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2 A-DASH is commissioned by the Joint Commissioning Group for Young People s Substance Misuse, a sub group of Hertfordshire Children s Trust Partnership. The service is based within Hertfordshire Partnership NHS Foundation Trust. For those with less complex needs, A-DASH provides a targeted service based in Youth Offending Teams (for line management purposes). A - DASH 15 Forest Lane Shenley, Nr Radlett Hertfordshire WD7 9H

3 Comments from young people who have used A-DASH 3

4 Adolescent Drug and Alcohol Service Hertfordshire A-DASH provides a specialist drug and alcohol treatment for young people who are under 18 and a targeted service with those with less complex needs. They work in close co-operation and partnership with the other key providers of services to young people e.g. Children, Schools and Families (CSF) services (Youth Connexions, Youth Offending Teams), Child and Adolescent Mental Health Services (CAMHS). The need for partnership working is critical. Unless a young person is supported holistically, all drug interventions are less likely to be effective in the long term. This is why the A-DASH care plans reflect the Every Child Matters Outcomes: Being Healthy Staying Safe Enjoying and Achieving Making a Positive Contribution Economic Wellbeing A-DASH is a multidisciplinary team. Team members are from professional backgrounds in counselling, psychology, social work, youth work, criminal justice, nursing and medicine. A-DASH offers multidisciplinary assessment and treatment provision, which includes: Psychosocial interventions, Pharmacological prescribing interventions, Specialist harm reduction Family interventions. Care Plans may include various forms of residential intervention such as hospital admission, drug rehabilitation or specialist foster placements. The service is based on ten key principles: 1. A child or young person is not an adult; 2. The overall welfare of the individual child or young person is of paramount importance; 3. The views of the young person are of central importance and should always be sought and considered; 4. Services need to respect parental responsibility when working with a young person; 5. Services must co-operate with the Local Authority in carrying out its responsibilities towards children and young people; 6. A holistic approach is vital at all levels as young people s problems do not respect professional or service boundaries; 7. Services must be child-centred; 8. A comprehensive range of services needs to be provided; 9. Services must be competent to respond to the needs of young people 10. Services should aim to operate, in all cases, according to the principles of good practice. Health Advisory Service Review (HAS), Substance of Young Needs ( 2001). 4

5 The majority of young people in Hertfordshire will never need to access a drug & alcohol service. For the minority who occasionally use drugs and alcohol, information and advice should be given by workers they are most commonly in touch with. Where such use is seen to be causing significant problems in the young person s life then a call should be made to A-DASH for support. INVOLVING A-DASH To receive support from A-DASH the young person needs to be: under the age of 18 years at point of referral with a drug or alcohol problem living in Hertfordshire or have a Hertfordshire General Practitioner or attending school in Hertfordshire For young people who do not fit the criteria above contact the national drug helpline FRANK to find your local service provider. Any person working with, or a carer of, a young person, can call the service for advice and help. They can have an anonymised discussion about how a young person s drug use can be addressed. A drug or alcohol problem usually means misuse of Class A substances (cocaine, heroin), volatile substance use (lighter fuel, gas or petrol, solvents) or daily problematic consumption of Class B (amphetamines, cannabis) or C drugs (some painkillers, ketamine) or significant alcohol use. It may also be appropriate to contact A-DASH if the young person has lesser substance misuse needs but what they use causes possible ongoing mental health issues or impacts on their education, training, family relationships. For younger children under the age of 14 years or those with additional developmental needs, any level of drug use is of concern and may warrant recognition as a child in need. Call A-DASH for further guidance. A-DASH Service Hours Young people are seen in planned outreach appointments between 9am and 4.30pm Monday to Friday. A-DASH is not an emergency or out of hours service. In appropriate circumstances appointments can be scheduled outside office hours during the week. In case of an emergency outside office hours contact Children, Schools and Families Public Enquiry line on For medical emergencies call 999 immediately. Integrated Practice Arrangements A-DASH workers are associate members of local Multi Agency Teams (MATs) and can contribute to Common Assessment Framework (CAF) by offering advice, support and consultancy to any professional in contact with a young person. After discussion on specific cases A-DASH workers can be invited to a Team Around the Child (TAC) meeting and provide support as part of a CAF action plan. It is unlikely that A-DASH workers will be Lead Professionals within Integrated Practice as the drug and/or alcohol use is unlikely to be the main presenting issue. 5

6 A-DASH &A How do I know if it s right to involve A-DASH? Give A-DASH a call for a what if or send an . Initially, they will not need the young person s details to help you work out if they are the right service. Alternatively, you could complete the CRAFFT assessment tool. CRAFFT is a very simple questionnaire found at the back of this booklet (page 10). Each question is given a score. A score of 2 or more (1 or more if the young person is under 14 years of age), suggests it s worthwhile to contact A-DASH. A-DASH can also assist in helping you complete CRAFFT. A ½ day free course on assessment skills using CRAFFT is available to all professionals working in Hertfordshire. Contact A-DASH for more information on How can I access the service for the young person? Please phone A-DASH on in order to request a service and ensure the initial information is comprehensively collected. A-DASH can also help you to complete a CAF or discuss any concerns regarding a young person s drug use. Who can access the service on behalf of the young person? Anyone can, as long as the parent, carer or professional has asked the young person s permission or has the consent of the parents and child if they are aged 13 and under. Can a young person access the service directly? Yes, they can contact A-DASH directly. If there is a professional working with the young person, A-DASH would ask that professional to follow up with a phone call. This will allow the worker to check if the young person did make contact as A-DASH would not want to miss an opportunity to help. How quickly can the young person be seen? A-DASH aims to see all young people within 5 working days. 6

7 What type of intervention may be given? Individual intervention packages are tailored to each client. For example, a limited programme of harm reduction and drug education may be most appropriate. In some cases an extended programme of substitute prescribing, individual work, conjoint work with carers and multi-agency liaison with other agencies would be explored. Harm reduction focuses on safer drug use rather than telling someone to stop. As part of their first contact A-DASH workers will assess the level of drug problems and other related risk factors. This will enable them to provide information and advice to help reduce the health and social risks surrounding a young person s drug use e.g. overdose or accidental harm whilst under the influence. It may include indirect effects relating to mental health, sexual health or risk of offending. Where are the young people seen? A-DASH offers an outreach service making it more accessible to young people. As long as the young person and staff feel safe, A-DASH can arrange to meet at various locations across the county including Youth Connexions One Stop Shops, GP surgeries and schools. If appropriate, A-DASH can meet the young person in their home. What do I do if the young person declines the service or doesn t need a specialist intervention? If this is the case and some kind of intervention is required, A-DASH will support Integrated Practice arrangements by ensuring a drugs worker attends a Team Around the Child Meeting or by offering further advice. What happens when treatment finishes? There are a number of other services in Hertfordshire available to young people after they are discharged. Many of these services will already be involved as part of the holistic care plan addressing the Every Child Matters outcomes and may include education, housing, other medical and mental health services, Youth Connexions etc. All young people, their carers (if involved) and their key professional will be asked to complete a service feedback form to help monitor the care and support provided and help to make any improvements. 7

8 What happens when the young person turns 18 years? Substance Misuse services in Hertfordshire follow a Transition Protocol when a young person continues to need treatment into adulthood. Good transitional arrangements will ensure that treatments are provided consistently, with no loss of effectiveness, and that risks to the young person are minimised. Not all young people will be ready to make the transfer to adult services at the same time; therefore, any transfer should be decided on the needs of the individual young person and we may need to delay the transition process until after their 18th birthday. A transitional care plan will be developed by A-DASH and the agreed Adult Service. Discussions will take place with the young person as part of the process and be recorded in the care plan. All agreed transitional arrangements will be closely monitored as stated within the Substance Misuse Services Hertfordshire Transition Protocol 2008 How do you deal with confidentiality issues? All A-DASH staff are duty bound to respect the confidentiality of people referred to their service. Information is shared with other workers on a "need to know" basis. In situations where there is a serious risk either to the young person or to others, the local safeguarding procedures will be implemented. Information is recorded on a computer system which can be accessed by the relevant A-DASH staff. A-DASH do not routinely contact GPs unless there is a medical reason to do so e.g. prescribing issues or requirements for blood tests etc. If a young person is legally competent to understand fully what is proposed (sometimes known as Fraser competent), confidentiality will be maintained and their wishes will be respected. Information will not be automatically passed to parents or carers. However within the spirit of the Children Act (1989) A-DASH always attempts to work in partnership with families and carers if at all possible. EUAL OPPORTUNITIES Hertfordshire Partnership NHS Foundation Trust works toward eliminating all forms of discrimination and promoting equality of opportunity for all. If the young person or their carer would like the help of a language interpreter during the appointment, please contact A-DASH to arrange this service. Sign language interpreters are also available. This service is free to users of our service. 8 The information in this booklet can be provided in other formats and languages. Should you require this service or any additional copies of this booklet please contact A-DASH on

9 ACCESS TO RECORDS The Data Protection Act 1998 gives every living person the right to apply for access to their health records. Clients have the right to request access to all records held about them, although some information may be withheld if it is felt to be detrimental to their mental health. All clients accessing A-DASH are involved in developing their care plan and will be routinely offered a copy, which indicates the current treatment and support that has been agreed. COMMENTS, COMPLIMENTS AND COMPLAINTS A-DASH is always pleased to hear from young people or carers and professionals who feel A-DASH have provided a good service and always welcome suggestions on how improvements can be made. Hertfordshire Partnership NHS Foundation Trust encourages their staff to help deal with any concerns or complaints in a friendly, confidential manner. The Trust also recognises that some groups of people can experience unfair discrimination because of their age, gender, disability, race or sexuality. The Trust is committed to ensuring that everyone is able to make a comment or complaint and to have any issues addressed fairly. Contact the Patient Advice and Liaison Service (PALS) on to report your complaint. If, after speaking with a member of staff or PALS, you feel that your concern has not been satisfactorily resolved, you can telephone or write to: Hertfordshire Partnership NHS Foundation Trust, 99 Waverley Road, St Albans AL3 5TL If you feel your concern has not been satisfactorily resolved you can send your complaint to: The Complaints Manager or the Chief Executive, Hertfordshire Partnership NHS Foundation Trust 99 Waverley Road, St Albans AL3 5TL Or you can telephone the Complaints Department on

10 CRAFFT TOOL Drug/Alcohol Assessment tool for use with young people. Evidence from young people accessing the Adolescent Drug and Alcohol Service in Hertfordshire (A-DASH) suggests that they did tell someone about their drug use early in their drug using history, but it was ignored. CRAFFT is a multi-agency tool that will enable staff as part of any assessment process to identify young people s drug and alcohol use early. The tool consists of CRAFFT questions that have been validated in the USA. You do not need specialist drug knowledge to use this tool. The idea is to ensure early drug and/or alcohol use is identified and the appropriate services and responses are provided. The questions can contribute to other assessment processes e.g. CAF, ASSET. It can also be used in a discussion with a young person about their drug use. If you require further support or training to complete CRAFFT please call A-DASH for assistance. Trigger questions: Do you have concerns regarding a young person s drug use? Has drug and/or alcohol use/misuse been mentioned in an assessment or discussion? If the answer is yes to one of the above then ask all the CRAFFT six questions CRAFFT questions yes no 1. Have you ever ridden in a Car driven by someone (including yourself) who was high or had been using alcohol or drugs? 2. Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in? 3. Do you ever use alcohol or drugs while you are by yourself Alone? 4. Do you ever Forget things you did while using alcohol or drugs? 5. Do your Family or friends ever tell you that you should cut down on your drinking or drug use? 6. Have you ever been in Trouble while you were using alcohol or drugs? SCORING If a young person under 14 years of age answers yes to 1 or more of these questions then this indicates the need to have a consultancy conversation with A-DASH - see contact details below. If a young person between years of age answers yes to 2 or more questions then this indicates the need to have a consultancy conversation with A-DASH - see contact details below If the young person does not require or declines any targeted or specialist intervention, you can call A-DASH to discuss the situation on a 'what if' basis without having to disclose the name, address etc of the client. Depending on the age of the client, integrated practice arrangements may need to be undertaken. 10 The Adolescent Drug and Alcohol Service for Hertfordshire (A-DASH) provides professional advice to staff or parents on young people s drug and alcohol use, harm minimisation, treatment and support. A-DASH also provides a service for young people under 18 in Hertfordshire who have issues/problems with their own drug and/or alcohol use. Contact A-DASH on or or text In relation to the CRAFFT tool Drugs refers to medicines, volatile substances, alcohol and illegal drugs.

11 Useful Contacts: Family Information Service - ( ) or or visit Integrated Practice For the latest information on the Common Assessment Framework and Integrated Practice visit: FRANK - ( ) Is a free national and confidential information and advice line, 24 hours a day, or visit FRANK leaflets and action packs on a range of subjects including Families, Cannabis, Diversity and Vulnerable Groups, can be accessed from Parentline Plus - ( ) Offers support for anyone parenting a child, 24 hours a day or visit Parental Drug Awareness Service - ( ) Is a free and confidential service offering information, support and advice to parents and carers in Hertfordshire who may be concerned about their children and drug, alcohol and solvent use or misuse. Health Promotion Hertfordshire - ( ) Provides health information resources for professionals. This includes leaflets, posters, training packs, models and games. Online booking available from Adfam ( is a national organisation working with families affected by drugs and alcohol and is a leading agency in substance related family work. It provides a range of publications and resources for families. 11

12 Date of publication September 2009 Produced by A-DASH on behalf of HPFT

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