6.9 Health of young offenders

6.9 Health of young offenders 6.91 Introduction The youth justice system (YJS) was set up under the Crime and Disorder Act (1998), to prevent young people from reoffending. The Youth Offending Service (YOS) work with 10 to 18 year old Barking and Dagenham residents who come into contact with the criminal justice system. The Crime and Disorder Act requires that local authorities, the police, probation, and health (Clinical Commissioning Groups (CCGs)) set up Youth Offending Services (YOSs) to work with children and young people who were offending or at risk of offending. The CCGs were required to: Co-operate with local authorities in establishing YOSs; Contribute to their budget; and Provide or nominate a member of the YOS team. The YOS had to include representatives from the police, probation, health, education and children s services and have responsibility for children and young people sentenced or remanded in custody. With the extension of the Healthy Child Programme to children aged 5-19, guidance for school health teams highlights the importance of providing enhanced support for vulnerable children and young people. The aims of this section are to: Outline the main health needs of the young offender population in Barking and Dagenham; Determine the extent to which current service provision is addressing the needs of the young offender population; and Make recommendations on how the health of the young offender population can be improved. London and National Picture Youth Offending Teams have three performance targets that they are regularly monitored on which are:- Reduce First Time Entrants Reduce Re-offending Reduce the use of custody In April 2013 the courts introduced restorative solutions such as Youth Conditional Cautions and Triage as an alternative to reprimands and warnings.

In 2013/14, 61,053 offences were committed by young people aged 10-18 in England and Wales 1. Of these, 22,393 (37%) were first offences and the rest were further offences (63%) (See Figure 1). In 2003/04, 185,478 offences were committed by young people, of which 48% were first time offences. So, over the last few years, there has been a large decrease in the number of offences committed by young people in England and Wales. Figure 1: First and further offences committed by young people in England and Wales, 2003/04 to 2013/14 1 There has been a downward trend in the number of first time entrants to the YJS since the peak in 2006/07. The number of first time entrants to the YJS has fallen by 75% since 2003/04, and by 51% since 2010/11. Females made up 22% of the first times entrants to the YJS in 2013/14, down from 28% in 2010/11. Furthermore, since 2010/11 the number of young females entering the YJS has fallen by 61%, whilst in young males it has fallen by 48%. Young people who were Black, Asian or Other Minority Ethnic groups made up 16% of all first time entrants to the YJS in 2013/14, which is the same level as reported in 2010/11. Young people who were White made up 78% of first time entrants, and 6% had an unknown ethnicity. The number of young offenders in secure estates has fallen over the last seven years (See Figure 2). This figure has fallen considerably as a result of attempts to work with more young offenders in the community and by offering alternative measures outside of custodial sentences. 1 Source: Youth justice annual statistics, 2013 to 2014, January 2015, available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/399379/youth-justice-annual-stats-13-14.pdf

Figure 1: Average Secure Estate for Children and Young People Population, 2005/06 2014/15* 3500 3000 2832 2915 2932 2881 2500 2000 1500 1000 2418 2040 1963 1544 1216 1048 500 0 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15* Source: Youth Custody Report, May 2015, available at: https://www.gov.uk/government/statistics/youth-custody-data#history *2014/15 data is provisional at time of publication and finalised figures will be available in the Annual Youth Justice Statistical publication. In 2014-2015 the average population of young people (under 18s) in custody in England and Wales was 1,048 (see Figure 2). 6.9.2 Local Picture In addition to the National Youth Offending Team performance targets, several KPIs have been agreed locally with regard to health needs specifically (See Table 1). Table 1: Rates of young people aged 10-17 receiving their first out of court disposal or conviction. KPIs Number of ASSET assessments undertaken by YOS worker with completed health section Number of ASSET assessments reviewed by health worker within 72 hours Number of CYP receiving second tier general health assessment and screening Measurement - comments Number of new ASSET assessments completed in the relevant quarter with completed health section Number of new ASSET assessments completed in the relevant quarter with completed health section reviewed within 72 hours by health worker Number of CYP receiving second tier general health assessment and screening in relevant quarter following completion of ASSET assessment/health review.

Number of CYP who access mental health/physical health care following general health assessment Number of CYP who access mental health/physical health care following general health assessment in relevant quarter. Number of CYP stepped up to tier 3 CAMHs Number of CYP who are stepped up to tier 3 CAMHS in relevant quarter. Number of CYP smoking at general health assessment Number of CYP smoking at general health assessment for reporting quarter in question. Number of CYP in service for over 6 months smoking Number of CYP on health caseload smoking after 6 months for reporting quarter in question. NB this will not report changes in same cohort but should overtime provide indication of changes in smoking status for CYP with general health interventions In 2013, for every 100,000 10-17 year olds in the population of Barking and Dagenham, 463.1 received their first reprimand, warning or conviction. The England value is 440.9. Table 2 shows comparisons to national and regional data. Table 2: Rates per 100,000 young people aged 10-17 receiving their first reprimand, warning (now known as out of court disposal) or conviction. Barking and Dagenham First time entrants to the youth justice system (2010) First time entrants to the youth justice system (2011) First time entrants to the youth justice system (2012) First time entrants to the youth justice system (2013) 957.2 817.6 517.3 463.1 London 983.1 795.9 591.3 458.2 England 901.7 725.6 556 440.9 Source: Department for Education. Further information: www.education.gov.uk/rsgateway/db/str/d000895/index.shtml The local Youth Offending Service (YOS) work with 10 to 18 year old Barking and Dagenham residents who come into contact with the criminal justice system. Once an initial assessment is completed, those young people with additional needs such as substance misuse or mental health needs are then referred to the appropriate workers or services. The following chart outlines the number of individuals accessing the YOS during 2014/15 and the number of those with additional needs that have been referred to substance misuse or mental health workers.

Kingston and Richmond Merton Sutton Bexley Greenwich Harrow Hounslow Havering Camden Ealing Barnet Bromley Westminster Tower Hamlets and City Hillingdon Enfield Redbridge Southwark Barking and Dagenham Waltham Forest Croydon Kensington and Chelsea Newham Lambeth Wandsworth Hammersmith and Lewisham Hackney Brent Islington Haringey Figure 3: Youth offenders in Barking and Dagenham 2014/15 300 250 253 200 150 175 100 50 0 Total Caseload Substance Misuse Mental Health Source: Barking and Dagenham Youth Offending Service The total caseload in Barking and Dagenham for 2014/5 was 253 young offenders. There were 175 substance misuse referrals, and 18 young people were referred to the psychologist within the team (See Figure 3). A wider range of young people received lower level emotional well being support. 18 6.9.3 Custodial Sentences Barking and Dagenham has the 13th highest rate of custodial sentences for youth offenders in London (See Figure 4), and is therefore in line with the London average. Figure 4: Rate of custodial sentences for youth offenders, Barking and Dagenham and London, rate per 1,000 population aged 10-17 years, 2013/14 2.5 2 Custodial Sentences London 1.5 1 0.5 0 Source: Youth Justice Management Information System (YJMIS)

6.9.4 Risk behaviours Teenage pregnancy National data suggests there is a higher engagement in crime by male children of adolescent mothers (Maynard, 1997). Estimates also suggest that around 39% of young women under the age of 21 in prison are mothers, and 25% of young men are fathers (NICE 2007). Table 3 shows the rate for under 18 conceptions per 1,000 females aged 15-17 years in Barking and Dagenham compared to national and regional data. Between 2005/06 and 2013/14 the under 18 conception rate per 1,000 females aged 15-17 years has dropped from 65.9 to 40.1 in Barking and Dagenham. Over the same period the average rate in England decreased from 41.4 to 21.3 per 1,000 female population aged 15-17. Table 3: Under 18 conception rate (per 1,000 females aged 15-17 years) Barking and Dagenham 42.5 Under 18 conception rate (per 1,000 females aged 15-17 years) (2013/14) London 21.8 England 23.9 Source: Office of National Statistics Please see Section 7.13.2 Teenage Pregnancy for further details on Teenage Pregnancy in Barking and Dagenham, and the work being undertaken to reduce this. 6.9.5 Substance Misuse During 2014/15 the substance misuse workers within the YOS received 175 referrals. The majority of these referrals were in relation to alcohol and cannabis use. Most substance use amongst the youth offending population remains alcohol and cannabis use with very little class A or legal high use. Substance misuse sessions primarily focus on an education and harm reduction model. What are the needs locally? The current training needs of case managers within the Youth Offending Service are not fully known at present. A full review of current skills within the team and an outline of all training needs of staff would benefit the team as a whole and allow them to offer the best possible support for the young offenders of Barking and Dagenham. However a focus on speech and language and discussing healthy relationships with young people would be of benefit. YOS staff are currently trained to complete assessments of sexualised behaviour utilising the AIM2 model, however there is a further need for training in the delivery and supervision of these cases.

Comprehensive Health Assessment Tool (CHAT) Young people who are in contact with the Youth Justice System (YJS) are generally a socially excluded population with complex health care needs. There is evidence to suggest that young people who offend are less likely to have their health care needs recognised and these needs tend to remain unrecognised as they enter the YJS. The most common reason for unmet need is a lack of screening. The Offender Health Research Network (OHRN) has developed the Comprehensive Health Assessment Tool (CHAT). The CHAT provides the opportunity for standardised holistic screening and assessment of all young people throughout the YJS, aiding early intervention of needs. The CHAT looks at the following needs of a young offender: Physical Health Substance Misuse Mental Health Neurodevelopment disorders, including learning disabilities The following guidance available from OHRN outlines who should complete each section of the CHAT. The Physical and Mental Health Assessment should be completed by nurses with Registered General Nurse (RGN), Registered Mental Nurse (RMN), or Registered Nurse (specialising in children; RNC) status or experienced Child and Adolescent Mental Health Services (CAMHS) practitioners with the relevant training. The Substance Misuse Assessment should be completed by staff with expertise in the assessment and treatment of young people with substance misuse problems, specifically a substance misuse worker, RGN, RMN or experienced CAMHS practitioners (RGNs/RMNs/CAMHS practitioners may need additional training/supervision in substance misuse). The Neurodisability Assessment should be completed by an RGN, RMN, Registered Learning Disability Nurse (RLDN) or experienced CAMHS practitioner (RGNs/RMNs/CAMHS practitioners may need additional training/supervision in neurodisability). The CHAT is a very sophisticated assessment tool and must be completed by professionals who have been fully trained in using it. According to the 2015 Ministry of Justice Youth Custody Data Report, a review of data suggests that the prevalence of neurodevelopmental disorders such as dyslexia, communication disorders and epilepsy amongst young people in custody is higher than in the general youth population. This along with other evidence that highlight the unmet health needs in young offenders shows that there is a need to fully assess the health needs of young offenders, and also shows that pathways are needed to allow for referrals to appropriate services once needs are identified.

The YOS currently has just one health staff member within the team who is a registered psychologist. The use of the CHAT tool is currently under discussion as this will bring with it a need to identify who is most relevant to complete this with young people. Autistic Spectrum Disorders A study in South East London, (Baird et al, 2006) estimated the prevalence of childhood autism at 38.9 per 10,000 and that of other ASDs at 77.2 per 10,000. This made the total prevalence of all ASDs 116.1 per 10,000 or approximately 1%. If the prevalence rate found in Baird's study were applied to the population aged 5 to 16 years of Barking and Dagenham this would give an estimate of approximately 293 children. Learning disability It is estimated that 25 to 30 per cent of children and young people in the YJS have learning disabilities, and that this rises to around 50 per cent of those in custody (HM Government, 2009). Estimating the prevalence of learning disability is problematic and should be treated with caution. One general population study (Emerson and Hatton, 2004) estimated that 2% of the total population has a learning disability, and the researchers calculated age related prevalence as follows: 5 to 9 years - 0.96%; 10 to 14 years - 2.26%; and 15 to 19 years - 2.67%. The estimated total number of children with a learning disability in Barking and Dagenham are shown in Table 4. Table 4: Estimated total number of children with a learning disability Barking and Dagenham Ages 10 to 14 (2010) 268 Ages 15 to 19 (2010) 315 Source: Estimates based on ONS population data Speech and Language Therapy (SALT) Over 60% of young people in the justice system have a communication disability (Bryan et al, 2007 2 ). SALT interventions can help prevent and reduce the re-offending rate by increasing access to a wider range of rehabilitation and treatment programmes and subsequently empower them to change their offending behaviour (Crace, 2006 3 ). 2 Bryan K, Freer J, Furlong C. Language and communication difficulties in juvenile offenders. International Journal of language and communication difficulties, 2007; 42, 505-520.

SALT is commonly used to help people with language or communication difficulties. A Speech and Language Therapist is trained to assess and treat speech, language and communication problems in people of all ages to enable them to communicate to the best of their ability. 6.9.6 How to address the local needs Recommendations Recruitment of worker who can complete physical and mental health assessments. Pathways for physical and mental health interventions would need to be in place to allow identified needs to be met. Provision of drop in clinics with a health professional to ensure all health needs of young people are identified and addressed. An audit of training needs for all case managers and the development of a training schedule to ensure all workers have the necessary training to fully support the young offenders on their case loads. Offering interventions to young offenders around sexual health and risky behaviours. Access to Speech And Language Therapy (SALT) through clear pathways and screening tools. Provision of annual health checks and immunisations for young offenders. Implementation of the Completion of the Comprehensive Health Assessment Tool (CHAT) including training of appropriate health professionals to deliver. Pathways would also need to be developed to ensure that all young people accessing the YOS can be assessed. Partners should consider the provision of adequate health services to support young offenders, with a clear set of outcomes and activity expectations. 3 Crace, J. Talking your way out, Guardian, Tuesday 28 February 2006: A short course in oral communication skills is providing the best way to stop prisoners offending.