• National Institute for Health and Clinical Excellence (NICE). Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Mar. 46 p. (Public health intervention guidance; no. 4). [22 references]

This is the current release of the guideline.

Substance misuse

Assessment of Therapeutic Effectiveness
Counseling
Prevention

Family Practice
Nursing
Pediatrics
Psychiatry
Psychology

Advanced Practice Nurses
Hospitals
Nurses
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Public Health Departments
Substance Use Disorders Treatment Providers

To reduce substance misuse among vulnerable and disadvantaged children and young people

Vulnerable and disadvantaged children and young people under age 25 who are at risk of misusing substances including:

• Those whose family members misuse substances
• Those with behavioural, mental health or social problems
• Those excluded from school and truants
• Young offenders
• Looked after children
• Those who are homeless
• Those involved in commercial sex work
• Those from some black and minority ethnic groups

1. Screening and assessment to identify young people misusing or at risk of misusing substances
2. Brief interventions in educational or other community settings
3. Family-based programme of structured support
4. Family therapy
5. Group-based behavioural therapy (for children)
6. Group based training in parenting skills (for parents/carers)
7. Motivational interviews

• Prevention of substance misuse
• Reduction of problematic substance misuse
• Cost effectiveness of community-based interventions

Searches of Electronic Databases

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Study Type

• Meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs (including cluster RCTs)
• Systematic reviews of, or individual, non-randomised controlled trials, case-control studies, cohort studies, controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, correlation studies
• Non-analytical studies (for example, case reports, case series)
• Expert opinion, formal consensus

Study Quality

++ All or most of the criteria fulfilled. Where they have not been fulfilled the conclusions are thought very unlikely to alter.

+ Some criteria have been fulfilled. Those criteria that have not been fulfilled or not adequately described are thought unlikely to alter the conclusions.

- Few or no criteria fulfilled. The conclusions of the study are thought likely or very likely to alter.

The interventions were also assessed for their applicability to the UK and the evidence statements were graded as follows:

1. Likely to be applicable across a broad range of settings and populations
2. Likely to be applicable across a broad range of settings and populations, assuming they are appropriately adapted
3. Applicable only to settings or populations included in the studies – broader applicability is uncertain
4. Applicable only to settings or populations included in the studies

Systematic Review with Evidence Tables

Informal Consensus

How Public Health Interventions Advisor Committee (PHIAC) Formulated the Recommendations

At its meetings in September and October 2006, the Public Health Interventions Advisor Committee (PHIAC) considered the evidence of effectiveness and cost effectiveness. In addition, at its meeting in January 2007, it considered comments from stakeholders and the results of fieldwork to determine:

• Whether there was sufficient evidence (in terms of quantity, quality and applicability) to form a judgment
• Whether, on balance, the evidence demonstrates that the intervention is effective or ineffective, or whether it is equivocal
• Where there is an effect, the typical size of effect

PHIAC developed draft recommendations through informal consensus, based on the following criteria.

• Strength (quality and quantity) of evidence of effectiveness and its applicability to the populations/settings referred to in the scope
• Effect size and potential impact on population health and/or reducing inequalities in health
• Cost effectiveness (for the National Health Service and other public sector organisations)
• Balance of risks and benefits
• Ease of implementation and the anticipated extent of change in practice that would be required

Where possible, recommendations were linked to an evidence statement(s) – see appendix A in the original guideline document for details. Where a recommendation was inferred from the evidence, this was indicated by the reference 'IDE' (inference derived from the evidence).

Not applicable

External Peer Review
Internal Peer Review

The draft guidance, including the recommendations, was released for consultation in November 2006. The guidance was signed off by the National Institute for Health and Clinical Excellence (NICE) Guidance Executive in March 2007.

This document constitutes the Institute's formal guidance on community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. The recommendations in this section are presented without any reference to evidence statements. Appendix A in the original guideline document repeats the recommendations and lists their linked evidence statements.

Community-based interventions are defined as interventions or small-scale programmes delivered in community settings, such as schools and youth services. They aim to change the risks factors for the target population.

For the purposes of this guidance, substance misuse is defined as intoxication by – or regular excessive consumption of and/or dependence on psychoactive substances, leading to social, psychological, physical or legal problems. It includes problematic use of both legal and illegal drugs (including alcohol when used in combination with other substances).

Recommendation 1

Who is the target population?

Any child or young person under the age of 25 who is vulnerable and disadvantaged

Who should take action?

Local strategic partnerships

What action should they take?

• Develop and implement a strategy to reduce substance misuse among vulnerable and disadvantaged people aged under 25, as part of a local area agreement. This strategy should be:
  • Based on a local profile of the target population developed in conjunction with the regional public health observatory. The profile should include their age, factors that make them vulnerable and other locally agreed characteristics
  • Supported by a local service model that defines the role of local agencies and practitioners, the referral criteria and referral pathways.

Recommendation 2

Who is the target population?

Any child or young person under the age of 25 who is vulnerable and disadvantaged

Who should take action?

Practitioners and others who work with vulnerable and disadvantaged children and young people in the National Health Service (NHS), local authorities and the education, voluntary, community, social care, youth and criminal justice sectors. In schools this includes teachers, support staff, school nurses and governors.

What action should they take?

• Use existing screening and assessment tools to identify vulnerable and disadvantaged children and young people aged under 25 who are misusing --or who are at risk of misusing – substances. These tools include the Common Assessment Framework and those available from the National Treatment Agency.
• Work with parents or carers, education welfare services, children's trusts, child and adolescent mental health services, school drug advisers or other specialists to:
  • Provide support (schools may provide direct support)
  • Refer the children and young people, as appropriate, to other services (such as social care, housing or employment), based on a mutually agreed plan. The plan should take account of the child or young person's needs and include review arrangements.

Recommendation 3

Who is the target population?

• Vulnerable and disadvantaged children and young people aged 11–16 years and assessed to be at high risk of substance misuse
• Parents or carers of these children and young people

Who should take action?

Practitioners and others who work with vulnerable and disadvantaged children and young people in the NHS, local authorities and the education, voluntary, community, social care, youth and criminal justice sectors. In schools this includes teachers, support staff, school nurses and governors.

What action should they take?

• Offer a family-based programme of structured support over 2 or more years, drawn up with the parents or carers of the child or young person and led by staff competent in this area. The programme should:
  • Include at least three brief motivational interviews (see glossary) each year aimed at the parents/carers
  • Assess family interaction
  • Offer parental skills training
  • Encourage parents to monitor their children's behaviour and academic performance
  • Include feedback
  • Continue even if the child or young person moves schools.
  • Offer more intensive support (for example, family therapy) to families who need it.

Recommendation 4

Who is the target population?

• Children aged 10–12 who are persistently aggressive or disruptive and assessed to be at high risk of substance misuse.
• Parents or carers of these children.

Who should take action?

Practitioners trained in group-based behavioural therapy.

What action should they take?

• Offer the children group-based behavioural therapy over 1 to 2 years, before and during the transition to secondary school. Sessions should take place once or twice a month and last about an hour. Each session should:
  • Focus on coping mechanisms such as distraction and relaxation techniques
  • Help develop the child's organisational, study and problem-solving skills
  • Involve goal setting
• Offer the parents or carers group-based training in parental skills. This should take place on a monthly basis, over the same time period described above for the children). The sessions should:
  • Focus on stress management, communication skills to help develop the child's social-cognitive and problem-solving skills
  • Advise on how to set targets for behaviour and establish age-related rules and expectations for their children.

Recommendation 5

Who is the target population?

Vulnerable and disadvantaged children and young people aged under 25 who are problematic substance misusers (including those attending secondary schools or further education colleges).

Who should take action?

Practitioners trained in motivational interviewing.

What action should they take?

• Offer one or more motivational interviews (see glossary), according to the young person's needs. Each session should last about an hour and the interviewer should encourage them to:
  • Discuss their use of both legal and illegal substances
  • Reflect on any physical, psychological, social, education and legal issues related to their substance misuse
  • Set goals to reduce or stop misusing substances

None provided

The type and quality of supporting evidence is identified and graded for each recommendation (see Appendix A of the original guideline document).

Prevention and reduction of substance misuse among vulnerable and disadvantaged individuals under the age of 25 years

Not stated

Staying Healthy

Effectiveness
Patient-centeredness

• National Institute for Health and Clinical Excellence (NICE). Community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Mar. 46 p. (Public health intervention guidance; no. 4). [22 references]

Not applicable: The guideline was not adapted from another source.

2007 Mar

National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]

National Institute for Health and Clinical Excellence (NICE)

NICE Project Team
Public Health Interventions Advisory Committee (PHIAC)

NICE Project Team Members: Professor Mike Kelly, CPHE Director; Simon Ellis, Associate Director; Dr Nichole Taske, Analyst; Dr Amanda Killoran, Analyst; Dr Louise Millward, Analyst; Chris Carmona, Analyst; Dr Alastair Fischer, Health Economics Adviser

Public Health Interventions Advisory Committee (PHIAC) Members: Mrs Cheryll Adams, Professional Officer for Research and Practice Development with the Community Practitioners' and Health Visitors' Association (CPHVA); Professor Sue Atkinson, CBE Independent Consultant and Visiting Professor in the Department of Epidemiology and Public Health, University College London; Professor Michael Bury, Emeritus Professor of Sociology at the University of London and Honorary Professor of Sociology at the University of Kent; Professor Simon Capewel,l Chair of Clinical Epidemiology, University of Liverpool; Professor K K Cheng, Professor of Epidemiology, University of Birmingham; Mr Philip Cutler, Forums Support Manager, Bradford Alliance on Community Care; Professor Brian Ferguson, Director of the Yorkshire and Humber Public Health Observatory; Professor Ruth Hall, Regional Director, Health Protection Agency, South West; Ms Amanda Hoey, Director, Consumer Health Consulting Limited; Mr Andrew Hopkin, Senior Assistant Director for Derby City Council; Dr Ann Hoskins, Deputy Regional Director of Public Health for NHS North West; Ms Muriel James, Secretary for the Northampton Healthy Communities Collaborative and the King Edward Road Surgery Patient Participation Group; Professor David R Jones, Professor of Medical Statistics in the Department of Health Sciences, University of Leicester; Dr Matt Kearney, General Practitioner, Castlefields, Runcorn and GP Public Health Practitioner, Knowsley; Ms Valerie King, Designated Nurse for Looked After Children for Northampton PCT, Daventry and South Northants PCT and Northampton General Hospital, Public Health Skills Development Nurse for Northampton PCT; Dr Catherine Law (Chair) Reader in Children's Health, Institute of Child Health, University College London; Ms Sharon McAteer, Health Promotion Manager, Halton PCT; Professor Klim McPherson, Visiting Professor of Public Health Epidemiology, Department of Obstetrics and Gynaecology, University of Oxford; Professor Susan Michie, Professor of Health Psychology, BPS Centre for Outcomes Research & Effectiveness, University College London; Dr Mike Owen, General Practitioner, William Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative. Chair of Trustees of the Breastfeeding Network; Dr Mike Rayner, Director of British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; Mr Dale Robinson, Chief Environmental Health Officer, South Cambridgeshire District Council; Professor Mark Sculpher, Professor of Health Economics at the Centre for Economics (CHE), University of York; Dr David Sloan, Retired Director of Public Health; Dr Dagmar Zeuner, Consultant in Public Health, Islington PCT

All members of the Public Health Interventions Advisory Committee are required to make an oral declaration all potential conflicts of interest at the start of the consideration of each public health intervention appraisal. These declarations will be minuted and published on the National Institute for Health and Clinical Excellence (NICE) website.

Members are required to provide in writing an annual statement of current conflicts of interests, in accordance with the Institute's policy and procedures.

Potential members of the Public Health Programme Development Groups (PDG), and any individuals having direct input into the guidance (including expert peer reviewers), are required to provide a formal written declaration of personal interests. A standard form has been developed for this purpose which also includes the Institute's standard policy for declaring interests. This declaration of interest form should be completed before any decision about the involvement of an individual is taken.

Any changes to a Group member's declared conflicts of interests should also be recorded at the start of each PDG meeting. The PDG Chair should determine whether these interests are significant. If a member of the PDG has a possible conflict of interest with only a limited part of the guidance development or recommendations, that member may continue to be involved in the overall process but should withdraw from involvement in the area of possible conflict. This action should be documented and be open to external review. If it is considered that an interest is significant in that it could impair the individual's objectivity throughout the development of public health guidance, he or she should not be invited to join the group.

This is the current release of the guideline.

None available

This summary was completed by ECRI on June 20, 2007. The information was verified by the guideline developer on July 17, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.