Upload
armen
View
48
Download
0
Embed Size (px)
DESCRIPTION
Nordic Ministerial meeting on Substance Abuse Isafjordur, 10-11th of August 2004 Youth Substance Abuse in Iceland: prevention and treatment. Bragi Guðbrandsson Director Gov. Agency for Child Protection. Outline. Some research findings on substance abuse among Icelandic youth - PowerPoint PPT Presentation
Citation preview
Nordic Ministerial meeting on Substance AbuseIsafjordur, 10-11th of August 2004
Youth Substance Abuse in Iceland:
prevention and treatment
Bragi Guðbrandsson
Director
Gov. Agency for Child Protection
Outline Some research findings on substance abuse among
Icelandic youth Primary and secondary prevention: the role of the state,
local government and NGO´s Treatment services for youth in Iceland Voluntary treatment: SÁÁ Intervention by the CPS “Gatekeeping” in treatment services The benefits of “Contracting out” treatment services• Future orientations: home-based intervention
©ICSRA 2004
Trends in substance use among 10th grade students in Iceland from 1998-2003
28
11
6 6 7 7 84 4 4 5
26
333235
42
1414151619
23
13111112
15
17
0
5
10
15
20
25
30
35
40
45
50
1998 1999 2000 2001 2002 2003
%
Have become drunk the past 30 daysSmoke dailyHave tried hashishHashish more than 3 timesHave tried amphetamin
©ICSRA 2004
Proportion of students in 10th grade who have become drunk 10 times or more during last 12 months (ESPAD 1995)
1 1 2 3 3 3 4 4 4 5 6 6 7 7 7 811 11
1820 21 22
2528
32
0
5
10
15
20
25
30
35
Port
ugal
Ukr
aine
Cyp
rus
Fran
ce
Gre
ece
Tur
key
(Ist
anbu
l)
Cro
atia
Ital
y
Mal
ta
Slov
ak R
epub
lic
Est
onia
Hun
gary
Lith
uani
a
Pola
nd
Slov
enia
USA
Cze
ch R
epub
lic
Nor
way
Swed
en
Irel
and
Icel
and
Faro
e Is
l.
U.K
.
Finl
and
Den
mar
k
%
©ICSRA 2004
Proportion of students in 10th grade that have had accidents or injuries in relation to alcohol use (ESPAD 1995)
2
4 45 5 5
6 67 7 7 7 7
89
1112
14 14
17
0
2
4
6
8
10
12
14
16
18
Port
ugal
Nor
way
Hun
gary
Tur
key
(Ist
anbu
l)
Slov
ak R
epub
lic
Mal
ta
Ukr
aine
Ital
y
Slov
enia
Lat
via
Faro
e Is
l.
Est
onia
Cro
atia
Lith
uani
a
Cze
ch R
epub
lic
Swed
en
Irel
and
Finl
and
Icel
and
U.K
.
%
©ICSRA 2004
Proportion of students in 10th grade in 1997 that have become drunk in the last 30 days by how many of their friends use alcohol
1,8 0,07,1 4,0
16,9 17,0
54,5 52,0
77,572,5
0
10
20
30
40
50
60
70
80
90
100
Boys Girls
%
Almost noneFewSomeManyAlmost all
©ICSRA 2004
Proportion of students in 10th grade that have become drunk the last 30 days by how often they spend time with
their parents after school during weekdays
60,856,0
28,3 28,6
10,915,4
0
10
20
30
40
50
60
70
80
90
100
Boys Girls
%
Almost never/rarelySometimesOften/almost always
©ICSRA 2004
Daily smoking and drug use in three groups: Among those with the highest participation in unsupervised youth activities, in organized
youth work and in sports
43,4
67,7
28,7
15,5
34,6
9,910,0
24,5
7,5
0
10
20
30
40
50
60
70
80
90
100
Daily smoking Intoxication past 30 days Have used hashish
%
Unsupervised leisure activities
Organized youth work
Sports
Primary prevention: The role of the Public Health Institute of Iceland
• The PHI is a center for preventive work in various public health areas: accident prevention, dental health, nutrition, mental health, tobacco, alcohol and drug abuse
• The Alcohol and Drug Abuse Council: aims at professionalism and continual search for knowledge, incl. assessment of preventive measures
• Regular surveys on alcohol- and drug related problems, e.g. hospital admissions, criminal offences and drunken driving
• Coordination and collaboration
Primary and Secondary prevention: The role of Local Governments
• Wide range of services for youth, including supervised leisure activities and sports
• Educational measures, campaigns (Drug free Iceland 2002) and other preventive activities, esp. in elementary schools
• Intervention by the local Child Protection Services: family support and counselling, psychological and other therapeutical services, support persons for youths etc.
Prevention: The role of NGO´s
• The Drug Free Youth, a parental organization• The Parent´s House: hotline services, parent support
groups, aftercare counselling and group work for youth, programs for children of alcoholics etc.
• SÁÁ: the mainstream treatment services for substance abuse in Iceland, operates a detoxification clinic, two outpatient units, two treatment clinics, three recovery houses and a social center
SÁÁ: Voluntary Treatment Services for Youth
• an operation of a special detox division for young substance abusers
• young substance abusers integrated into mainstream treatment services
• based on the 12 step program with an emphasis on alcoholism as a progressive disease
• substance abuse seen as a focal point – a primary concern• emphasis on growth of spiritual awareness and promotion of new
and healthy lifestyles• voluntary intake based on the request of the youth him/herself• 120 to 130 adolescents submitted annually during the past years
Shortcomings of the 12 step voluntary treatment services for
youth
• lack of comprehensive diagnosis other than addiction (social/family assessment, ADHD/Attention deficit, depression, PTD etc.)
• the applicability of the disease model to youth• “to hit bottom” – limited a fragmented history of abuse• the issue of “labelling”• the principle of abstinence – doomed to failure?• the vicious circle of treatment “drop-outs” and re-admissions• negative treatment outcomes: low risk youth and negative
socialisation or “infectious effects”
Intervention by the Child Protection Services
• The “honeymoon phase” and self destructive behaviour• The provisions of the Child Protection Act:
- refer to specialised treatment for alcohol and drug abuse, serious behavioural problems and criminal offences- refer to the obligation of the CPS to take supportive measures before placement in institutions- intake or placement in institutional treatment is considered “last resort”- The Government Agency for Child Protection bears the responsibility of providing the appropriate treatment facilities
The Organization of Child ProtectionThe Organization of Child ProtectionServices in IcelandServices in Iceland
Ministry of Social Affairs
Government Agency ForChild Protection
Child ProtectionAppeal
Committee
STATEState Treatment
Center for AdolescentsResidentialTreatment
Homes
Child Protection Committees
Departments of Social Services
LocalAuthorities
General SocialServices
LOCALAUTHORITIES
Cooperationschool, health care authorities, police
a.o.
Children’s house (Barnahus)
Children’s house (Barnahus)
The JudicialSystem
The JudicialSystem
Child Protection and Treatment Services for Youth
• reorganisation of the treatment services 1995 – 2000
• 5 state operated treatment facilities closed• A new diagnostic center established• Long-term treatment in “family settings”• Two basic principles: • “Gatekeeping”• “Contracting out” of long-term treatment
Gatekeeping
• To ensure that services are provided only to those who meet specified eligibility criteria
• To ration and make effective use of scarce resources
• To focus on the youths needs and targeting services
• Should raise thresholds for unnecessary or even harmful placement (low risk youth)
Application for institutional placement-
“gatekeeping”
All appropriate supportive measures have been unsuccessfully tried
Child Protective Services apply for placement to the Government Agency for Child Protection.
Application assessment (incl. advice from the Child Psychiatry Hospital)
Government Agency for Child Protection decides on placement
Applications based on a
contract with the Prison
Administr.
General principles: 1. Respect for the child’s wishes 2. Partnership with family
Young substance abusers: institutional treatment
Child Protection Services
Diagnostic Center for YouthDiagnostic Center for Youth
Acute placement
1-2 weeks
Assessment
2-4 weeks
Treatment
2-4 weeks
Police
Treatment Facilities
Prison Authorities
Discharge
1. Home(aftercare)
Long-termtreatment
facilities(specialized)
Long-term treatment services
• eight long-term treatment facilities with 60 beds• typical size is 6 youth living sharing their lives with the
treatment provider• emphasis put on “emotional nourishment”• different target groups and variation in treatment goals• two facilities specialize in substance abuse• behaviouralistic and environmental approach• educational objectives and meaningful responsibilities• psychological- and family counselling
“Contracting out” treatment services
The overt goal: to improve quality of treatment, increase flexibility and improve cost efficiency
Quality is improved by clearer definition of standards and the separation of service and supervision
Flexibility is increased as it is easier to accommodate for demand for treatment that changes from one time to another
Cost control is more effective as a fixed price is negotiated, overhead costs are reduced and management more efficient
The Contractual Framework
• Identifies treatment facilities and location• Defines treatment goals and “modules”• Identifies target group and number of youth• Number of staff, training and special qualification (incl. psychological
services)• Defines the intake and discard process• Identifies established procedures like the rights of children in
institution, confidentiality etc.• States the monitoring role of the GACP, reports and other
information to be submitted• Defines financial remuneration, the duration of the contract and
framework for revision/disagreements
0
10
20
30
40
50
60
70
80
90
1995 1996 1997 1998 1999 2000 2001 2002
Budg
et (%
)
"Contracted out"
Operated by the state
Transforming public into private operation
0
20
40
60
80
100
120
140
160
180
200
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
%
Exposed costs Budgetary appropriation=100
Matching costs to the Budget
93%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Post reorganization 2002 Prior to reorganization 1994
The effect of reorganization on capacity utilization
5,5
7,6
4,4
5,5
0
1
2
3
4
5
6
7
8
Full capacity utilization Real capacityutilization
M.k
r. Before reorganisation
After reorganisation
Contracting out and cost efficiency
Future orientations
• The importance of research and evidence based interventions
• Interventions/treatment can exacerbate risk factors, e.g. placing antisocial youth together in groups
• Pathway plans and post-treatment care• Alternatives to institutional treatment• MST, a model of home-based service delivery• Implementing MST and PMT nationwide in Norway: a
beautiful social experiment