Glue and disinfectant have their place in all our houses, but their use as intoxicants threatens, as cocaine use or pill popping do not, the boundary roles between the normal and the deviant, and undermines the safe roles they have been assigned in our world. Certainly it is true that if these drug practices became common, no home would be safe. But our reaction is primarily aesthetic. We are revolted by the ease with which the normal can become abnormal. It challenges our vision of what is natural; it is a threatening example of matter out of place.
Manderson, D. (1995) 'Metamorphoses: clashing symbols in the social construction of drugs' The Journal of Drug Issues, 25, 4 799-816
The programme is designed for use by staff within Scottish social work departments. These staff may not necessarily be trained in substance misuse issues, but they may be best placed to screen individuals who are vulnerable to substance misuse or to recognise those currently using substances and thereby support the assessment process of individuals.
These staff may be involved in the delivery of prevention programmes through, for example, drug and alcohol education or Health Promoting Schools. They may also provide the first level of interventions with the young person such as information and advice, health promotion or support to the young person and their family, with referral if necessary.
They need to be aware of policy and procedures relevant to their role and organisation, such as drug intoxication policies, emergency procedures, issues of confidentiality, with parents, school, police and within social work services, and risk assessment in line with local child protection policies.
The programme is therefore designed for use with the following:
Following this training course, as a participant you will have had the opportunity to:
Your work may include the following:
The pack aims to link into the relevant National Occupational Standards.1
The most recent figures show that just under 13,000 children were looked after by local authorities on 31st March 2006, an increase of 6 per cent from 2005. However that year for the first time young people aged 18 or over were included in these statistics. When the 216 young people aged 18 or over are excluded, the increase since 2005 is 5 per cent.2
Fifty-six per cent of looked after children were placed at home with parents or with friends/relatives. There were 29 per cent (3,731) in foster care and 13 per cent (1,638) were looked after in residential accommodation. This ranged from 6 per cent in Clackmannanshire to 31 per cent in Orkney.
While there has been a decline in the numbers of children in residential placements at any one time, the number of residential establishments in Scotland shows a somewhat different pattern. In the mid-1970s, there were 288 establishments, and this fell to 158 by the end of the 1980s. However, this had increased to 207 in 2002. This can be explained by the long-term decrease in the size of residential establishments; falling from an average of 25 places in the 1970s to an average of six places in 2003. The agenda for improvement in all care services has been taken forward by establishing independent, national bodies to register and inspect care services. In Scotland, the Scottish Commission for the Regulation of Care (the Care Commission) was established on 1 April 2002. The Scottish Government issued 19 volumes of National Care Standards in the spring of 2002 covering a wide range of social care services. The volumes on care homes for children and young people and school care accommodation services are the most relevant and important for residential child care (Scottish Government 2002a, b). The main principles upon which the National Care Standards are based relate to the needs of children and young people for dignity, privacy, choice, safety, realising potential, and equality and diversity.
Alongside the establishment of the Care Commission, the Scottish Social Services Council was established to regulate the workforce. It sets standards of conduct and practice for the workforce and publishes codes of practice for social services workers and their employers. It has established a register of individuals working in social work and social care and is able to discipline individuals and, ultimately, remove individuals from the register. The council also regulates education and training and approves courses. In Scotland, residential child care workers are included in the first phase of the registration process.
This pack could be an opportunity for taking a broader approach to training in this field. The training could include social work staff with a range of roles, but it could also include representatives from education, youth work, police, housing, drugs projects, peer education projects etc. The advantages of a multidisciplinary approach go far beyond the subject of this course, although there are also disadvantages. However with the current initiatives for an integrated framework for assessment and the promotion of Integrated Children's Services Plans one logical progression is for the appropriate adoption of integrated training and workforce development.
The following elements in this section are taken from Kate Skellington Orr and David Shewan's Review of Evidence Relating to Volatile Substance Abuse in Scotland, commissioned by the Scottish Government Justice department.
In 2000, the Scottish Government published the Drugs Action Plan: Protecting our Future, which set out the various measures being implemented by the government to tackle drug abuse in Scotland. One of the core strands of the plan is the need for targeted work with young people to reduce the prevalence of substance misuse among this group, to decrease the likelihood of VSA-related harm, and to prevent young people from entering into chaotic lifestyles often associated with drug misuse. This includes improved education and awareness of the risks and outcomes associated with substance misuse, as well as reducing the social pressures often associated with entry into abuse and other antisocial behaviour.
There is a significant uptake of drugs by young people with the experience of being looked after compared with other teenagers. Around a third (31%) have first tried drugs while in care, but just over two-thirds had taken drugs before coming into care. Looked after and accommodated children in Scotland aged 11 to 17 were twice as likely to smoke, drink or take drugs as their English counterparts.
The Scottish Government Plan highlights the nature of joint responsibility for ensuring that young people resist drugs, including greater awareness raising among the population per se, and carers in particular, with regards to the dangers of drugs and emphasising the legal responsibilities of retailers and others in restricting access to age-restricted goods to children and young people. More recently, a specific VSA framework document published in England by the Department of Health (Out of Sight?... not out of Mind: Children, young people and volatile substance abuse,2005) set out a number of recommendations for implementation by a range of stakeholders in reducing child and youth involvement in volatile substance misuse including:
This framework makes clear the collaborative approach that is required to address VSA and also highlights the role of research in ensuring that policies are targeted and evidence based.
A lack of survey work among young people outwith mainstream education means that it is difficult to fully assess the direct relationship between different forms of social vulnerability and likely use of inhalants. In particular, research with looked after and accommodated children and those in secure accommodation may be needed. The lack of consultation work with young people and older users with solvent abusing histories also makes it difficult to develop a full epidemiological understanding of VSA.
It appears that there is little dedicated evidence that focuses on minority groups, especially in the UK. What is available mostly stems from Australia and the US and suggests that VSA is more prevalent among white people than minority ethnic groups. It remains to be fully explored as to whether cultural differences would affect the findings or transferability of this work to the Scottish context.
Other areas of research could include:
There is a clear message that VSA is not taken as seriously as other drug use. This is because only a minority of those who try VSA go on to become habitual users and, of those who do continue with their use, only a small number will experience serious health problems associated with their use.1 Further, evidence suggests that negative stereotypes associated with solvent abuse may compound problems of hidden use. Lake (2004)2 suggests that sniffing solvents is considered by young people to be 'filthy', something which in itself may be problematic since it encourages users not to disclose their use and the problem therefore, may remain hidden. See also 'Just a Dirty Kind of Drug: Young People's Perceptions of Chroming'.3 This suggests that sensitive approaches may be required to making clear the harm minimisation strategies that can be used (i.e. social using), however, this would need to be handled in a way that did not, as a consequence, increase potential for experimentation.
In achieving a better understanding of the views of professionals in Scotland in relation to VSA, it may prove useful to audit:
Although the survey evidence points towards use of VSA as a gateway drug, there may be potential to further explore the relationship between VSA and other concurrent drug use.
Specifically, it may be useful to explore whether solvents, in particular, are mixed with other drugs and/or alcohol rather than being used independently. Further, whilst there may be some resistance to future allocation of resources aimed specifically at VSA, due to its perceived low prevalence and severity compared to other drugs, a better understanding of VSA as a gateway into illegal drug misuse may warrant further attention. Decreasing participation in VSA at a young age may act as an early prevention of entry into the forms of drug misuse that do currently receive attention and resources.
It seems that despite a large body of guidance material, there is little that evaluates this material or monitors its use. Whilst discussions with stakeholders suggest that evaluative work is undertaken, this is very much hidden in the 'grey literature'. Undertaking formal evaluation of the effectiveness of various VSA awareness raising activities/campaigns seems a sensible next step. Until both process and outcome evaluation has been carried out of these interventions, little information is available with regard to their actual impact.
The lack of consultation work is also highlighted by the 2005 Department for Health VSA Framework, with a commitment by the DoH that such work will be undertaken. Given regional variations in prevalence rates, and the differing socio-demographic and geographical characteristics of Scotland and the rest of the UK, there may be a need for local consultation work to be undertaken as this seems to be the biggest single gap in the evidence to date.