Alcohol and/or drugs: Guideline for Emergency Departments, Minor Injury Units and Receiving Units where a child or young person presents under the influence of

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Objectives

This document provides clear guidance for the management of children attending with alcohol and/or drug misuse.

Scope

This guideline covers the whole of NHS Greater Glasgow and Clyde Health Board area and provides a framework to help Emergency Medicine health professionals identify concerns and those intoxicated children/young people at risk, undertake a standard assessment and ensure an appropriate response. This response may include an opportunistic brief intervention with the provision of health promotion/harm reduction advice or submission of a Notification of Concern (NOC). 

It is intended that professionals from Emergency Departments, Minor Injury Units and Receiving Units will find this document helpful when dealing with intoxicated children and young people up to 16 years old or up to 18 if looked after by the local authority. It is also intended that this document will assist health professionals in their child protection decisions and to discharge safely with appropriate follow up.

Audience

Professionals working with, or in contact with, children or young people and/or their families have a duty of care to ensure that the child’s or young person’s needs are considered with them in the context of their individual circumstances.

Appendix 1 provides a guideline in flowchart format for the management of children/young people presenting to Emergency Departments, Minor injury units and Receiving Units under the influence of alcohol and/or drugs.

Introduction

Adolescence is a period of significant physical, cognitive and social change. It is now well established that increasing numbers of young people are engaging in a range of risk behaviours including the misuse of alcohol, drugs and other substances before reaching the age of 16 years. Alcohol and/or drug misuse is now known to feature in the sexual exploitation of young people.

Principles and procedures

A Notification of Concern (NOC) must be submitted to social work services for any child of 12 years and under presenting under the influence of alcohol and/or drugs.

For children and young people aged 13 years and over, where there is a concern/risk regarding alcohol and/or drug misuse and/or other circumstances, Social Work Services should be contacted to establish if the young person is already known to Social Work, or any another support service. A NOC should be submitted to social work regardless of whether the young person is or is not already known to Social Work Services, for consideration of a single/multi-agency needs/risk assessment.  (See Appendix 1)

Staff should ensure a copy of the NOC is sent to the Child Protection Service (CPS) the next working day.

The child or young person should not be discharged until the Emergency Medicine Physician is fully satisfied that the child or young person is medically fit for discharge, the parents/guardian are involved, an immediate risk assessment has been completed and Social Work Services and/or the police contacted if indicated. Once the CPS receives a copy of the NOC form it will be forwarded to the acute addictions office that will liaise with youth substance misuse services in the community for onward referral and follow up. Notification of actions and interventions undertaken by social work/substance misuse services will be uploaded onto clinical portal and located under correspondence section/social service letter.

 

An online training programme for staff is available to support implementation of these guidelines and can be accessed on Staffnet through the Learnpro application or via the link https://nhs.learnprouk.com

Sharing of information

If a practitioner/professional is concerned that the child/ young person may potentially be at risk of future harm, the sharing of information between agencies and between staff within agencies is crucial to help safeguard the child or young person and facilitate appropriate assessment/care management. Currently the School Nurse Team Lead forwards information to the relevant school nurses. Consent to share information is not required

As a standard of good practice to link with community services, the school nurse team lead is copied into the GP letter when the patient is discharged from the department or ward. If the patient absconds from the department the police and/or social work should be contacted as well as the parents or guardian.

Admission to hospital

On occasions where it is necessary to admit a child or young person to hospital as a direct consequence of intoxication or substance misuse, or through illness/injury caused as a result of intoxication/substance misuse, the assessing doctor at first point of contact should follow procedures as outlined in the guideline, including completion of the NOC Form and progressed in line with local hospital admissions policy.

Wherever possible, staff should undertake opportunistic brief interventions including appropriate health promotion/harm reduction advice together with the issue of information/education leaflets, as a minimum standard of good practice.

Appendix 1: Guideline flowchart for intoxicated child/adolescent presentation

Editorial Information

Last reviewed: 13 June 2016

Next review: 13 June 2019

Author(s): Wendy Mitchell, Chief Nurse & Head of NHSGGC Child Protection Unit

Approved By: Child Protection