GETTING OUR PRIORITIES RIGHT (GOPR)

SCOTTISH GOVERNMENT POLICY UPDATE

CHILD PROTECTION

NATIONAL GUIDANCE ON CHILD PROTECTION (SCOTTISH GOVERNMENT, 2010)

In 2010 the fully revised National Guidance on Child Protection in Scotland was published. This, together with GIRFEC, has become the foundation of the work all agencies undertake in order to protect vulnerable children and young people. This includes children affected by a parent(s) problem drug and/or alcohol use. The evolution of the Child Protection guidance and also the GIRFEC national change programme has led to a change in language and philosophy. As a result, children should now be at the centre of decision making processes and their needs should be central to all decisions taken by local services. The introduction of the GIRFEC approach means that interventions should be put in place earlier by services when the likelihood of risk to the child - including to their general well-being - is first identified. The evidence base around recovery also links to GIRFEC work, focussing on the benefits of family centred recovery outcomes.

NATIONAL RISK ASSESSMENT TOOLKIT

The national risk assessment toolkit, currently under development by Garth Associates, will be ready for final dissemination to all potential users over the summer 2012. The work with the pilot areas is near completion. A programme of regional training events for the late summer and autumn to help users familiarise themselves with the toolkit and explore how it can improve their current processes will be announced in the early summer by the Scottish Government.

GETTING IT RIGHT FOR EVERY CHILD AND LEGISLATION

The Scottish Government is committed to introducing legislation to ensure investment in early years is not an optional extra. It would also explore legislative options to ensure Getting it right for every child is embedded throughout the public sector.

THE EARLY YEARS FRAMEWORK (SCOTTISH GOVERNMENT, 2009)

The Early Years Framework published jointly by Scottish Government and COSLA in December 2008 sets the strategic direction for early years policy in Scotland.

The Scottish Government wants to see a significant shift to preventative spend in the early years and has set up an Early Years Task Force to lead the drive to preventative spend at a national level. This will be supported by the establishment of a £270 million Early Years Change Fund over this Parliamentary term.

The Early Years Task Force and Change Fund will help to deliver on the key themes of:

Supporting our universal ambitions - we want to reduce inequalities in a variety of policy areas and raise the bar for all children and families across Scotland;

Taking action to identify those at risk and preventing that risk materialising;

Making sustained and effective interventions in cases where problems have been identified

Shifting the focus from service delivery to building the capacity of individuals, families and communities to secure outcomes for themselves, making use of high quality, accessible public services as required.

Unlocking resources currently invested in dealing with acute problems.

EARLY LEARNING/CHILDCARE PROVISION

There are several strands of work underway to increase the level of affordable, flexible, accessible early learning and childcare provision in the short and medium term:

A £4.5 m Communities and Families Fund will be delivered over 3 years from April 2012 as part of the Early Years Change Fund. The fund will support projects that bring real tangible benefits for children and families, such as community playgroups/crèches; wrap around care provision; parents' groups and wider family support.

From April 2012, funding of £1.5 million per annum will also be made available to local authorities in their role as corporate parents for additional early learning and childcare provision and/or work with parents for all 2 year olds in Scotland who are looked after.

In addition, the First Minister announced on 10 March that the 2013 Children's Bill will include an extension to the level of funded early learning and childcare provision, from the current level of 475 hours to a minimum of 600 hours per annum. All 3 and 4 year olds, and 2 year olds who are looked after, will benefit from this expanded provision, which will be delivered from 2014.

CHANGING SCOTLAND'S RELATIONSHIP WITH ALCOHOL: A FRAMEWORK FOR ACTION (SCOTTISH GOVERNMENT, 2009)

The World Health Organisation has stated that alcohol interventions targeted at vulnerable populations can prevent alcohol-related harms, but that whole population policies can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. The Scottish Government's Alcohol Framework, Changing Scotland's Relationship with Alcohol: A Framework for Action prioritises sustained action in four broad areas: reducing overall alcohol consumption; supporting families and communities; promoting positive public attitudes towards alcohol to ensure that individuals are better placed to make positive choices about the role of alcohol in their lives, and; improving support and treatment for those who require it.

ALCOHOL ETC. (SCOTLAND) ACT 2010

The Alcohol etc. (Scotland) Act 2010 was came into force on 1 October 2011 and is a significant step in the battle against Scotland's unhealthy relationship with alcohol. The main measures in the Act are:

• a ban on quantity discounts in off-sales that encourage customers to purchase more than they might have;
• a restriction on where material promoting alcohol may be displayed;
• the involvement of health boards in licensing issues;
• a requirement for an age verification policy which is to be set at 25; and
• the setting out of a broad framework for a Social Responsibility Levy.

The Act is just one part of the work ongoing in Scotland to tackle our unhealthy relationship with alcohol.

ALCOHOL (MINIMUM PRICING) (SCOTLAND) BILL

The Scottish Government believes addressing price is an important element in any long-term strategy to tackle alcohol misuse given the link between consumption and harm, and the evidence that affordability is one of the drivers of increased consumption. The introduction of a minimum price of alcohol is one of the most effective ways of reducing alcohol misuse and harm, and that is why we have introduced a minimum pricing bill.

DRUGS POLICY

THE ROAD TO RECOVERY: A NEW APPROACH TO TACKLING SCOTLAND'S DRUG PROBLEM

The Scottish Government's national drug strategy, the Road to Recovery sets out a new vision for tackling Scotland's drug problems with the principles of recovery central to the provision of effective drug treatment and rehabilitation services. The strategy highlights the need for improved identification and assessment, particularly by services treating adults, of any affected children and young people, sharing information amongst agencies where appropriate, and building the capacity, availability and quality of support services. The intention is to ensure that those children at risk or in need of additional support are identified early and receive appropriate levels of care and support. This work builds on influential publications on care and treatment.

SUPERVISED METHADONE CONSUMPTION

The prescribing of opiate substitutes, (for example, methadone) in Scotland is carried out by clinicians in line with the Drug Misuse and Dependence: UK Guidelines on Clinical Management, 2007. These guidelines were jointly drafted and agreed by all four UK administrations. They are based on current evidence and professional consensus on how to provide drug treatment. They describe how and when to safely introduce methadone as a treatment and how and when to detoxify from it safely.
www.nta.nhs.uk/guidelines-clinical-management.aspx

Chapter 5.4 (Supervised consumption) explains to clinicians "When and how to use supervised consumption". This section thoroughly sets out the evidence base and recommendations for supervised consumption.

NALOXONE

Naloxone is an opiate antidote which can temporarily reverse the effects of an opiate overdose, providing more time for an ambulance to arrive and treatment to be given. The Scottish Government officially launched the national take home naloxone programme (http://www.scotland.gov.uk/Topics/Justice/law/Drugs-Strategy/drugrelateddeaths/NationalNaloxone) in 2011.

The Scottish Government is supporting the roll out of the national programme in 2012-13 through a package of funding which includes:

1. Reimbursement for all kits issued (via ADPs and Health Boards).

2. A national co-ordinator post based at the Scottish Drug's Forum
(http://www.sdf.org.uk/index.php/drug-related-deaths/take-home-naloxone-thn-overdose-intervention-training/).

3. A national monitoring and evaluation programme

KINSHIP CARE

Kinship carers are fulfilling the role of parents - not foster carers - and the benefits system should recognise them as such. Through the Children's Services Bill we plan to ensure kinship carers receive fair financial support for caring for some of Scotland's most vulnerable children. We are working with the UK Government to ensure allowances are received by carers in full, to support some of the most vulnerable children in our society.

We have listened to and will continue to listen to the needs of kinship carers and the children and young people in their care. On the recommendation of carers, in March 2011 we launched the first National Advice and Support Service for all kinship carers http://www.children1st.org.uk/services/170/kinship-care which offers sustainable support to carers and their families:

• The service is informed by service users - 190 carers are regularly consulted across Scotland.
• It supports over 37 kinship carer groups across Scotland - hundreds of kinship carers are benefiting from face to face support
• Support provided by Parentline via email doubled in November as awareness of the service grew.
• The service includes a comprehensive telephone advice line and support for local kinship carers groups.
• Funding to Citizens Advice Scotland provides advice and information to carers particularly on maximising income.

CARE AND PERMANENCE PLANNING

Evidence shows that stability and permanence in the life of children can aid the creation of secure attachment and leads to improved life chances. Intervening in a child's life is not an easy decision to make, planning needs to be made to ensure that the needs of the child are met; this all takes time to do properly. Some of the processes and decisions to be made could be completed more efficiently if clearer support and guidance was provided.

Through the work of the Looked After Children Strategic Implementation Group (LACSIG), SCRA produced a Care Planning and Permanence report in 2011 (which looked at the effectiveness of 100 recent adoptions in Scotland). SG responded with comprehensive plan to speed up and improve permanence decisions, which will eventually form a whole systems approach. Current priorities are:

• Analysis of local authority Adoption Service Plans to build knowledge of the challenges and opportunities for service planning by councils; identify good practice and gaps in the system.
• Establishing the Centre of Excellence for Looked After Children (CELCIS) Permanence Team to provide short term support to Local Authorities and undertake long term re-design of care and timescales.
• Committed to enhancing Scotland's Adoption Register and holding exchange days to promote further adoptions.
• Publish a good practice report on attachment theory in practice across professions, with a view to spreading good practice.
• Improving self-evaluation and addressing systemic problems by holding local events for all professions involved in looked after children.
• Identifying gaps in the system and funding councils and partners to carry out projects that will help unblock the system for looked after children to find permanent and stable homes as quickly as possible.

YOUNG CARERS

The Scottish Government in partnership with COSLA have produced a National Carers Strategy entitled "Caring Together" and "Getting it Right for Young Carers" The Strategy has a five year life span 2010 - 2015. The document comprises two sections covering adult and young carers

"Getting it Right for Young Carers" - The Young Carers Strategy for Scotland 2010 - 2015

The SG believe the information and action points within the Strategy will result in better outcomes for young carers. To the best of our knowledge, it is the first ever national Young Carers' strategy in Europe. We recognise that many young people can benefit from providing care to a relative or friend affected by illness, disability or substance misuse. However, we are committed to ensuring that young carers are relieved of inappropriate caring roles and are supported to be children and young people first and foremost. We are taking important steps to improve young carer identification and support within schools, colleges and the health service. The strategy also endorses an approach which organises services around the child or young person so that all the needs of the child or young person will be identified and addressed, including the impact of caring on their health, well-being and education.

Getting it Right for Young Carers and Caring Together can be found at:
http://www.scotland.gov.uk/Topics/Health/care/Strategy/carers-strategy

The Sexual Health and Blood Borne Virus Framework 2011-2015

The Sexual Health and Blood Borne Virus Framework 2011-2015 sets out the Scottish Government's agenda in relation to sexual health, HIV, hepatitis C and hepatitis B. It presents an ambitious vision for these four policy areas and brings them together into a single integrated strategy for the first time. The Framework builds on the solid foundations of previous policy (Respect and Responsibility, the Hepatitis C Action Plan and the HIV Action Plan) and represents the first overarching national policy for hepatitis B. In line with the Scottish Government's Quality Strategy, the Framework adopts an outcomes based approach to describe our ambitions for sexual health, HIV, hepatitis B and hepatitis C in Scotland:

• Fewer newly acquired blood borne virus and sexually transmitted infections; fewer unintended pregnancies
• A reduction in the health inequalities gap in sexual health and blood borne viruses.
• People affected by blood borne viruses lead longer, healthier lives.
• Sexual relationships are free from coercion and harm.
• A society where the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and blood borne viruses are positive, non-stigmatising and supportive.

The Framework highlights the need to improve outcomes for children and young people in respect of sexual health and blood borne viruses by addressing health and social inequalities and risk taking behaviours. It advocates for prevention, education and awareness initiatives (that include building resilience, aspiration and self-esteem) and the integration of sexual health and blood borne virus services into wider work streams. This recognises the risks and vulnerabilities of young people particularly those not in school, young offenders, those who are looked after or accommodated and those with alcohol and/or drugs problems.

STEERING GROUP

Angela McTeir - (Chair) - Scottish Government Children Affected by Parental Substance Misuse Policy
Gillian Buchanan - Professional Adviser to Scottish Government
Joy Barlow - Scottish Training on Alcohol and Drugs (STRADA)
Hazel Robertson - Angus Alcohol and Drug Partnership
Elaine Wilson - Lloyds TSB Partnership Drugs Initiative
Martin Kettle - Glasgow Caledonian
Louise Hill - Strathclyde University
Bill Atkinson - Perth and Kinross Alcohol and Drug Partnership
Mary Hepburn - NHS Glasgow
Anne Whitaker - NHS Lothian
Sally Ann Kelly - Barnardos Scotland
Alex Cole Hamilton - Aberlour Child Care Trust
Liz Dahl - Circle
Anne Neilson - NHS Lothian
Alan Crawford - ACPOS
David Carracher - North Ayrshire
Nick Hobbs - SCRA
Julie Taylor - NSPCC
Margo Williamson - South Ayrshire Council
Julie Murray - Borders Alcohol and Drug Partnership
Jacquie Roberts - Care Inspectorate
Malcolm Schaffer - SCRA
Julia Swan - ADES
Karen Wallace - SCRA
Dr Deirdre McCormick - Scottish Government - Chief Nursing Officer - Patient, Public and Health Professionals Directorate
Jackie Pepper - The Care Inspectorate
Tom Leckie - The Care Inspectorate
Catriona Laird - Child Protection National Co-ordinator
Boyd McAdam - Scottish Government Getting it Right for Every Child Policy
Marj Stewart - Scottish Government Getting it Right for Every Child Policy
Marion Gibbs - Scottish Government Homelessness policy
Laura Powrie - Scottish Government Drugs Policy
Grant Campbell - Scottish Government Alcohol Policy
Graeme Hunter - Scottish Government Child Protection Policy
Christopher Bain - Scottish Government Child Protection Policy
Christine Duncan - Scottish Government Child and Maternal Health Policy

Children and families at risk of blood borne viruses

• HIV, hepatitis B and hepatitis C are blood borne virus infections that are more prevalent in adults, children and families affected by problem drug and alcohol use.
• Children can be at risk of blood borne viruses through:

1. Mother-to-child transmission (during pregnancy, childbirth and breastfeeding).
2. 'Household contact' with adults at risk or adults and children who are infected with blood borne viruses.
3. Accidental injury involving used injecting equipment e.g. a needle-stick injury.

HIV: While a majority of early cases of HIV infection in Scotland were among injecting drug users this is no longer the case and new infections among injecting drug users are very uncommon. Nevertheless to maintain this success all those with a history of injecting drug use should be provided with information about and the offer of testing for HIV infection together with measures to prevent infection (condoms, clean needles and syringes, substitute medication etc). There is a significant risk of mother to child transmission of HIV if the mother is not known to be HIV +ve and/or does not receive appropriate treatment. However with appropriate specialist care the risk of transmission in the UK is <1%. Antenatal HIV testing is now routinely offered to all pregnant women in the UK. If offered together with appropriate information and support, refusal is extremely uncommon and in Scotland the uptake is >95%. Women who decline testing should receive a repeat offer later in pregnancy.

HBV: Drug use in the UK increased dramatically in the mid 1980s and at that time there was also a dramatic increase in infections with HBV among injecting drug users. Introduction of harm reduction measures together with HBV vaccination programmes among drug users has reversed this trend and new HBV infections among drug users are now uncommon. There is a significant risk of mother to child transmission of HBV if the mother is not known to be HBV +ve and/or mother and baby do not receive appropriate treatment. However with immunisation of the baby at birth (and recently the offer of drug treatment for the pregnant woman) the rate of transmission in the UK is <5%. Antenatal screening for HBV has been routinely offered in the UK for many years with current uptake of >98%.

HCV: HCV infection among injecting drug users in the UK is very common. However, in contrast with HIV and HBV infections the rate of vertical transmission is low (approx 5%) and there are currently no interventions that can prevent this. There is therefore no need to modify maternity care if the woman is known to be HCV PCR+ve and maternal HCV infection is not a contraindication to breast feeding. Consequently, there is no indication for routine antenatal screening of all pregnant women in the UK for HCV.

In summary, all adults with a history of injecting drug use attending primary care or addiction, services should be provided with information about these 3 blood borne viruses and offered testing for the three viruses in line with national guidance. Diagnostic testing may also be offered in other settings if indicated by clinical presentation. In pregnancy, pregnant women with a history of injecting drug use should be offered information about all 3 blood borne viruses. According to UK guidelines, all pregnant women should be offered testing for HIV and hepatitis B. as part of routine antenatal screening.

Much of this text is an excerpt from:

Whittaker A. (2011) The essential guide to problem substance use during pregnancy: a resource book for professionals, London, DrugScope.

BHIVA, BASHH, BIS (2008) UK National Guidelines for HIV Testing 2008, British HIV Association, British Association of Sexual Health and HIV, British Infection Society.
www.bhiva.org

BHIVA/CHIVA (2008) Guidelines for the management of HIV infection in pregnant women, British HIV Association and Children's HIV Association.
www.bhiva.org

CHIVA (20110)
http://www.chiva.org.uk/

CHIVA 'Don't Forget the Children'. Guidance for the HIV testing of children with HIV-positive parents
http://www.chiva.org.uk/files/guidelines/dont-forget.pdf

CHIVA Standards of Care for Infants, Children, and Young People with HIV (including infants born to mothers with HIV)
http://www.chiva.org.uk/files/guidelines/chiva-standards2009.pdf

De Ruiter A., et al (2008) British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008, HIV Medicine, 9, 452-502. www.bhiva.org

RCM (2008) Hepatitis C Position Statement, London, Royal College of Midwives.

RCOG (2010) Green-top Guideline No.39 - Management of HIV in pregnancy.
www.rcog.org.uk

Salisbury D., Ramsay M., and Noakes K. Eds (2006) Immunisation against infectious disease: 'The Green Book', London, Department of Health.
www.dh.gov.uk

SIGN (2006) Management of hepatitis C: A national clinical guideline No.92. Scottish Intercollegiate Guidelines Network
www.sign.ac.uk

WHO (1996) Hepatitis B and breastfeeding - Update No. 22, Geneva, World Health Organization.