Young People in Contact with the Criminal Justice System

JOINT STRATEGIC NEEDS ASSESSMENT (JSNA)

YOUNG PEOPLE IN CONTACT WITH THE CRIMINAL JUSTICE SYSTEM

August 2014

Summary

The purpose of this Joint Health Needs Assessment (JSNA) is to examine the health needs of young people who have come into contact with the criminal Justice system in the London Borough of Lewisham. It is envisaged that the document will inform practitioners and policy makers and enable commissioners to identify, prioritise, plan and target resources.

The key points covered in the JSNA are:

Population

It is predicted that the total population of Lewisham will increase by 13.6% between 2011 and 2020 compared to a national estimated increase of 6.8%. In the same time period the population of children in Lewisham aged less than 15 years is expected to increase by 15.9%. The increase may lead to a rise in the numbers of young people coming into contact with the youth justice system in Lewisham, and is also likely to have a significant impact on health/social care resources and service provision.

Information from ASSET: National Assessment Tool

The JSNA looked at data collected by Lewisham YOS using ASSET. ASSET is an assessment tool used by the youth justice system (Asset) to assess risk in relation to offending and to measure progress in preventing re-offending. The tool includes sections on physical, emotional and mental health, substance misuse, and other issues relevant to well-being. The focus is on the extent to which health and well-being needs are associated with the likelihood of further offending.

Lewisham YOS (Asset)

Of the total cohort recorded for Lewisham on the YOS database from January to December 2013 (274 young people), 48 assessments were scored in relation to Risk of Harm and Vulnerability A significant number of assessments were classified as high or medium risk of harm and vulnerability in relation to Emotional and Mental Health, Thinking and Behaviour, and Substance Use.

Whilst the number of assessments is small and therefore should not lead to definitive conclusions, they are nevertheless indicative and consistent with national evidence regarding high levels of mental health problems in young people who offend. It is further recognised that mental health problems can lead to the misuse of drug and alcohol and other emotional and wellbeing issues. In addition there is a strong link between substance and alcohol misuse leading to reoffending. Overall the rate of young people under 18 admitted to hospital because they have a condition wholly related to alcohol, such as an alcohol overdose during the period 2008-11 was lower than the England average.

Whilst the overall rate of hospital admissions in the under 18 for alcohol or self harm related conditions may be lower than the national average, these figures are not specific to youth offenders. To obtain a clearer picture of hospital admissions and offender health, hospital admissions would need to implement ways of identifying if the person is in contact with the CJS .

Health and Wellbeing

The JSNA looked at information and data on health and wellbeing.There was a gap in information specific to children and young people in touch with the criminal justice system. The information summarized below on physical, mental and sexual health are not specific to children in the YOS however;the factors outlined reflect the close relationship between health inequalities and young peopleand are therefore issues that are relevant and important when looking at the health of young people in the Youth Justice System.

Physical Health

Data pertaining to the physical health and wellbeing of Young people who offend nationally is limited.The lack of national data on the physical health of children and young people in contact with the YJS is due to the way in which data has previously been collated, with the focus being primarily on the risk of reoffending. However, a new assessment tool(CHAT) has been developed by the youth Justice Board (YJB) and the department of health. This tool will enable more detailed information to be captured. It is imperative that:

YOS staff receive training to ensure the tool is used effectively
Plan of action is agreed on how the data is extrapolated from the assessment tool and is used and shared appropriately to commission and develop service provision targeting this group .
Data is used to improve access for young people and vulnerable families to access services

Sexual Health

Lewisham has significantly higher teenage conception rates for women under 18 years in London and England

Mental Health

The number of young people aged under 18 admitted to Lewisham hospitals as a result of self harm is lower than the England average. However, current evidence acknowledges an over representation of young people in contact with the CJS.

Recommendations

The report identifies a number of gaps in service provision and opportunities to enhance and build upon the service already provided. As part of the JSNA process key stakeholders were involved. The following are the key recommended actions::

Opportunities for sharing information between key stakeholders who work with the YOS should be improved through regular meetings. This would facilitate knowledge sharing and the establishment of best practice approaches to the services being provided.
Access to health, speech and language assessment and provision should be enhanced by providing, on a pilot basis initially, specialist services which are based at the YOS. This would support early detection and assessment of young peoples’ support needs.
In light of increasing rates of offending amongst young people during their teenage years, especially Black Caribbean and Black African groups. Interventions targeting this group, need to be explored this might include the YOS working closely with health visitors and school nurses.
The systems and methods of data collection need to be reviewed and clear procedures and standards defined for the capture of client information. The systems in place should support and facilitate simplicity and completeness in the data collection process. The introduction of CHAT is an opportunity to increase the completeness and quality of information collected.
Stakeholders may be able to support the objectives of the YOS by having greater access to client information. The possibility for greater sharing of client information should be explored, such as providing Merlin records to school nurses, and identifying what is feasibly within the requisite limitations of data protection and confidentiality.
A more streamlined approach to client care should be established via the development of a Pathway and Shared Health Care Plan for Young people. This should document a clear route of care for the client and document needs and assessments completed.
The care plan should also involve parents, ensuring that the pathway identifies support for parents before the child reaches a state of crisis. Health initiatives should also incorporate parent’s health so an awareness of the client’s background, parental and family needs should also be considered within any planned programme of support.
The YOS and partners need to have a multi agency, co-ordinated approach to health services delivered within the YOS. These relationships will support the success of the Care plans and be more effective once specialist services are also made available within the YOS.
The transition between youth and adult services should be strengthened and work should be done with the Metropolitan Police to ensure custody suites provide an age appropriate service for young people who are detained, and to ensure that children are not treated as adults in such instances.
A review of substance misuse pathways into treatment should be undertaken, especially in regards to identification and referral from custody in order to ensure that issues are identified and dealt with appropriately.
The review and enhancement of services, systems and relationships within and connected to the YOS should serve to fill a number of gaps in service provision and ensure that issues relating to health in young offenders can be identified and assessed rapidly and in partnership with relevant stakeholders.

Conclusion

The information on the physical health and well being needs of young people in contact with the CJS is limited . However , the body of evidence is growing and it is becoming evident that young people in contact with the criminal justice system experience greater health inequalities than their peers. Young people who offend often have multiple and complex health needs.

The information gleaned from key stakeholder events provide an opportunity for services to explore how they can develop early intervention strategies, work in partnership , pool resources and ensure services effectively meet the needs of young people before they are in contact with or in the CJS.

The introduction of CHAT will improve health intelligence on Young people who offend and provide opportunities to ensure resources are allocated appropriately, inform targeted health improvement programmes, service development /delivery.