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13.7 Substance Misuse

SCOPE OF THIS CHAPTER

This chapter relates to children placed in residential care. It details the prevention and detection of drug activity within the Home. It also covers allegations and the confiscation and disposal of substances.

RELEVANT LEGISLATION AND GUIDANCE

Children's Homes Quality Standards and Regulations, The Protection of Children Standard

New Psychoactive Substances (NPS) Resource Pack for Informal Educators and Practitioners (Home Office)

Promoting the Health and Wellbeing of Looked After Children

AMENDMENT

In January 2017, a link was added to the New Psychoactive Substances (NPS) Resource Pack for Informal Educators and Practitioners (Home Office) in the Relevant Legislation and Guidance section.


Contents

  1. Introduction
  2. Warning Signs of Possible Drug Misuse
  3. Where there is an Allegation or Suspicion of involvement in Drug, Alcohol or Solvent use
  4. Dealing with Substance Misuse Incidents
  5. Confiscation and Disposal
  6. Supplying Drugs to other Young People
  7. Confidentiality


1. Introduction

Nottinghamshire County Council Children’s Social Care and Health does not condone the use of alcohol, drugs (including the misuse of prescribed medication) and other intoxicating substances by young people for whom it has responsibility.

Staff employed within Children’s Social Care are charged with a duty to protect young people and provide positive care by taking all reasonable steps to prevent them from harming themselves and others.

The Manager of the Home has a legal responsibility to ensure that staff follow policies to prevent drug activity within the Home by following these guidelines.

Staff are under a legal obligation to report crime. However, judgements will need to be made about whether to inform or involve the Police. These decisions will depend on the nature and seriousness of the situation.

Residential staff should ensure the young person's social worker is informed when caring for a young person involved in substance misuse.

Where a young person Looked After is known to be misusing substances, or is suspected of doing so, the Care Plan and review will address the issues and agree the action necessary. It will also be appropriate to undertake a risk assessment.

The young person should be involved in any discussions and decisions as far as possible.

The Department will make every effort to provide effective services for young people who experience problems related to their use of alcohol or other drugs. Where services prove ineffective the Department will undertake to review the Care Plan of the young person concerned.

The Department will work collaboratively with other agencies, in particular those agencies in the non-statutory and health sector with specialist knowledge and experience of working with young substance misusers.

Staff will maintain clear recordings, usually on the young person's file, which specify the circumstances, decisions, any action taken, and the rationale for these.

The Department should ensure that staff receive the appropriate training and advice, and this should be recorded and actioned through the supervision and EPDR process.


2. Warning Signs of Possible Drug Misuse

Some possible signs of drug misuse can be confused with signs of other problems or quite innocent behaviour. Care should be taken not to jump to conclusions. However, there are signs which, when taken together, may prompt the need for further investigation with drug or other substance misuse in mind.

Those where equipment is required:

  • Containers made from silver foil, perhaps discoloured by heat;
  • Small bottles or pill bottles;
  • Twists of paper used to wrap powders;
  • Corners of clear plastic bags used to wrap powders;
  • Packages labelled as bath salts or plant food;
  • Straws used for inhaling;
  • Syringes or needles;
  • Empty solvent containers;
  • Cigarette lighters;
  • Plastic bags or crisp packets for holding glue;
  • Drink cans with extra holes and signs of scorching;
  • Spoons for 'cooking' substances.

Physical and behavioural symptoms:

  • Sudden changes in mood, unusual outbreaks of temper;
  • Disregard for physical appearance;
  • Use of deodorant to cover the smell of drugs or solvents;
  • Drowsiness, sleeplessness or slurred speech;
  • Unusual smell, stains or marks on clothes or body and around the nose and mouth;
  • Marked interest in glue or other solvents;
  • Soreness or redness around the eyes or mouth;
  • Meeting with others in secretive places;
  • Enlarged or dilated pupils;
  • Unsteady on feet;
  • Staining on hands;
  • Excessive fluid intake;
  • Increased or decreased appetite;
  • Hallucinating;
  • Agitation or manic behaviour;
  • Increase in physical activity;
  • Sleeplessness.


3. Where there is an Allegation or Suspicion of involvement in Drug, Alcohol or Solvent use

This guidance is to help staff deal with young people who use drugs, alcohol and solvents whilst they are Looked After in residential care.

Where a young person who is suspected of having taken an intoxicating substance it is the duty of Children’s social care and the staff to care for that young person and to look after them.

Where a medical emergency exists then an ambulance will be called.

Where the young person shows any signs of alcohol intoxication then it may be advisable for them to sleep it off in a safe warm environment under constant observation with regular review of their condition.

Before following this course, staff should check with the young person what they have taken, and consider known and suspected drug and alcohol patterns before deciding on the level of possible risk.

If there are any doubts or concerns then medical advice should be sought.

Where the young person shows signs that they may harm themselves or others, e.g. by becoming violent, at risk of accidental injury or hallucinating, then steps may be taken to protect the young person, others and property. Efforts should be made to diffuse any violence or risk rather than to inflame or escalate the situation and risk further harm. This can be particularly important when managing a young person who is hallucinating. Staff may consider calling the Police where behaviour escalates out of control. See Contacting the Police in respect of Children in Residential Care Procedure.

When the immediate situation has calmed and the effects of the substance have worn off, staff will need to discuss the situation/incident with the young person. Staff will need to offer a helping hand to the young person and enable them to discuss possible substance misuse in a supportive atmosphere. While not condoning drug or alcohol misuse, staff need to be able to deal with the reality of the young person's experience in a non-judgmental and helpful way.

Staff will need to sensitively elicit information about the substance use in order to inform and help them work with the young person. Careful consideration needs to be given to whether providing this information to the Police will be in the young person's best interests. The Police should be informed if significant quantities of illegal substances are found on the premises or the young person is deemed to be exploiting others by the supply of illegal substances.

Staff should work with young people to motivate them and help them to access support and advice on their substance misuse through Nottinghamshire County Council’s Targeted Support and Youth Justice Service. Staff can also access advice from the service. Specialist staff can work with young people to help reduce or cease substance misuse; to reduce the risks posed from substance misuse or to divert them into more positive activities.

Any agreed actions to manage substance misuse should be captured within the young person’s Care Plan. In some circumstances following a competency assessment (see Fraser Guidelines below) and where the young person cannot be persuaded to involve carers, young people may receive a confidential service in relation to their substance misuse. Confidentiality would only be broken if there was a risk of serious harm to the young person, themselves or others.

Where the substance misuse of the young person gets worse consideration may need to be given to moving the person to other more suitable accommodation where further assistance can be given and/or the behaviour managed more effectively. Alternatives may include, for example, an application to secure accommodation, a drug rehabilitation unit, or to specialist foster carers. This would form part of the young person's care planning through the review process.


4. Dealing with Substance Misuse Incidents

Procedures for Dealing with Emergencies

Where a young person is unconscious, fitting or convulsing or otherwise appears to be seriously ill, staff must apply emergency First Aid and call immediately for an ambulance.

Where there is an indication that a young person may have taken an overdose of medication, illicit drugs or alcohol staff should either arrange to take the child immediately to the nearest Accident and Emergency Department or call for an ambulance.

A GP may be called in preference to the emergency services when the child is displaying signs of mental disturbance rather than actual poisoning or overdose. However, if in doubt an ambulance should be called.

social worker/Emergency Duty Team and parents should be informed if the young person becomes a medical emergency or if the Police become involved.

The procedures for notification when a young person sustains an injury or dies should be followed.

Staff must record the event or incident in the young person's case records.

DO

  • Keep calm - anger and confrontation will not help at this stage;
  • Try to sit the person in a quiet room;
  • Provide fresh air by opening windows;
  • Talk quietly and calmly;
  • Keep them under observation until help arrives;
  • Be ready to administer first aid;
  • Try to have a colleague nearby;
  • Try not to let any unpleasant/aggressive behaviour upset you; do not take it personally.

DO NOT

  • Put the young person to bed or on a couch to sleep it off and leave them alone;
  • Chase or threaten anyone who may have used solvents; some solvents can cause heart failure;
  • Restrain in cases of hallucination unless absolutely necessary to protect the young person or others.

It is vital that some form of action is taken and recorded.

Procedure for Dealing with Non-Emergencies

Where a young person reports or appears to be in possession, or may be using or supplying intoxicating substances, i.e. alcohol, controlled drugs, or solvents, staff must consult the Unit Manager and, if possible, the social worker and the situation carefully considered before taking any action.

The young person's need and the most effective method of intervening should be considered.

This may mean not reporting the situation to the Police if the situation is of a lesser nature and other young people are not being placed at significant risk of harm. Lesser nature may mean, for example, a small quantity for personal use as opposed to a larger quantity for possible supply to others. This judgement should be made by the Unit Manager/the senior member of staff available in conjunction with the social workers wherever possible.

Unless there is a need for immediate action, because of the medical situation, or the severity (e.g. supplying drugs to others), the decision on what action to take will include consultation between the unit, the social worker, Key Worker and, where appropriate, parents and Team Manager as part of the child's Care Plan. The local Liaison Officer may be helpfully involved in the discussion, even though there are no intentions to involve the Police formally or to pursue criminal charges. The decision will be taken by the Unit Manager because of their ultimate responsibility for the Children's Home. If the Unit Manager believes that s/he or staff are compromised by the young person's on-going behaviour, s/he retains the right to inform the Police. Options available include:

  • No further action;
  • Call a strategy meeting;
  • A review meeting;
  • Provide in-house intervention (relevant information, advice, support, counselling, in-house sanctions);
  • Conduct an assessment of the young person's situation, possibly involving a worker from a drug and alcohol service agency, a GP, the Police etc.;
  • Refer the young person to an appropriate agency which may include a specialist drug and alcohol service, a GP, the Police, Probation Provider, etc.
  • All planned interventions should be noted in the young person's records and their effectiveness monitored through the review.


5. Confiscation and Disposal

All reasonable attempts should be made to remove materials from the young person.

Under normal circumstances the young person should be politely, but definitely requested to hand over any such substances. It is normally advisable to have a second member of staff present where possible. Care should be taken not to raise the anxiety level of the young person where they are suspected to be under the influence of an intoxicating substance. This may provoke medical problems such as heart failure or breathing problems where certain drugs are involved. Provocation may also lead to aggression and this is to be avoided where possible.

Before taking any action the senior person on duty may want to discuss and agree with his/her manager the level of risk posed to the young person, other residents, or to staff.

Where the young person refuses to hand over the substance the Unit Manager or senior person on duty must decide what action to take, including calling the Police. Every effort should be made to avoid escalating the situation within the limitations of the law and the duty to care for the young person and others.

Managers and staff should work within the Department's safety policy, the Violence to Staff guidelines, and the policy and procedure on physical contact when making any decisions.

It is preferable for any confiscation of intoxicating substances to be witnessed by another member of staff. Where this is not possible the confiscation should be reported to another member of staff and the Unit Manager at the first opportunity.

Drugs and drug-related material should be stored securely before handing to the Police. These should not be disposed of by staff. These can be handed over for disposal without identifying the name of the young person.

The record of the removal should be kept by staff which includes:

  • A name of the person removing the material;
  • A description of the material;
  • The circumstances of the removal;
  • The time and date of the removal;
  • The time and date that the material is placed in secure storage;
  • The signature of the person putting the article in to storage countersigned by a second member of staff;
  • The time and date of notification to the Police, and the message number provided by the Police control room;
  • The time and the date the material was removed by the Police.
  • When Police remove the material, this should be recorded.

The Police should be contacted as soon as possible so that controlled substances should not be stored in a Children's Home for longer than necessary.

Staff should first contact the local Police control room to arrange for the Local Liaison Officer to attend the Home. The route allows for the recording of the request on the Command and Control system, generating a message number for the benefit of the residential staff. If this officer is not available, then arrangements should be made for another officer to attend.

The officer attending is then responsible for recovering the suspected controlled substances in to Police possession and conducting any subsequent investigation in line with existing Police policy.

Alcohol and canisters can be disposed of safely by staff; it is important that the disposal is witnessed and a record kept which includes:

  1. A name of the person removing the material;
  2. A description of the material;
  3. The circumstances of the removal;
  4. The time and date of the removal;
  5. The time, date and means of disposal.

A record must always be kept on the young person's case records.


6. Supplying Drugs to other Young People

If there is evidence or reasonable suspicion that a young person is supplying controlled drugs to others then the Police will be informed. This decision is taken by the Unit Manager/senior member of staff available with the involvement of the child's social worker and the Team Manager. When the Police are informed, the parents of the young person will also be informed.

This may include the quantity of substances in the possession of the young person, their behaviour, and reliable information about their activities. Suspicion alone is insufficient.

The young person will need to be made aware of the seriousness with which the Department views this activity and the legal implications of what they are doing. Advice and involvement from one of the specialist drug and alcohol services may be considered.


7. Confidentiality

In order to provide care it is important that the young person feels able to disclose their substance use and associated problems. Informing parents or Police of such information needs to be considered in the knowledge that this may result in the young person failing to disclose their substance misuse. When a young person admits they are using drugs they should be encouraged to share any problems with their parents.

If the young person is considered to be of sufficient age and understanding to acknowledge the dangers and implications of their drug or alcohol use, then parents and the Police may not need to be informed. This decision should be taken at a planning meeting or a review. This should be based on an open and honest assessment of the current substance use and potential future use. This would need to take account of the Gillick Competencies and:

  • What substances are being used, how often, by what method and over what period this has occurred;
  • An assessment of the level of risk that the young person is exposed to;
  • The way in which the money for the substances is acquired;
  • Any involvement in the trading of sex for drugs or money and whether there is exploitation by adults. See Nottinghamshire and Nottingham City Safeguarding Children Boards’ Safeguarding Children Procedures.
  • The Fraser Guidelines, covering decisions about when treatment can be given with Parental Consent are as follows :
    • .”.:a practitioner can give advice and treatment provided they are satisfied in the following criteria:
      1. That the person (although under the age of 16years of age) will understand the advice;
      2. That the practitioner cannot persuade them to inform their parents or to allow him to inform the parents that she is seeking contraceptive advice;
      3. That they are very likely to continue in the behaviour;
      4. That unless they receive advice or treatment their physical or mental health or both are likely to suffer;
      5. That their best interests require the practitioner to give them advice, treatment or both without parental consent.”

The Department works, wherever possible, with parents. The withholding of information about serious incidents requires very careful consideration.

The young person's wishes about who should be informed should be taken into consideration alongside legal obligation on the part of staff. 

The young person should be made aware of the circumstances when the emergency services or Police may be called and when parents may be informed:

  • Where there is any indication of Sexual or Physical Abuse;
  • Where there is a clear medical emergency and an ambulance is called;
  • Where the young person is under 16 and considered not to be of sufficient age or understanding to be aware of the risks to themselves or the advice given;
  • There is a refusal to stop the use of intoxicating substances on the premises;
  • Where the young person is deemed to be exploiting others by the supply of illegal substances or by the encouragement of use;
  • Where significant quantities of illegal substances are found on the premises.

End