South West Safeguarding and Child Protection Procedures
South West Safeguarding and Child Protection Procedures South West Safeguarding and Child Protection Procedures

5.5.5 Drug Use Screening Tool Procedure

SCOPE OF THIS CHAPTER

This chapter deals with the Drug Use Screening Tool (DUST) which is designed to help practitioners who do not have specialist drug knowledge to distinguish between 'drug use' and 'drug misuse', assess those risk factors and identify responses to meet the child or young person's needs.

References

  • The National Drugs Strategy - Drugs: Protecting Families and Communities (2008 - 2018);
  • National Youth Alcohol Action Plan (2008);
  • Plymouth Corporate Improvement Plan (2009-2012) Priority 7 - Safeguarding Children;
  • Plymouth Children and Young People's Plan Priority 8 - Reducing risk taking behaviour (2008 - 2011);
  • Plymouth's Young People's Substance Misuse Strategy, Minimise Harm Prevent Escalation (2009 - 2011);
  • Plymouth's annual Young People's Substance Misuse Treatment Plan (2010/2011).


Contents

  1. Introduction 
  2. Using the DUST Toolkit 
  3. Who can use the DUST Toolkit
  4. Access to Forms
  5. When DUST can be used
  6. Parental Consent
  7. Engagement with DUST Screening
  8. On completion of the DUST Questionnaire
  9. DUST Training
  10. Eligibility Criteria for referral to Specialist Substance Misuse Service
  11. Assessment

    Appendix 1: Drug use Screening Tool Flowchart


1. Introduction

Many young people will try drugs at some time and most do not progress beyond experimentation. However, research indicates that many risk factors can increase the likelihood of a young person moving from 'drug use'[1] to 'drug misuse'[2].

The Drug Use Screening Tool (DUST) is designed to help practitioners who do not have specialist drug knowledge to distinguish between 'drug use' and 'drug misuse', assess those risk factors and identify responses to meet the child or young person's needs.

DUST is a voluntary assessment that the child or young person will need to be fully engaged with in order to meaningfully identify their needs and plan a response.

(1) Drug use - means the consumption of a drug that does not cause any perceptible immediate harm - even though it may carry some risk of harm.
(2) Drug misuse - use of a drug or combination of substances, that harms health or social functioning - either dependent use or use that is part of a wider spectrum or problematic or harmful behaviour.


2. Using the DUST Toolkit

Using DUST will:

  • Improve consistency in our assessment of substance misuse risk;
  • Ensure there are consistent responses to any substance misuse concern;
  • Demonstrate a systematic and professional response to substance misuse needs.

The use of DUST supports:


3. Who can use the DUST Toolkit

Any DUST trained children's social care practitioner concerned by a child's or young person's substance use can carry out a screening for substance misuse, using the DUST tool.


4. Access to Forms

Each team in children's social care will have a team administrator who holds hard copies of the DUST tool.


5. When DUST can be used

DUST screening can be used when you are concerned by a child or young persons substance use. It can be used:

  • Alongside any routine assessment, for example, the Social Work Assessment or at review;
  • At any time with a child or young person outside of routine assessment or review if required.

In addition to children and young people who are using substances, children and young people with the following profiles may also be at risk of harm from substance misuse:

  • Those with parental/family history of substance misuse;
  • Those who have been homeless;
  • Those who have been previously/currently referred to CAMHS;
  • Those who have been in a secure unit;
  • Those who may have some evidence of physical change/ deterioration;
  • Those who may raise suspicions of the workers with respect to a worsening of health and well being;
  • Younger adolescents who have a history of behavioural problems before the age of 11.


6. Parental Consent

Prior to screening, parental/carer consent must be sought for any child under 13 unless doing so would put the child at risk.

For all young people aged 16 and under, it is good practice to gain parental/carer involvement in the decision to undertake a screening though this is not necessary for over 13s.

Fraser Guidelines, are appropriate for young people aged between 13 and 16.


7. Engagement with DUST Screening

DUST is voluntary and must always be undertaken with the child or young person present.

The tool must be explained to the child or young person including what it is trying to achieve and how that will be achieved.

The child or young person must want to engage in the process to make the outcome meaningful.

When engaging with a child or young person to complete a DUST screening, the social care worker must ensure that they consider all equality and diversity issues that may be relevant.

If the child or young person is willing to engage then the reason(s) for the possible use of DUST should be explained to them. Explanations can include:

  • Concern or worry about their substance use;
  • Helping identify what may help reduce problems with their alcohol and/or drug use;
  • Identifying how risky use is.
If the child or young person refuses to engage with the DUST screening this should be recorded in their case notes, along with the practitioner concerns that triggered the need for the screening. The practitioner may wish to consult with the child's or young person's specialist treatment service to seek guidance on any information, advice or support that could be possible in this circumstance, which should also be recorded.


8. On completion of the DUST Questionnaire

On completion the questionnaire is passed to the department's administration team to be input onto CareFirst.

If a referral to the Drug and Alcohol Service has been offered and accepted, administration is to send the hard copy to 'Harbour', (Young Peoples Specialist Substance Misuse Service).

After the questionnaire has been entered onto CareFirst and, where relevant, the referral has been sent to 'Harbour', the form is to be shredded.

If relevant, state on the child's or young person's plan what interventions were planned or offered along with any communication with the treatment service with respect to referral or advice.

Any interventions identified and agreed should be reviewed and recorded in the child's or young persons plan.

A further DUST could be undertaken in the future at the discretion of the practitioner if there was a need to re-look at a child's or young person's substance use. This will be relevant to children and young people who:

  • Refused to be referred;
  • Did not require a referral but whose substance use continues to cause concern.


9. DUST Training

DUST screening is only be undertaken by practitioners who have been trained in its use.

Training will be provided on a quarterly basis throughout the year by the specialist treatment service/lead commissioner for substance misuse.

The professional development administrator within Children's Social Care will hold the dates for the training.


10. Eligibility Criteria for referral to Specialist Substance Misuse Service

General

  • The young person is under 18 years of age;
  • A young adult 18 or over if their maturity and understanding has been formally assessed as being equivalent to a person under the age of 18;
  • A young adult 18 or over who has been assessed by a professional as having their needs most appropriately met within a young person's service, including those young people who have been in the young people's substance misuse service and whose needs are now being addressed through a Transition Plan enabling a supported and planned move into an adult service;
  • The child or young person is currently misusing illegal drugs, alcohol, prescribed drugs or volatile substances (butane/gas);
  • The child or young person is a Plymouth resident or is the responsibility of Plymouth Children's Social Care Services.

Specific

  • The child or young person has a history of overdose, either deliberate or accidental and a pattern of high risk substance misuse;
  • The child or young person is injecting;
  • The child or young person is experiencing disrupted education, training or employment due to substance misuse;
  • There is, or may be, sexual exploitation or risky sexual behaviour particularly to finance or gain access to substances and /or injecting equipment;
  • There is offending behaviour that includes violence, arson or frequent criminal damage linked to substance misuse;
  • The child or young person has offending behaviour linked to financing their own use of substances;
  • The child or young person is using in dangerous physical environments such as near roads, railway lines, alone, inappropriate accommodation or while driving;
  • There is significant concern about the young person's physical well-being linked to their substance misuse;
  • Someone else is administering substances to the child or young person;
  • The child or young person is taking substances with older people, including siblings and partners, who have more established hazardous or problematic substance misuse issues;
  • Taking substances with parents/ carers who are normalising the use and who themselves have problematic substance misuse issues;
  • The young person is a parent or carer with a child or children who are negatively affected through the impact of the parent /carer's own substance misuse;
  • The child or young person is using a range of substances that include alcohol and prescribed drugs and these are used in a dangerous fashion i.e. through mixing different substances that leads to consequent danger either physically, psychologically or behaviorally;
  • The child or young person is directly inhaling a substance e.g. butane;
  • The child or young person is experiencing extreme intoxication resulting in blackouts and loss of consciousness;
  • There is significant concern about the child or young person's emotional well-being or mental health being affected by their substance misuse;
  • The child or young person has coexisting mental health problems such as psychosis, post traumatic stress disorder, suicidal thoughts and self harm alongside substance misuse;
  • The child or young person has coexisting physical health problems such as epilepsy, breathing and heart conditions;
  • The child or young person is misusing substances and is pregnant.


11. Assessment

There are three sections (domains) that are assessed as part of the screening:

Domain 1: Substance Use

  • Low Risk;
  • Medium Risk;
  • High Risk.

Domain 2: Social Situation/Behaviour

  • Low Risk;
  • Medium Risk;
  • High Risk.

Domain 3: General and Psychological Health

  • Low Risk;
  • Medium Risk;
  • High Risk.

Each domain has specific questions that should be completed. The resultant scores for each question will need to be totalled and will identify low, medium or high risk. Within the high risk category there will be a range of scores - the higher the score in the high risk category the more serious the risk.

If possible the child or young person may wish to complete the tool themselves in your presence but it is important that both young person and practitioner try to agree on the score for each question. If this is not possible the young person's assessment should be used.

If differences occur on a particular response the practitioner should explain why their judgement may differ.

It is possible that a lot of information will already be known to the practitioner, for example Social Work Assessment, annual Review Health Assessment for looked after children, reviews and also current knowledge of the child's or young person's needs.

Every question does not need to be responded to. Reasons for this could include uncertainty over what the response could be or the issue may feel inappropriate to ask about. An example of the latter would be the question around age appropriate sex (section 2) which may feel inappropriate to ask especially if the practitioner does not know the young person well.

Scores should be totalled. Depending on the scores the following are the possible outcomes:

Domain 1: Substance Use

  • Low Risk;
  • Medium Risk;
  • High Risk.

Domain 2: Social Situation / Behaviour

  • Low Risk;
  • Medium Risk;
  • High Risk.

Domain 3: General and Psychological Health

  • Low Risk;
  • Medium Risk;
  • High Risk.

2 x High Risk

A score of high risk in each domain suggests a referral to 'Harbour' - Young Peoples Specialist Substance Misuse Service - should be made. The higher the scores the more certain a referral is required. The child or young person needs to consent to referral. Consult with 'Harbour' before completing referral. If the young person does not want to engage with 'Harbour', advice from 'Harbour' should be sought to minimise substance misuse harm.

The areas identified that contributed toward high risk in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

3 x High Risk (including substance use) and 1 x Medium Risk

If one of the High Risk domains is substance misuse this suggests a possible referral to Harbour. The higher the scores the more certain a referral is required. The child or young person needs to consent to referral. Consult with 'Harbour' before completing referral. If child or young person does not want to engage with 'Harbour' advice, from 'Harbour' should be sought to minimise substance misuse harm.

The areas identified that contributed toward high risk and increased vulnerability in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

2 x High Risk and 1 x Medium Risk (substance use)

If the substance misuse domain is Medium Risk this would suggest seeking advice from 'Harbour' in the context of how high risk and vulnerability in the other two domains could compound substance use. This is unlikely to require a referral to Harbour. The areas identified that contributed toward high risk in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

1 x High Risk (substance use) and 2 x Medium Risk

If the High Risk is substance misuse this could lead to a possible referral to 'Harbour'. This is more likely the higher the score. The child or young person needs to consent to referral. Consult with 'Harbour' before completing referral. If young person does not want to engage with 'Harbour', advice from 'Harbour' should be sought to minimise substance misuse harm.

The areas identified that contributed toward medium risk in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

1 x High Risk and 2 x Medium Risk (including substance use)

If the substance misuse domain is Medium Risk this would suggest seeking advice from 'Harbour' in the context of how the high risk domain and the medium risk domain compound substance use. This is unlikely to require a referral to 'Harbour'.

The areas identified that contributed toward high risk and medium risk in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

4 x Medium Risk

This would require information and advice for the child or young person on the substances being used and clarification over the law. Use FRANK if no other information available.

The areas identified that contributed toward medium risk and medium risk in the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.

All other combinations

Would normally require a minimum intervention e.g. information provision - use FRANK.

Areas identified that contributed toward a medium risk in either of the two domains 'social situation / behaviour' and 'general and psychological health' should be noted in so far as how well are these being addressed in any current care plan.


Appendix 1: Drug use Screening Tool Flowchart

Click here to view Appendix 1: Drug use Screening Tool Flowchart

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