Quality statement 1: Assessment of looked-after children and young people | Drug misuse prevention | Quality standards

Quality statement

Looked-after children and young people having their annual health plan review are assessed for vulnerability to drug misuse.

Rationale

Looked-after children and young people are at increased risk of drug misuse. Assessing vulnerability as part of their annual health plan review provides an opportunity to give early targeted support, which can reduce the likelihood of drug misuse.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements for the use of an agreed brief and valid questionnaire to assess looked-after children and young people's vulnerability to drug misuse at their annual health plan review.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from service specifications.

b) Evidence of local arrangements for staff to be trained by specialist services in how to assess looked-after children and young people's vulnerability to drug misuse.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from service specifications.

Process

Proportion of looked-after children and young people having their annual health plan review who have an assessment of vulnerability to drug misuse.

Numerator – the number in the denominator who have an assessment of vulnerability to drug misuse.

Denominator – the number of looked-after children and young people who have had a health plan review in the previous 12 months.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example, local audit of local authority records.

Outcome

a) Number of looked-after children and young people who misuse drugs.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records.

b) Proportion of looked-after children and young people misusing drugs, who access support for drug misuse.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient records. Data collection is required for the Children looked after data return (SSDA903) on whether children looked after by local authorities in England are identified as having a substance misuse problem for each year up to 31 March.

What the quality statement means for different audiences

Service providers (such as primary care services and looked-after children health teams) ensure that staff who assess the health of looked-after children are provided with guidance and training from specialist services so that they know the indicators of drug misuse, how to approach the assessment with sensitivity, how to use brief questionnaires (such as CRAFFT) accurately and how to respond to identified needs. They ensure that arrangements are in place for assessments to be included in the annual health plan review.

Healthcare professionals (such as GPs and school nurses) use a consistent, locally agreed brief and valid questionnaire, such as CRAFFT, to assess looked-after children and young people for vulnerability to drug misuse at their annual health plan review. They use an approach that is respectful, non-judgemental and proportionate to the young person's presenting vulnerabilities, and consider whether any further action is needed.

Commissioners (NHS England and local authorities) work with providers to produce a strategy to identify looked-after children and young people who are at risk of drug misuse. They ensure that they commission services in which looked-after children and young people have an assessment of vulnerability to drug misuse at their annual health plan review.

Children and young people who are looked after are asked brief questions at their annual health plan review to assess whether they are at risk of drug misuse. This is so that their needs can be identified and responded to.

Source guidance

Drug misuse prevention: targeted interventions. NICE guideline NG64 (2017), recommendation 1.2.1

The annual review timeframe is based on the Care Planning, Placement and Case Review (England) Regulations 2010. It is not derived from the source NICE guidance, but considered a practical timeframe to enable stakeholders to measure performance.

Definitions of terms used in this quality statement

Assessment of vulnerability to drug misuse

An assessment that is respectful, non-judgemental and proportionate to the child or young person's presenting vulnerabilities that uses a consistent, locally agreed, brief and valid questionnaire, such as CRAFFT. The child or young person's circumstances should be discussed, taking account of their age and developmental stage. The initial discussion could include:

their physical and mental health and their personal, social, educational or employment circumstances (which may trigger a more in-depth assessment)
any drug use (including the type used and how often).

[Adapted from NICE's guideline on drug misuse prevention, recommendations 1.2.2 and 1.2.3, and College Centre for Quality Improvement's Practice standards for young people with substance misuse problems]

Health plan review

A looked-after child has a health plan review at least once every 12 months from the age of 5.

A looked-after child or young person's health plan forms part of their wider care plan. It is based on the written report of the health assessment, which takes place before the child or young person is placed with the local authority, or if that is not reasonably practicable, before their first case review. [Adapted from The Care Planning, Placement and Case Review (England) Regulations 2010]