworkoftheLicensedPremisesGroup,jointenforcementpatrolsonFridayandSaturdaynights,aninformation-sharingprotocol,nightzonesandtheGetHomeSafecampaignitselfintermsofmarketingandawareness-raising.*TheProjectOfficerandAlcoholMisuseWorkerpostsarefundedbyBelfastCityCouncil
3.7 Costsofalcoholmisuse(NI)InJune2010theDepartmentofHealth,SocialServicesandPublicSafetypublishedtheirreportintotheSocialCostsofAlcoholMisuseinNorthernIrelandfor2008/09.TheresearchteamlookedatawiderangeofinformationsuchasGPvisitsandprescribing,hospitaladmissions,fundingprovidedtoservices(includingPHAdrugandalcoholfunding),costsincurredbyservices(policing,prosecution,prison,youthjusticeandsocialservices)aswellasabsenteeismandunemploymentcostsduetoalcoholmisuse.
Totalestimatedcosttohealthcare £122.2
Totalestimatedcosttosocialwork £48.5
Totalestimatedcosttofireandpoliceservices £223.6
Totalestimatedcosttocourtsandprisons £83.8
Totalestimatedcosttowidereconomy £201.7
Totalestimatedcost £679.8
ThecosttosocietyofalcoholmisuseinNorthernIrelandbasedon2008/09prices,isestimatedtobe£679.8million(withinarangeof£500.8millionand£884.4million).Theresearchisasrobustandevidence-basedastheavailableinformationallows,butupperandlowerlimitsforeachthemehavebeenprovidedasitisrecognisedthatcostestimatesinanumberofareasmaybesubjecttoadegreeofuncertainty.
AssumingthatprevalenceandcostsareequallydistributedacrossNI,thecostofalcoholmisuseinBelfastamountstojustunder£102million(withthecosttoeachindividuallivinginBelfasttotalling£380).
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INFORMATION AND AWARENESS-RAISING
4.1 What does the evidence say?4.2 What’s in place? 4.3 Gaps/Issues4.4 Recommendations
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INFORMATION AND AWARENESS-RAISING
4.1 What does the evidence say?4.2 What’s in place? 4.3 Gaps/Issues4.4 Recommendations
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4 InformationandAwareness-Raising
4.1 Whatdoestheevidencesay?Itisimportanttoacknowledgethatmassmediapublicinformationprogrammeshaveaparticularroletoplayinreinforcingcommunityawarenessoftheproblemscreatedbyalcoholuseandtopreparethegroundforspecificinterventions(AndersonandBaumberg,2006).
TheWorldHealthOrganisationhasstated:“Ingeneral,publicinformationcampaignshavebeenfoundtobeineffectiveinreducingalcohol-relatedharm(1).Exceptionsaremassmediacampaignstoreducedrinkinganddrivingwhich,whenimplementedinthepresenceofstrongdrinkinganddrivingcountermeasures,canhaveanimpact(85).Counter-advertising,avariantofpublicinformationcampaignswhichprovidesinformationaboutaproduct,itseffectsandtheindustrythatpromotesitinordertodecreaseitsappealanduse,hasinconclusiveeffects(1).”(Anderson2009)(References:(1)Baboretal2003;(85)Elderetal2004)
4.2 What’sinplace?CampaignsArangeofpublicinformationcampaignshavebeenandcontinuetobedeliveredataregionallevel.Manyofthesearemulti-agencyinitiatives.Someexamplesarelistedbelow:- Alcohol&breastcancer/bingedrinkingetc.(PHA)- Drink/drugdrivingcampaign(PSNI/NIO)- You,YourChildandAlcohol(PHA/PSNI/DOJ)- ThinkChild,ThinkParent,ThinkFamily(indevelopment)- HiddenHarmAwarenesscampaign(indevelopment)
Inaddition,localcampaignshavealsobeendeveloped,someexamplesoftheseare:- GetHomeSafe(BCC/BCSP)- ParentalAwarenessCampaign(EDACT/BCSP/DOJ)
WebsitesManydrugandalcoholorganisationshavetheirownwebsitesandthePHAhavearegionalwebsiteondrugsandalcohol(www.drugsalcohol.info).SomeoftheabovecampaignsarealsosupportedbyspecificwebsitessuchasKnowyourLimits.
LeafletsThePHAhasproducedarangeofleafletsandpostersondrugsandalcoholincludingsolventabusewhichareavailabletoorganisations.Inadditionsomeorganisationsproducetheirownleafletsonparticularissues,forexampleFASAhavedevelopedarangeofyouthfriendlymaterials.
DirectoriesEDACTpublishesitsdirectoryofsubstancemisuseservicesonanannualbasis.ThisisdistributedtoGPs,schools,libraries,relevantpublicsectororganisationsandcommunitygroups.In2009/10EDACTalsoproducedat-a-glanceA5wallchartdirectories(oneforBHSCTandoneforSEHSCT)detailinglocalitybasedserviceswhichweredistributedviathecommunitysupportserviceandlocaldrugandalcoholforums.
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AwarenesscoursesSubstancemisuseawarenessprogrammes(bespoke&OCNaccredited)areprovidedbymanyservicesincommunitysettingstoarangeofgroups.Demandforthesecontinuestobehighparticularlywhennewsubstances(so-calledlegalhighs)emerge.
LocalforumsLocaldrugandalcoholforumsexistinsomeareas:SEBSAN(SouthandEastBelfastSubstanceAbuseNetwork)–drugandalcoholissuesare
alsodiscussedattheSouthBelfastPartnershipBoard’sHealthandWellbeingForumwhichwasestablishedinAugust2010;
WestBelfastDrugandAlcoholForum;andTheRADICALforuminNorthBelfastnolongerexistsandasaresultdrugandalcoholissues
areaddressedthroughtheNorthBelfastPartnershipBoard’sHealthandWellbeingForum.Someoftheseforumshaveundertakenawarenessraisinginitiativesinthepastbutafewhavebeenstrugglingwithattendance(especiallyinrelationtocommunityrepresentation)inmorerecenttimes.
BelfastCommunitySupportServiceThisserviceishostedbyFASA.Theprojectworkswithlocalcommunitiestoidentifydrugandalcoholissuesintheirareaandhowtheywanttorespond.Thefocusisonskillingupcommunitymemberstobeabletoaddresssomeoftheissuesaswellassourcingappropriateexternalsupport.Theservicealsosupportsgroupsinterestedinrunningdrugandalcoholawarenessevents,healthfairsetc.Anewsletter,“TheFix,”isproducedregularlyhighlightingcurrentissues/emergingtrends,providinginformationaboutservicesandlocalinitiatives.
Area-basedPartnershipBoardsTheseorganisations,especiallywheretheyhaveestablishedhealthandwellbeingforums,canprovideanopportunityfordrugandalcoholservicestoraiseawarenessaboutwhattheydoandwhatcantheyoffer.WorkerswithinthePartnershipBoardsassociatedwiththeseforumsarealsobestplacedtodistributeinformationondrugandalcoholissuestotheirmembers.
ResearchThereareanumberofstatutoryagenciesresponsibleforcollatingandreportingondrugsandalcoholstatisticsandresearchsuchastheNorthernIrelandStatisticsandResearchAgencyandthePublicHealthandInformationResearchBranchoftheDHSSPS,alongwiththeResearchandDevelopmentDirectorateandtheHealthIntelligencedepartmentofthePHA.
OverthepastfewyearstherehavealsobeenseveralpiecesofBelfast-focusedqualitativeresearchpublishedsuchasRADICAL’sStillBlottingitOut?reportandtheInnerNorthBelfastNeighbourhoodRenewalPartnership’sInnerNorthCommunityHealthAudit(moreinformationgiveninSection9).
TheEasternTraumaAdvisoryPanelpublishedareporton‘Trauma,AlcoholandDrugsCo-morbidity’inMarch2011.Theresearchexaminestheimplicationsofapersondealingwithbothpost-traumaticstressdisorder(PTSD)andsubstanceabuse(alcoholordrugs/prescriptiondrugs).Copiesofthereportareavailablebyemailingmartina.mullin-o’[email protected].
EDACTandtheBHDUcommissionedGEMSNItocarryoutsomequalitativeresearchintosubstancemisuseintheolderpopulationinBelfastasanissue.ThefinalreportwillbelaunchedinSeptember2011;emailelma.greer@bhdu.orgforfurtherinformationorforacopyofthereport.
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4.3 GapsGeneralThepublicneedtobemadeawarethatearlyintroductiontoalcoholcouldleadtodependencyThedangersofdrinkingduringpregnancyneedtobehighlighted-woulditbepossibleto
incentiviseabstinenceduringpregnancy?TheroleoftheareaPartnershipBoard’sHealthDevelopmentWorkersandtheirHealthand
WellbeingforumsneedstobeconsideredinfutureplanningCommunicationMechanisms/systemsshouldbeputinplaceforgreaterlocalandregionalcoordination
regardingtheplanningofcampaignsThepublicshouldbeconsultedBEFOREdevelopingleaflets,campaignmaterialsetc.tofind
outifthemessagesandcontentarerelevant(suchtestinganddevelopmentisconsistentwithbestpractice)
Thereisaneedtoinformortrainpeopleonthegroundtobeabletorelayand‘translate’keymessages
Localinitiativesshouldbeconsistentwith,andreinforcethemessageswithin,regionalcampaigns–thereshouldalsobeamechanismforsharing/replicatingproven/well-receivedinitiativesinotherareasoronaregionalbasis
ThespecificneedsofgroupssuchasIrishTravellers,EthnicMinorities,OlderPeople,theLesbian,Gay,BisexualandTransgendercommunityandotherSection75groupsshouldbetakenintoaccountwhendevelopinganddisseminatinginformationondrugsandalcohol
ResearchThereareconsiderablegapsintheresearchandevidenceavailableatalocallevelThereneedstobemoresupportandfundingmadeavailabletoevaluateservicesinorder
tobeabletobuildanevidencebaseandtoensurethatfuturefundingisdirectedtoserviceswhichhaveastrongevidencebase
Thereisalsoaresponsibilitytoshareresearchresultsandevidenceofgoodpracticewiththewidercommunity
Thereneedstomorelongitudinalresearchcarriedoutsuchaslongtermfollowupofindividualsthroughtreatmentinordertoassessimpact
Informationonservices/servicedevelopmentCommunityworkersneedquickandeasyaccesstonames,telephonenumbersandservice
details;it’saboutmakingdirectories‘real’andensuringthatfrontlineworkersknowenoughtobeabletosignpostappropriately
ThereisaspecificneedaroundhowtoaccessTrustservicesespeciallyregardingemergencynumbersandcrisisresponse(needtoknowwho/what/how?)
Mechanismsneedtobeinplaceinordertobeabletorespondtoemergingissuesandtoshareinformationquicklywithservicesconsultedabouttheircapacitytorespond
Agenciesneedtobemorewillingtoworktogether
4.4 InformationandawarenessraisingrecommendationsGeneralThePublicHealthAgency,BelfastHealthandSocialCareTrustandBelfastCityCouncil
shouldmeettodiscusshowbetterlinkagescouldbemadebetweendrugandalcoholserviceprovidersandcommunitysupport/healthdevelopmentworkerssuchasthosewithintheareaPartnershipBoards,HealthLivingCentres,etc.toensurethattheyarekeptup-to-dateandcanavailoftrainingandsupportasappropriate
CommunicationThePublicHealthAgencyshouldproduceacomprehensive‘Communicationstrategy’for
drugsandalcohol(agreedmessages/mediaguidelines/processforcampaigndevelopmentandtimescales/informationonandpromotionofservices/processforsharinginformation)
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ThereisaneedtostrengthenthelinksbetweenthosecommissioningandprovidingservicesandrelevantumbrellaorrepresentativeorganisationsforSection75groupssothattheirviewsandneedsaretakenintoaccount
ResearchThereneedstobestrongerlinkagesestablishedbetweenthoseresponsibleforcommissioning
and/orcarryingoutresearch(DHSSPS-PHIRBandPHAResearchandDevelopmentdirectorate)andthoseresponsiblebothforcommissioninganddeliveringservicesinordertobeabletobetterdefineresearchgaps,decideobjectivesandprioritiesforanynewresearchtobeundertakenandensurethatthereisabalancebetweenlocalandregionalresearchagendas
Servicesneedtobesupportedtobeabletoevaluateandsharelearninginordertobuildontheevidencebase
Informationonservices/servicedevelopmentThePublicHealthAgencyshouldcontinuetoproduceanddisseminatearangeofservice
directoriesfordrugsandalcoholwhichshouldincludeclearinformationonreferralroutes/pathwaysforaccessingservices
BHSCT,inconjunctionwiththedrugandalcoholtreatmentserviceprovidersshoulddesignanddevelopa‘Pathwaytoservices’documentwhichshouldbewidelydisseminatedbothtoGPs(asakeytargetgroup)andgenericcommunityservices
PublicHealthAgencyshouldundertakeareviewoftheroleandimpactoftheCommunitySupportServices(fordrugsandalcohol),aspecificrequirementunderNSD,inordertosharethelearninglocallyandbuildonbestpracticeelements
An‘earlywarningsystem’shouldbeestablishedatbothlocal(i.e.bythePHA)andregionallevel(i.e.bytheDHSSPS)toensuretimelysharingofinformationandtheBelfastCommunitySupportServiceshouldbetaskedwith,andsupportedtobeableto,offerpracticalinformationsessionsonemergingissuesatcommunitylevel
PHAshouldtakeamodellingapproachandwherepossiblereviewandevaluateanyinitiativeswhichshowpromiseorarehavinggoodoutcomeslocallywithaviewtotriallinginotherHSCTareas
Aspartofthetacklinghealthinequalitiesagenda,PHAshouldconsiderincentivisingparticipationindrugandalcoholprogrammes/services(takingonboardthefindingsoftherecentlypublishedNICE’sCitizen’sCouncilreporton‘Theuseofincentivestoimprovehealth’)http://www.nice.org.uk/media/10C/48/CitizensCouncilIncentivesReport.pdf
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EDUCATION AND PREVENTION
5.1 What does the evidence say?5.2 Scale of the problem 5.3 What’s in place?5.4 Gaps/Issues5.5 Recommendations
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5 EducationandPrevention
5.1 Whatdoestheevidencesay?Overalltheimpactofeducationandpreventionprogrammesislimited.However,manyresearchershavecommentedonthefactthatthereisalackofconsistencyinthedesign,contentandimplementationofpreventionprogrammesandassuchitisverydifficulttoconcludewhatworksinprevention.(NICE,2006)
Evidencefromsystematicreviewssuggestthatthefollowingprogrammes(mostlyAmerican)providepromiseinaddressingyoungpeople’ssubstancemisusesomeofwhichhaveahighlevelofparentalinvolvement.(NICE,2007)StrengtheningfamiliesandBotvin’sLifeskillstraining(LST).Outcomes: long term reductions
in alcohol use (more than three years).Interventionsusingthelifeskillsapproachorfocussingonharmreductionthroughskills
basedactivities,SchoolHealthandAlcoholHarmReductionProject(SHAHRP).Outcomes: reductions in alcohol use, in particular risky drinking behaviours such as drunkenness and binge drinking.
SeattleSocialDevelopmentProject(SSDP)andLinkingtheInterestsofFamiliesandTeachers(LIFT)whichtargetarangeofproblembehaviours,includingalcoholuse.Outcomes: long term effects (more than three years) on heavy and patterned drinking behaviours.
AdolescentTransitionsProgram(ATP)apreventionstrategyfocussingonparentingpracticesanddeliveredaccordingtotheneedsofthefamilyidentified. Outcomes: decreases in overall substance use by young people and significant long term reductions in overall alcohol, tobacco and cannabis use. (NICE, 2007e)
Theprinciplesofeffectivefamily-basedinterventionsasoutlinedabovearenotspecifictopreventionorreductionofdruguse,butcoverbroaderbehaviouralproblemsinyoungpeople.Secondly,itshouldbenotedthatmanyoftheseprogrammesoriginatedintheUSAandtheeffectivenessoftheseprinciplesmightnotbegeneralisabletoUKsettingsorpopulations.
5.2 ScaleoftheproblemLatestprevalencedatashows:AdultsAccordingtothe2007/07DrugPrevalenceSurvey;cannabiscontinuestobethemostpopular
illicitdrugofchoicewithbothlastyearandlifetimeprevalenceratesincreasing.(Lastyearuseofcannabisincreasedfrom5.4%to7.2%andlifetimeuseofcannabisincreasedamongalladultsaged15-64from16.8%in2002/03to24.7%in2006/07.)
However,lastyearandlifetimeprevalenceratesforcocaineuseisalsoontheincreaseespeciallyamongsttheyoungwithfourtimesasmany15-34yearolds(9%)reportingeverusingcocaineascomparedto2%ofthoseaged35-64.Usedoesappeartoberecreationalwithallofcurrentusersreportingusingcocainelessthanonceaweek.
TheAdultDrinkingPatternsinNorthernIreland2008reportstatedthatacrossNorthernIreland72%ofthepopulationdrinkalcoholwhereaswithintheeasternarea(Belfast&SouthEasternHSCTrusts)prevalenceisslightlyhigherat78%.AhighproportionofthosedrinkingalcoholinNIaredoingsotounsafelevelswithalmostaquarter(24%)reportingdrinkingabovetheweeklysensiblelimitsandalmostathird(32%)ofthosewhodrankintheweekbeforethesurveyreportinghavingengagedinatleastonebingedrinkingsession.
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YoungPeopleWhilstencouraginglytheSecondaryAnalysisofthe2007YoungPersons’Behaviourand
AttitudesSurveyfoundthatlifetime,lastyearandlastmonthuseofanydrugsorsolventshaddecreasedbetween2003and2007theresearchstillshowedthat,in2007,almostafifth(19%)ofyoungpeoplesurveyed(aged11-16)reportedhavingtakendrugsandoverhalf(55%)statedthattheyhaddrankalcoholwithoverhalf(55%)ofthese,i.e.30%ofthosesurveyed,reportinghavingbeendrunkonatleastoneoccasion.
Almostthreequartersofpupils(73%)reportedknowingalotorquiteabitabouttherisks/effectsofdruguse,with18%sayingtheyknowsomethingand9%knowinglittleornothing.
QUB–YouthDevelopmentStudy(*Belfastschoolsonly)
Substance Year1 Year5
Boys Girls Boys Girls
Alcohol 75% 67% 93% 95%
Alcohol-intoxicated
23% 9% 71% 73%
Cannabis 17% 3% 53% 47%
Solvents 10% 4% 15% 15%
Ecstasy 3% 1% 13% 15%
Cocaine 3% 1% 9% 8%
Year1=Year8pupils(1styearofsecondaryschoolagedbetween11and12)InterviewedinJantoMay2001Year5=Year12pupils(5thyearofsecondaryschoolagedbetween15and16)InterviewedinJantoMay2005
Recent use
Substance Year5
Boys Girls
Alcohol 87 90
Alcohol-intoxicated 68 70
Cannabis 44 41
Solvents 8 7
Ecstasy 14 13
Cocaine 9 8Recentusereferstouseinthelast12months
InYear1moreboysthangirlsreportedeverusingalcohol,beingdrunkonatleastoneoccasionandeverusingdrugs.HoweverbyYear5thesedifferenceshadlevelledoutwiththegirlsevenovertakingboysinrelationtousingalcoholandhavingbeenintoxicated.
*ChildrenattendingBelfastHSCT-basedschoolsmayliveinadifferentHSCTarea
//24 ScopingReportonDrugsandAlcoholServicesinBelfast
SHAHRP(*Belfastschoolsonly)
Atage13/1419%ofthechildrensurveyedwithintheBelfastschoolshadnevertriedalcoholandjustover42%weredrinkingonalessthanmonthlybasis,however10.3%weredrinkingonceaweek,and5.6%reportedthattheyweredrinking2-3timesperweek.Afifthreporteddrinkingmorethan8unitswhentheylastusedalcohol.Themajorityreporteddrinkingalcopops(45.4%),followedbycider(12.9%)andthenbeer(10.2%)atlastuse.
Byage16only4.2%oftheBelfastschoolchildrensurveyedreportedneverhavingtriedalcoholwiththemajoritynowdrinkingonamoreregularbasis;17.7%twotothreetimesaweekand19.5%onaweeklybasisandlessthanathird(28.6%)drinkinglessthanmonthly.Overhalf(50.8%)reporteddrinkingmorethan8unitswhentheylastusedalcohol.Themajorityreporteddrinkingalcopops(35.8%),followedbyspirits(24.4%)andthenbeer(15.5%)atlastuse.
Inanaccompanyingstudy,1,651BelfastschoolchildrenalsocompletedtheAdolescentAlcoholInvolvementScale(AAIS).Intotal,605wereclassifiedasabstainers,760asnon-problematicdrinkersand286asproblematicdrinkerswithtwiceasmanyfemales(67%)asmalesdrinkingatlevelsconsideredproblematic.InYear8only12ofthe324(4.2%)whocompletedAAISwereclassifiedasproblematicdrinkers;howeverbyYear12thatfigurehadrisento43%(309completedAAIS).
*ChildrenattendingBelfastHSCT-basedschoolsmayliveinadifferentHSCTarea
5.3 What’sinplace?SchoolHealthandAlcoholHarmReductionProgramme(SHAHRP)SHAHRPisatwophasealcoholharm-reductionpupileducationandteacher-trainingprogrammetargetedat3rdand4thyearpupilsinpost-primaryschoolsaswellasaone-offworkshopforyear9,12and13pupilsonage-specificalcohol-relatedissues.Theprogrammeisdeliveredinallbutoneofthepost-primaryschoolsintheBelfastarea(itisalsodeliveredintheSouthEasternHSCTarea).The3rd/4thyearprogrammeisdeliveredbytheteacherswhileLisburnYMCAstaffdelivertheadditionalinterventions.
BelfastEducationandLibraryBoardSchoolshavearesponsibilitytoprovidedrugandalcoholeducationthroughthelearningforlifeandworkprogrammeandtheEducationandLibraryBoardsoffertraining,supportandmaterialsforteacherstoensurethattheyarecompetenttodelivereducationonthisarea.Someschoolsstillpreferoutsideagenciestocomeinanddeliverdrugandalcoholeducation.
TheyouthservicewithintheEducationandLibraryBoardsprovidearangeofpersonaldevelopmentprogrammesforyoungpeoplewheredrugandalcoholissuesareaddressed.OutreachservicesalsoexistincertainareasacrossBelfastandplayavitalroleinsupportingyoungpeople.
VoluntaryandcommunityprovisionEducationprogrammesareprovidedtogroupsofyoungpeoplebyarangeofprovidersincludingOpportunityYouth,ASCERT,FASAandFallsCommunityCouncil.Aconsiderablenumberofyoungpeopleaccesstheseservicesmanyofwhicharetargetedtothoseatriskofdevelopingproblemsasaresultoftheiruse.Therearealotofcoursesonoffersomeofwhichprovidediversionaryactivitiesandoutdoorpursuits.Othersinvolveyoungpeopleindesigningdrugandalcoholeducation/informationmaterials.Themajorityoftheseprogrammesoccuroutsideoftheschoolenvironment.
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Inadditiontothese,numerousyouthorganisationsprovidepersonaldevelopmentprogrammesforyoungpeopleintheirareaswhichwilladdressdrugandalcoholissueswhennecessary.
ThePSNIdeliverdrugandalcoholeducationtoschoolsandyouthclubsaspartoftheCitizenshipandSafetyEducation(CASE)programme.Inadditiontothis,educationtalksaregiventootheryouthandadultgroupsonrequest.
BCChasundertakenworkaddressingvolatilesolventabuse.Thisincludesdeliveringtalksinschoolsandgivingoutinformationpackstoretailers.
YJAcommunityservicesstaffaretrainedintheuseoftheRegionalInitialAssessmentTool(RIAT)forassessingyoungpeople’ssubstancemisuseandcandeliverdrugandalcoholeducationprogrammes(subjecttoyouthconferenceplans).TheYJAisdesigninganin-housedrugandalcoholawarenessprogrammesothatyoungpeopleattendingservicesinlocalofficesandyoungpeopleincustodyreceiveauniformresponse/approach.
TheTalkingtoyourchildrenaboutToughIssues(TATI)programmetrainsfacilitatorstodeliverathreesessioncoursetoparents.Itistargetedtowardsparentsofchildrenaged10-13andfocusesonalcoholandiscoordinatedbyLisburnYMCA.OpportunityYouth,ASCERT,FASAandFallsCommunityCouncilalsoprovidecoursesforparentsfocusingondrugandalcoholeducation.
ASCERToffersaonedaycoursein‘Workinginprevention’andafivedayOCN-accreditedcoursein‘Puttingpreventionintopractice’undertheirworkforcedevelopmenttrainingprogramme.
5.4 GapsGeneralPreventionneedsastrategyofitsown;there’salotofworkgoingonbutitneedstobeco-
ordinated/joinedupanditneedstobelinkedwithotherissues(suchasmentalhealthandsuicideandotherrisk-takingbehaviours)assubstanceuse/misusecannotbeaddressedinisolation
Thereisaneedtotacklethe‘normality’ofalcoholandprescribeddruguse/misuse;ahugetaskbutitisimportanttotackletheacceptabilityofboth
Servicedevelopment/deliveryMostpeopleneededucationandprevention(tiers1and2)veryfewpeopleneedtreatment
(tiers3and4)thisfactneedstoberememberedwhendesigningandcommissioningservicesExistingservicesaremostlyavailableattier3levelandthereisaneednowtostartfleshing
outwhatisavailableattier2wherearguablythegreatestneedis/numbersofpeopleinneedare
Muchofwhatiscurrentlybeingprovidediseducation-focussedorfocussedoneducatingaboutpreventionratherthanactualprovisionofprevention-focussedprogrammes
Lotsoftrainingandcoursesoneducationandpreventionarehalfdaytoadayatbest(althoughRISEoffersthreedaytraining)howeversubstancemisuseisacomplexissueandneedstobetreatedassuchandthetimegiventoexploreitindetail
Thereisaneedformorebroad-basededucationprogrammesaboutaddictioningeneralThereisaneedtobemorecreativeinhoweducation/preventionsessionsareoffered
especiallyinthecommunitysetting(i.e.coffeemornings)Thereneedstobemoreeducationandpreventioninitiativestargetedatfamilies(partofthe
hiddenharmagenda)Thoughtneedstobegivenastowhoisbestplacedtodoeducationandpreventionwithadults
inrelationtoaddressingsubstancemisuseEmployersareakeytargetgroupintermsofensuringthattheyhavepoliciesinplaceGPsareoftenthefirstpointofcontactforsomeonewithsubstancemisuseissuesorconcerns
//26 ScopingReportonDrugsandAlcoholServicesinBelfast
andsoareakeytargetgroupintermsofensuringthattheyarewellinformedinordertobeabletosignpost,referonandinterveneasappropriate
TheDrugsandAlcoholCommunitySupportWorkersService,basedinFASA,needstobepromotedmorewidely
Therearealsoanumberofothercommunitydevelopment/supportpostswhicharefundedtoraiseawarenessandsignpostwhowouldbeakeytargetgroupfordrugandalcoholtrainingandforkeepinguptodateonavailableservicesetc.
Providersshouldcometogetherandensurethatthereisconsistencyinwhatisbeingoffered/delivered(qualityassurance)
ServicesforyoungpeoplespecificallyWorkinschoolsneedstobecoordinatedasthereareinstanceswhenthereareseveral
agenciesgoingintoschoolsallofferingthesamethingtothesamepupils;thereisaneedtoensurethatservicescompliment,addvaluetoeducationandprovisionalreadybeingdeliveredinschools
Therearedifficultiesaroundbeingabletoworkinschools,especiallyinprimaryschools,yetresearchwouldsuggestthatitiswheredrugsandalcoholeducationshouldstart
Foryoungpeopletherearegapsineducation/preventionprovisionsuchasforthosenotattendingschoolandthosewhodon’t‘do’youthclubs
ThereisalackofknowledgeandawarenessofBELB’syouthserviceprovisionacrossthecityandthereisaneedtoencouragebetterlinksbetweenBELBandyouth-focusseddrugsandalcoholserviceprovidersandthatBELBisrepresentedonrelevantpartnerships(BDAWG/EDACT)astheyareakeystakeholder
5.5 EducationandpreventionrecommendationsGeneralAllthoseresponsibleforcommissioningservicesshouldworktogethertodevelopasystematic
andtargetedapproachtowardsraisingawarenessofplannedandexistingserviceswithinrelevantsectorssuchas:primarycare;communityandvoluntary;education;socialservicesandcriminaljustice
Servicedevelopment/deliveryWorkwiththoseprovidingeducationandpreventionprogrammestodefinewhattheyareable
tooffer(content/capacity)thusensuringbetterpromotion,coordinationandtargetingThoseprovidingdrugandalcoholeducationandpreventionprogrammesshouldensurethata
communitydevelopmentapproachistakentoengagementanddeliveryThoseresponsibleforcommissioningservicesshouldensurethatadditionalresourcesare
targetedatTiers1and2toensureamuchstrongerfocusisputonpreventionExistingestablishedcommunitynetworksshouldbeconsultedtoidentifygenericcommunity
workerswithahealthremitwithaviewtokeepingthemuptodateondrugandalcoholissues,servicesandtrainingavailable
ReviewthecurrentpromotionalactivitiesandawarenessraisingstrategiesoftheBelfastDrugandAlcoholCommunitySupportServicewithaviewtoensuringthattheyremainfitforpurpose
DHSSPSshouldreviewtheirguidanceondevelopingworkplacedrugandalcoholpolicieswiththegoalofputtinginplaceasystematicplanfordisseminationandpromotionofbestpracticetoemployers
TosupportthedisseminationandadoptionoftheregionalPHA/DHSSPS‘Guidingeffectivedrugprevention’documentandprinciplesandtoraiseawarenessoftheaccompanyingfreetrainingprogrammeinhowtodesignanddeliverdrugandalcoholpreventionprogrammes(offeredbyASCERT)
//27
GPsremainthefirstpointofcontactformanyindividualsandneedtobekeptuptodateaboutcurrentprovisionandreferralpathwaysinordertosignpostandreferpeopleontoappropriateservices
Moreeducationandpreventioninitiativestargetedatfamiliesshouldbedevelopedandresourced
Moreeducationandpreventioninitiativeslookingattheinter-relationshipbetweenmentalhealthanddrugsandalcoholshouldbedevelopedandresourced
Focusandsupportthetransitiontoa‘wholefamily’approachwithinbothpolicy(HiddenHarm/ThinkChildThinkFamily)andservicedevelopmentsuchaspilotingevidence-basedfamilyinitiativesliketheStrengtheningFamiliesprogramme
Thereisaneedtodevelopandresourcemoreeducation/preventionworktargetedattheadultpopulation
ServicesforyoungpeoplespecificallyDiscussionsshouldbeundertakenbetweenPHAandBELBtoexplorebestpractice
inrelationtoaddressingdrugsandalcoholissues(frompreventiontocrisisresponse) withintheschoolsetting(primaryaswellaspost-primary)andtoagreeaconsistent approachwiththeintentofdisseminatingwider
BELBshouldconsultwiththoseprovidingservicestothosenotinschool/notinyouth clubsi.e.alternativeeducationestablishmentsaswellasdetachedyouthworkersto assesstheneedsoftheseyoungpeopleinrelationtodrugsandalcohol
//28 ScopingReportonDrugsandAlcoholServicesinBelfast
TREATMENT AND SUPPORT
6.1 What does the evidence say?6.2 Scale of the problem 6.3 What’s in place?6.4 Gaps/Issues6.5 Recommendations
6
//29
TREATMENT AND SUPPORT
6.1 What does the evidence say?6.2 Scale of the problem 6.3 What’s in place?6.4 Gaps/Issues6.5 Recommendations
6
//30 ScopingReportonDrugsandAlcoholServicesinBelfast
6 TreatmentandSupport
6.1 Whatdoestheevidencesay?Children,youngpeopleandfamiliesTheNICEguidance,Community-BasedInterventionstoReduceSubstanceMisuseamongVulnerableandDisadvantagedChildrenandYoungPeople(NICE,2007e)providesguidanceonrecommendedinterventions,includingtheuseofmotivationalinterviewingforproblematicsubstancemisusers.
NationalTreatmentAgencyguidance,DrugMisuseandDependence:UKGuidelinesonClinicalManagement(2007),recommendsthefollowinginterventionsforyoungpeople:Briefinterventionsmaybeusefultodivertyoungpeoplewithless-severesubstancemisuse
problemsawayfromdevelopingmoresevereproblemsandsubstance-relatedharm.Moreintensesubstancemisusetreatmentepisodesmayberequiredforthosewithmoresevere
problems,perhapsinvolvingfamilyandtheyoungperson.Aminorityofunder-18sarelikelytorequirelonger-termretentionintreatment.Forthosewith
complexneeds,substancemisusetreatmentshouldbesetwithinthecontextofawiderpackageoftreatmentdeliveredbymainstreamchildrenandfamilyhealth,socialandeducationservices.
Thereisasignificantevidencebasefortheuseoffamilytherapyintreatingsubstancemisuseamongyoungpeopleincluding:NationalInstituteonDrugAbuse(2009),PrinciplesofDrugAddictionTreatment:AResearch
BasedGuide,2ndEdition http://www.nida.nih.gov/PDF/PODAT/PODAT.pdfNationalInstituteonDrugAbuse(2001),EffectiveDrugAbuseTreatmentApproach
http://www.nida.nih.gov/BTDP/Effective/Liddle.htmlCentreforTreatmentResearchonAdolescentDrugAbuse,UniversityofMiami
http://www.med.miami.edu/CTRADA/x14.xml
AdultsThereisextensiveevidencefortheimpactofbriefadvice,particularlyinprimarycaresettings,
inreducingharmfulalcoholconsumption.Howeverthereissomedisagreementaboutwhetherimpactsfoundinresearchprojectswillbereplicatedinnormalpractice:
‘Alcohol-usedisorders-preventingthedevelopmentofhazardousandharmfuldrinking’ http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdfThereisconsistentevidencethatbehaviouralandpharmacologicaltherapiesareeffectivein
treatingalcoholusedisorders.(Anderson2009)Theeffectivenessofwell-delivered,evidencebasedtreatmentfordrugmisuseiswell
established.UKandinternationalevidenceconsistentlyshowthatdrugtreatmentcoveringdifferenttypesofdrugproblems,usingdifferenttreatmentinterventions,andindifferenttreatmentsettingsimpactspositivelyonlevelsofdruguse,offending,overdoseriskandthespreadofblood-borneviruses(Hubbardetal.,1989;1997;Wardetal.,1998;Simpsonetal.,1999;SorensenandCopeland,2000;Gossopetal.,2003;Hseretal.,2005).
TheNationalTreatmentOutcomesResearchStudy(Gossop,2001)showedthat,forasignificantproportionofthoseenteringtreatment(betweenaquarterandathird),drugtreatmentresultsinlong-termsustainedabstinence.
TheNationalInstituteforHealthandClinicalExcellencepublishedtwotechnologyappraisals(NICE,2007a;2007b)andtwoguidelines(NICE,2007c;2007d)onarangeofdrugtreatmentinterventions,whichendorsemuchofthemainstreamdrugtreatmentprovidedintheUKasevidencebasedandcosteffective.(Dept.ofHealth2007)
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ACochraneReviewoftheeffectivenessofAlcoholicsAnonymousand12-stepprogrammesingeneralfoundthat,whileparticipationinsuchprogrammesmayhelptokeeppeopleintreatment(evidenceforthiswasnotconclusive),therewasnoevidencethatAAor12-steptreatmentswereanymoreeffectivethanothertreatments.(Ferrietal2006)
6.2 ScaleoftheproblemRegisteredaddicts(infoprovidedbyPHIRB)Therewere288personsregisteredontheNorthernIrelandAddictsIndexat31December2009(81%male,24%aged29orunder,80%addictedtoheroin).
BelfastHSCThad98registeredaddictsat31December2009andthehighestnumberofnewaddictswerenotifiedfromwithintheBelfastHSCT(23in2009).However,thiscouldpartlybeattributedtothefactthatBelfastCommunityAddictionServicehasadedicatedserviceforinjectingheroinandcocaineusers(theDrugOutreachTeam).
NeedleandSyringeExchangeScheme(infoprovidedbyPHIRB)In2009/10,therewere15,828visitstoparticipatingservicesacrossNIbyusersofthescheme(anincreaseof18%onthe2008/09figure).Eighty-sixpercentofvisitswerebymaleclientsandoverhalf(53%)ofallvisitsweremadebyindividualsaged31orolder.
ThelargestagegroupaccessingserviceswithintheBHSCTareawerethoseaged36-40accountingfor23%ofthetotal,and85%ofclientsateachvisitweremale.Therewereatotalof6,593visitstoBelfast-basedservices(41%oftheNItotal)andatotalof49,075syringesissued(40%oftheNItotal).
HepatitisC(infoprovidedbyCDSCNI)InfectionwithHepatitisCvirusisassociatedwithintravenousdruguseorbloodproducts.In2009,therewerea112labreportsofHepC(provisionalfigure).Ofthe112casesrecorded;twowereagedunderayear,sixty-sevenwereaged15-44years,thirty-fourwereaged45-64years,eightwereaged65oroverandoneperson’sdateofbirthwasunknown.
SubstitutePrescribingScheme(infoprovidedbyPHIRB)InNorthernIrelandduring2009/10,atotalof576individualswereincontactwithsubstituteprescribingtreatmentservicescomparedto550in2008/09.
On31March2010,466individualswerereceivingsubstituteprescribingand457ofthosehadbeenstabilised(52%onmethadoneand47%onbuprenorphine).Themeanageofclientswas35yearsandalmostthreequarters(72%)weremale.
TheBelfastHSCThadthesecondhighest(aftertheNorthernHSCT)incidenceofreferralsforsubstituteprescribing(45clientsper100,000population).Bothoftheseareashavewellestablishedserviceswhowouldworkwithinjectingdrugusers(mainlyheroinusers)withtheaimofsignposting/redirectingthemintotreatmentservicessuchastothesubstituteprescribingteams.
DrugMisuseDatabase(infoprovidedbyPHIRB)InNorthernIrelandduring2009/10,2,008individualspresentedfortreatmentandconsentedtotheirdetailsbeingincludedintheDMD(anincreaseof14%onthepreviousyear).Themajorityofclientsweremale(72%)andaswithpreviousyearcannabisremainedasthemostcommonlyreportedmain
//32 ScopingReportonDrugsandAlcoholServicesinBelfast
drugofmisuse(42%).
Intotal1,427clients(67%male)presentedtoEasternarea-basedtreatmentservicesfordrugmisusein2009/10(ariseof29%onthe2008/09figureof1,102).
Eastern-areatotalbyagerangeofclientspresentingfordrugmisusein2009/10:
Agerange Total
17andunder 34
18-21 197
22-25 208
26-29 200
30-39 332
40andover 455
Unknown 1
Total 1,427
Ofthese1,427clients1,184(83%)presentedtoBelfast-basedservices(ascomparedto1,102in2008/09)andsixty-eightpercentoftheseclientsweremale.
Ofthe1,184overhalf,775clients(68%),wereseenbythestatutoryBelfastCommunityAddictionService(DOTfigureexcludedasnotprovidedbyPHIRB)–brokendownasfollows:
S&EBelfastCAT 33
N&WBelfastCAT 311
Prescribedmedicationservice 334
Drugarrestreferralproject 97
Community/voluntaryservices(CHILL-OpportunityYouthfigureexcludedasnotprovidedbyPHIRB)sawafurther397clientsfordrugmisuse–brokendownasfollows:
AddictionNI 172
AddictionNI-RATSDAM 87
Dunlewey 93
FASA 45NBAddictionNIwereformerlyknownasNICAS
Aswithpreviousyearsthemajorityofthe1,184clientsreportedcannabisastheirmaindrugofmisuse(34%)closelyfollowedbybenzodiazepines(30%).Acommonperceptionisthatbenzodiazepinesaremisusedmorebywomenthanmenbutofthe360clientsreportingproblembenzousetherewasmoreorlessanequalgendersplit(48%male/52%female).Sixty-ninepercentofclientsaged17andunderreportedcannabisastheirmaindrugofmisuseascomparedwith26%ofthoseaged26yearsandolder(38%ofthisagegroupreportedbenzosastheirmaindrugofmisuse).
Ofthe1,184clientsseenbyBelfast-basedservices,223(19%)reportedhavingdependentchildrenandthemaindrugofmisuseforthemajorityoftheclientswerebenzodiazepines(50%).
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ClientpostcodeanalysisAtotalof960clientswhopresentedtoservicesfordrugmisuseintheEasternareain2009/10residedintheBHSCTarea.
Atotalof297residedinSouthandEastBelfast(includingCastlereagh).ThetopthreewardsfornewdrugreferralsinthislocalitywereBallymacarrett(87),Botanic(61)andWoodstock(38).
Atotalof663residedinNorthandWestBelfast.ThetopthreewardsfornewdrugreferralsinthislocalitywereFalls(204),Legoniel(139)andShankill(126).
Alcoholreferrals(infoprovidedbyEDACT)AlcoholreferralstoEastern-areabasedtreatmentservicescontinuetoriseyearonyear–from3,039newclientsin2007/08,to3,372in2008/09,to4,485in2009/10(63%male).
Eastern-areatotalbyagerangeofclientspresentingforalcoholmisusein2009/10:Agerange Total17andunder 10818-21 16722-25 20326-29 24030-39 63140-49 68050-59 37660andover 172Unknown *1,908Total 4,485NB*BHSCTwereunabletoprovideagerangeinformationfortheir1,901clientsin2009/10
Ofthe4,485atotalof1,901clients(42%)wereseenbythestatutoryBelfastCommunityAddictionService(BCASreceivedafurther1,826referralswhodidnotattend/engage).
Thecommunity/voluntaryservices;CarlisleHouse,DAISY,Dunlewey,FallsCommunityCouncil,FASAandAddictionNI,andmostofwhicharebasedinBHSCTarea,sawafurther1,438clients(32%)foralcoholmisuse.
ClientpostcodeanalysisAtotalof2,879clientswhopresentedtoservicesforalcoholmisuseintheEasternareain2009/10residedintheBelfastLocalCommissioningGrouplocality.
ThetopthreewardsfornewalcoholreferralsintheBelfastLCGlocalitywereFallsandShankill(both162),Shaftesbury(131)andLegoniel(125).
//34 ScopingReportonDrugsandAlcoholServicesinBelfast
Drugandalcoholmisuseamongstyoungpeople(infoprovidedbyPHIRBviaRIMT)In2009/10theDrugandAlcoholInterventionServiceforYouth(DAISY)deliveredinpartnershipbyOpportunityYouthandASCERTsawatotalof251youngpeoplewithsubstancemisuseissues(223oftheseclientsweredirectlyaffectedand28wereindirectlyaffected).Seventy-twopercentofclientsseenduringthisperiodweremale.
Theyoungestpersondirectlyaffectedwas9yearsofage(usingalcohol)andtheyoungestpersonindirectlyaffectedwas8yearsold.Agerange Total12andunder 1913-15 8716-18 11319-22 8Unknown 24
Themajorityofclientsaffecteddirectlyreportedalcoholastheirmaindrugofmisuse(128).Ofthe95clientswhoreportedmisusingdrugsalmostthree-quarters(73%)weremisusingcannabis.
Ofthe251clientsseenbyDAISYin2009/10,51%(129)residedintheBHSCTlocality(5%ofclientsresidedoutsideoftheEasternareaortheirpostcodewasn’trecorded).
Prescribedmedication(infoprovidedbyHSCB)Atotalof604,346scriptsfor*Benzodiazepineswerewrittenin2009,intheEasternareaatatotalcostofover£1.5millionpounds(NItotalforsameperiodwas1,443,145scriptscostingjustover£3millionpounds).*BenzodiazepinesincludeChloradiazepoxide,Diazepam,Lorazepam,Lormetazepam,Nitrazepam,Oxazepam,Temazepamandthe‘3Z’drugs–Zalepon,ZolpidemandZoplicone.
Atotalof393,356scriptsforbenzodiazepines(for13,818,116tablets)werewrittenoutin2009intheN&WandS&EBelfastLHSCGlocalitiesatacostof£917,676.
LHSCGlocality 2009 2008 2007TotalScripts TotalScripts TotalScripts
S&EBelfast 169,033 163,775 165,330N&WBelfast 224,323 231,919 241,639Belfasttotal 393,356 395,694 406,969
Upuntilthestartof2010,HSCBfurtherbrokedowntheEasternareadatabyLocalHealthandSocialCareGrouplocalities–NBtheLHSCGsdisbandedin2006.From2010onwardsthisdatawillbebrokendownbyLGDarea.
Ascanbeseenfromthetableabovebenzodiazepineprescribingonthewhole(itroseslightlyinS&EBelfastfrom2008to2009)inBelfastcontinuestosteadilydecreaseyearonyear.ServicessuchastheBHSCT-basedprescribedmedicationservice(PHA/EDACTfunded)whichworkswithGPsurgeriestoraiseawareness,helpreduceprescribinglevelsandassistpatientstodecrease/desistusealongwiththeHSCB-basedprescribingadviserswhoalsoofferadviceandsupporttoGPshavehadanimpactincontributingtothisreduction.
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HospitaladmissionsDrugandalcohol-relatedadmissionstoEastern-areabasedhospitalscontinuetoriseyearonyear–from2,022in2008/09,to2,216in2009/10(basedonprimarydiagnosis)andafurther4,277in2008/09and4,346in2009/10(basedonsub/secondarydiagnosis).
Primarydiagnosisadmissionsaremostlymale(68.8%in2009/10)andaverageagewas43years.Therewere4.7timesasmanyadmissionsforalcohol(1,830in2009/10)asdrugs(386).Themajorityofadmissionsin2009/10wereinanemergency(2,100asopposedto104planned),and85.8%ofthesewereaged26orolderhoweverjustover3%(69)ofprimarydiagnosisadmissionswereforthoseaged16orunder.
In2009/10therewereatotal1,083primarydiagnosisalcohol-relatedadmissionstoBelfast-basedhospitalscomparedto223drug-relatedadmissions.
PrimaryDiagnosis BelfastCity Mater RoyalVictoria WindsorHouse
TotalAlcohol 338 300 442 3
PrimaryDiagnosis BelfastCity Mater RoyalVictoria WindsorHouse
TotalDrug 81 84 56 2
TotalCombined 419 384 498 5
NBPeoplewhoattend/areadmittedtoBelfast-basedhospitalsmaynotnecessarilyresideintheBHSCTarea.
Drugandalcohol-relateddeathsThemostsizeableinequalitygapsbetweendeprivedareasandNorthernIrelandoverallwereevidentinalcoholrelateddeaths(121%higher),drugrelateddeaths(113%higher),admissionsforself-harm(94%higher),teenagebirths(80%higher),suicide(73%higher),respiratorydeathrates(66%higher)andlungcancerincidence(65%higher).Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009
Alcohol-relateddeaths(providedbyNISRA)In2009,therewere283alcoholrelateddeaths;187menand96women.Thisisamarkedincreasefromtenyearsagowhentherewere174alcoholrelateddeathsrecorded.
Thealcoholrelateddeathraterosebyaround10%between2005and2008inbothdeprivedareasandNorthernIrelandgenerally.Despitesomeminorfluctuationsinthegapacrosstheperiod,thedepriveddeathratehasremainedlargeataround120%higherthantheNIrate.Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009
Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS),
//36 ScopingReportonDrugsandAlcoholServicesinBelfast
Sub-regional inequalities – HSC Trust 2010 Thelargestsub-regionalinequalitygapsbetweenthehealthoutcomesexperiencedinthemostdeprivedareasinBelfastTrustandtheTrustitselfoccurredinalcoholrelatedmortality(103%),self-harmadmissionstohospital96%)andteenagebirthrates(93%).
Overtheperiod(2001-2008)theincreaseinalcoholrelatedmortalitywithintheBelfastTrustanditsmostdeprivedareas(2%and3%respectively)grewataslowerratethaninNIoverall(10%increase).Despitethis,thealcoholrelateddeathrateinBelfastTrustwasstill69%higherthaninNIin2008.TheStandardisedDeathRate(SDR)indeprivedareaswasconsistentlydoublethatintheoverallTrustacrosstheperiod.
Locality 2004-2008
Deathsper1000population
BelfastdeprivedSOAs 48.8
BelfastTrust 24
NI 14.2
Drug-relateddeaths(providedbyNISRA)In2009,therewere84drugrelateddeathsinNorthernIreland.Thisisamarkedincreasefromtenyearsagowhentherewere50drugrelateddeathsrecorded.
Thereareproportionatelyfewerdeathsinvolvingheroin/morphineandmethadone.However,thereisagreaterroleplayedbyhypnotics/sedativesandanti-depressants.Therelativelyhigherinvolvementofhypnotics/sedativesissimilartothepatterninScotland,andtoalesserextentinWales(asopposedtoopiatesinEngland).
AlthoughthenumberofdrugrelateddeathsinNorthernIrelandarerelativelow,thestandardiseddeathrateduetodrugrelatedcausesincreasedsteeply(byalmost40%)inbothdeprivedareasandNIasawholebetween2005and2008.DrugrelatedmortalityindeprivedareaswasconsistentlymorethandoubletheNIratethroughouttheperiod.Northern Ireland Health and Social Care Inequalities Monitoring System (NIHSCIMS), Third Update Bulletin 2009
6.3 What’sinplace?
StatutoryprovisionThissectionoutlinesthemaindrugandalcoholfocusedtreatmentandsupportservicesinplaceacrossBelfast.Itshouldberememberedthattheseservicesareinadditiontotheservicesprovidedbyprimarycare.
AlltheservicesonthefollowingpageareadultservicesmanagedbytheBHSCT’sBelfastCommunityAddictionService(BCAS)withtheexceptionoftheDrugandAlcoholMisuseMentalHealthService(DAMMHS)whichworkswiththoseaged17andunderandwhichisaccessedviaCAMHS.
NB For a description of the tiered approach to service provision please refer to Appendix 2
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TIER 1AlcoholHospitalLiaisonServicesProvidesarangeofassessment,care,treatmentandsupportserviceswithinA&Eandmedicalwards.CurrentlybasedwithintheMaterandRVHhospitals.ServicealsoplannedforBelfastCity.
TIER 2DrugArrestReferralScheme(DARS)Triageandassessmentservicesforindividualswhoarearrestedforcrimesrelatedtotheirdrug/alcoholuse.
DrugOutreachTeam(DOT)Lowthresholdserviceforinjectingdrugusers.
AssertiveOutreachServiceBCASprovidesanassertiveoutreachserviceinpartnershipwithanumberofvoluntaryagenciesforthosewhoareidentifiedasvulnerableandatriskandhavefailedtoattendtheirinitialappointments.
TIER 3CommunityAddictionTeams(CATs)Providearangeofassessment,care,treatmentandsupportservicesthroughouttheTrustareaincluding:AlcoholdependencywithdrawalprogrammesManagementofwithdrawalfrombenzodiazepinesandClassA,BandCillicitdrugsAlcoholAssertiveOutreachServiceinpartnershipwithvoluntarysectorproviders
AddictionDayTreatmentServices(ADTS)Psychologicalinterventionssuchassolutionfocusedtherapy,motivationalinterviewing.Patienteducationprogrammesincludingaccesstoalternativetherapiessuchasreflexology,
acupunctureandIndianheadmassage.DailyopiatedetoxificationFamilysupportservicesPatientsupportgroups
SubstitutePrescribingTeam(SPT)Opiatesubstituteprescribingservice.
PrescribedMedicationTeamProvidesadedicatedprescribeddrugmisuseserviceinprimarycareassistingGPstoidentifypatientswhoarebenzodiazepinedependentandtosupportthepersontoreducetheirdependence.
DrugandAlcoholMisuseMentalHealthService(DAMMHS)Theserviceworkswithyoungpeopleaged17andunderwhoareexperiencingmentalhealthproblemsrelatedtotheirsubstancemisuse.ItispartofCAMHSandismanagedbyBelfastHSCT.
TIER 4BelfastTrustdoesnotprovideaTier4adultinpatientservice.IthasacontractwithCarlisleHouseTreatmentCentreproviding6bedsforBelfast.Youngpeoplewithdualdiagnosisproblemscanbereferredtotheregionalin-patientCAMHSservicewhereappropriate.
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Voluntary/CommunityProvisionTIER 1 and 2FASAFASAhastwoofficesinBelfast,ontheWoodvaleandShankillRoads,providingarangeofeducation,supportandmentoringservicesaswellasalternativetherapies.Servicesareavailabletobothyoungpeopleandadultsandfamilies(FamilyMattersProject).
ExternThealcoholtenancysupportprojectprovidessupporttovulnerableadultsinmaintainingtheirtenanciesandworkstopreventtheiralcoholissuesdeterioratingfurther.
DAISYThisserviceprovidesarangeofsupportandinterventions,includingmentoringanddiversionaryactivities,foryoungpeopleexperiencingsubstancerelatedharm.Serviceisprimarilyforthoseaged17andunderbutwillacceptreferralsofyoungpeopleagedup21whereappropriate.
RISEFoundationServiceprovidesafamilyprogramme(grouptherapybasedresidential)andacommunityeducationandtrainingprogramme.
FallsCommunityCouncilThecommunitydrugsprojectprovidessupporttofamiliesexperiencingproblemsasaresultofsubstancemisuse.
TIER 3FASAServicehastwoofficesinBelfastprovidingcounsellingforindividuals(youngpeopleandadults)andtheirfamiliesaffectedbysubstancemisuse
DunleweyServicehasoneofficeinBelfastprovidingacounsellingandstructureddayprogrammeforindividualsover18andtheirfamiliesaffectedbysubstancemisuse
NICASServicehasthreeofficesinBelfastprovidingcounsellingforindividualsover18andtheirfamiliesaffectedbysubstancemisuse.
NICAShasaspecialistserviceforthoseagedover55–CounsellingforOlderPeopleatHome(COPAH)andalsodeliverstheRATSDAMservicewhichworkswithoffendersreferredfromthecourts.
PharosServiceprovidesasupportandinterventionserviceforfamiliesaffectedbysubstancemisuse.Servicesareavailableforboththeparentsandchildren.
DAISYThisserviceprovidescounsellingandstructuredfamilysupportforyoungpeopleexperiencingsubstancerelatedharm.Anintensivesupportpilotforchaoticusersisalsoavailableforalimitednumberofyoungpeople.Serviceisprimarilyforthoseaged17andunderbutwillacceptreferralsofyoungpeopleagedup21whereappropriate.
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TIER 4CarlisleHouseServiceprovidesa4-8weekresidentialprogrammefordrugandalcoholusers.Thereare6bedsreservedforreferralsfromBelfast(HSCT)CommunityAddictionServices.
In addition to the above, many other community based services particularly those providing mental health interventions and generic counselling offer treatment and/or support to people with drug and alcohol problems. However, scoping these services is outside the remit of this report.
SelfhelpgroupsTherearealsoarangeofselfhelpgroupsinexistenceacrosstheTrustareabasedonvariousmodelsincludingthepopular12-stepapproach(suchasadoptedbyAA,NA,Alanonetc.)–theseareeitherrunindependentlyorinsomeinstancesareofferedorsupportedbyaddictionservices.
6.4 GapsGeneralConsiderhoworganisationscanworktogethertoensurethatpeoplereceivethesameservice
irrespectiveofwhateverservicetheyenter(‘Nowrongdoor’agenda)Awarenessofoverlapamongstservices–eatingdisorders,drugsandalcohol,mentalhealth
andgambling–focusonaddictionsRemovecompetitionandproviderscompeting–needtolookattheissue(s)collectivelyNeedtobeabletotrackpeople/clientsacrossservicesThereneedstoberecognition,andtrackingof,servicesabilitytorespond
Informationon/promotionofservicesLittleknowledgeonthegroundaboutTrustservices–especiallyre.howtoaccessthemand
whattodoinacrisissituationGPs,ingeneral,havelittleknowledgeaboutcommunityservicesandwhattheycanoffer
yettheyarethefirstpointofthecontact(needtobeawareofallavailableprovisionnotjuststatutory,capacitytorespondandhowtoaccess)
Needstobeappropriateandtimelyfollowuptocrisisincidents(especiallywithinA&E–cardbeforeyouleaveschemeastartbutpooruptakereportedanecdotally)
Servicedevelopment/deliveryCommissionersneedtorecognisetheneedforflexibility–6or8sessionsisn’tenoughforthe
majorityofclients–ifservicescouldofferlongertermtreatment(whichisproventobemoreeffective)itwouldallowtimetoexploreotherimpactingissuesandultimatelyhelptobreakthecycleofreturningclients
Needstobearangeofmodelsoftreatmentavailable(includingearlyandbriefinterventionsaftercareservicesandpostventionsupportforclientsandfamilies)
Ensurethatservicesareaccessiblelocally–thatsupportisavailablewherepeopleliveNeedbetterservicesinplaceforpeoplewhoneedhelpandsupportbutnotfullblown
treatment(i.e.largerpopulationdrinkinghazardouslythandrinkingdangerously)Exploringtheneedforaresidentialrehabfacilityforyoungpeople(suchastheICAPinitiative)Dualdiagnosisisabigissue–criteriaforaccessingstatutoryservicesistoorigidandasa
resultcomm./vol.servicesareholdinglargenumbersofclientswithco-morbidityissues–thereneedstobeawiderrangeofsupportservicesavailableandthecomm./vol.sectorneedstobeadequatelyresourcedtorespondappropriately
Widerangeofsupportneedswiththosegroupswhofallshortofthecommunityaddictionteamand/orthementalhealthteamcriteria
FamiliesThedevelopmentofspecificfamilybaseddrugandalcoholservicesistobewelcomedbut
securefundingfortheseservicesremainsaconcern
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Thereisgeneralagreementamongserviceprovidersthattheneedsoffamiliesarenotaddressedsufficiently
Needstobewidersupportavailableforfamilieswherethe‘addict’isn’tengagedintreatment(stat.servicescanonlyworkwithfamiliesofclients)
Theremaybemeritinlookingathowtheconceptof“enabling”canhelpinformhowtosupportfamiliesinaddiction
6.5 TreatmentandsupportrecommendationsInformationon/promotionofservicesNeedtoensurethataplannedandtargetedapproachistakentowardsdisseminatingand
promotingasharedunderstandingaboutexistingprovision,capacityandreferralpathwaysDHSSPS/PHA/HSCB/HSCTsshouldinvestigatethedevelopmentofaco-ordinateddata
contentmanagementsystemtoensurethatagreedinformationandprotocolsareenforced,therebypromotinglessduplicationandensuringthattheindividual’sneedsarebestmetacrossallservicesandsectors
Servicedevelopment/deliveryWhendesigningtendersandcontractscommissionersshouldembedaprocessofengaged
flexibilityintohowcommissionedserviceswillbedeliveredi.e.itshouldbeprimarilyaboutmeetingtheneedofclients
Thoseresponsibleforcommissioningservicesshouldensurealltreatmentandsupportservicesadoptawholefamilyapproachtotreatingdrugandalcoholaddictionandthataftercare/followonsupportisbuiltinasanessentialelementforbothclientsandtheirfamilymembers
PHA,andspecificallytheBamfordSubstanceMisuseGroup,shouldbesupportedinundertakingtheplannedreviewofaddictionservices:theplannedreviewshouldensurethatthereareadequateservicesavailableateachtier(tomeetneed)forbothadultsandyoungpeopleandthatservicesareabletoprovidearangeoftreatmentmodelstobothclientsandtheirfamiliesasappropriate
Inrelationtodualdiagnosis(specificallymentalhealthandaddiction)PHAandBHSCTshouldestablishaworkinggroupwiththegoalofcreatingaseamlessreferralpathwayforpeoplepresentingwithcomplexneedsconsistentwiththetheoryof‘nowrongdoor’
Considerationshouldbegiventodevelopingacrosstraining/placementprogrammeforthoseworkingintheaddictionsandmentalhealthfields
Crisisresponse:actionneedstobetakenatanumberoflevelstoensureplannedandevidence-basedcrisisresponsei.e.thosewhofund/commissionservicesneedtoensurethatcrisisresponseisbuiltintotheserviceprovisionandatcommunitylevelthereneedstobeawarenessraisinginrelationtowhattodoandhowtoaccessservicesforpeopleincrisis
SPECIFIC SERVICES FOR VULNERABLE GROUPS
7.1 What does the evidence say?7.2 Scale of the problem 7.3 What’s in place?7.4 Gaps/Issues7.5 Recommendations
7
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SPECIFIC SERVICES FOR VULNERABLE GROUPS
7.1 What does the evidence say?7.2 Scale of the problem 7.3 What’s in place?7.4 Gaps/Issues7.5 Recommendations
7
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7 Specificservicesforvulnerablegroups
AkeyprioritywithintheNSDADis‘TargetingthoseatRiskandVulnerable’,whichreferstobothyoungpeopleandadults.Inrespectofalcoholanddrugmisuse,anumberofgroupsweredescribedinthedocumentaspotentiallyvulnerable:Homeless,includingroughsleepersRefugeesandasylumseekersEthnicminoritiesPeoplelivingwithdomesticviolenceSexworkersEx-offendersVulnerableyoungpeople(i.e.younghomeless,looked-afterchildren,youngoffenders,school
excludees,andchildrenofsubstanceusingparentsOlderpeopledependentonalcoholand/ordrugsPeoplewithmentalhealthproblemsPeoplewithlearningdisabilitiesStreetdrinkersThoseexcludedfromcommunitiesbecauseoftheiralcoholanddruguse.
Itisrecognisedthatthisisnotanexhaustivelist,andassuch,whentenderingforservicestosupporttheneedsofvulnerablegroupsEDACTaskedthoseapplyingtooutlinethelevelofneedfortheparticulargroup(s)thattheywishedtocaterfor.
7.1 Whatdoestheevidencesay?Thereisarangeofevidenceavailableonawidevarietyofgroupsandtheirneedsinrelationtodrugsand/oralcoholmisuseataregional/worldlevel,althoughthereismuchlesslocal(NI)researchinexistence.ThisreportconcentratesforpracticalpurposesonpresentingevidenceforthegroupswhichEDACTcurrentlyfundsservicestosupport.
OffendersTheUKDrugPolicyCommission(2008)notesthattheevidencebasefordrugtreatmentinterventionswithinthecriminaljusticesystemisweak,andthatthisisaconsiderableimpedimenttothedevelopmentofpolicyandpractice.TheCommissionalsofoundhoweverthatthemodelofcounselling,assessment,referral,adviceandthroughcare(CARAT)seemstoworkeffectively.
McMurran(2007)foundthatcognitivebehaviouraltherapiesandmotivationalinterviewingwereeffectivewiththistargetgroup.TheeffectivenessofCBTgenerallyintreatingsubstancemisuseproblemsiswelldocumented.
HomelessTheScottishGovernmentpublishedareporton“EffectiveServicesforSubstanceMisuseandHomelessnessinScotland:EvidencefromanInternationalReview”in2008.Thisreport,producedbyNicholasPleace,CentreforHousingPolicy,UniversityofYork,foundthatsubstancemisuseamongthehomelesspopulationwasstronglyassociatedwithmentalhealthproblemsandwasmoreprevalentamongyounghomelesspeopleandlonehomelesspeople,withratesofsubstancemisuseamonghomelessfamiliesbeingonlyslightlyhigher,orthesameas,thegeneralpopulation.Theresearchalsofoundthatabstinence-basedserviceshadmuchlowerratesofsuccesswithhomelesspeoplethanharmreductionservices,withthefloatingsupportmodelbeingparticularlysuccessful.
Thereportacknowledgesthattheharmreductionserviceshavemorelimitedgoals,butmakesthepointthatservicesandcommissionersneedtosetrealistictargets.Thereportalsonotesthatthe
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interventionsbeingprovidedmayneedtobelong-termandthatsuchinterventionswillneedsecurefundingandthatthereareareaswherethenumberofhomelesssubstancemisusersdonotjustifyadedicatedserviceandthatmodificationofexistingservicesmaybemoreappropriate.Thereportalsomakesthepointthatamixtureofservicesneedtobeprovidedforthisgroupasthereisarangeofneeds.
Thisechoesthefindingsofthe‘ResearchintoHomelessnessandSubstanceMisuse’publishedbytheDHSSPSNIinSeptember2004.Thisreportrecommended“acontinuumofintegratedservicesinrelationtosubstancemisuseandhomelessness…appropriatetodifferentgroupswithdifferentneeds”(pg93)includingoutreachservices.Thereportalsorecommendedthedevelopmentofbetterlinksbetweentreatmentandaccommodationservices.
ElderlyAlcoholdependenceinolderpeopleisoftenunder-detected(O’Connelletal,2003)andunder-estimated(Mehtaetal,2006).Researchintothissubjectacknowledgesthatinordertoensureolderpeoplehaveaccesstotreatmentforalcoholdependency,anage-specific,outreachapproachshouldbedeveloped(Dar,2006).ItisenvisagedthattheBelfast-focussedresearchintosubstancemisuseintheolderpopulationwhichEDACTandtheBHDUhavecommissionedGEMSNItocarryout(anticipatedcompletiondateJune2011)willgiveamorelocalisedoverviewoftheneedsofolderpeopleaswellasthoseworkingwith/caringforolderpeoplewhohaveasubstancemisuseproblem.
“LookedAfter”YoungPeopleNICEguidanceliststhisgroupasasubsectionof‘vulnerableanddisadvantagedchildrenandyoungpeople’.Guidanceexistson“Community-basedinterventionstoreducesubstancemisuseamongvulnerableanddisadvantagedchildrenandyoungpeople”(NICE2007e).Thisguidancerecommendsastrategicresponsetotheissueofsubstancemisuseamongvulnerableanddisadvantagedchildrenandyoungpeople,uptoage25,andthatthefollowinginterventionsareused,dependingonthecircumstances:screeningandassessment,family-basedprogrammeofstructuredsupportovertwoormoreyears(11-16yroldsathighrisk);group-basedbehaviouraltherapyoveronetotwoyearsbeforeandduringthetransitiontosecondaryschool(10-12yroldsathighrisk;motivationalinterviewingforproblematicusers.
7.2 ScaleoftheproblemIn2008,EDACTcommissionedtheClinicalEffectivenessSupportUnitwithinKeeleUniversitytoundertakesomeresearchintotheneedsofvulnerablegroupsinrelationtosubstancemisusewithintheEasternarea.
Thekeyfindingsfromtheirscopingstudywereasfollows:Alcoholand/ordrugmisuseisasubstantialissueamongstvulnerableadultgroupsfora
varietyofreasons.Certaingroupsappeartobeatparticularrisk,andtheseareex-offenders,peoplewithmentalhealthproblems,peopleexcludedbecauseofsubstancemisuseissues,olderpeople,andsexworkers.
Mentalhealthissuesappeartobecommonacrossadultvulnerablegrouppopulations,andmentalhealthissuesareoftenaccompaniedbyotherproblematicissuesinindividuals’lives.
Beingvulnerableisnotnecessarilyaprerequisiteforalcoholand/ordrugmisuse.Rather,thereisamorecomplexrelationshipbetweenanumberoffactors,andthisrelationshipbetweenfactorshelpstodeterminewhetherornotavulnerablepersonhasasubstancemisuseissue.Thiscanbeexpressedascomplex,multipleissuescomingtogethertocreateaproblematicclusterinanindividual’slife.Forservicestoaddressthisclusteringofissuesintheserviceuserstheysupport,accountneedstobetakenoftheinterrelationsbetweenissues.
Organisationsworkingwithvulnerableadultgroupshaveahighlevelofawarenessabout
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substancemisuseissuesinthesepopulations,areknowledgeableaboutspecialistsupportforsubstancemisuseissues,andarefamiliarwithgapsinprovisiontosupportvulnerablegroupswithalcoholanddrugmisuseissues.
HomelessnessTheResearchintoHomelessnessandSubstanceMisuse(DeloitteMCSLtd2004)commissionedbytheDHSSPS,whichinterviewed154homelesspeopleandconsultedkeystakeholders,indicatedthatsubstancemisuseisasignificantissueamonghomelesspeopleintermsofbothprevalenceofuseanddependency.Riskbehaviourswereassociatedwithsubstanceuseandtheincidenceofmentalillhealthamongthepopulationwashigh.Theresearchalsoindicatesthatsubstanceuseisafactorinbecominghomeless,repeathomelessnessandremaininghomeless.Thekeyfindingsarepresentedbelow:Themajorityofalcoholuseamongthehomelesssamplewasathazardouslevelsandaround
23-27%indicatedsymptomsofdependencyandharmfulalcoholuse.NorthernIreland-widestudiesindicatealowerlevelofhazardoususeamongthepopulationasawhole.
Theprevalenceofdruguseamongthestudy’shomelesssamplewasmuchhigherthanforNIasawhole–two-thirdsofthesamplehaduseddrugsandmorethanathirdwerecurrentdrugusers–almostalldrugusewasfoundtobeatproblemlevelsandtestsindicatedsymptomsofdependency.
Inthesample,mostdrugandalcoholusebeganbeforeindividualsbecamehomelessandtherewasastrongconnectionbetweenageoffirstsubstanceuseandageoffirsthomelessness.Howevertherewasalsoevidenceofpeoplebeginningtousesubstancesaftertheybecamehomelessandmorelimitedevidenceofpeoplestoppingsubstanceuse;althoughsomehadneverengagedinsubstanceuseatall.
Therewasahighlevelofriskbehaviourgenerallyamongthosetakingpartintheresearch–aroundhalfreportedsuicidalbehaviourandpracticingunsafesex;two-fifthswereinvolvedincriminalbehaviourandtwofifthsreportedself-harming.
Therewasahighincidenceofillhealthamongthesample,inparticularmentalillhealth–35%hadadiagnosedpsychiatricillnessand22%werereceivingtreatmentforpsychiatricillness.
RegionalImpactMeasurementTooldataforPHA/DACTfundedservicesfor2008/09EXTERNworkedwith88clientsintotalacrosstheBelfastHSCTarea(andalsohadcontact
withanother5).Justover77%ofclientsweremaleandallweremisusingalcohol.CHNIdeliveredatotalof41trainingcoursestoatotalof461participants(286female/174
male)acrosstheBHSCTandSEHSCTareas.AddictionNI’sRATSDAMservicesawatotalof276clients(98%male)acrosstheBelfastand
SouthEasternHSCTs.Alcohol(64%)wasthemostcommonlyreportedsubstanceofabuse.AddictionNI’sCOPAHservicesawatotalof141clients(55%male)acrosstheBelfastHSCT
area.Alcohol(94%)wasthemostcommonlyreportedsubstanceofabuse.Barnardos’PHAROSserviceworkedwith54familiesintotalacrossBelfastandSouthEastern
HSCTs.Injustover70%ofthefamiliesthemotherhadproblemswithsubstancemisuse,in15%thefatherandintheremaining15%bothparentshadissueswithsubstancemisuse.Alcohol(83%)wasthemostcommonlyreportedsubstanceofabuse.
7.3 What’sinplace?HomelessExtern’sMultidisciplinaryHomelessSupportTeamhastwomembersofstaffdevotedtopreventingtenancybreakdownduetoalcoholmisuse.
TherearearangeofhostelsinBelfastthatprovidetheirservicestothoseaffectedbyalcoholanddrugs.
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NIHE’sSupportingPeoplehavefloatingsupportservicesinplacetopreventtenancybreakdown;therangeofissuesaddressedincludessubstancemisuse.
CHNIprovidestrainingtothosewithintheaddictionandhomelessnessfields.
OffendersAddictionNI’sRATSDAMserviceforoffenders,referralsmadeviathecourtserviceandprobation.
ElderlyAddictionNI’sCOPAHserviceforolderpeopleprovidedintheirownhomeswhichoperatesonanopenreferralprocess.
VulnerableyoungpeopleRegionalInitialAssessmentTool:thePublicHealthAgencyisofferingkeystaffwithinagenciesworkingwithyoungpeople(i.e.youthjustice,socialservices,education,community/voluntaryyouthproviders,etc.)traininginhowtousetheRegionalInitialAssessmentTool(RIAT)forassessingsubstancemisuseinyoungpeople.Thistwo-daytrainingenhancestheirknowledgeofsubstances,servicesandappropriateinterventionstousewithyoungpeopleandthetoolitselfallowsthemtoidentifylevelofuse,associatedrisks,toassessneedsandmotivationandtorespondbyeitherreferringonorinterveningthemselves.Todate,YouthJusticeAgencycommunityservicesstaff,earlyinterventionprojectstaffwithinNIACRO,ActionforChildrenandExternandasmallnumberofsocialservicesstafffromtheBHSCTandSEHSCTareashavebeentrained.
StrengtheningFamilies:theBelfastHealthDevelopmentUnit(BCC,BHSCTandPHA)havejustcompletedapilotrunoftheStrengtheningFamiliesprogramme.This14-weekintensiveprogrammeistargetedathighstressfamilies.
DAISY:theyouthsubstancemisusetreatmentandsupportserviceprovidesarangeofinterventionstoyoungpeopleusing/misusingsubstancesandwillacceptselfreferralsaswellasfromstatutoryservicesfocussedonaddressingtheneedsofvulnerablegroupssuchaslookedafterchildrenandthoseintheyouthjusticesystem.
ThePHAROSservice:deliveredbyBarnardo’s,workstoaddressthe‘hiddenharm’agendaandofferstreatmentandsupporttofamiliesaffectedbysubstancemisuse.
7.4 GapsTherearelotsofgroupswhocouldbeclassedas‘vulnerable’todrugsandalcoholmisuseand
whodidn’tmaketheNSDAD’slistforexampletheLGBTgroup/communityThosewithmentalhealthissues(especiallythosewithanon-diagnosedordiagnosablemental
healthdisorder)areakeygroupForsomegroupsthereislittleornoknowledgeaboutwhattheirneedsareinrelationto
substancemisusei.e.ethnicgroups,Travellersandsoitwillbeimportanttoconsultandengagewithsuchgroupstofindouttheirneedsandwhatthebarrierstotreatmentare,orcouldbe,forthem
Itshouldbeuptothoseagencieswhorepresentvulnerablegroupstoassessandinformservicesaboutneeds
Servicesneedtobeawarethatclientsmayhavespecificneedsbecausetheybelongtooneormorevulnerablegroupsandbewillingandabletoworkwiththemwhentheypresenttoovercomeanybarriers
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Itcouldbearguedthat,duetohealthinequalities,allthosewholiveinareasofdisadvantage,regardlessofgrouping,arevulnerable
Thoseworkingwithsubstancemisusingclientsarealsovulnerableandneedsupportandthissupportshouldbedeliveredinaconsistentandequitableway
7.5 SpecificservicesforvulnerablegroupsrecommendationsAprocessofsystematicengagementshouldbedesignedandsupportedincollaborationwith
thoseagencieswhorepresentvulnerablegroupstoenablesharingofinformationwithregardstodrugandalcoholneedsandbarrierstoaccessingexistingservices
DHSSPS,PHA,HSCBandBHSCTshouldconsidertheneedsofethnicminorities,specificallyinrelationtoaddressinglanguageandculturalbarrierswhenaccessingandavailingofdrugandalcoholservices,ensuringthatanappropriatepackageofsupportisputinplaceandthatbothserviceprovidersandclientsareawareofwhatthisisandhowtoaccessit
WORKFORCE DEVELOPMENT
8.1 What’s in place?8.2 Gaps/Issues 8.3 Recommendations
8
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8 WorkforceDevelopment
8.1 What’sinplace?TIER 1 and 2
ASCERTworkforcedevelopmenttrainingTheworkforcedevelopmentprogrammeisprovidedbyASCERT(fundedbyEDACT/PHA)targetingnon-specialistworkers/skillingthemuptobeconfidentandskilledinaddressingsubstancemisuse.Thecoursesarefreeandincludeaccreditedandnon-accreditedoptions.BelowisasummaryofwhatiscurrentlyavailablefromASCERT;Understandingapproachestoeffectivelyworkingwithandtreatingsubstancemisuse(5days/
OCNlevel3–6credits)Educatingandsupportingindividualsabouttheeffectsofalcoholanddrugmisuse(2days/
OCNlevel3–3credit)Practicalwaysofworkingwithsubstancemisusingclients:assessmenttoreferral(5days/
OCNlevel3–6credits)Understandingbriefinterventionapproachesandhowtousethemwithdrugandalcohol
misusingclients(2days/OCNlevel3–3credits)Puttingpreventionintopractice(5days/OCNlevel3–6credits)Additionalonedaycoursescovering;basicdrugawareness,legalhighs,alcoholandyoung
people,usingCBTapproaches,supportingandengagingclients,workinginprevention,conflictmanagementandtrainingintheuseoftheRegionalInitialAssessmentToolandspecifictrainingforfostercarers.
TakingtheLidOff(livingwithaddiction)trainingprogrammeASCERT,inpartnershipwithBarnardosandSEHSCTofferthefollowingcourses:Atwo-dayskills–developmentcourseaimedatthoseinroleswheretheymayencounter
substancemisusewithinafamilywhichwillenablethemtoidentifyandsupportindividualslivingwithaddiction/substancemisuse.
Ahalf-day‘IntroductiontoHiddenHarm’coursewiththeaimofincreasingtheawarenessoftheharmlivingwithsubstancemisusehasonfamilies,childrenandyoungpeopleandtheneedsofthosefamilymemberstoreducethatharm.
RegionalInitialAssessmentToolAgenciesworkingwithvulnerableyoungpeoplearebeingtrainedtoassessyoungpeople’sdrugandalcoholuse,todeliverinterventionsandhowtoreferontomorespecialistdrugandalcoholservicesasappropriate.TheYouthJusticeAgency,anumberofvoluntaryorganisationsnamelyExtern,NIACROandActionforChildren(earlyinterventionprojects)havebeentrainedintheuseofthetool–withsocialservicesandschoolcounsellingstaffcurrentlyconsideringthetraining/tool(PHAco-ordinating).
GPtrainingEDACT/PHAranthe‘HowMuchisTooMuch’coursewhichwasapilottrainingprogrammeforprimarycarecliniciansondeliveringbriefalcoholinterventionson11thMarch2009intheWellingtonParkHotelinBelfast.Thecourseprovidesasimplewayofidentifyingwhichpatientsaredrinkingatriskylevels(usingarangeoftools/materials),andasaresultwhoshouldbeofferedsimplestructuredadvice,amoreextensivebriefintervention,orwhoshouldbereferredontoamorespecialistservice.Twenty-fiveprimarycareprofessionalsworkingintheEasternareaparticipated.ThetraininghassincebeenevaluatedandisnowbeingconsideredforfurtherrolloutbythePHA.
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TeachertrainingAsstatedunderthesectiononeducationandpreventiontheEducationandLibraryBoardshaveresponsibilityfortrainingteacherstodeliveronthenewcurriculum.InadditiontothisLisburnYMCA,aspartoftheirfundingagreementwithEDACT/PHA,aretaskedwithensuringthatteacherswithintheschoolstheyaredeliveringinareultimatelyabletodelivertheSHAHRPprogrammethemselves.
BelfastCommunitySafetyPartnership/BelfastCityCouncilBCSPprovidesfreetraining,freeofcharge,tooff-licenceandbarstafftoencourageresponsibleservingwhichaimstoreducealcoholrelatedanti-socialbehaviour.In2009,twelvetrainingsessionswereheldwithatotalof135participantsattending.
TIER 3 and 4
CHNItraining(alsospansTier2)CHNIarefundedbyEDACT/PHAtodeliverarangeofbespokeandaccreditedtraining(fromknowledgeandskills-basedcoursestoseminarsandplacements)tostaffwithinthehomelessnessandsubstancemisusesectors.
EDACTranagrantsprogramme(2009-2011)foraddictiontreatmentservicestoidentifytheirworkforcedevelopmentneedsandhowtheycouldbemet.Thefollowinggroupsarecurrentlyfundedthroughthisprogramme:AddictionNI(formerlyNICAS)/FASACarlisleHouseBelfastHealthandSocialCareTrustASCERT/OpportunityYouth–DAISYstaff
NB Furthermore all services funded by EDACT/PHA are tasked with offering advice, support and training to external agencies as appropriate.
8.2 GapsNon-specialistworkersneedtobeskilledupinordertobeabletoassistpeoplewithdrugsand
alcoholproblemsFrontlineworkersneedtobeabletoassessriskandadequatelysignpostinrelationtoa
numberofissuessuchasmentalhealth,suicideandsubstancemisusethereforethistrainingshouldbelinkedwherepossible
Twodaytrainingisenoughtoraiseawarenessoftheissuebutisn’tlongenoughtodevelopskillsandconfidenceforpeopletoaddresstheissueinanygreatdepth
Itisunclearhowthequalityoftrainingprovidedisvalidatedandconsistencyensuredbothintermsoftheskillsofthestaffandintheservicesprovided
Forrealimpactthereneedstobeorganisational‘buyin’withtrainingmanagerstargetedandthetrainingembeddedintrainingschedules
Trainingneedstobeincorporatedintocollege/universityprogrammesforteachers,socialworkers,primarycareprofessionals,etc,itneedstobesubstantial,consistentandpartofthecoreprogrammeoftheirstudying
TrainingforGPsshouldinvolvethecomm/volsectoraswellasthestatutorysectorandshouldalsocoverawareness-raisingofservices
Ifneedbe,GPsshouldbepaidtoaddressdrugsandalcoholmisuse(DES)TrainingneedstobedevelopedaroundprescribedmedicationChurchesareakeytargetgroupfordrugandalcoholtrainingRegulartrainingforthoseprovidingteir3/4servicesiscrucialAstrategicregionalapproachisneeded:weneedtodefinewhoneedswhat,towhatlevel,and
tobeconsistentintermsofcontentanddelivery
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8.3 WorkforcedevelopmentrecommendationsEDACTshouldundertakeareviewofwhattraininghasbeendelivered,tohowmany
participants(ateachlevel)whatnumbersandwhattheimpacthasbeenwithaviewtoinformingfuturestrategiccommissioningoftraining
Thereneedstobestrategicplanningandtargetingoftrainingi.e.PHA/EDACTshoulddevelopadrugandalcoholworkforcedevelopmentstrategywhichshouldidentifywhatleveloftrainingshouldbeprovidedtowhoandgiveclearguidancearoundwhatthattrainingshouldcoverandwhatitthenequipstraineestodo
PHA/EDACTshouldalsoexaminebestpracticeanddevelopguidanceonamodelofselfcarefortheworkforcewhichcanbetailoredtomeetthedifferentlevelsofriskresultingfromexposuretodrugandalcoholrelatedtrauma
Thoseresponsibleforcommissioningservicesshouldensurethatself-careforstaffisincludedasanessentialrequirementwithintenderspecsand/orcontractsforthosewhowillbeprovidingdrugandalcoholservicestoclients
Availabletraining,forbothspecialistandnon-specialiststaff,shouldbeevidence-basedandconsistentinitscontentandhowitisdelivered
PHA/EDACTshouldensurethatoneofthecoreelementsofallworkforcetrainingoffered/deliveredisaboutincreasingknowledgeofexistingcross-sectoralprovisiontoenablesignpostingorreferraltoappropriateservices
Across-sectoraltrainingmodel,toincludecrossplacements,shouldbedevelopedforthosesectorsand/oragencieswhointerfacemostwithaddictions(i.e.homelessness,mentalhealth,criminaljusticeandsocialservices)toallowfortransferofknowledgeandskills
Genericcounsellingproviders(private/stat/comm/vol)shouldbeofferedappropriatedrugsandalcoholtrainingwhichshouldcoverassessmenttechniquesandwho,andhow,tomakereferrals
PHAshouldadvocatefordrugandalcoholtrainingtobeincorporatedasasubstantial,consistent,corepartofcollege/universityprogrammesforteachers,socialworkersandhealthprofessionals
BriefinterventiontrainingforGPsshouldalsocoverawareness-raisingofservices(bothstatutoryandcomm/volprovision)andwherepossiblebedeliveredbyrepresentativesfrombothsectors
SKILLING UP OF AND SUPPORTING COMMUNITIES
9.1 What does the evidence say?9.2 Scale of the problem 9.3 What’s in place?9.4 Gaps/Issues9.5 Recommendations
9
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SKILLING UP OF AND SUPPORTING COMMUNITIES
9.1 What does the evidence say?9.2 Scale of the problem 9.3 What’s in place?9.4 Gaps/Issues9.5 Recommendations
9
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9 Skillingupofandsupportingcommunities
9.1 Whatdoestheevidencesay?Researchliteratureshowsahighassociationofalcoholanddrugproblemswithinequalityandthatwhererelativeinequalityislower,soarealcoholanddrugproblems.InNI,foragivenlevelofalcoholconsumption,peoplefromlowersocioeconomicgroupsareatincreasedriskofanalcohol-relateddeath,compoundedbyareaswithahigherdegreeofdisadvantage.(NorthernIrelandHealthandSocialCare,InequalitiesMonitoringSystem,3rdUpdateBulletin2009:alcoholrelateddeaths121%higherindeprivedareas)
Emphasisneedstobeonstrengtheningthesocialcapitalofcommunitiesandtheircapacitytodeveloptheirownpreventiveandharmreductionresponses.StrongevidenceexistsforinvestmentinearlyyearsprovisionsuchastheNurseFamilyPartnership.Scotland’sFuturesForum(2008)
CommunityActionInitiativesAddressingSubstanceMisuseThereisevidencethatcommunitybasedinitiativescanbeeffectiveinreducingarangeofproblemsassociatedwithdrinkinginlicensedpremises(e.g.noiselevels,customerbehaviour,aggressivebehaviour,etc.).Thisevidenceislargelyconcernedwithaction‘atacommunitylevel’,ratherthannecessarilyactionbyacommunity;thelevelofinvolvementoflocalcommunitiesvariesacrossthesestudies.ManyoftheproblemstackledbytheseprojectswouldcurrentlyinNIbeaddressedbyCommunitySafetyPartnerships,sotheevidencewouldseemtosupporttheCSPscontinuedengagementwithcommunitiestofindsolutionstolocalproblems.Theevidenceonthisissueisreviewedin:Anderson2009Evidencefortheeffectivenessandcost-effectivenessofinterventionstoreducealcohol-relatedharm,WorldHealthOrganisationRegionalOfficeforEurope.
Communitiesaremorelikelytogetinvolvedinresponsestodrugswhichareleasttightlyprofessionalised,e.g.educationandprevention,andleastlikelytogetinvolvedinactivitieslikelawenforcementandtreatmentwhicharemoretightlyprofessionalised.Thereisverylittlerobustevidenceontheeffectivenessofsuchcommunityactivities.Shineretal.(2004)
9.2 ScaleoftheproblemAlotofpeopleatcommunitylevelwanttobeabletoaddresstheissuestheyareseeinganddealingwithbutdonotknowhowtoengageeffectively.Thereisalsothefearthatfamiliesareafraidofbeingstigmatisedbystatutoryservices–itisoftenaviciouscircle.
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NeighbourhoodRenewalPartnershipsThereareatotalof14NeighbourhoodRenewalAreaPartnershipsinexistenceintheBelfastLocalGovernmentDistrictarea.EachofthesehasdevelopedaNeighbourhoodRenewalActionPlantopromoteregenerationoftheirareaandtoaddressidentifiedneedsorissuesofconcerns.Alloftheseplanshaveahealthandwellbeingelement,withsomehavingalreadyidentifiedspecificactionsinrelationtodrugsandalcohol.ItisacontractrequirementoftheCommunitySupportService(hostedbyFASA)thattheylinkinwith,andwherepossiblesupporttheworkof,theNRPsinrelationtosubstancemisuse.
NorthBallysillan/UpperArdoyneCrumlin/ArdoyneBelfast-InnerNorthLigoniel
SouthBelfast-InnerSouthBelfast-SouthWest
WestGreaterFallsColinUpperSpringfield/WhiterockLenadoonAndersonstownGreaterShankill
EastTullycarnetBelfast-InnerEast
InnerNorthCommunityHealthAuditTheInnerNorthBelfastNeighbourhoodRenewalpartnership
DuringJulytoSeptember2009,85peopleparticipatedinaCommunityHealthAuditconsultationthroughinterviewsorcompletingandreturningasurveyorquestionnaire.Thoseinvolvedintheconsultationcamefromthestatutory,voluntaryandcommunitysectors,andfromthecommunity.
Throughouttheconsultationtwomajorissuesofconcernwerefrequentlyraised:mentalhealthandemotionalwellbeinganddrugs,alcoholandsubstanceabuse/misuse.
AsaresultoneofthesuggestedactionfortheInnerNorthBelfastNeighbourhoodRenewalPartnership’sActionPlanis:Tobringtogethercommunity,voluntaryandstatutoryorganisationsprovidingsupport
servicestothoseabusingandmisusingdrugs,alcoholandothersubstances,andraisingawarenessabouttheuseofdrugsandalcohol;toagreeastrategyforlong-termstructuredintervention,withasharedvisionandstrategicapproachforInnerNorthBelfast.
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SixYearsOn…StillBlottingitOut?RADICALtheNorthBelfastdrugandalcoholforumcommissionedthispieceofqualitativeresearch,carriedoutin2007,whichlookedattheimpactofalcoholandsubstancemisuseonfourcommunitiesinNorthBelfast(Ardoyne,Duncairn,NewLodgeandTiger’sBay)andwhetherthingshadchangedsinceasimilarpieceofresearchwascarriedoutin2001.Inthereportunderthesectionon‘CommunityWorkers–OverLoadedandUnderResourced’thefollowingwasnoted:
ProblemstatementCommunityworkersinNorthBelfastareacutelyawareoftheseriousproblemsofdrugandalcoholmisuseandtheimpactitishavingontheircommunities.Theyshouldbekeystakeholdersintheformulationofanystrategicresponseandoperationalactionbutarecurrentlyunabletodoanythingotherthan‘fire-fighting.’Thisisdue,astheysay,toalackofresourcesbutalsoinmanyinstancestoalackofinterestorapathywithinthecommunitiestheyserve.IssuesforconsiderationCommunityorganisationsandworkersareakeygroupforproviderstotargetinrelationtothetrainingandservicestheycanofferinrelationtosubstancemisuse.Again,itismorethanjustsendingthemaleafletoraservicedirectory–theyneedtobeequippedwiththein-depthknowledgeofwhatservicesdoandhowtheycanbeaccessed,and,intheirsignposting/firstpointofcontactrole,theywouldbenefitfromhavingsomeskillsintermsofbasicdrugawarenessandmotivatingpeopletogethelp.
9.3 What’sinplace?CommunityDrugAwarenessTrainingThistrainingisprovidedfreeofchargetocommunitygroupsbyASCERT,FallsCommunityCouncilandFASA.BespokecoursesareprovidedalongwithOCNlevel1,2and3courses.Level3coursesavailableinclude‘trainthetrainer’whichskillsparticipantsuptobeabletodeliversubstancemisusecoursesthemselves.
BelfastCommunityActionandSupportTeamThisservicesupportslocalcommunitiestoaddresslocalconcernsarounddrugandalcoholmisuse.Someoftheworklocalcommunitieshaveundertakenincludeskillinguplocalcommunityleaders,holdingdrugawarenesseventsandconsultations,planninganddeliveringeducationprogrammesforawiderangeoftargetgroupswithinthecommunity.
AsnotedearlierinthereportPartnershipBoards,andtheirHealthDevelopmentWorkersandHealthandWellbeingForumsinparticular,couldplayavitalroleinlinkingdrugandalcoholserviceprovidersandcommissionerswithlocalcommunity,voluntaryandstatutoryproviders.TheyalsohaveestablishedlinkswiththeNeighbourhoodRenewalPartnershipsintheirarea.
9.4 GapsAcriticalpointistheneedforunderstandingtheissueofaddictionanddealingwithitasan
illness,usingcompassionandempathy,withthosecommunityvolunteersandworkersallhelpingtoeducatefamiliesusingtheguidanceonearlysignsandsymptoms
Withregardtotheissueofalcohol,‘buyin’fromlocalcommunitiesisessential–the‘TotalPlace’approachcurrentlybeingconsideredbytheBHDUandbeingtrialledatamorelocallevelwithinMountVernoncouldprovideausefulmodel
OCNaccreditedtraining:thereneedstobebetterfollowupinrelationtothosetrainedand/orbettertargetingorstrategicselectionintermsofwhoisputforwardforthistraining(needto
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reachoutbeyondtheusualsuspectsandbeyondthoseworkingdirectlyindrugsandalcohol)Thereiscurrentlynomechanisminplacetoreportbackontraininganditseffectiveness
(qualityassurance)andthereisalackofsupportregardingputtingitintopracticeThereneedstobesomeworkdonearoundtheneedsofcommunityworkersintermsofwhat
trainingtheyfeeltheyneedasexistingcommunitydrugawarenesstrainingonlyequipsthemtobeawareoftheissueandtosignpostbuttheypossiblyneedmorein-depthorspecifictraining
CurrentlythereisalackofclarityabouttheroleofthosewhohavebeentrainedThereareopportunitiestodevelopvolunteersandtoexamineingreaterdepthwhatrolethey
couldplayThereisaneedforbothplannedandresponsivetraining/courses
9.5 SkillingupofandsupportingcommunitiesrecommendationsTocontributetotheexplorationofthedevelopmentofalocalityapproachtoaddressingdrugs
andalcoholmisuseinBelfastwithinacommunitysettingThequality,quantityandleveloftrainingprovisiondeliveredwithincommunitiestodateshould
beidentifiedandassessedandthisinformationshouldbeusedtoinformthefuturedirectionofcommunitydrugawarenesstraining
Clearinformationshouldbegivenaboutthecommunitydrugawarenesstrainingavailableinorderthatcommunityorganisationsand/orworkerscanmakeinformeddecisionsspecificallyaroundthedesired/requiredlevelofcompetencyinaddressingdrugandalcoholissues
Trainingorganisations,fundedtodelivercommunitydrugawarenesstraining,shouldworkwithkeycommunityrepresentatives/organisationstodevelopatrainingprogrammesuitedtotheirneeds(fromscreening/initialassessmenttoreferringonandinterveningifappropriate)
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REDUCING AVAILABILITY
10.1 What does the evidence say?10.2 Scale of the problem 10.3 What’s in place?10.4 Gaps/Issues10.5 Recommendations
0
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10.1 What does the evidence say?10.2 Scale of the problem 10.3 What’s in place?10.4 Gaps/Issues10.5 Recommendations
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10 ReducingAvailability
10.1 Whatdoestheevidencesay?Thereisstrongevidencefortheeffectivenessofpoliciesthatregulatethealcoholmarketincluding:Pricing/taxation.Outcomes: young drinkers tend to choose cheaper drinks.Managingtheavailabilityofalcoholbyrestrictionsonhoursanddaysofsaleandonthe
numberanddensityofoutlets,raisingtheminimumdrinkingageandtrainingofbarstaff(requiresreinforcementwithrefreshercourses).
Enforcement-salestounderagedrinkers/responsiblesales.Alcoholpricepromotion.Outcomes: point of purchase promotions is likely to affect the overall
consumption of underage drinkers.Actiononalcoholadvertising:thereisevidenceofsmallbutconsistenteffectsofadvertisingon
theconsumptionofalcoholbyyoungpeople.Restrictionsshouldfirsthavethesupportofcommunitiestoensureeffectiveness.(AndersonandBaumberg,2006;Hawksetal,2002;Boothetal2008;NationalDrugResearchInstitute,2007)
DrugsThereisevidencetoshowthat,despitetoughersentencingofsellersofcontrolleddrugs,anddespiteincreasingeffortsatinterdictioninternationally,pricesofthesesubstanceshavedecreasedbetween10%and30%overthepast10years,indicatingagreateravailabilityoftheseproducts.ReuterPandTrautmannF[Eds.](2009)
Retailpriceshavegenerallydeclinedinwesterncountries,includingthosethatincreasedthestringencyoftheirenforcementagainstsellers,suchastheUnitedKingdomandtheUnitedStates.Therearenoindicationsthatthedrugshavebecomemoredifficulttoobtain.Indeed,surveydatasuchasMonitoringtheFuture,showverylittleevidenceofchangesinperceivedavailability.Johnston et al. (2007)
10.2 ScaleoftheproblemPSNIseizuresAtotalof3,319drugseizureincidentswererecordedacrossNIin2009/10andasinpreviousyearscannabiswasthedrugmostcommonlyseized.Thestreetvalueofdrugsseizedamountedto£9,055,735and2,250peoplewerearrestedintotalacrosstheregion.
Therewere1,512seizureincidentsintheEasternareain2009/10andatotalof845arrests.ClosetohalfofallseizuresinNorthernIreland(46%),and38%ofarrests,occurredintheEasternarea.
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PSNISeizuresintheBelfastHSCTarea
DCUlocality Seizureincidents No.ofarrests
2009/10 2008/09 2009/10 2008/09
NorthBelfast 303 322 131 150
SouthBelfast 374 284 231 192
EastBelfast 157 137 89 84
WestBelfast 151 137 89 84
Castlereagh 69 49 21 32
BHSCTtotal 1,054 929 554 545
Almost70%ofseizuresandalmost65%ofarrests,intheEasternareain2009/10occurredintheBelfastTrustarea.
10.3 What’sinplace?PSNIhaveundertakenactionsagainstunderagedrinkingthroughoperationSNAPPER.InadditiontheyworkverycloselywithBCCundertakingjointenforcementsonlicensedpremisesandeventsinthecity.
DistrictPolicingPlansprioritisewhatissuesneedtobeaddressed.ManyoftheplanswithinBelfasthaveidentifiedunderagedrinkingasapriority.
Legislationisnowinplacetoallowfor‘testpurchasingofalcohol’withpilotsduetohappenbeforetheendof2010/11.Theschemeisamechanismforreducingtheamountofalcoholillegallysoldtopersonsunder18yearsofageinlicensedpremises.ItalsoallowsPSNItogatherevidenceregardingunderagesaleswithaviewtoprosecutingwhereappropriate,thosewhoarefoundsellingalcoholtominors.
DrugdisposalbinsarealsolocatedinanumberofGPsurgeriesacrossthecityandPSNIhavealsoestablishedprotocolswithsomelocalcommunity/voluntaryorganisationsforsuchbinstobelocatedintheiroffices.
BCCmonitorthesalesofButanegastounder18’s.Theyundertaketestpurchasinginrelationtothesellingofalcoholtominors.BCCalsoinvestigatecomplaintsinrelationtoconcernsabouttheuseofalcohol.
10.4 GapsProductplacementandsponsorshipofsportingeventsbyalcoholfirmsshouldbeaddressedThereisaneedtotacklecheapalcoholinsupermarketsanddialadrink/drugtaxifirmsWhilstproxybuyingisdifficulttoproveandtackle,itisanissuewhichneedstobeaddressed
(particularlyinrelationtoparentssupplying(buying)alcoholfortheirchildren)perhapsthroughawareness-raisingre.thedangers/risksifnotthroughenforcement
Otheroptions(ratherthanviaseizuresand/orprosecution)shouldbeexploredtotacklingunderagedrinkingsuchassignpostingtocomm/volservicesorthedevelopmentofjointinitiatives
Needtohaveservicesavailableattherighttimesforyoungpeoplei.e.eveningsandweekends
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Needtolistentowhatyoungpeoplefeel/wantinrelationtobothalternativeandsupportservices
Legalhighsshouldbebannedorregulatedandmoreofafocusgiventothepremisessellingthemintermsofregulations
TheBHSCTprescribedmedicationserviceisunderresourcedandneedscomm/volservicesputinplacetosupportandcomplementit
Reducingtheprescribingof,andmisuseof,painmedicationisanotherkeyareafordevelopment
10.5 ReducingavailabilityrecommendationsTosupportthePHAandBCCtoadvocateforareductionintheavailabilityofalcoholby
legislativemeasures(e.g.minimumpricing,bans/restrictionsonpromotionsandadvertising)TosupportthePHAandBCCintakingonanadvocacyrolearoundreducingavailabilityofso
called‘legalhighs’Totestalternativeapproachestoreducingunderagedrinkingandtodevelopprotocols
betweenPSNI,BCCandrelevantcomm/volyouthdrugandalcoholserviceprovidersToidentifybestpracticeinworkinglocallywithsupermarkets,off-licencesandlicensed
premisestodevelopstrategicapproachesforreducingavailabilityPHAandHSCBtoinvestigatelevelsofpainmedicationprescribingandassesswhethera
specificresponseisrequired(suchashasbeentakenforaddressinghighlevelsofanti-depressantprescribing)
TACKLING SUBSTANCE RELATED CRIME/VIOLENCE
11.1 What does the evidence say?11.2 Scale of the problem 11.3 What’s in place?11.4 Gaps/Issues11.5 Recommendations
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TACKLING SUBSTANCE RELATED CRIME/VIOLENCE
11.1 What does the evidence say?11.2 Scale of the problem 11.3 What’s in place?11.4 Gaps/Issues11.5 Recommendations
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11 Tacklingsubstancerelatedcrime/violence
11.1 Whatdoestheevidencesay?In2008SouthBankUniversityproducedareporton‘What works’ to tackle alcohol-related disorder? An examination of the use of ASB tools and powers in London.
Thereportconcludedthatitwasdifficulttoassesstheimpactofanyparticularinterventionbecause:1)thedefinitionsofalcohol-relateddisorderandASBarefluidandcontested;2)localstrategiesworktoachieveoverallaimsandhencetheintendedoutcomesforinterventionsareoftenmultipleandoverlappingandformpartofanoverallstrategy;3)alcoholuseiscloselyconnectedtoarangeofotherissuessuchasdruguse,mentalhealthconditionsandsocialexclusion;and4)acrossLondonthecontextsinwhichtheyareimplementedandthemechanismsthroughwhichtheyworkarediverse.
ResearchcarriedoutbyYoungetal(2008)suggeststhatthemainpredictorofalcoholrelatedanti-socialbehaviour(includingviolence)isapropensityforsuchbehaviourearlierinlifeandthatalcohol(mis)usemerelyexacerbatessuchbehaviour,ratherthanbeingaprimarycause.Thiswouldsuggestthatinterventionstopreventsuchbehaviourshouldfocusonearlyidentificationofthosewithsuchpropensities.
Violenceassociatedwithillegaldrugstendstobesystemicviolence,i.e.violenceassociatedwiththetradeinillegaldrugsratherthanviolentactsperpetratedbyusersofillegaldrugs.(Stevens et al 2009)
11.2 ScaleoftheproblemPSNIcrimesfordrugoffencesAcrossNI,in2009/10atotalof3,146crimesrecordedwerefordrugoffences(up5.8%on2008/09figure),ofthese668werefortraffickingoffenceswhilst2,478werefornon-traffickingoffences.
AcrossNI,in2008/09atotalof10,402peopleweresearchedunderPACE(PoliceandCriminalEvidenceAct1984)fordrugsandasaresultofthesesearchesatotalof695peoplewerearrested.
PSNIroadtrafficcollisionsThemostcommoncausesoffatalandseriousinjuryroadtrafficcollisionsinNIin2009/10were:Excessivespeedhavingregardtoconditions–158collisionsAlcoholordrugs(allroadusers)–112collisionsInattentionorattentiondiverted–81collisions
IntotalacrossNItherewere369injurycollisionswerealcoholordrugs(allroadusers)wasidentifiedastheprincipalfactorandintotaltherewere582casualties.Ofthese528,23peoplewerekilled,120seriouslyinjuredand439slightlyinjured.
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Tacklinganti-socialbehaviour(PSNIandBCSP)
PSNIdrugandalcoholanti-socialbehaviourincidentsrecordedintheBelfastHSCTarea
DCUlocality StreetDrinking Substancemisuse
2009/10 2008/09 2009/10 2008/09
NorthBelfast 333 407 0 2
SouthBelfast 141 184 0 2
EastBelfast 27 46 0 1
WestBelfast 300 159 0 4
Castlereagh 46 97 0 0
BHSCTtotal 847 893 0 9
*FromApril2009onwards‘Substancemisuse’dataisnowcountedunderthe‘Rowdy/Nuisance–Environmentaldamage/Littering’category.
BelfastCommunitySafetyPartnership
Month 2009/10 2008/09Unitsofalcoholseized
No.ofunderagecautions
Unitsofalcoholseized
No.ofunderagecautions
April 4,174 4
DatanotcollectedatthistimeMay 421 13June 544 10July 373 0August 103 2 446 5September 321 3 140 6October 365 11 433 7November 266 5 144 1December 38 3 140 7January 126 4 572 32February 818 20 1,118 14March 2,086 0 2,052 15Total 9,634 75 5,045 87
Over18’ssentforprosecutionunderalcoholbye-lawApril2009toMarch2010–576April2008toMarch2009–444
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NIPrisonService(NIPS)statisticsTheinformationbelowrelatestothethreeoperationalsitesoftheNIPrisonServicenamely:HMPMaghaberry(Easternarea),HMPMagilligan(Westernarea)andHydebankWoodYOC(Easternarea).
Sentencedreceptionsfordrugoffences,2006/07to2009/10
2009/10 2008/09 2007/08 2006/07
Male 102 95 89 85
Female 2 4 2 5
%oftotalnumberofsentences
7.5% 7.2% 6.9% 7%
DrugfindsinformationNIPS,2007/08to2009/10
Year(MarchtoFebruary) 2009/10 2008/09 2007/08
Averageno.ofprisonerscommittedondrugrelatedcharges
135 119 122
Drugsdependencyoncommittal
Year(MarchtoFebruary) 2009/10 2008/09 2007/08
Alcohol 1,108 1,047 1,104
Cannabis 608 715 622
Prescriptiondrugs 220 258 154
Ecstasy 188 242 299
Heroin 101 100 34
Amphetamines 67 88 86
Voluntarydrugtesting
Totalno.ofvoluntarydrugtestsforperiod 4,660 4888 3,989
Totalno.ofnegativeresultsrecorded 3846(83%) 3637(74%) 2,863(72%)
Averageno.ofvisitorsfortheperiod 129,824 118,474 27,969
Passivedogindications
Totalno.ofpositiveindicationsmadebythepassivedog
1,049 1,819 1,643
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Illicitdrugfinds
TotalamountofAmphetamines(grams/tablets) 13.7g 19.2g 38.7g1tablet
TotalamountofCannabis(grams) 838.5 1,241.8 474.9
TotalamountofEcstasy(tablets) 12 - 100
TotalamountofHeroin(grams/tablets) 74.9g 3tablets 3.4g8tablets
TotalamountofOtherDrugs(tablets) 1,602.01 637 2,310
TotalamountofPrescriptionDrugs(tablets) 481.5 179.5 971.5
TotalamountofSteroids^(tablets) 202 547 70
TotalamountofTemazepam(tablets) 2 18 61^While the use of steroids is not considered illegal, their abuse in prison is
Thefindsofillicitdrugsinprisonestablishmentslistedaboveweremadebyprisonstafffollowingrandomandtargetedsearches.Thefiguresexcludefindsmadeonvisitorsbeforeenteringprisonestablishments–thepolicearenotifiedandaskedtoinvestigateinthesecases.
Theincreaseindrugrelatedincidentsandevidenceofincreasedmisuseofdrugsineachoftheprisonswascausingsignificantconcernandasaresultin2007thePrisonsMinisteratthetime,PaulGoggins,askedthePrisonServicetoreviewcurrentarrangementsforreducingthesupplyofillegaldrugstoprisoners.InthesubsequentmonthsacomprehensivereviewofthosearrangementswascarriedoutbytheProjectTeamandareportentitled‘ReportonminimisingthesupplyofdrugsinNIprisons’waspublishedinJuly2008whichmadeanumberofrecommendationsonhowsystemsandprocedurescouldbeimproved.Thefindingsofthisreport,alongwiththoseofanin-depthreviewofaddictionserviceswithinprisons,andindividualcasereviewsbythePrisonsOmbudsman,haveledNIPStomakeseveralchangestoPrisonRuleswhichwillenabletheServicetotacklemorerobustlytheissueofillicitdrugswithinprisons.Forexample,from1June2010thePrisonServicewillintroducesalivatesting,whichwillallowformoreimmediateindicationofthepresenceofdrugs.
TheSouthEasternHealthandSocialCareTrust,responsibleforhealthcareinprisons,havealsodevelopedacomprehensiveHealthcareImprovementPlan,includingacontractforthedeliveryofAddictionServices,whichwillbetakenforwardin2010/11.
11.3 What’sinplace?LisburnYMCAdeliversSHAHRPinallbutonesecondaryschoolsintheBelfastHSCTarea–thisalcoholeducationprogrammefocusesnotonlyon‘ownharm’fromusing/misusingalcoholbutalsoon‘elseharm’(i.e.passengerinacardrivenbysomeoneundertheinfluence/victimofanalcohol-fuelledassault).Italsonowincludesaspecificinterventionaimedat16-yearoldswheretheyareshownfacialtraumainjuriescausedbyalcohol-relatedassaults.
YouthJusticeAgencyhasacentralrolewithyoungpeopleinvolvedinsubstancerelatedcrime.Itsaimistopreventreoffendingthroughreparation,rehabilitationandreintegration.YJAprovidesdrugandalcoholprogrammes,andusestheRegionalInitialAssessmentToolforsubstancemisuseinyoungpeople(RIAT),asandwhenappropriate.YJArefersyoungpeopleontoarangeofserviceswhichareavailableinBelfastandarealsoapartnerinthepilotoftheDAISYservice’sIntensiveSupportProgramme(ISP).
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BCSPprovideanumberofprojectsthroughitsGetHomeSafePartnershipwhichaimstoreducealcohol-relatedviolentcrimeincluding;AlcoholBye-Laws–Enforcementofalcoholbye-lawswithPSNIJointenforcement–BCCofficersworkwithPSNIatweekendsandeventstotackleonstreetandunderagedrinkingOff-LicenceCodePractice–Workwithoff-licencestoimplementcodewhichlooksatresponsibleretailinginordertoreduceunderagedrinking&ASBOff-Licence&BarStaffTraining–ProvidefreetrainingtostafftoencourageresponsibleservingwhichaimstoreducealcoholrelatedASBParentalAwarenessCampaign–InpartnershipwithPHA&DOJrunacampaignaimedencouragingparentstoseekadviceabouttheirchildandalcoholGetHomeSafeMarketingCampaign–Regularcampaignaimedat18-24yearoldswhichchallengespeopletothinkabouttheirbehaviourwhentheyareoutdrinkingLicensedPremisesGroup–ImprovesoncoordinationbetweenPSNI/BCCtoworkwithlicensedpremisestosolveissuesandreducealcoholrelatedviolenceInformationSharingProtocol–ProjectthatallowslicensedpremisesshareinformationregardingpatronswhocausetroubleinentertainmentvenuesandbarsinBelfastNiteZones–Projectwhichisdevelopingsafespacesin4pilotareasofthecitybyintroducing,taxis,streetpastors,lighting,emergencycontactpointsetcCommunitySafetyWardens–thewardenserviceisdeployedinvariouspartsofBelfastanddealwithanti-socialbehaviourandalcoholabuse
PSNIworksverycloselywiththeBCSP/BCC.Italsoaddressesalcohol/drugrelatedviolencethroughreferringyoungpeopletoyouthdiversionandanti-socialbehaviourforumsaswellasspecialistsubstancemisuseserviceswhereappropriate.
11.4 GapsSpecificworkrequiredaroundeducatingyoungmenabouttherisksassociatedwithsubstance
misuseandsex–beingaccusedoforactuallycommittingsubstancerelatedsexualassaultsLinksshouldbemadewithdomesticviolenceservicesNeedtotackletheprescribedmedicationblackmarketNeedtotackledialadrink/drugtaxifirmsNeedtotackleproxybuyingPSNI/BCCshouldworkwithlocalcommunitiestodevelopplans/initiativestotackleASBAftercareservicesneededforoffenders(toreduceriskofreoffendingand/orrelapse)
11.5 Tacklingsubstancerelatedcrime/violencerecommendationsThoseresponsiblefordevelopingcampaigns/initiativesshould,wherepossible,makelinkages
betweensubstancemisuseandrisktakingbehaviourswhichresultincrime/violenceSupportthePHAinworkingwiththeSEHSCT,PrisonServiceandProbationBoardinrelation
tosubstancemisuseprevention,interventionandpost-ventionwithregardtoensuringthereisadequatemeasuresinplacetoreducetheriskofre-offendingand/orrelapse
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CO-ORDINATION AND INFORMATION SHARING
12.1 What’s in place?12.2 Gaps/Issues12.3 Recommendations
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12 CoordinationandInformationSharing
12.1 What’sinplace?TheHealthandSocialCareBoardisresponsibleforcommissioningstatutoryaddictionserviceswiththeHSCTs.
BamfordSubstanceMisuseGroupisasubgroupoftheBamfordImplementationGroupandwillbetakingforwardtheregionalreviewofaddictionservices,aswellasanumberofotherinitiativeswhicharebestprogressedonaregionalbasis.
EDACTcurrentlycoordinatesthePublicHealthAgency’sresponsetoreducingthehealthimpactofdrugandalcoholuseintheBelfastandSouthEasternHSCTlocalities.Arangeofrelevantstakeholdersarerepresentedontheteamincluding;PHASEHSCTBHSCT4representativesfromtheVoluntary/CommunitysectorPBNIEducation
(PSNIattendona‘asrequired/requested’basis).
TheIndependentSectorForumcurrentlyprovidesaforumforthevoluntaryandcommunitysectortofeedintoEDACT.Theforummeetseverytwomonthsandisopentoallwithaninterestinaddressingsubstancemisuse.
Localdrugandalcoholforumsexistinsomeareas;SouthandEastBelfastSubstanceAbuseNetwork(SEBSAN)WestBelfastDrugandAlcoholForumTheRADICALforuminNorthBelfastnolongerexists.Drugandalcoholissuesarenowraised
andaddressedthroughtheNBPB.
TherearetheHealthDevelopmentWorkersandtheHealthandWellbeingForumswithinthefivearea-basedPartnershipBoardsinBelfast.InadditiontherearethehealthandwellbeingsubgroupswithintheNeighbourhoodRenewalPartnerships(rolesandfunctionsasoutlinedinprevioussectionsofthisreport).
TheDrugandAlcoholCoordinationProjectBoardwasestablishedinNovember2006.TheBoardwassetupundertheHAZpartnership.CurrentandpastmembershipincludedBelfastHealthandSocialCareTrust;EastBelfastPartnershipBoard;EDACT;FallsCommunityCouncil;FASA;GreaterShankillPartnershipBoard;HealthActionZone;NorthBelfastPartnershipBoard;RADICAL;SEBSAN;SouthBelfastPartnershipBoard;WestBelfastDrugandAlcoholStrategyGroupandWestBelfastPartnershipBoard.
TheProjectBoardwassetuptoprovidedirection,supportandadviceonthedevelopmentandimplementationofacoordinatedapproachtosupportcommunityorganisationstodevelopeffectiveresponsestoneedandsubstancemisuseinBelfast.Itmetupto4timesperyearandcontinuedtomeetupuntilNovember2010.ThecontinuationoftheBoardwillneedtobeconsideredbythemembershiptakingaccountoftheoutworkingoftheBelfastDrugsandAlcoholWorkingGroup.
BROinvestapproximately£400,000indrugandalcoholprojects/servicesacrossBelfast.Theyarecurrentlyexploringnewdeliverymodelsforalltheirservicesandarekeentopilotthisnewapproach
//69
withthecurrentfundingallocatedtoaddressdrugandalcoholissues.DiscussionsareongoingwithinthePHAandBHSCTonhowfuturefundingmightbeadministered.
BCSPcurrentlycoordinatearangeofinitiativesaimedatreducingtheimpactofdrugandalcoholrelatedviolenceandcrime.SimilartoEDACT,arangeofrelevantstakeholdersarerepresentedonthepartnership.Theinitiatives/projectsBCSPleadonaredetailedinSection11ofthisreport.GoodrelationshipsexistbetweenEDACTandBCSPandtogethertheyhavefundedaparentalawarenesscampaignforanumberofyears.
BCC/BelfastHSCThaveappointedaProgrammeDevelopmentOfficer(ChildrenandYoungPeople’sHealth)focussingonalcoholharmreductionwhocameintoposton16thAugust2010.
BelfastCityCouncil/PHAandBHSCTaredevelopinga‘TotalPlace’approachtoaddressingthemisuseofalcoholacrossthecity.
12.2 GapsStrategicfocusThereisaneedforaBelfast-widemodeland/orapproachtotacklingsubstancemisuse
focusingongoalsoroutcomesthatlocalareascanthentranslateintolocalactions/plansThereisalackofsecurityinrelationtoresources:longertermfundingcommitmentsare
requiredsothatservicesareabletoestablishthemselvesonafirmerbasisThereisaneedtolookattheinter-connectionamongstallthestrategiesbothatdepartmental
leveli.e.fordrugsandalcohol,mentalhealth,suicideprevention,sexualhealth,earlyyearsintervention,etc.aswellasthespecificlocalityfocussedstrategiessuchasthoseproducedbythearea-basedPartnershipBoards,etc.
Considerationshouldbegivenastohowthelearningfromthedevelopmentandimplementationofthesuicidepreventionstrategyistakenonboard
Thereisaneedtomakedrugsandalcohola‘big’issue,itneedstobefocussedwithdedicatedgroupslookingattheissueatalllevels(strategic-operational-local)
ThereisaneedtoraisetheprofileofEDACTasthereappearstobealackofawarenessofwho/what/why
BDAWGhasaroletoplayespeciallyinrelationtolobbyingandadvocacybutallrepsneedtoattendandparticipate
AlldrugandalcoholservicesneedtobemoreinvolvedinthedevelopmentofanyBelfaststrategy
Information-sharing/datamanagementInformationsharingisabigissueespeciallyforthosefunding/commissioningservicesand
thereneedstobebettercommunicationespeciallyinrelationtowhatthestatutorysectorisfundingbothwithotherstatutoryagenciesandwiththecommunity
Needtomakebetteruseofthedatawealreadycollectandputinplaceinformationmanagementsystemsand/orprotocolsforsharinginformation
Jointworking/increasedcoordinationNeedtoestablishaserviceprovidersforum(i.e.thedrugandalcoholservicescouldwork
moreoncoordinationbetweenthem)NeedtohavebetterlinksandcommunicationamongstallkeyplayersEachareaofBelfastisdifferentyetthereneedstobeadegreeofconsistencyandequityin
relationtoservicesbeingprovidedandinabilitytoaccessservice
12.3 Coordinationandinformation-sharingrecommendationsAllthosewithaninterestin/remitforaddressingdrugsandalcoholshouldusetheconsultation
process(ontherelaunchoftherevisedNSD)toensurethatitadequatelyreflectsthepriorities
//70 ScopingReportonDrugsandAlcoholServicesinBelfast
identifiedbyBDAWGandmembersshouldspecificallycommentonwhethertherevisedstrategydemonstratesinter-connectednesswithallotherrelevantstrategiesandissuesforexamplementalhealthandwellbeingandsexualhealth
Aninformationandcommunicationsstrategy(asstatedearlier)shouldbedevelopedbythePHAasaprioritytosupporteffectivecommunicationandinformationsharingatregionalandlocallevel;thisshouldincludeaspecificactionaroundsupportingbettercoordinationandinteractionbothbetweenandwithinfundedservices;andthestrategyshouldalsoclarifyroles,responsibilities,membershipandexpectedcontributionofpartnersandpartnershipstoaddressingtheissueofsubstancemisuseinBelfast
AllrelevantstakeholdersandpartnershipsshouldadviseandsupporttheBelfastStrategicPartnershipandBelfastHealthDevelopmentUnit(BHSCT/BCC/PHA)indeveloping,anddeliveringon,aBelfast-widemodelfortacklingsubstancemisuse–ensuringthatassociatedprioritiesandactionsareevidence-based
SUMMARY OF RECOMMENDATIONS
3
//72 ScopingReportonDrugsandAlcoholServicesinBelfast
13 SummaryofRecommendations
Therecommendationsasoutlinedinthepreviouschaptershavebeensummarisedinthefollowingtable.Themainagencieswho,couldeitherhaveleadresponsibility(highlightedinbold),orwhocouldbeinfluentialintakingtherecommendationsforward,havebeenidentifiedhowevertheremayalsobeotherswhocouldprovideassistanceandtheagencywithleadresponsibilityshouldconsiderwhoelseshouldorcouldbeconsultedand/orinvolved.
Timescaleshavealsobeenassignedandaredefinedasbelow:Short-term–withinthenextyearMedium-term–withinthenext2-3yearsLong-term–withinthenext4-5years
SomeoftherecommendationsappliedwiderthanjusttheBelfastlocality(i.e.theyshouldbeconsideredandtakenforwardataregionallevelaswell)andthesehavebeenhighlightedinblue.
BDAWGisawarethatthisreporthasbeenproducedduringaperiodofongoingrestructuringduetoRPAandsoresponsibilityhasbeenassignedtothoseagencieswhocurrentlyleadon/andorcommissiondrugsandalcoholworkandservices.However,thoseconsideringtheserecommendationsshoulddosoinlightofthenewandevolvingstructures–especiallyinrelationtotheBelfastHealthDevelopmentUnitandthefactthatithasalreadyhighlighted‘alcohol’asapriorityareaunderitsdraftactionplan.TheBelfastStrategicPartnershipisintheprocessofdevelopinga‘FrameworkforActiontoAddressLifeInequalities.’TherecommendationspresentedinthisreportshouldalsobeconsideredbytheBSPwhenconsideringanddevelopingprioritiesundertheframework,fortheBelfastlocality,overthecomingyears.
//73
Issue
Recommendation
Responsibility
Timescale
Commissioning
Tho
se r
espo
nsib
le fo
r co
mm
issi
onin
g an
d de
sign
ing
serv
ices
sho
uld:
whendesigningtendersandcontracts,embedaprocessofflexibility
intohow
com
missionedserviceswillbedeliveredintermsofmeeting
theneedsofclientsratherthanpre-settargets
ensurethatself-careforstaffisincludedasanessentialrequirement
withintenderspecsand/orcontractsforthosewhowillbeproviding
drugandalcoholservicestoclients
PHA(EDACT),
HSCB,B
HSCT,
BRO,B
CC
(BCSP),PSNI,
NIHE,etc.
Short-term
Coordination
andinform
ation
sharing
BHSCT,inconjunctionwiththecommunity/voluntarydrugandalcohol
treatmentserviceproviders,shoulddesignanddevelopa‘Pathw
ayto
services’docum
entw
hichshouldbewidelydissem
inatedtoGPsasa
keytargetgroupalongwithgenericcom
munityserviceproviders
BHSCT,P
HA/
EDACT,Relevant
EDACT-funded
serviceproviders
Short-term
An‘earlywarningsystem’shouldbeestablishedatbothlocaland
regionalleveltoensuretimelysharingofinformation.Inthefirstin-
stancetheBelfastCom
munitySupportServiceshouldbetasked,and
supportedto,offerpracticalinformationsessionsonem
ergingissues
atcom
munitylevelw
hereappropriate
DHSSPS,P
HA
BHSCTandPSNI
Short-term
Moreformalmechanism
sshouldbeputinplaceforbettercoordination
andinteraction,bothbetweenandwithin,agencies/servicesfundedto
deliverdrugandalcoholservices
PHA(EDACT)
Short-term
BHDUandtheBelfastStrategicPartnershipshouldbesupportedand
assistedindeveloping,anddeliveringon,aBelfast-wide‘TotalPlace’
modelfortacklingsubstancemisuse
BHDU,B
CC,
BHSCT,PHA
andallrelevant
stakeholders
Shortto
medium-term
BHSCTshouldestablishaworkinggroupwiththegoalofcreatinga
seam
lessreferralpathw
ayforpeoplepresentingwithcom
plexneeds
(mentalhealthandaddiction)consistentw
iththetheoryof‘nowrong
door’
Afram
eworkandassociatedtrainingprogram
me(RIAT)hasbeenput
inplaceforassessingandrespondingtotheneedsofyoungpeople
inrelationtosubstancemisuse(includinghowandwhotoreferon
to)–perhapsasimilarfram
eworkcouldbedevelopedfortheadult
population
BHSCT,H
SCB,
PHA/EDACT,
PHA-funded
serviceproviders
Shortto
medium-term
//74 ScopingReportonDrugsandAlcoholServicesinBelfast
Acoordinateddatacontentm
anagem
entsystemand/ordata/informa-
tionsharingprotocolsshouldbedevelopedtherebyprom
otinglessdu-
plicationandensuringthattheindividual’sneedsarebestm
etacross
allservicesandsectors
DHSSPS,P
HA
HSCB,B
HSCT
andBRO
Mediumto
long-term
Communication
andinform
ation
sharing
Arangeofservicedirectoriesfordrugsandalcoholshouldcontinueto
beproducedwhilstensuringthataplannedandtargetedapproachis
takentowardsdisseminatingandprom
otingasharedunderstanding
aboutexistingprovision,capacityandreferralpathw
ays
PHA(EDACT),
BHSCT
Short-term
Adrugsandalcoholinformationandcommunicationsstrategyshould
bedevelopedasaprioritytosupporteffectivecommunicationandin-
formationsharingatlocallevel–thestrategyshouldalsoclarifyroles,
responsibilities,mem
bershipandexpectedcontributionofpartnersand
partnershipstoaddressingtheissueofsubstancemisuseinBelfast
PHA(EDACT)
Shortto
medium-term
Thoseresponsiblefordevelopingcam
paigns/initiativesshould,where
possible,m
akelinkagesbetweensubstancemisuseandotherrisktak-
ingbehavioursandtheincreasedriskofparticipatingin/beingavictim
ofcrim
e/violence
DHSSPS,P
HA,
BHSCT,BCC,
PSNI
Medium-term
Currentservice
provision
Educationandpreventionservices
Thoseprovidingdrugandalcoholeducationandpreventionpro-
gram
messhouldensurethat,w
herepossible,acom
munitydevelop-
mentapproachistakentohow
clientsaretargetedandengagedand
howsessions/programmesaredelivered
PHA(EDACT)&
relevantEDACT-
fundedservice
providers
Short-term
Communitysupportservices
Thequality,quantityandleveloftrainingprovisiondeliveredwithin
communitiestodateshouldbeidentifiedandassessedandthisinfor-
mationshouldbeusedtoinformthefuturedirectionofcom
munitydrug
awarenesstraining
PHA(EDACT)
&relevantE
DACT-
fundedservice
providers
Short-term
//75
Existingestablishedcommunitynetworksshouldbeconsultedto
identifycommunityworkerswithahealthrem
itinordertokeepthem
uptodateondrugandalcoholissues,servicesandtrainingavailable
Clearinformationshouldbegivenaboutthecom
munitydrug
awarenesstrainingavailableinorderthatcom
munityorganisations
and/orworkerscanmakeinformeddecisionsspecificallyaroundthe
desired/requiredlevelofcom
petencyinaddressingdrugandalcohol
issues
RelevantEDACT-
fundedservice
provider
Short-term
Thecurrentpromotionalactivities/awarenessraisingstrategiesofthe
BelfastDrugandAlcoholCom
munitySupportServiceshouldbere-
view
edtoensuretheyrem
ainfitforpurpose
PHA(EDACT)&
relevantEDACT-
fundedservice
provider
Short-term
TheroleandimpactoftheCom
munitySupportServices(fordrugs
andalcohol)currentlyfundedregionallyshouldbeevaluatedinorder
tosharethelearninglocallyandbuildonbestpracticeelem
ents
PHA&relevant
PHA-funded
serviceproviders
Medium-term
Workforcedevelopment
PHAshouldundertakeareview
ofcurrentworkforcedevelopment
trainingatbotharegionalandlocallevelwithaviewtoinforming
futurestrategiccom
missioningandensuringbetterlocalandregional
consistency
Oneofthecoreelem
entsofalltraining(tocom
munitiesortothe
workforce)deliveredshouldbeaboutincreasingknowledgeofexisting
provisiontoenablesignpostingorreferraltoappropriateservices
Availabletrainingshouldbeevidence-basedandconsistentinits
contentandhow
itisdelivered
PHA&relevant
PHA-funded
serviceproviders
Short-term
Treatm
entandsupportservices
Theneedsofethnicminorities,specificallyinrelationtoaddressing
languageandculturalbarrierswhenaccessingandavailingofdrug
andalcoholservices(andfollowonsupport)shouldbeaddressed,en-
suringthatanappropriatepackageofsupportisputinplaceandthat
bothserviceprovidersandclientsareaw
areofwhatthisisandhow
to
accessit
DHSSPS,P
HA,
HSCB,BHSCT
andrelevantPHA-
fundedservice
providers
Short-term
//76 ScopingReportonDrugsandAlcoholServicesinBelfast
Alltreatmentandsupportservicesbeencouragedandsupportedto
adoptawholefamilyapproachtotreatingdrugandalcoholaddiction
andaftercare/followonsupportshouldbebuiltinasanessential
elem
entforbothclientsandtheirfamilymem
bers
Carepathwaysneedtobedevelopedtoenablethosewithmore
complex/im
mediateneedstobefast-trackedintoservicesaswell
asasystemformonitoringresponseratesandappropriatenessof
responses
Atcom
munitylevelthereneedstobeaw
arenessraisinginrelation
towhattodoandhow
toaccessservicesforpeopleincrisisand
inparticularhow
toaccessoutofhoursprovisionwithinstatutory
services
PHA(EDACT),
HSCB,B
HSCT
andrelevant
EDACT-funded
serviceproviders
Medium-term
Futureservice
development
Educationandpreventionservices
AdditionalresourcesshouldbetargetedatTiers1and2toensurea
muchstrongerfocusisputonprevention
Moreeducationandpreventioninitiativestargetedattheadult
population,atfam
iliesandatthosewithcom
binedmentalhealthand
drugs/alcoholneedsshouldbedevelopedandresourced
PHA(EDACT),
HSCB,B
HSCT,
BRO,P
HA,
BHSCT,BRO
Medium-term
Communitysupportservices
Trainingorganisations,fundedtodelivercom
munitydrugaw
areness
training,shouldworkwithkeycom
munityrepresentatives/organisa-
tionstodevelopatrainingprogram
mesuitedtotheirneeds(from
screening/initialassessm
enttoreferringonandinterveningifand
whenappropriate)
Relevant
EDACT-funded
serviceprovider
&com
munity
agencies
Short-term
Workforcedevelopment
Thereneedstobestrategicplanningandtargetingoftraining–adrug
andalcoholw
orkforcedevelopmentstrategyshouldbedevelopedasa
prioritytoincludebestpracticeandguidanceondevelopingamodelof
selfcarefortheworkforce
PHA
Shortto
medium-term
TheplannedbriefinterventiontrainingforGPsshouldcoveraware-
ness-raisingofservices(bothstatutoryandcomm/volprovision)and
wherepossiblebedeliveredbyrepresentativesfrom
bothsectors
PHA&HSCB
Shortto
medium-term
//77
Across-sectoraltrainingmodel,toincludecrossplacem
ents,should
bedevelopedforthosesectorsand/oragencieswhointerfacemost
withaddictions(i.e.hom
elessness,mentalhealth,crim
inaljusticeand
socialservices)toallowfortransferofknowledgeandskills
Genericserviceproviders(comm/vol/stat/private)shouldbeoffered
appropriatedrugsandalcoholtrainingwhichshouldcoverassessment
andreferral
PHA&Relevant
EDACT-funded
serviceprovider
Shortto
Mediumterm
Drugandalcoholtrainingshouldbeincorporatedasasubstantial,con-
sistent,corepartofcollege/universityprogram
mesforteachers,social
workersandhealthprofessionals(lobbyingrole)
DHSSPS,P
HA
andUniversities/
FEColleges
Mediumto
long-term
Treatm
entandsupportservices
Levelsofpainmedicationprescribingshouldbeinvestigatedandan
assessmentm
adeastowhetheraspecificresponseisrequired(such
ashasbeentakenforaddressinghighlevelsofanti-depressantpre-
scribing)
PHA&HSCB
Medium-term
Anincreasedrangeofprogram
mesandservicesneedtobemade
availableforfamiliesaffectedbysubstancemisusewhethertheperson
withinthefamilywhoismisusingsubstancesisseekinghelpfortheir
addictionornot
PHA(EDACT),
HSCBand
relevant
fundedservice
providers
Medium-term
Arangeofservicesfrom
prevention,interventionandpost-vention
shouldbeavailablewithinthecriminaljusticesettingtoensuread-
equatemeasuresareinplacetoreducetheriskofre-offendingand/or
relapse
PHA,H
SCB,
SEHSCT,
NIPS,P
BNI&
YJA
Shortto
medium-term
TheBam
fordSubstanceMisuseGroup,shouldbesupportedinun-
dertakingtheplannedreview
ofaddictionservices–thereview
should
ensurethatthereareadequateservicesavailableateachtier(tomeet
need)forbothadultsandyoungpeopleandthatservicesareableto
providearangeoftreatmentm
odelstobothclientsandtheirfamilies
asappropriate(andfamilymem
bersshouldbeabletoaccesssupport
serviceswhethertheactualsubstancemisuserisengagedornot)
BSMG,P
HA,
HSCB,H
SCTs
&PHA-funded
serviceproviders
Shortto
medium-term
//78 ScopingReportonDrugsandAlcoholServicesinBelfast
General Aspartofthetacklinghealthinequalitiesagenda,incentivisingpar-
ticipationindrugandalcoholprogram
mes/services(takingonboard
thefindingsoftherecentlypublishedNICE’sCitizen’sCouncilreport
on‘Theuseofincentivestoim
provehealth’)shouldbeconsidered/
explored
PHA,H
SCB,
BHSCT&BRO
Shortto
medium-term
TheDHSSPSguidanceondevelopingworkplacedrugandalcohol
policiesshouldbereview
edwiththegoalofputtinginplaceasystem-
aticplanfordissem
inationandprom
otionofbestpracticetoemployers
DHSSPS
Shortto
medium-term
Goodpractice
Anyinitiativeswhichshowpromise/arehavinggoodoutcom
eslocally
shouldbereview
edand/orevaluated(modellingapproach)withaview
totriallinginotherHSCTareas
Aprocessofsystematicengagem
entshouldbeundertakenwith
relevantumbrellaorrepresentativegroupsforminoritiesand/or
vulnerablegroupsinrelationtodrugandalcoholneeds/barriersto
accessingservices
ThedisseminationandadoptionoftheregionalPHA/DHSSPS
‘Guidingeffectivedrugprevention’docum
entandprinciplesshould
besupportedregionally,andtheaccompanyingtrainingprogram
me
availableintheEasternareainhow
todesignanddeliverdrugand
alcoholpreventionprogrammesshouldbereviewed/evaluatedwitha
view
towiderrolloutifim
pactproven
PHA
Medium-term
//79
Needs
assessment/
Researchagenda
DiscussionsshouldtakeplacebetweenPHAandBELB
toexplorebest
practiceinrelationtoaddressingdrugsandalcohol(from
preventionto
crisisresponse)withintheschoolsetting(prim
ary&post-primary)and
toagreeaconsistentapproach
PHA&BELB
Shortto
medium-term
BELB
shouldleadinaconsultationwiththoseprovidingservicesto
thosenotinschool/notinyouthclubsinordertoassesstheneedsof
thisgroupofyoungpeopleinrelationtodrugsandalcohol
BELB,E
DACT,
AEPs,Com
munity-
basedDetached
YouthW
orkers
Shortto
medium-term
Ascopingexerciseshouldbeundertakenwithdrugandalcoholserv-
iceprovidersacrossthetiersinordertoassesstheextentandim
pact
ofthosepresentingtoserviceswithdualdiagnosisneeds(substance
misuseandmentalhealthissues)andhowthenspecificallytheirmen-
talneedsarecurrentlybeingmetandwhattheneedsareofthese
servicesinthefutureinordertobeabletomeettheirneedsbetter(the
findingsoftheWestB
elfastPrim
aryCarePartnershipmappingexer-
ciseintomentalhealthservicesmayalsofeedintothisprocess)
PHA(EDACT),
BHSCTandPHA/
HSCBfunded
serviceproviders
Shortto
medium-term
Servicesneedtobebettersupported/resourcedtobeabletoevaluate
andsharelearninginordertobuildontheevidencebase
PHA,H
SCB,
BHSCT,BRO
Medium-term
Ataregionallevel,discussionsshouldtakeplacearoundwhatare,
andhowbestdowemeet,theneedsof‘N
EET’s’–thoseNotinEdu-
cation,EmploymentorTraininginrelationtosubstancemisuse
PHA,D
E,D
EL,
PSNI,YJA
Mediumto
long-term
Betterlinkagesneedtobeestablishedbetweenthoseresponsible
forcommissioninganddeliveringservicesinordertobeabletobet-
terdefineresearchgaps,decideobjectivesandprioritiesforanynew
researchtobeundertaken,andtoensurethatthereisabalancebe-
tweenlocalandregionalresearchagendas
DHSSPS(PHIRB),
PHA(R&D),
BHSCT,PHA-
fundedservices
Mediumto
long-term
//80 ScopingReportonDrugsandAlcoholServicesinBelfast
Reducing
availability/
Tacklingcrime
Lobbyinglocally(ultim
atelyforaregionalapproach/response)should
continueforareductionintheavailabilityofalcoholbylegislative
measures(e.g.introductionofminimum
pricing,bans/restrictionson
prom
otionsandadvertising)andwherepossiblyweshouldtakeon
boardandadoptlearningfrom
elsew
hereonhowtoinfluencechange
ontheseissues
PHA(EDACT),&
BCC(BCSP)
Short-term
Optionsshouldbeexploredandconsideredlocallyforreducingavaila-
bilityofsocalled‘legalhighs’soldviaretailprem
isesinBelfastknown
asheadshops/sm
artshops/hydroponicshops
PHA(EDACT),
BCC(BCSP)&
PSNI
Short-term
Bestpracticeinworkinglocallywithsupermarkets,off-licencesand
licensedprem
isestodevelopstrategicapproachesforreducingavail-
abilityshouldbeexploredanddissem
inated
BCC(BCSP)
Short-term
Alternativeapproachestoreducingunderagedrinkingandprotocols
forworkingwithcom
m/volyouthdrugandalcoholserviceprovidersto
addressthisissuelocallyshouldbedevelopedandtested
Jointinitiatives(suchasthoseundertakenfortobaccocontrol)should
bedevelopedandtestedtoaddressunderagedrinkinginbarsand
socialclubsacrossBelfast
BCC(BCSP),
PSNI&
Relevant
EDACT-funded
serviceproviders
Short-term
Testpurchasingofage-restrictedproducts(tobacco,alcoholand
solvents)shouldbeimplem
entedasapriorityandcarriedoutregularly
Amappingexerciseshouldbeundertakenofallthelicensedbarsand
socialclubscurrentlyinexistence(aswellasplanned)intheBelfast
areaandthefindingsconsideredinrelationtoavailabledrugand
alcohol/crim
estatisticswithaviewtomakingrecommendationsto
informfuturelicensing/planningpractice
BCC,B
CSP&
PSNI
Shortto
medium-term
//82 ScopingReportonDrugsandAlcoholServicesinBelfast
14 Conclusions
Itwastheintentionofthosewhohavebeeninvolvedinthisscopingexercisenotonlytoidentifygapsandmakerecommendationsforserviceimprovementbutalsotohighlighttheconsiderableamountofworkthathasalreadybeenundertakenbyarangeofpartnershipsandagenciesindevelopingtheserviceswehaveinplacetodate.
Whilstthisreportisbeingpublishedinatimeofuncertaintyduetothefinancialsituationandongoingrestructuringwithinthestatutorysector,membersoftheBelfastDrugandAlcoholWorkingGroupfeltthatitisalsoatimeofopportunityintermsofmakingbetteruseofexistingresourcesandtoallowusalltobemorecreativeandflexibleinhowweworktogethertoaddressthecomplexandwide-rangingneedsofthepeopleofBelfastinrelationtosubstancemisuse.
Giventhebackgroundtohowthispieceofworkwasinitiatedtheremustalsobeacommitmentinthefuturetoestablishingbettermechanismsforcommunicationandinformationsharingbetweenthoseresponsiblefordevelopinganddeliveringdrugandalcoholservices,whethertheyarestatutoryorcomm/volproviders,withthosecommunityprovidersandrepresentativeswhoareoftenthefirstpointofcontactformanyinlocalcommunitiesconcernedaboutdrugsandalcoholeitheronapersonalleveloronacommunitylevel.
MembersofBDAWGhavebeenencouragedtousethisreportasabasisforrespondingtotheconsultationprocess(ontherelaunchoftherevisedNewStrategicDirectionforAlcoholandDrugsfortheperiod2011-2016)toensurethatitadequatelyreflectstheprioritiesidentifiedbyBDAWG(particularlyinaddressingtherecommendationswhichwerehighlightedinthepreviouschapterasbeingapplicableregionally).
AllrelevantstakeholdersandpartnershipsinvolvedwithBDAWGarewillingtoadviseandsupportthenewly-formedBelfastStrategicPartnershipandBelfastHealthDevelopmentUnitindeveloping,anddeliveringon,aBelfast-widemodelfortacklingsubstancemisuse,andtosupportthePHA’sEasternDrugsandAlcoholCoordinationTeaminthedevelopmentofitslocalactionplanandinparticularhowneedsareidentifiedandaddressedwithinBelfast.
MembersaskthatthePHAconsiderthebestmechanism(s)forimplementingandoperationalisingtherecommendationsasoutlinedinthisreportandfeedbackondecisionstakentotheBelfastDrugandAlcoholWorkingGroup.
//83
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Appendix1:TheFourTierModel
TheNew Strategic Direction for Alcohol and Drugs 2006-2011summarisedthefourtiermodelforadultsasfollows:
Adultservices
Tier1-NondrugtreatmentspecificservicesTier1consistsofservicesofferedbyawiderangeofprofessionals(e.g.primarycaremedicalservices,genericsocialworkers,teachers,communitypharmacists,probationofficers,housingofficers,homelesssupportstaff).Tier1servicesworkwithawiderangeofclientsincludingsubstancemisusers,buttheirsolepurposeisnotsimplysubstancemisuse.
Tier2-OpenaccessdrugandalcoholtreatmentservicesTier2servicesprovideaccessibledrugandalcoholspecialistservicesforawiderangeofdrugandalcoholmisusersreferredfromavarietyofsources,includingself-referrals.Thistierisdefinedbyhavingalowthresholdtoaccessservices,andlimitedrequirementsondrugandalcoholmisuserstoreceiveservices.OftendrugandalcoholmisuserswillaccessdrugoralcoholservicesthroughTier2andprogresstohighertiers.
Theaimofthetreatmentintier2istoengagedrugandalcoholmisusersindrugtreatmentandreducedrug-relatedharm.Tier2servicesdonotnecessarilyrequireahighlevelofcommitmenttostructuredprogrammesoracomplexorlengthyassessmentprocess.
Tier2servicesincludeneedleexchange,drug(andalcohol)adviceandinformationservices,andadhocsupportnotdeliveredinthecontextofacareplan.Specialistsubstancemisusesocialworkerscanprovideserviceswithinthistier,includingtheprovisionofaccesstosocialworkadvice,childcare/parentingassessment,andassessmentofsocialcareneeds.Tier2canalsoincludelow-thresholdprescribingprogrammesaimedatengagingopioidmisuserswithlimitedmotivation,whileofferinganopportunitytoundertakemotivationalworkandreducedrug-relatedharm.
Tier3-Structuredcommunity-baseddrugtreatmentservicesTier3servicesareprovidedsolelyfordrugandalcoholmisusersinstructuredprogrammesofcare.Tier3structuredservicesincludepsychotherapeuticandpharmacologicalinterventions(e.g.cognitivebehaviouraltherapy,motivationalinterventions,structuredcounselling,substituteprescribingprogrammes,communitydetoxification,ordaycareprovidedeitherasadrugandalcoholfreeprogrammeorasanadjuncttosubstituteprescribingprogrammes).Community-basedaftercareprogrammesfordrugandalcoholmisusersleavingresidentialrehabilitationorprisonarealsoincludedinTier3services.
Tier4-ResidentialservicesfordrugandalcoholmisusersTier4servicesareaimedatindividualswithahighlevelofpresentingneed.Servicesinthistierinclude:in-patientdrugandalcoholdetoxificationorstabilisationservices;drugandalcoholresidentialrehabilitationunits;andresidentialdrugcrisisinterventioncentres.
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Youthservices
TierOneThefrontlineofservicedeliverytowhichchildren,youngpeopleandtheirfamilieshavedirectaccessandwhichprovidethefirstresponsetotheneedsofchildrenandadolescents.Examplesofsuchservicesincludeschoolsprovidingsubstancemisuseeducationandprimarycareservicesofferingmedicaladvice.TheyalsoreferindividualyoungpeopletoTier2/3/4servicesifappropriate.
TierTwoFrontlineyoungpeople'sspecialistservicesarecriticaltotheidentificationofvulnerablechildrenandearlyidentification.Theirrolesshouldbeconcernedwiththereductionofrisksandvulnerabilitiestosubstancemisuse,andthereintegrationandmaintenanceofyoungpeopleinmainstreamservices.Examplesofsuchservicesincludesocialservicesassessingsubstancemisuseamonglookedafterchildren,voluntaryagenciesprovidingcounsellingservices,targeteddrugeducationandcriminaljusticeagenciesaddressingoffendingissues.
TierThreeServicesdemonstratingathresholdofexpertiseandcompetencethatiscapableofcomprehensiveassessmentandformulationofanoverallplanforsubstanceuseandvariousotherproblems,includingoutcomedomains.Theservice(s)willdealwiththecomplexandoftenmultipleneedsofthechildoryoungperson,includingsubstanceproblems.Theaimistoreintegrateandincludethechildoryoungpersonintohis/herfamily,communityandschool,trainingorwork.ExamplesofsuchservicesmaybestandaloneserviceseitherwithinthevoluntaryorstatutorysectororspecialistservicesintegratedacrossCAMHS.
TierFourVeryspecialisedchildrenandyoungpeople'sservicesusedforparticularinterventionsorfocusedworkand/orshort/temporaryperiods.Thismightconsistofinpatientadolescentservicesorforensicunitscomplementedbyspecialistyoungpeople'saddictionstaff,paediatricbedsorintensivedaycentresfordetoxification,crisisplacements,specialisthousingorfostering.Theaimwouldbetoprovidespecialistinterventionsandasettingforaparticularperiodoftime,andforaspecificfunction,asanadjunctto,andabackstopfor,theservicesforothertiers.Continuityofcarepre,during,andpostadmissionisimportant.
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Appendix2:ListofAbbreviationsUsedintheText
‘3Z’drugs Zalepon,ZolpidemandZoplicone
A&E AccidentandEmergency
AA AlcoholicsAnonymous
AAIS AdolescentAlcoholInvolvementScale
ADTS AddictionDayTreatmentServices
AEPs AlternativeEducationProviders
ASB AntiSocialBehaviour
ATP AdolescentTransitionsProgramme
ASCERT ActiononSubstancesthroughCommunityEducationandRelatedTraining
Benzo(s) Benzodiazepines
BCAS BelfastCommunityAddictionService
BCC BelfastCityCouncil
BCSP BelfastCommunitySafetyPartnership
BDAWG BelfastDrugandAlcoholWorkingGroup
BELB BelfastEducationandLibraryBoard
BHDU BelfastHealthDevelopmentUnit
BHSCT BelfastHealthandSocialCareTrust
BRO BelfastRegenerationOffice
CAMHS ChildandMentalHealthService
CARAT Counselling,Assessment,Referral,AdviceandThroughcare
CASE CitizenshipandSafetyEducationprogramme
CAT CommunityAddictionTeam
CBT CognitiveBehaviouralTherapy
CDSCNI CommunicableDiseasesSurveillanceCentreforNorthernIreland
CHILL CounsellingHelpandInformationforLifestyleandLiving
CHNI CouncilfortheHomelessNorthernIreland
CODA CommunityDrugAwarenessProject
comm community
COPAH CounsellingforOlderPeopleatHome
CSPs CommunitySafetyPartnerships
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DAAMHS DrugandAlcoholMisuseMentalHealthService
DAISY DrugandAlcoholInterventionServiceforYouth
DARS DrugArrestReferralScheme
DE DepartmentofEducation
DES DirectedEnhancedService
DEL DepartmentofEmploymentandLearning
DHSSPS DepartmentofHealth,SocialServicesandPublicSafety
DMD DrugMisuseDatabase
DOJ DepartmentofJustice
DOT DrugOutreachTeam
DPPO DesignatedPublicPlacesOrder
EDACT EasternDrugsandAlcoholCoordinationTeam
FASA ForumforActiononSubstanceAbuseandSuicideAwareness
FPNs FixedPenaltyNotices
GP GeneralPractitioner
HAZ HealthActionZone
HepC HepatitisC
HMP HerMajesty’sPrison
HSC HealthandSocialCare
HSCB HealthandSocialCareBoard
HSCT HealthandSocialCareTrust
ICAP InterChurchAddictionProject
ISP IntensiveSupportPilot/Programme
IV intravenous
LCG LocalCommissioningGroup
LGBT Lesbian,Gay,BisexualandTransgender
LGD LocalGovernmentDistrict
LHSCG LocalHealthandSocialCareGroup
LIFT LinkingtheInterestsofFamiliesandTeachers
LST LifeSkillsTraining
MARC MakingARealChange
N&W NorthandWest
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NA NarcoticsAnonymous
NBPB NorthBelfastPartnershipBoard
NEETS NotinEducation,Employment,TrainingorSchool
NI NorthernIreland
NIACRO NorthernIrelandAssociationfortheCareandResettlementofOffenders
NICAS NorthernIrelandCommunityAddictionService
NICE NationalInstituteforClinicalExcellence
NIDA NationalInstituteonDrugAbuse
NIHE NorthernIrelandHousingExecutive
NIHSCIMS NorthernIrelandHealthandSocialCareInequalitiesMonitoringSystem
NIO NorthernIrelandOffice
NIPS NorthernIrelandPrisonService
NISRA NorthernIrelandStatisticsandResearchAgency
No. Number
np-SAD NationalProgrammeonSubstanceAbuseDeaths
NRPs NeighbourhoodRenewalPartnerships
NSD NewStrategicDirection
NSDAD NewStrategicDirectionforAlcoholandDrugs
NTE NightTimeEconomy
OCN OpenCollegeNetwork
PACE PoliceandCriminalEvidenceAct
PHA PublicHealthAgency
PHIRB PublicHealthInformationandResearchBranch
PND PenaltyNoticesforDisorder
PSNI PoliceServiceofNorthernIreland
QUB QueensUniversityBelfast
RADICAL ResponsestoDrugsandAlcoholinCommunitiesandLives
RATSDAM RapidAssessment,TreatmentandSupportforDrugandAlcoholMisusers
RIAT RegionalInitialAssessmentTool
RIMT RegionalImpactMeasurementTool
RPA ReviewofPublicAdministration(inNorthernIreland)
RVH RoyalVictoriaHospital
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S&E SouthandEast
SDR StandardisedDeathRate
SEHSCT SouthEasternHealthandSocialCareTrust
SEBSAN SouthandEastBelfastSubstanceAbuseNetwork
SF StrengtheningFamilies
SHAHRP SchoolHealthandAlcoholHarmReductionProgramme
SPT SubstitutePrescribingTeam
SSDP SeattleSocialDevelopmentProject
stat statutory
TATI TalkingtoyourChildrenaboutToughIssues
UK UnitedKingdom
USA UnitedStatesofAmerica
vol voluntary
WHO WorldHealthOrganisation
YJA YouthJusticeAgency
YOC YoungOffendersCentre
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Appendix3:MembershipofBDAWG
BrianAllen,TheRISE Foundation
LindaArmitage,East Belfast Partnership
ClaireArmstrong, Addiction NI
AnneBill,Forum for Action on Substance Abuse and Suicide Awareness
FrancesBlack,TheRISE Foundation
[MaryBrannigan,Youth Justice Agency]
JustineBrown,North Belfast Partnership Board
EdeleCleary,BCC-Belfast Community Safety Partnership[replacedStevieLavery]
ClaireCrainey,Northern Ireland Housing Executive
AlisonCrawford,BCC-Belfast Health Development Unit
TomCrossan,BCC-Belfast Health Development Unit
KellyGilliland,PHA-Eastern Drugs and Alcohol Coordination Team
MaireadGilmartin,Holy Trinity Family Centre
BillyHutchinson,Mount Vernon Community Development Association
UnaLappin,South Belfast Partnership Board
[StevieLavery,BCC-Belfast Community Safety Partnership]
BennyLynch,Falls Community Council
AndrewMacQuarrie,YouthJusticeAgency[replacedMaryBrannigan]
ElaineMcCarthy,PHA-Belfast Health Development Unit
MichaelMcKay,Lisburn YMCA
JohnMcGeown,Belfast Health and Social Care Trust
AidanMcGoran,Belfast Regeneration Office
GaryMcMichael,Action on Substances through Community Education and Related Training
BrendanNellis,Barnardos
BryanNelson,Belfast Health and Social Care Trust
BrianO’Kane,Northern Ireland Housing Executive
OwenO’Neill,PHA-Eastern Drugs and Alcohol Coordination Team
BriegeQuinn,Belfast Health and Social Care Trust
IreneSherry,Bridge of Hope/Ashton Community Trust
AlanSwann,Police Service of Northern Ireland
CarolineWilson,Police Service of Northern Ireland [replacedJonathanWilson]
[JonathanWilson, Police Service of Northern Ireland]
*PleasenotethattheCODAProjecthassincefoldedandthatSEBSANhasnotmetinsometime
Appendix4:OverviewofservicesinBelfastcurrentlyfundedbyEDACT/PublicHealthAgency
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Report produced by the Belfast Drug and Alcohol Working Group on behalf of the Public Health Agency.
For more information, or to request a hard copy of this report, please contact Kelly Gilliland in the Public Health Agency T: 028 9031 1611 orE: [email protected]