8.44 Young Persons’ Substance Misuse
- Links with Section 47 Enquires
- Confidentiality and Consent
- Further Reading
Substance use among young people has increased in recent decades and should be routinely explored within assessments of need and risk in all children's services.
All substances, including alcohol carry potential risks if misused. For example, statistically there are more deaths among school age children from inhaling chemical substances than from all other illegal drugs.
It is important for those working with children and young people to be able to recognise experimental or recreational use and distinguish this from a young person's problematic use.
For the purposes of this guidance problematic use is looked at in terms of frequency, patterns of use, method of use, amounts used, social, emotional and physical effects and any other wider issues of vulnerability and risk.
Not all problematic use will need to be considered in terms of child protection processes but for some young people their problematic substance use, and related issues, will need to be considered as an issue of actual or potential Significant Harm.
In terms of the recognition of problematic substance use, the following common indicators should be considered:
As with all general risk factors it is important to appreciate that there can be other reasons underlying the difficulties and careful assessment is needed.
Particular attention also needs to be given to vulnerable young people who are known to fall into groups where substance misuse is likely to be more prevalent. These are:
Links with Section 47 Enquires
There are a number of questions that can be asked when considering the need for a referral to Children's Social Care as a child in need of protection.
If the young person has a combination of these factors in their problematic substance use then careful assessment using the four parameters outlined in the assessment section should be undertaken. It is important that professionals understand how to access their local specialist young people's substance use team to make use of their specialist knowledge and skills.
If it is felt that that the young person's substance use has or is likely to become a child protection issue the general processes laid out in this guidance with regard to referring to Children's Social Care must be followed - see Making a Referrals Procedure. If workers are not sure of the need for referral, consultation should always occur with Children's Social Care and be recorded as an outcome.
Any agency concerned that the young person's drug/alcohol use is a child protection matter must also refer to the young persons' substance misuse service as well Children's Social Care. If the use is that problematic there is probably a need for a rapid response to reduce risk, the double referral will reduce delay.
Workers in universal and targeted services should consult with the local young people's substance use services in deciding whether a young person's substance use is an issue of Significant Harm or escalating risk. Where there are actual or potential issues of Significant Harm relating to a young person's substance use this liaison and consultation must take place.
Certain vulnerable groups such as children of substance misusing parents for whom there may be a concern around whether or not they are using substances, should always be referred to specialist services for joint assessment purposes.
Confidentiality and Consent
The duty of confidentiality owed a young person under 16 is the same as that owed to any other person, but the right to confidentiality is not absolute.
Where there is a child protection risk associated with the young person's substance use this outweighs the young person's right to privacy - see Information Sharing and Confidentiality. In these circumstances professionals should act in accordance with the Making a Referral Procedure.
A young person should be encouraged to accept a referral to specialist young peoples substance use services but as above, in cases where actual or potential Significant Harm are arising, professionals need to seek the advice and support of colleagues in specialist services when acting to safeguard young people from substance related Significant Harm and refer appropriately.
In cases of potential Significant Harm relating to a young person's substance use consideration will need to be given to the involvement of parents and carers, if they do not already know about or recognise the young person's substance use as an issue of Significant Harm.
In relation to substance use the case law (Fraser Guidelines) suggests that young people using substances problematically may be less able to give informed consent.
The 'Four Parameters' guidance below sets out a framework for identifying when a young person's substance use may be actually or potentially a child protection issue.
The age and maturity of the child or young person
The younger the child, the more problematic it is to guarantee or maintain confidentiality. Given the problems of establishing competence, and therefore capacity to consent, young people under the age of 13 are unlikely to be offered confidential treatment for substance use, and should have parental consent and/or involvement unless this puts them at further risk. It is possible that failure to inform parents/carers that a young person is misusing drugs could lead to a possible negligence action if the service failed to take sufficient action to protect the child from harm as a result of that drug misuse.
The degree of seriousness of drug misuse
The more serious the drug (or substance) misuse, the more likely it is that disclosure of confidential information to other agencies will have to be considered. In deciding whether to disclose, the service must take into account the patterns and levels of drug taking, the risks of morbidity, mortality and health risks, and other risks such as involvement in crime and other behaviour linked with the substance misuse. The supply source of the young person's drugs may also be important, particularly if he/she is at risk of exploitation or coercion.
Whether harm or risk is continuing or increasing:
Harm from drug-taking needs to be assessed with consideration of past, present and potential future behaviour. If there is a clear risk to the child or young person arising from present behaviour, or evidence of an escalation of risk to an unacceptable level, it is important that the service takes steps to ensure the future safety of the child or young person.
General context in which drug taking is set:
Where the child or young person has multiple problems, it is likely that they may be more at risk of misuse, having less protective factors available to them. Services must assess the child's full circumstances and determine whether to disclose confidential information against the child's wishes.
(SCODA/CLC) Standing Conference on Drug Abuse and Children's Legal Centre (1999) Young people and drugs: Policy guidance for drug interventions London: DrugScope (original document which lays out the four parameters guidance).
DfES (2005), Every Child Matters: Change for Children, Young People and Drugs, DfES, Nottingham (outlines the government's proposals for integrating substance use services for young people within general children's services).