Guideline for Emergency Departments, Minor Injury Units and Receiving Units where a child or young person presents under the influence of alcohol and/or drugs

GGC Paediatric Guidelines
NHS GGC

Objectives

This document provides clear guidance for the management of children attending with alcohol and/or drug misuse.

Scope

This guidance relates to all children and young people up to the age of 18 years (National guidance for Child Protection 2023) where there may be concerns about their drug and/or alcohol use.

This guideline provides a framework for all health professionals who work in Emergency Departments, Minor Injury Units and Receiving Units however is equally applicable to any health professional who has a concern about drug and/or alcohol use by a child or young person.

In all cases a standard risk assessment should be undertaken to ensure appropriate action, which should include an opportunistic brief intervention with the provision of health promotion/harm reduction advice. A Notification of Concern form should be submitted for all young people under 16 years (See Appendix 1) with risk assessment conducted for 16 & 17 year olds (See Appendix 2) and a Notification of Concern submitted where concerns or risks indicated.

It is also intended that this document will assist health professionals in their child protection decisions and to plan safe discharge with appropriate follow up.

Audience

Roles and Responsibilities: Professionals working with, or in contact with, children or young people and/or their families have a duty of care to ensure that the child’s or young person’s needs are considered with them in the context of their individual circumstances. This guideline aligns with the principles of GIRFEC and the national child protection guidelines, 2023.

Process flowcharts are provided at Appendices 1 and 2 to assist clinicians with child protection risk assessment and management of children/young people under 18 years presenting to Emergency Departments, Minor Injury Units and Receiving Wards under the influence of alcohol and/or drugs.

Introduction

This guidance is designed to promote the rights of children and young people, ensure appropriate support is available and ensure children and young people attain the highest standard of health.

NHSGGC in its approach to supporting and protecting children and young people fully supports the implementation of the United Nations Convention on Rights of the Child (UNCRC). This guidance reflects national child protection legislation and child protection guidance (National Guidance for Child protection 2023)1

It is recognised that adolescence is a period of significant physical, cognitive and social change. It is now well established that increasing numbers of young people are engaging in a range of risk behaviours including alcohol/drug use and other substances before reaching the age of 18 years. Alcohol and/or drug use is now known to feature in significant other aspects of life for example sexual exploitation of young people or concerns about their mental health.

Young people’s organs and brains are more vulnerable to the effects of alcohol and drug use because they are still growing and developing. Alcohol and drug use can cause short and long-term harm to health, as well as put young people in risky situations when they are under the influence. Research shows that the earlier a young person starts drinking alcohol, the more likely they are to drink in ways that can be harmful later in life.

The Health and Wellbeing Census Scotland 2022 (see references) provided national level data on physical and mental health, drinking, drug use and lifestyle issues amongst Scotland’s secondary school children. The results indicated:

Nearly half (43.9%) of S2 and S4 pupils have ever had an alcoholic drink. A fifth (20.1%) of S2 and S4 pupils said they usually drank alcohol at least once a month. This reached a third for older S4 pupils (33.3%). Girls (21.8%) were slightly more likely to have drunk monthly than boys (18.4%). Almost 1 in 3 (32.3%) S4 pupils get their alcohol from a friend or relative, while (30%) reported getting their alcohol from home (either with or without permission).

1national-guidance-child-protection-scotland-2021-updated-2023.pdf

Principles and procedures

A Notification of Concern (NOC) must be submitted to social work services for ALL children and young people under 16 years (Appendix 1) presenting under the influence of alcohol and/or drugs. A robust risk assessment MUST be completed in line with flowchart (Appendix 2) for all 16 & 17 year olds and where risks/concerns indicated a NOC should be completed.

Where there is a concern/risk regarding alcohol and/or drug use and/or other circumstances, Social Work Services should be contacted to establish if the young person is already known to Social Work, or another support service. A NOC should be submitted to social work regardless of whether the young person is or is not already known to Social Work Services, for consideration of a single/multi-agency needs/risk assessment.

Further guidance on completing a NOC can be found on the Public Protection Service SharePoint page - Raising a Child Protection Notification of Concern

Staff should ensure a copy of the NOC is sent next working day to

The child or young person should not be discharged until:

  • The Emergency Medicine Clinician is fully satisfied that the child or young person is medically fit for discharge
  • The parents/guardian are informed
  • An immediate risk assessment has been completed and Social Work Services and/or the police contacted if indicated (follow process flow charts as appropriate. Appendices 1 and 2)
  • Patients under 16yrs must be discharged into the care of a responsible adult

Actions for Acute Addiction Team:

  • Contact Social Work Service to obtain confirmation of receipt of Notification of Concern(NOC) from appropriate local authority
  • Forward a copy of NOC together with outcome form to alcohol and drug recovery services in the community for onward referral and follow up by local youth teams in young person’s area of residence
  • Outcome form with recorded actions and interventions undertaken by social work service/alcohol and drug recovery service youth teams returned to acute addiction team
  • Completed outcome form uploaded to clinical portal in the patient’s Emergency Department record under clinical summary section, correspondence
  • Copy of completed outcome form forwarded to Emergency Department Child Protection Clinical Leads for information and shared learning across Emergency Departments

Public Protection Service can be contacted for advice:

  • Tel: 0141 451 6605 Monday–Friday, 9am – 5pm
  • Out of Hours: Contact the Duty Child Protection Consultant via switchboard

An online training programme for staff is available to support implementation of these guidelines and can be accessed on the Learnpro platform or via the link https://nhs.learnprouk.com. Module located under CPD, GGC 152 Intoxicated Children and Young People.

Sharing of information

If a practitioner/professional is concerned that the child/young person may potentially be at risk of future harm, the sharing of information between agencies and between staff within agencies is crucial to help safeguard the child or young person and facilitate appropriate assessment/care management. Consent to share information is not required.

As a standard of good practice to link with community services, the school contact personnel in most areas are copied into the GP letter when the patient is discharged from the department or ward. Discharge letter to GP should include that Notification of Concern has been completed. If the patient absconds from the department the police and/or social work should be contacted as well as the parents or guardian.

Please detail exact reason for referral/request for services in section 6 of NOC and document as much information as possible re discussion/engagement with young person as social work do not have access to Clinical Portal.

Admission to hospital

On occasions where it is necessary to admit a child or young person to hospital as a direct consequence of alcohol and/or drug use, or through illness/injury caused as a result of alcohol and/or drug use, the assessing clinician at first point of contact is responsible for completing the NOC Form.

Children under 16 years requiring admission to hospital should be discussed with the paediatrics medical receiving team at RHC - 0141 452 4678

Young People 16-17 years requiring admission should be discussed with medical receiving team and referral to alcohol and drug liaison nurse considered/ suggested if appropriate to facilitate harm reduction whilst in hospital.

Wherever possible, staff should undertake opportunistic brief interventions including appropriate health promotion/harm reduction advice together with distribution of information/education leaflets, as a minimum standard of good practice.

Appendix 1: Guideline flowchart for intoxicated child/adolescent presentation under 16yrs or up to 18yrs if care experienced

GUIDELINE FLOWCHART FOR INTOXICATED CHILD/YOUNG PERSON PRESENTATION
UNDER 16YRS OR UP TO 18YRS IF CARE EXPERIENCED

CPS email - ggc.cpadmin@nhs.scot
Acute Addiction Team email – ggc.acute.intoxicatedsharedrefs@nhs.sco

Appendix 2: Guideline flowchart for intoxicated child/young person presentation 16 and 17 yr olds who are not care experienced

GUIDELINE FLOWCHART FOR INTOXICATED CHILD/YOUNG PERSON PRESENTATION
16 AND 17 YR OLDS WHO ARE NOT CARE EXPERIENCED

Editorial Information

Last reviewed: 01/06/2025

Next review date: 30/06/2028

Author(s): Barbara McMenemy, Acute Adiction Manager, Dr Kerry Milligan, Public Protection Medical Lead.

Version: 3

Approved By: Public Protection Service

References
  1. www.scotland.gov.uk/gettingitright
  2. NHS GGC Public Protection Strategy 2023-2026: Safeguarding – It Matters To Us
    NHSGGC PUBLIC PROTECTION STRATEGY 2023 - 2026
  3. United Nations Convention on the Rights of the Child (UNCRC) 2022
    Children's rights - Human rights - gov.scot
  4. National guidance for Child Protection 2021 (Updated 2023)
    Raising a Child Protection Notification of Concern
  5. Health & Wellbeing Census 2021 – 22
    Health and Wellbeing Census Scotland 2021- 2022 - gov.scot