Alder Hey Children’s Hospital – Young Person Alcohol Poisoning Intervention
| Description | Identifying children with problematic alcohol and/or drug use and establishing a care pathway and referral service. |
|---|---|
| Setting | The A&E department of a hospital. |
| Populationting | Young people aged between 0-16 years in A&E. |
| Intervention summary | Providing an information pack of resources on drug, alcohol and sexual health issues, offering brief interventions and screening on alcohol misuse with a view to referral on to outside support services. |
| Outcome Summary | Early identification of young people with alcohol related issues. Reduction in risk taking behaviour. |
| Startup Cost | The project was launched on a ‘shoe string’, costing around £7000 over two years but with a considerable amount of help and support from the local medical staff. If the project is found to be viable, then funding should be mainstreamed. |
| Running Cost | £3500 each year |
| Funding | The project received initial funding and support from Liverpool Drug and Alcohol Action Team (DAAT). |
| Started | May 2005 |
| Ended | To be confirmed. |
| Location | Liverpool, England |
| Contact |
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Background
A 2003 survey of Liverpool Alder Hey Children’s Hospital showed that youngsters were drinking as young as 10 years of age. This confirmed the Government’s opinion that alcohol consumption by young people was on the increase, especially among young girls. This survey also highlighted the risks that young people take when they have been drinking, with many found collapsed alone in fields, parks and streets, and one 14 year old boy had fallen in the river.
This project is one element of the alcohol care pathway being constructed in Liverpool. We consider the support and education of young people about the hazards of irresponsible drinking to be of paramount importance in ensuring a future healthy lifestyle. Alcohol harm can create additional problems around safety, sexual health, achievement, and social maturity. It can also mask various social and environmental problems. All of these things can be highlighted and a solution sought if the initial screening and brief interventions are performed.
What is the problem you are trying to solve?
Evidence from the National Alcohol Harm Reduction Strategy suggests that young teenagers are drinking more and are also more likely to binge drink 1 . It is important to support this age group, both medically and psychologically, and provide them with sufficient and accurate information to enable them to use alcohol sensibly.
What local organisations are involved?
Training was provided from a specialist alcohol service within the NHS. Further support was provided from the Liverpool Primary Care Trust (PCT), as well as children’s services, police, and community service providers in Liverpool.
How many people are running this project and who are they?
The initiative was initially run on a rota basis, using A&E nurses, who provided advice and staffed the brief intervention clinic. Duties were carried out based on payment for overtime working to prevent disruption of current programmed work.
What local population are you targeting?
We are targeting young people up to the age of 16 years attending Alder Hey Hospital, Royal Liverpool Children’s NHS Trust.
How many people are you targeting?
Approximately 250 to 300 per annum
Interventions
What interventions are you using to address the problem?
Alder Hey A&E department has designed a care pathway which addresses the assessment, treatment and follow up of all young people who attend A&E as a result of drinking alcohol. All attendees are given a pack containing information leaflets on alcohol and drug use, offered a clinical appointment to discuss their drinking, receive some basic health and safety advice in the form of a brief intervention, and are screened for the need to refer on to other support services. This provides an opportunity to identify young people with problematic alcohol and/or drug use, or other issues such as anxiety or depression, and they can be referred to outside support agencies.
In addition, A&E medical and nursing staff were provided with alcohol awareness training to enable them to identify and process patients who had an alcohol related problem.
Information is gathered using an audit tool to assist partner organisations identify hot spots of activity (areas where young people gather to drink and developing trends of behaviour). The audit tool is completed by medical or nursing staff at initial attendance and completed at a clinic if necessary. Local schools are also provided with sanitised information to help them identify problem activity within their schools.
Is the project design based on evidence? If so, please state reference.
There was no published data about the effectiveness of brief interventions in young people. Published data is on adult population and usually chronic long term users. The design of the project was influenced by the lack of evidence of effective interventions and an awareness of a gap in service provision and inconsistency in follow up.
Outcome
What outcomes or planned outcomes are you measuring?
There has been one annual audit and further performance monitoring will be used to determine the future of the project.
We are monitoring re-attendance to A&E, referral to outside support services, increased awareness, and identification of “hot spots” (areas or venues which young people gather to drink).
Do you have any outcomes or results yet? If so, what are they?
Roughly 50% of attendees accept a brief intervention clinic appointment. We aim to see them within one week. Currently 50% of those offered attend. Out of the 253 attendees in 2004-5, we referred 16 young people to tier three services.
An audit carried out for the period June 2004 to May 2005 found the following:
- Of the 253 young people attending A&E, 180 (71%) were female and 73 (29%) male.
- 30% of attendances were on Friday night and 28% were on Saturday night.
- 75% of the young people included in the audit were aged 14-15 years.
- The 253 attendances at A&E were divided almost equally between summer (April to September) and winter (October to March) months.
- 168 (66%) of arrivals at A&E were between the hours of 6 pm and midnight.
- 96 (38%) of the young people who were placed on the pathway had been drinking vodka.
- Alcopops were ingested in 16 (6%) of cases. In 10 (4%) of these, alcopops were ingested in combination with other drinks.
Is your project relevant to a government target or guideline?
The Alcohol Harm Reduction Strategy for England 1
Feedback
What obstacles did you have to overcome to set up this project?
Administration processes had to be agreed to collect the required information. Initially the audit department in the Trust supported our data collection but this has not been ongoing and it has been difficult to find resources or time to keep contemporaneous data input.
We had to ensure that other medical staff received alcohol awareness training and were motivated to seek alcohol related causes among patients.
Links had to be made with outside organisations such as substance misuse services, police, school nurses, and children’s services. Accessing the right person within these services was initially difficult. Steering group members were not always able to attend meetings.
What have you learned about the project so far?
It is important to involve senior medical staff at a strategic level to ensure proposals are compatible with other initiatives and policies.
What would you do differently?
N/A