Young Person s Health Drop In Services chill

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					        Young Person‟s Health Drop In Services

                       Shetland

          Health Promotion Report 2006 - 2007




Report prepared by:                  Claire Jamieson




                                                       1
Contents:
Introduction                                   Page 3 – 5

Purpose of Report                              Page 6

General Local Information                      Pages 7 - 9

What they do well                              Page 10 - 11

What could improve                             Pages 11 - 12

Summary                                        Page 13

Recommendations                                Pages 14 – 17

Funding                                        Pages 18 -21

Appendix A: Abbreviations                      Page 22

Appendix B:          SYIS                      Pages 23 - 25

                     Brae                      Pages 26 -29

                     Anderson High             Pages 30 -31

                     Sandwick                  Pages 32 -35

                     Aith                      Pages 36 -38

Appendix C: Sandwick Consultation Results.     Pages 39 - 49

Appendix D: Sandwick Evaluation                Pages 50 – 51

Appendix E: Sandwick Statistics                Page 52

Appendix F: Comments from Gwen Williamson      Page 53
            Counselling and support worker

Appendix G: Outreach drop-in recording sheet   Page 54

Appendix H: Child Health A&E Statistics        Page 55

References                                     Page 56




                                                               2
  Young Persons‟ „Drop In‟ Services Report – Shetland

Introduction

With the shift in emphasis to a NHS which focuses on health
improvement and the publication of the Action Framework ‘Delivering
a Healthy Future’ it is important that we look at what is being done
locally to secure and enhance the foundation of the society in which
we live: the children and young people of Shetland.
‘Children and young people are a vital part of the Scotland of today and all
of our nation’s tomorrow. Safeguarding their health well-being during the
vulnerable and formative years of life is a crucial and shared responsibility
of a civilised society. Beyond that the way in which we nurture them
through childhood and adolescence into adult life will have a major impact
on the future health of our nation and on its prosperity and stability.’ (1)

It is well documented that there are many barriers for young people in
accessing primary health care. This may be compounded for some
young people in Shetland ‘whose parents are not able to ensure they are
able to access opportunities and grow up feeling part of the community
within which they live’.(2) We are not talking here about very young
children who are high users of primary care for minor illnesses, (via
their parents), but those young people in the transition period
between adolescence and adult life. The demand of this group on
primary care services is minimal. We could assume many reasons for
this, a) this group of patients are young and healthy, and therefore
there is no demand, b) Primary Care services are not set up to cater
for this age group, c) young people go without treatment or choose
self care options, d) ‘self-consciousness and the question of
confidentiality(3)’ on behalf of the young person. Whatever the case,
this „should not constitute a basis for a failure to give due attention and
priority to the challenge of providing age appropriate, equitable accessible
and high quality care to children and young people.’(4)

Although here in Shetland we are doing well in comparison with some
national health improvement targets, i.e. teenage pregnancy rates are
lower than the national average and we are on target for 60% of 5
year olds having no fillings, cavities or extractions by 2010, we cannot
afford to be complacent. Other lifestyle choices or circumstances
young people are dealing with in Shetland should concern us.

                                                                           3
Local Identified Need
Indications of some lifestyle choices that young people are making
and possible identified areas of need for targeted intervention have
come from:

 NHS Shetland Secondary 2 health questionnaire responses for
  2003 – 2006 where an average of:

     21% of pupils don’t eat breakfast regularly.
     12% of pupils don’t eat fruit and vegetables every day.
     3% of pupils never take some form of exercise.
     11% of pupils are carers for someone at home.

 Scottish Schools Adolescent Lifestyle and Substance Use Survey 2002
  (5) the following findings were made:



   9% of 13 year olds and 18% of 15 year olds were regular
    smokers,
    This is not significantly different from reported national
    prevalence.
   31% of 13 year olds and 51% of 15 year olds had drunk alcohol
    in the week prior to the survey.
    The proportion of 13 year olds who drank alcohol in the week
    prior to the survey was higher than the reported national
    prevalence for this age group.

 Scottish Schools Adolescent Lifestyle and Substance Use Survey 2006
  (6):



   4% of 13 year olds and 17% of 15 year olds were regular
    smokers,
    Although there has been a decline in 13 year old regular
    smokers there are still similar levels smoking regularly at 15.
   15% of 13 year olds and 40% of 15 year olds had drunk alcohol
    in the week prior to the survey.
    Again a small decline in numbers from 2002 figures.



                                                                    4
 Local figures from the Child Health department indicates the
  numbers and reasons young people presented to accident &
  Emergency during 2002 - 2005:

     27 deliberate self-harm
     39 alcohol involvement
     36 emergency contraception
     71 burns / scalds
     613 head injuries

      The figures also suggest that whilst the teenage transition
      period does not make high demands on primary care services,
      more young people between 13 –15 are likely to present to
      A&E. During 2002 – 2005 approximately 350 young people
      between the age of 13 – 15 presented at A&E in comparison to
      155 7 year olds over the same period. (See appendix h)


 Youth Voice conference in 2005, in the ‘Health’ workshop
  delivered by Health Promotion and the Community Health
  Partnership: Young people felt they were unable to access health
  services in remote and rural areas, and they depended on a
  parent/adult to escort them to GP practices. In some
  circumstances this is not ideal, especially if the young person
  wants to access healthcare anonymously and speak in confidence.
  This can be more difficult for those young people who do not have
  a positive relationship with family, friends or their community or are
  living with poor emotional and financial situations.




                                                                      5
Purpose of Report
‘Across Scotland much good work is already underway in respect of child
health. Much more still remains to be done if we are to address not only the
patterns of childhood illness that continue to be seen in a modern society
but also the behaviours, attitudes and life-circumstances which impact on
our children and young people and threaten their prospects of sustained
good health.’(1)

In some Shetland communities’ young people’s health ‘drop ins’ have
been developed, in response to local identified need. The aim of
these has been to maximise the effective use of health services and
provide integrated services that compliment general practice
provision.

This report endeavours to look at the local need for such services, the
effectiveness of the interventions offered at Sandwick School and
whether there is a model that could be rolled out across seven
Shetland High / Junior High Schools.

‘All young people are entitled to receive appropriate health care wherever
they access it. Services need to take young people’s needs into account.
This includes primary, community, specialist and acute services.’ (7)




                                                                          6
Local Demographic Information

The last Census in 2001 showed there were some 5,809 children and
young people under the age of 20 in Shetland. This represents 26.4%
of the total population.

The graph below shows the breakdown of children and young people
registered with GPs in Shetland. Although not an exact
representation of the spread of the population it gives a very good
indication   of    where   the    younger    population    live   in
Shetland.
                      Graph showing GP practice registrations by age band at 1st July 2004
             700


             600


             500


             400                                                                                                      0-4
    Number




                                                                                                                      5-9
                                                                                                                      10-14
             300
                                                                                                                      15-19


             200


             100


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                                                           GP Practice


Note: Yell covers Fetlar, Whalsay covers Skerries, Walls covers Foula and Papa Stour and Levenwick covers Fair Isle




                                                                                                                       7
Current Drop In Services

Across Shetland there are five specific young persons ‘drop in’ health
services in operation. Shetland Youth Information Service (Lerwick)
has been in operation since December 2002 and has proved very
successful. The GP’s input to this service was originally funded
through the Health Improvement Fund, although subsequently has
been picked up by NHS Shetland. Three of the other four are based
in Junior High Schools: Aith, Brae, Sandwick; covering pupils from a
fairly wide geographical area. The last one, like SYIS, is based in
Lerwick at Anderson High School. Even though these sessions cover
a large percentage of the youth population, it leaves those in rural
and remote areas of Shetland without a consistent, appropriate
service. GP practices are not always perceived as the most user-
friendly place for a young person to attend.


Although the young persons’ ‘drop ins’ have been developed
independently they have much in common in terms of best practice.
Each drop in operates with an integrated multi-disciplinary staff and
has significant service user input. This means the services help to
break down the barriers between professionals and young people
and create improved communication channels. Also they are working
towards the de-stigmatisation of sexual health services. These
projects are improving their patients’ health education and self care
skills, empowering them and also developing a skill mix across all
agencies.




                                                                    8
Location of Drop Ins

The following depicts the geographical nature of the current young
person’s drop in services:




                                              Anderson High

                                              SYIS

                                              Sandwick

                                              Aith

                                              Brae




                                                                     9
What they do well

What all drop in services offer is a specific space where young people
can acquire information and support on a wide number of health and
social issues. These services are dedicated to addressing young
people’s needs and are easily accessible, (although not to those
excluded from school (accept SYIS in Lerwick) and this needs to be
addressed). They are confidential and help to de-stigmatise sexual
health issues and also help to break down the perception of
‘unapproachable adult professionals’ in young people. The multi-
disciplinary teams that deliver the drop in services enable a holistic
approach to be taken.

‘Education and social care, good nutrition and healthy life-styles,
environmental improvements and initiatives to address inequality and
disadvantage all play a vital role in promoting and protecting children and
young people’s health. These activities involve a range of Government
Departments, Local Authorities and the voluntary sector whose input is a
vital influence on the broader context within which this Action Framework
must be delivered.’(1)

They all offer some form of informal education regarding health and
social matters and promote responsibility in relation to health
management, maintaining health status and how to use health
services. These early positive experiences of health care will
hopefully empower young people and lead to proactive use of health
interventions in the future.

The ‘drop in’s’ are staffed and managed by a dedicated multi-
disciplinary team and are well attended. Staff involved in the young
persons’ ‘drop in’ services are highly committed both to their patients
and to the delivery of effective interventions. However, there is some
inconsistency in staffing between the ‘drop ins’ and a lot of staff time
is offered on the basis of ‘good will’ and not seen by all as a core
service, with protected time to offer within their remit. Covering the
‘drop ins’ is not part of individual staff performance objectives or in
service delivery plans. This means that the services are vulnerable to
closure if staff feel they can no longer offer their valuable time, this
threatens the continuity of the staff provision, which young people


                                                                        10
need. These services need dedicated staff time in order to ensure
quality service delivery.

The school nurse involvement appears to work extremely well. These
staff members are well known by the young people and trusting
relationships are already established, therefore promoting access.
Their involvement also enhances their link to education and primary
care.

Youth worker involvement also seems to work well and is needed to
ensure group work and informal sessions are managed effectively.
These staff are heavily involved in the informal education delivered.


What could improve


In writing this report it became clear that in some of the ‘drop in’
services staff roles and responsibilities are unclear. This appears to
be due to the way in which they have evolved, i.e. from identifying
young people’s needs at a very local level by a multi-disciplinary
team with no obvious lead. If services are not made a core part of
staff roles/remits’, GP practice provision need to offer appropriate
services to all its’ practice population, and not just to those who find it
most accessible.

There are also great inconsistencies in the funding arrangements for
each service and some are likely to disappear if ongoing funding is
not sourced and made available. Development is virtually impossible
as funding for the basic services is not secure. If these services are
not enhanced there must be a commitment to these responsibilities in
core service provision.

Promotion of these services could also be improved. Currently this is
done on an ad-hoc basis and if there were a more proactive
promotional campaign across the ‘drop in’ services access would
undoubtedly improve.

Links between the ‘drop in’ services and other services for young
people are informal and work better in some than others. This is often

                                                                        11
due to what other services are available and if they are willing to
engage with the ‘drop ins’.

Currently there appears to be no minimum standard of service
delivery, and there is no overall management / supervision of the
services across the locality to implement them.

Up until very recently links to Family Planning Services were through
GP practices. In November 2006 a Sexual Health and Well-Being
Clinic based in Lerwick was launched and a GP lead for Sexual
Health was appointed. This service offered young people a
confidential and anonymous place to seek sexual health advice and
was an effective signposting service. However due to unforeseen
circumstances this has had to be put on hold. When the service is to
re-open we need to coordinate interactions between the drop in
services and this service at a strategic and operational level.




                                                                   12
Summary

The young person’s ‘drop in’ services have been developed from
need identified with the local youth population and staff working with
these young people. These ‘drop in’ services will support the
modernisation of the whole range of NHS sexual health, counselling
services. They are also in line with HALL4 (8) guidelines, which reflect
a move away from a wholly medical model of screening for disorders,
towards greater emphasis on health promotion and primary
prevention.

The ‘drop in’ services also contribute significantly to Shetland’s
Integrated Children and Young People’s Services Plan 2005 – 2008
(9), particularly in the following areas:


 5.3 Theme: Healthy–

     o Develop alternative access points for young people to
       healthcare staff and health information.
     o Reduce the number of young people who start smoking and
       support young people in stopping smoking.
     o Ensure that young people are supported in the transition
       from child to adult services.
     o Develop flexible ways for looked after children and those
       receiving an aftercare service to access health services and
       ensure health needs are addressed.
     o To improve the sexual health of young people in Shetland.
     o To improve the mental health and well-being of children and
       young people.
     o To improve the effectiveness of health improvement services
       to children and young people, including prevention and
       protection programmes.

Young persons’ ‘drop in’ services need strategic, organisational,
financial and policy backing in order to ensure that Health Care
services are more appropriately suited to young peoples needs and
are sustainable. Otherwise these valuable resources could disappear.



                                                                     13
Recommendations
Generally, there are a number of issues that should be taken into
account when developing health services for young people:

     Accessibility
     Publicity
     Confidentiality and consent
     The environment
     Staff training, skills, attitudes and values
     Joined-up working
     Monitoring and evaluation, and involvement of young people
     Health issues for adolescents
     Sexual and reproductive health services

The Sandwick ‘drop in’ service has proven to be a popular way of
offering both generic health information and specific health advice
and there is clearly support of the service by the young people and
the dedicated staff involved.

As the ‘drop in’ is located in school premises and professionals are
coming to the young people, the set up and environment is
accessible and appropriate for a very large percentage of the
secondary school age population in this locality. Although there have
been some issues of privacy due to the open setting, this could be
easily remedied.

During the consultation the and at the ‘drop in’ clear information has
been given about confidentiality and this need was reflected in the
young people’s responses to the consultation.

The service has offered signposting opportunities and given young
people the confidence to access other services for themselves, (The
local surgery having noticed significantly more young people coming
to the practice for support and advice).

This joined-up way of working is an excellent example of integrated
work and ought to be considered in all localities.


                                                                    14
                                         GP Practice
   Model Of Practice
                                         Sexual Health
                   Drop In Service.      & Well-Being
                                         Clinic
                 SYIS / Youth Work
                                         SYIS –
                                         Counselling &
                                         Children‟s
                 Health Visitor/School   Rights
Young            Nurse
Person                                   Smoking
                                                         Specialist
                                         Cessation       young
                 Practice Nurse                          persons
                                                         services
                                         Additional
                                         Support
                 Pupil Support           Team

                                         Alcohol &
                                         Drug
                                         Services


                                         Local Support
                                         Coordinator
                                                         15
The following recommendations are being made:

  1. Senior management staff from the different professional bodies
     involved (Primary Care Teams, School Nursing, Education,
     SYIS and other voluntary sector organisations) come together
     to formalise their teams’ roles and responsibilities, through the
     inclusion of the drop in services in department plans and
     personal performance indicators and the development of
     service level agreements and protocols. This would include
     commitment to resource these projects by all agencies, whether
     through additional funding or within existing funds.

  2. That a management committee be recruited from senior level
     staff in the appropriate interested organisations, to oversee the
     delivery and development of all the young person’s ‘drop ins’.
     This could potentially be a sub-group of the Integrated Children
     and Young People’s Services Planning Group or the Child
     Health Strategy group. Alternatively management fees could be
     sort for one staff member to oversee this work.


  3. To introduce standard monitoring tools to evaluate the ongoing
     effectiveness of the ‘drop in’ services and ensure procedures
     are in place to consult with young people on a regular basis.


  4. That definite links to the Sexual Health And Well Being Clinic,
     School Nursing, Local Support Networks, Primary Care Teams,
     Counselling Services, CAMHS and other organisations and
     initiatives (i.e. Pupil Support, Hall4, Health Promoting Schools,
     Active Schools & Hungry for Success) are made in order to
     encourage quality seamless service provision and signposting.


  5. That access to condoms, pregnancy testing and emergency
     contraception as well as Nicotine Replacement Therapy (NRT)
     is available as a minimum in all the ‘drop in’ services. This could
     be done either through the development of a PGD or



                                                                     16
  alternatively through a GP with protected time to dedicate to the
  drop ins’.


6. That School nurse provision be enhanced to support the ‘drop
   ins’ and that all school nurses receive family planning training.


7. That consultation and awareness raising continues to happen
   amongst the young people and those adults involved i.e.
   parents.


8. That links are made with PSHE programmes, school health
   profiling, schools’ health promotion plans and activities, to
   ensure consistency and targeted messages are given.




                                                                  17
Funding

Below are three suggested funding options; a minimum, middle and
gold standard. There are a number of ways of implementing these
options;
      1) To have a universal service where all ‘drop ins’ are funded
         equally across the locality at minimum, middle or gold
         standard.
      2) That ‘drop in’s’ are funded according to levels of inequalities,
         teen pregnancy rates, lack of other young person’s services
         and levels of need.
      3) That those ‘drop in’s’ based in these areas of deprivation be
         funded at gold standard and so on.
      4) Per young person.
The figures below are based on supporting 7 drop in services:

Minimum standard

Element                 Cost per annum           Remarks
Staffing:                                        Based on offering 2
School / Practice       WER                      hours per week for 52
Nurse                                            weeks per year in 7
Youth Worker            WER                      sites.
Room Hire               Free accommodation       Must be youth
                                                 friendly and
                                                 accessible.
Administration,         WER
sundries & resources
Management              WER
Total                   WER                      Based on offering 2
                                                 hours per week for 52
                                                 weeks per year in 7
                                                 sites.

This option would offer young people the very minimum in condom
distribution and health and social care support/advice and
signposting. Provision of emergency contraception and NRT would
need to be addressed, as it may not be provided under this option.

                                                                      18
Middle standard
Element                 Cost per annum           Remarks
Staffing:
School Nurse (Family    WER
Planning trained &      £7,000.00                Based on offering 2
able to prescribe                                hours per week for 52
emergency                                        weeks per year in 7
contraception under                              sites.
PGD)
Youth Worker            £15,435.00

Room Hire               £10,920.00               Based on offering 2
                                                 hours per week for 52
                                                 weeks per year in 7
                                                 sites.
Administration,         £7,000.00                Based on offering 2
sundries & resources                             hours per week for 52
                                                 weeks per year in 7
Management              WER                      sites.
Travel                  £14,000.00               Based on 0.43 pence
                                                 mileage rate, an
                                                 average of £1000.00
                                                 per person per drop
                                                 in.
Total                   £57,855.00               Based on offering 2
                                                 hours per week for 52
                                                 weeks per year in 7
                                                 sites.

Ideally this would be what each ‘drop in’ would look like in order to
provide minimum contraceptive service and health and social care
support.




                                                                        19
Gold Standard
Element               Cost per annum   Remarks
Staffing:
School / Practice     £7,000.00         Based on offering 1
Nurse(Family                           session per week for
Planning trained &                     52 weeks per year.
able to prescribe
emergency
contraception under
PGD)
Youth Worker          £15,435.00

GP                    £15,000.00 per   Offering a rolling
                      annum            programme of visits
                                       to each drop in
Counsellor            £26,338.00       One full-time post to
                                       cover drop ins’ out
                                       with Lerwick (includes
                                       on costs)
Smoking Cessation     £15,000.00       Based on 0.5 WTE
Advisor                                including on costs
Room Hire             £10,920.00       Based on offering
                                       2hours per week for
                                       52 weeks per year.
Administration        £7,000.00        Based on offering 2
                                       hours per week for 52
                                       weeks per year.
Management            £3,500.00        Based on offering 1
                                       hour per week for 52
                                       weeks per year.
Resources &           £3,500.00        For educational
sundries                               games and activities /
                                       videos etc
Travel                £14,000.00
Total                 £117,693.00      Based on offering 2
                                       hours per week for 52
                                       weeks per year.


                                                           20
This option would offer a full support service model. This would
provide access to all contraception and NRT, which is crucial if no
other family planning services or smoking cessation services are
available locally. It would also offer young people access to other
health interventions via the GP.




                                                                      21
                                                    Appendix A
Abbreviations

CAMHS           Community Adolescent Mental Health Services

GP              General Practitioner

NHS             National Health Service

NI              National Insurance

PGD             Patient Group Directive

PSHE            Personal Social Health Education

NRT             Nicotine Replacement Therapy




                                                              22
                                                        Appendix B
Shetland Youth Information Service (SYIS)


Name of drop     Monday lunchtime clinic at SYIS.
in
& where and
when drop in
is held
Initial start    December 2002
date

Lead             SYIS Karen Smith
Organisation
& lead person
Contact          Karen Smith
Person           01595 692002
& telephone
no.
Partners         NHS Shetland

Who              Committee consisting of representatives from SYIS,
manages the      NHS, SIC oversee effective delivery, monitoring and
service? I.e.    evaluation.
committee
etc & who is
the contact?
Brief history    There was a pilot project in 1999 during the Tall
of the           Ships Race. This proved to be very successful and
development      subsequently a bid was submitted to Health
of the drop in   Improvement Fund to enable a ‘permanent’ Health
                 Clinic to operate from SYIS.




                                                                  23
Aims and Objectives
Aim: To offer accessible / alternative / confidential health care to any
young person aged 12 – 25.

Objectives:

   o Provide a qualified GP on a regular basis.
   o Provide a generic health clinic in a young persons setting.
   o Provide an appointment system that is both accessible and
     confidential, with a higher level of anonymity than traditional GP
     services.



Funding information
Funding was initially provided through the Health Improvement Fund.
The GP hours are now funded by NHS Shetland.



Services provided
What is provided?      By whom? I.e. G.P, Youth worker etc
Weekly generic         GP, Young Person’s smoking cessation
health clinic,         advisor, SYIS staff.
including health
promotion, sexual
health matters,
smoking cessation.




                                                                      24
Costs
What                                 Cost per annum
  o Staff                              £60-£80 per hour (GP time)
                                       other staff within existing
   o Room Hire                         resources
                                       WER

   o Resources & Equipment                WER

                                          WER
   o Management
                                          WER

   o Publicity & Promotion                WER


   o Refreshments


Evaluation
Confidential GP notes.
Daily statistical sheet (see appendix )
Monitoring and evaluation group.



Service User Involvement
Initial feedback from pilot in 1999. SYIS is in the process of setting up
a young persons management committee.




Data Collection
Daily statistical sheet.

                                                                       25
Brae


Name of drop     Tuesday lunchtimes, held in the leisure centre.
in
& where and
when drop in
is held
Initial start    2001
date

Lead             Joint provision between NHS & SYIS, Karen Smith
Organisation
& lead person
Contact          Health Visitor & School Nurse for Brae
Person           01806 522826
& telephone      Michael Welsh
no.              01595 692002
Partners         Additional Support Services, NHS Shetland, Brae
                 High School & SYIS
Who              SYIS manages the service. However it has been
manages the      identified that it needs to be managed by a multi-
service? I.e.    agency group informed by young people in Brae.
committee
etc & who is
the contact?
Brief history     A needs assessment was undertaken with the
of the           School pupils in 2001 and it became apparent that
development      they needed more information on health. The Drop-
of the drop in   in began soon after with a Smoking Cessation remit.
                 After a few months the emphasis had shifted to a
                 more generic need, which is what is offered
                 currently.




                                                                      26
Aims and Objectives
To offer a condensed version of Lerwick SYIS drop-in in the North
Mainland.


Funding information
Quality of Life funding had been granted for GP attendance (£5000).
However there is the possibility of £15,000.00 being awarded for
2007 – 2008.


Services provided
What is provided?     By whom? I.e. G.P, Youth worker etc
Generic health
information/support   Youth Worker, Health Visitor, GP (on
drop-in. Including    intermittent basis)
health promotion,
sexual health
matters, smoking
cessation.




                                                                    27
Costs
What                               Cost per annum

   o Staff                         £2205
                                   Additional support services are
   o Room Hire (inc care taker)    currently covering the cost of
                                   room hire at the leisure centre.
                                   WER
   o Resources & Equipment
                                   £500 – SYIS

   o Management                    £100

                                   None
   o Publicity & Promotion
                                   £700

   o Refreshments


   o Travel




Evaluation
Daily statistical sheet.
Weekly logbook.
Annual Reviews.


Service User Involvement
None as yet, but SYIS is in the process of setting up a young persons
management committee.




                                                                      28
Data Collection
Daily statistical sheet, weekly log book




                                           29
Anderson High


Name of drop     Nurse led one to one clinic, currently on Maternity
in               leave.
& where and
when drop in
is held
Initial start
date

Lead             NHS Shetland; Liz Gordon School Nurse
Organisation
& lead person
Contact          Liz Gordon or Janice Johnson
Person           01595 743076
& telephone
no.
Partners         SYIS


Who              School Nurse service – CHP
manages the
service? I.e.
committee
etc & who is
the contact?
Brief history    This service has been delivered through the School
of the           Nurse and local Smoking Cessation service.
development
of the drop in




                                                                       30
Aims and Objectives
  To offer one to one support and guidance on a range of health
  issues.



Funding information
Within existing resources – CHP managed


Services Provided
What is provided?       By whom? I.e. G.P, Youth worker etc
One to one support      School Nurse

Information             School Nurse

Smoking Cessation       Smoking Cessation Advisor

Health Checks           School Nurse



Evaluation
Secondary 2 questionnaire used as tool to identify individual health
issues. Generic results complied for 2003



Data Collection
S2 health interviews conducted on a one to one basis, see
questionnaire results appendix




                                                                       31
Sandwick

Name of drop     ‘Our Lipz are zipped’
in               Monday lunch times at Sandwick Junior High School
& where and
when drop in
is held
Initial start    April 06
date

Lead             Sandwick Junior High School
Organisation     John Morton
& lead person
Contact          John Morton
Person           01950 431454
& telephone
no.
Partners         SYIS (Young person’s Rights Officer and Young
                 Person’s Counsellor), NHS Shetland (Health Visitor
                 and Practice Nurse),
Who              Committee – SYIS, Sandwick School, Young
manages the      People, NHS Shetland
service? I.e.
committee        Health Outreach Group – strategic group. SYIS,
etc & who is     NHS, SIC.
the contact?
Brief history    Sandwick School approached SYIS requesting
of the           some input on an informal basis. After a number of
development      meetings involving NHS Shetland it was agreed to
of the drop in   pilot a joint drop-in.




                                                                  32
Aims and Objectives
Aim

To provide an easy accessible and confidential service to all
secondary pupils that promotes and enhances their mental, physical
and emotional well being in a collaborative approach with the
agencies and young people involved.

Objectives

     To offer regular consistent contact.
     To work in partnership with agencies and young people.
     To develop promotional material.
     To encourage and support young people in the transition from
      child health services to adult services.
     To encourage responsibility and confidence of users in
      accessing other mainstream services to address their health
      needs.
     Develop an effective signposting service for students.
     Encourage resilience and independence through support.
     Evaluate the service.
     Establish an effective information service.




Funding information
No specific funding has been sought or received. Current provision is
delivered within existing resources.




                                                                   33
Costs
What                        Cost per annum
  o Staff                     £3370

  o Room Hire                 WER

                              WER
  o Resources & Equipment
                              £500

  o Management                £250

                              None
  o Publicity & Promotion
                              £800

  o Refreshments


  o Travel




Evaluation
Monitoring committee
Young persons committee
Daily statistical sheet
Final evaluation sheets



Service User Involvement




                                             34
Young Persons Committee




Data Collection
Daily statistical sheet




                          35
Aith


Name of drop     Held weekly on a lunchtime at the School.
in
& where and
when drop in     The room is not ideal and they would like to explore
is held          other possibilities, perhaps the leisure centre.
Initial start    Sept 05
date

Lead             SYIS, Michael Welsh
Organisation
& lead person
Contact          Karen Smith
Person           01595 692002
& telephone
no.
Partners         Depute head, Health Visitor & SYIS worker


Who              SYIS
manages the
service? I.e.
committee
etc & who is
the contact?
Brief history    Aith School contacted SYIS in June 05 with
of the           concerns regarding the lack of information regarding
development      sexual health that was available to their pupils. It
of the drop in   was agreed to start an informal drop-in one day a
                 week in partnership with the School.




                                                                    36
Aims and Objectives

  To offer a condensed version of Lerwick SYIS drop-in in the West



Funding information
WER


Services provided
What is provided?     By whom? I.e. G.P, Youth worker etc
Generic
information/support   Youth Worker, Pupil Support Teacher, School
drop-in.              Nurse



Costs
What                               Cost per annum
  o Staff                          £2205


                                   WER
  o Room Hire
                                   WER
  o Resources & Equipment
                                   £500 – SYIS

  o Management                     £100

                                   None
  o Publicity & Promotion
                                   £400



                                                                    37
   o Refreshments


   o Travel



Evaluation

Daily statistical sheet. Weekly logbook. Annual Reviews




Service User Involvement
Consultation has taken place using the same tool as in Sandwick.
Feedback has been given to the students.



Data Collection

Daily statistical sheets




                                                                   38
                                                           Appendix C
Sandwick Consultation Results

S1                                        18 Respondents



“Lunch Time Drop In” or what would YOU call it?
        Chill Zone
        Drop In or Drop Out
        The Drop In
        Chill Out!
        The Chill Zone
        The Chill Zone
        Our Lips Are Zipped
        Drop In Zone!!
        Chill Zone!
        Drop-In Zone!



Which staff would you like to see there?
            Teachers – 4
            Nurses – 10
            Youth Worker – 13
            Shetland Youth Info Service Workers – 12
            Drugs Worker – 6
            Other – nil



Which qualities should these staff/visitors have?
        Friendly – 17
        Trustworthy – 15
        Good listeners – 16
        Sense of humour – 15
        Understanding – 17
        Other – nil




                                                                   39
What topics would you like to see discussed?
     Sex & relationships – 6
     Drugs – 11
     Alcohol – 11
     Smoking – 12
     Mental health e.g. stress – 8
     Physical activity – 9
     Bullying – 14
     Other – Problems



What rules should we have?
     Use school rules.
     It should be more private.
     Everybody has to respect; no bullying.
     Respect each other; fun; listen carefully; no bullying.
     No bullying. Be fair. Don’t be shy. Respect everyone.
     I think it would be way better if girls could have a separate session from
      boys.
     It’s confidential. Be friendly.
     Whoever speaks to someone must have their say being confidential
      unless they don’t want it to be.
     Everything should be confidential. Everybody should be respected.
     Nobody tells other people outside of the club. Respect others’ thoughts.
     Should be confidential. Friendly environment. Respect each other.
     Should be more private.
     No drugs. Be polite.
     No bullying, physically or mentally (verbal).
     Listen to one another.
     Should listen to everybody. No bullying.
     It should be confidential.
     No swearing.




                                                                                   40
What type of activities could we have?
     Sport.
     Football. DIY.
     Computing. Playstation.
     Rugby. Football. Boxing. Kick boxing.
     Swimming. Camping.
     Maybe some sports? Visits?
     Trampolining. Football. Rollerblading. Skateboarding. Tennis.
     We could do a variety of sports or crafts. Trampolining.
     Trampolining. Roller-skating.
     Trampolining. Kick boxing. Musical instruments. Playing. Tennis.
     Football.
     Football.
     Making things. Painting. Board games. Netball. Swimming. Hockey.
     X-box. Rugby. Pool. Football. Outdoor activity. Boxing.
     DIY.
     Group discussions.
     Arts and crafts.



We want you to have your say in planning this – what would you
like to have in the drop in? Eating zone? Chill zone? Other?
     An eating zone and a chill zone and a TV.
     Chill zone. Eating Zone.
     Chill Zone and the Eating Zone.
     Eating zone, Chill Zone, TV etc. Chatting zone. Computer zone.
     I would like it to be an eating and chilling zone.
     I would like there to be an eating zone and a chill zone.
     I would like it to be an eating zone and a chill zone. I would also like it to
      be a games zone.
     A music area, food area, chillzone.
     Eating zone. Fun zone. Chill zone.
     Games.
     Both the ideas above. Crafts area. Also I heard about something about
      Art therapy. What about that?
     Eating zone. Chill. Gaming zone. Archery.
     It shouldn’t be in the Social Area.
     Eating zone.




                                                                                   41
S2                                        11 Respondents




“Lunch Time Drop In” or what would YOU call it?
        Kut
        Da Health Check Up!
        Chill ZONE

Which staff would you like to see there?
        Teachers – 4
        Nurses – 4
        Youth workers – 6
        Shetland Youth Info Service workers – 4
        Drugs worker – 2
        Other – Anger management.


What qualities should these staff/visitors have?
        Friendly – 9
        Trustworthy – 9
        Good listeners – 9
        Sense of humour – 9
        Understanding – 9
        Other – nil



What topics would you like to see discussed?
        Sex & relationships – 4
        Drugs – 7
        Alcohol – 6
        Smoking – 6
        Mental health e.g. stress – 5
        Physical activity – 4
        Bullying – 10
        Other – nil




                                                           42
What rules should we have?
     No smoking or drinking. Go straight to lesson after bell.
     I think you should have a rule, which is that you should only give
      prescription medicines if you really think it’s necessary.
     I’m not bothered.
     The rules that you already have e.g. confidentiality, everything to be done
      in confidence.
     I’m not fussed about rules.
     Use the school rules
     Be able to take a friend if they’re wiling to come.

What type of activities could we have?
     Football. Boxing. Basketball. Internet. Outings. DVDs. Bowling. Dodge
      ball. Paintball. PSD. Minimoto trucks.
     You could have 6-10 cards on the table/desk and you could match them
      up.
     Craft activities. Sewing activities. Pets/animals – budgies! Knitting.
     Sport – football, basketball etc.
     Arts & crafts. Sports. Music. Lots of food and juice. Board games.
      Outdoor activities. Horse riding.
     PS2. Paintball. Dodgeball. Minimoto races.
     Sport activities like football and netball. Outdoor activities like we do at
      the school like going canoeing or bog diving.
     PS2. PC. Cricket. Football. Dodgeball. Paintball. Quad racing.
     Arts & crafts. Music. Sports. Reads, books/magazines. Chat & chill
      zone.
     Craft. Music. Sports.
     PS2. Cricket. Football. Paintball. Baseball. Rounders. Basketball.
      Quad racing.


We want you to have your say in planning this – what would you
like to have in the drop in? Eating zone? Chill zone? Other?
     Eating zone. Chill zone. Toilets. Protection tub.
     I think you should have a chill zone with food and drinks.
     Chill zone & eating zone. I would like to have an animal zone with posters
      and info books on them. Should have food and somewhere to sit and
      relax. Make it comfortable.
     Chill Zone with beanbag, cool lights, big TV, sofa, big CD player etc.
     PS2 zone.
     A TV, eating zone and games.
     PS2 zone. Eating zone. Game zone.
     Chill zone.
     Quiet room to sit in and have a laugh and an eating-place. Game room.
      Fun room.



                                                                               43
S3                                         13 Respondents


“Lunch time Drop In” or what would YOU call it?
        Drop In
        The Drop Ins


Which staff would you like to see there?
        Teachers – 2
        Nurses – 9
        Youth worker – 10
        Shetland Youth Info worker – 11
        Drugs worker – 4
        Other – nil

What qualities should these staff/visitors have?
        Friendly – 12
        Trustworthy – 11
        Good listeners – 11
        Sense of humour – 10
        Understanding – 11
        Other – nil

What topics would you like to see discussed?
        Sex & relationships – 7
        Drugs – 10
        Alcohol – 11
        Smoking – 11
        Mental health e.g. stress – 10
        Physical activity – 11
        Bullying – 10
        Other – nil




                                                            44
What rules should we have?
      Confidentiality.
      No smoking. No making fun of other’s problems.
      You should be kind and friendly. You should respect our views and listen
       to our problems or what we have to say.
      No smoking.
      Stop bullying. No smoking. No swearing. No drinking.
      Don’t muck around.
      Dunno.
      Confidentiality.


What type of activities could we have?
      Musical activities.
      Music workshops
      Musical activities (bands); workshops.
      Basketball. Netball. Musical activities.
      You could have quizzes, computers or reading activities.
      Football etc.
      Football, rugby, basketball, dodge ball.
      Quiz.
      Guitars.
      Monopoly.
      Board games.
      Board games.


We want you to have your say in planning this – what would you like to have in
the drop in? Eating zone? Chill zone? Other?
    Chill Zone.
    Music zone.
    Chill zone. Eating zone.
    Music zone.
    I would like a chill out zone where you could sit and ‘chill out’ during
       lunchtime.
    Chill zone.
    Private rooms. Eating zone. Refreshments.
    Internet. Guitars. Eating-place. Music.
    Eating zone.
    Eating Zone.
    Eating zone. Chill zone. Talking zone.




                                                                              45
S4                                          25 Respondents


“Lunch Time Drop In” or what would YOU call it?
        Lunch Time Drop In is fine.
        I don’t mind.
        Happy Days
        Cool Time
        Happy Dayz

Which staff would you like to see there?
        Teachers – 2
        Nurses – 15
        Youth workers – 12
        Shetland Youth Info workers – 11
        Drugs workers – 6
        Other – I don’t mind – 1

What qualities should these staff/visitors have?
        Friendly – 18
        Trustworthy – 18
        Good listeners – 17
        Sense of humour – 17
        Understanding – 14
        Other – Fit woman – 1
        Other – Hot woman – 1

What topics would you like to see discussed?
        Sex & relationships – 13
        Drugs – 13
        Alcohol – 11
        Smoking – 11
        Mental health e.g. stress – 11
        Physical activity – 10
        Bullying – 8
        Other – I don’t mind – 1




                                                             46
What rules should we have?
     Complete discretion. No bullying. Friendliness. Open-mindedness.
     ?
     Everybody should be listened to. Nobody makes fun of other’s opinions.
     You can run in the corridors.
     I don’t think that teachers should be allowed as it would make pupils feel
      uncomfortable. I don’t think that the Drop In should be in the social area
      as everyone can see you.
     None apart form confidentiality.
     N/A
     None.
     Confidential. Can’t force people.
     Confidentiality.
     Confidentiality.
     Everyone present should keep all information confidential.
     No one should have to do anything they don’t want to.
     No rules.
     Confidentiality.
     Don’t laugh at anyone.


What types of activities could we have?
     Games. Films. Playstation etc. Fun activities involving everyone.
     Fun activities.
     TV. PS2/Xbox/Game Cube. Anything competitive. Bungee Run. Bouncy
      castle. Trampoline.
     DVDs for free. Free food. Free drink. Playstation 2.
     Spongebob. TV. Free food/drink. Free pens. PCs.
     First Aid.
     ?
     Running. Playstation. Darts. Football. Rugby. Hockey.
     Chatting. Network games.
     PS2. TV. DVD. Wrestling.
     PS2. TV. DVD. Wrestling x 7!
     Football. Darts.
     Football.
     Fun 1s.
     Ones, which everyone can socialise.
     Sports, games activities everyone can join in even if they’re not good at
      some thing. Group quizzes.




                                                                                   47
We want you to have your say in planning this – what would you
like to have in the drop in? Eating zone? Chill zone? Other?
     Eating zone, chill zone, chatting zone, all sounds good to me!
     I don’t mind.
     Eating zone. Chill zone.
     Eating zone. Game zone. Fun zone.
     Eating zone. Chill zone.
     Study zone.
     ?
     Games zone.
     Eating zone. Drink zone.
     Eating zone. Beanbags zone.
     Eating zone. Chill zone. Smoking zone. Drinking zone.
     Eating zone. Chill zone.
     Eating zone, chill zone.
     Eating Zone.
     Somewhere where you can socialise while finding information out.
     Chill zone.
     Eating zone.


Unassigned                             2 Respondents


Which staff would you like to see there?
     Teachers – nil
     Nurses – 1
     Youth worker – 1
     Shetland Youth Info worker – 2
     Drugs worker – 1
     Other – nil

What qualities should these staff/visitors have?
     Friendly – 2
     Trustworthy – 2
     Good listeners – 2
     Sense of humour –1
     Understanding – 2
     Other – nil




                                                                         48
What topics would you like to see discussed?
     Sex & relationships – 2
     Drugs – 1
     Alcohol – 1
     Smoking – 1
     Mental health e.g. stress – 2
     Physical activity – 2
     Bullying – 2
     Other – Careers – 1



What rules should we have?
     Confidential and that no one can tease you if you go to see someone.
     None.


What type of activities could we have?
     Internet access.

We want you to have your say in planning this – what would you
like to have in the drop in? Eating zone? Chill zone? Other?
     All
     Eating zone, chill zone and games.




                                                                             49
                                                                   Appendix D
Sandwick Evaluation

Pupil Suggestion Box Responses
3 July 2006

Total of 33 responses.
10 Male
19 Female
4 not given

S1
No respondents

S2
Total 5
4 male
1 female

COMMENTS –
   I didn’t go myself but it sounds really helpful.
   I haven’t had to use it but I think it’s a great idea and has helped many
    people.
   It’s good for people who use it, though I don’t.
   I think it’s going very well and hope it keeps going.
   It’s really helped loads of people and it’s fun.
   It’s very good and interesting.
   It’s good fun and helpful.
   It’s fun and useful.
   It’s fun and useful.
   Make it so more people come.
   I think Drop-ins a good idea – especially the free-tasters. I think it should
    continue.
   Come back next term and keep up the good work.
   I think it’s good for info.
   It is good keep it up.
   This stuff has been great.




                                                                                50
S3
Total =10
5 male
5 female

COMMENTS –
   It is very useful to have and it is a great help.
   Useful.
   Really useful.
   Very good information.
   It is very useful if I needed help!
   Great – good for people who need it.
   You could have it in a place like the social area.
   Gives very good help.
   Good.
   You could have it more often.


S4
Total = 3
1 male
2 female

COMMENTS –
   The drop in centre should be in a more private area like the medical room.
   The drop in centre should be in a more private place. So that people
    would feel more comfortable coming for advice. So even in a room if
    someone wanted to talk.
   I think it should be put somewhere more private in a room because
    everyone can see you go when it is up in the hall.

Not Stated
Total = 5

COMMENTS –
   I didn’t go but if I did I am sure it will be helpful.
   I think the drop in centre is fine but it needs to be more private. E.g.
    classroom.
   Have more tasters.
   It was good but I enjoyed the thing that you blow in and it tells you how
    much smoke you’ve got in your lungs.
   I liked trying the food and it was an interesting thing to go to.




                                                                                51
                                                                  Appendix E
Sandwick Statistics
19 Dec 2005 to 3 July 2006 Inclusive

Drop In Numbers
Totals     293 visits made

One to One contacts and Issues
Education/Employment/Training                  3
Family and Relationships       6
Health (general)              10
Health (mental)               12
Health (sexual)                7
Pregnancy test
Condoms given out
Leisure and Travel
Money
Housing and Environment
Justice and Equality
Information Technology
Young Scot
Bullying/Fighting
Smoking                        9
Alcohol
Drugs                          3
Health Eating                  1

Referrals
Self                                       18

Telephone

School                                     2

Nurse/GP

Third Party                                    1
(e.g. parent, friend)

Visitors/Events –       Juergen Kurtz – Young People’s Alcohol Worker –19 Dec
                        2005. Food and Mood 13 March 2006 with Shetland Catch
                        (approx 50 young people came along). Final day 3 July
                        2006 Lucky Dip and Suggestion Box (33 responses).


                                                                                52
                                                                    Appendix F
Comments from Gwen Williamson
Counselling and support worker
Dec-June 2006

Things that worked
    Class Visits – YP responded well to initial visits by SYIS and NHS staff.
    Drop in - YP seemed to respond well especially to planned ‘events’
    Counselling referrals – Presence in school certainly had an impact. Aprox
      5 referrals. Two regular long-term clients seen at school. Lots of
      enquiries from teachers and parents.
    Mix of staff – good to have ‘one stop shop’ available. Some issues
      needed more than one professional involved.
    Building relationship with school and health centre– Staff very enthusiastic
      and supportive.

Things that need working on
    Young Person’s Committee – Lots of enthusiasm but no one from school
      available to take a lead.
    Counselling Service – lots of YP expressed a preference for counselling
      visits at school but we were unable to facilitate them all due to high
      demand.
    Communication – SYIS often had to take a lead in this due to other
      demands on NHS and School staff.
    Events – Going on the success of ‘food and mood’ and the alcohol support
      worker visit more events could be organised.
    Commitment from NHS and Education– Staff involved in this type of drop
      in work need the appropriate back up and plenty of time for preparation
      and to see clients 1-1 out with lunch time session. My experience was
      that I met clients before and after the lunch time drop in often spending the
      whole day on Clients, notes and drop in.




                                                                                53
            Appendix G

To follow




                    54
            Appendix H


To follow




                    55
References

1. Delivering a Healthy Future. An action framework for children and young
   people’s health in Scotland. Scottish Executive, Edinburgh, 2007.

2. Deprivation and social exclusion in Shetland. Executive summary. Shetland
   Islands Council. Shetland, 2006

3. A review of teenagers’ perceived needs and access to primary health care.
   Gleeson C 2001. Primary Health Care.11,9,33-36.

4. Delivering a Healthy Future. An action framework for children and young
   people’s health in Scotland. A draft Consultation. Scottish Executive,
   Edinburgh, 2006.

5. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
   National Report. Scottish Executive, Edinburgh, 2002.

6. Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
   National Report. Scottish Executive, Edinburgh, 2006.

7. You’re Welcome quality Criteria. Making health services young people
   friendly. Department of Health. London, 2005.

8. Health for all children 4: Guidance on Implementation in Scotland. Getting it
   right for Scotland’s Children. Scottish Executive. Edinburgh, 2005.

9. Shetland’s Integrated Children and Young People’s Services Plan 2005 –
   2008.




                                                                                   57

				
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