Taking on a Youth Challenge
By Thurtle, Val
Working with young offenders enables health promotion with an often overlooked client group Although primarily a school nurse, working with youth offenders is a significant part of Lynne Smith’s role. She spends two days a week interacting with 10-18 year olds who have committed offences.
Lynne has worked in school health since 2000 and graduated as a specialist practitioner. She still works in the school nurse team but is seconded to the Youth Offending Service (YOS) in Bracknell, Berkshire.
The YOS is a statutory agency within the criminal justice system; its primary aim is to reduce the risk of re-offending. It is a multi- professional service, which includes staff seconded from the police, drug and alcohol team, education and health.
The aim is to offer an holistic approach to the supervision of young people who have committed offences. Every PCT has a statutory obligation to provide health care for young people who are involved with the local YOS.
The Youth Justice Board sets and monitors standards and has performance measures related to mental, but not physical, health. The Youth Justice Plan is written for each area by the manager in that team and includes the national requirements. One of the performance measures is that all young people have access to Children and Adolescent Mental Health Services (CAMHS) and those who score over two on an ASSET (Assessment) have an immediate referral. This states that once the referral has been received, there is an obligation for the client to be seen within five working days. Non- acute cases have to be seen within 15 working days. These are highlighted in the E.P.Q.A. (Effective Practice Quality Assurance) document. There are no such requirements for young people in relation to physical health.
Lynne is probably the only school nurse involved in this field. Her role is to address physical health needs of the client group.
Although healthcare for physical needs is available via general practitioners, walk-in centres and school nurse drop-ins, it is sporadic and often not easy to access.
Given the vulnerability of those who attend YOS’s, clients often miss out on services aimed at children and young people. Teenagers are not always good at using healthcare services and those referred to YOS’s have frequently experienced disrupted schooling, thereby missing out on key health messages. The majority has had limited family support and some have no permanent home.
Physical health impacts on behaviour and mental wellbeing, so a large part of Lynne’s work is health promotion.
All new clients can be seen for a health assessment, looking at their nutrition, weight/height, hearing (known to be an issue for mature offenders), vision, sexual health, immunisation status, smoking and alcohol use. This may lead to health promotion work in, for example, smoking cessation or chlamydia screening.
While standard school nursing covers most of these areas, Lynne’s role in the YOS provides a comprehensive and holistic assessment of clients’ health needs. The interactive contact and relaxed setting of the YOS building helps to build a relationship based on mutual trust.
For hard-to-reach young people, presenting with closed body language and a hostile attitude, playing pool in the YOS centre can foster an atmosphere conducive to discussion and to promoting mental wellbeing.
Lynne may then help them to access other professionals and other services in the team. Recent examples have included audiology, contraceptive and sexually transmitted infections services. Some young people require a more in-depth health involvement. Other clients have now started to request follow-up appointments to see Lynne, which shows the positive response to this service.
One of the domains for speciality community public health nurses’ is the search for health needs. Many of the young people seen in this context have health needs, but opportunities to identify them are limited.
Specialist community public health nurses, in this case, a school nurse working in the YOS, can begin to address these needs by facilitating health-enhancing activities.
These might include working with a young offender on parenting his/her own child, encouraging young men to reflect on their own nutrition and to look after themselves.
Most of those referred to the team have had limited family family support and some have no permanent home
Case study
Joe (not his real name) is a 17-year-old who had been on the child protection register.
His parent was involved in drugs and alcohol which made Joe both upset and angry. His anger led him to drink heavily, leading to violent outbursts directed at cars and property, which resulted in him being given a court order.
The health assessment identified broken and missing teeth but Joe needed support to access dental services which involved him deciding he wanted treatment, finding a local NHS dentist, and accompanying him to appointments.
He is not involved with any adult member of his own family and had little experience in his childhood of using such services.
Dental treatment has led to a dental bridge, many fillings and a reduction in pain. Joe has developed sound oral hygiene as he takes on the responsibility of his own health.
Similarly, a trip to the optician was also needed but with this second referral, Joe had the confidence to attend the booked appointment by himself.
References
1 Nursing and Midwifery Council (NMC). Standards of proficiency for specialist community public health nurses. London: NMC, 2004.
Val Thurtle
Programme Director Primary Care and Public Health Nursing
University of Reading
Copyright TG Scott & Son Ltd. Jul 2007
(c) 2007 Community Practitioner. Provided by ProQuest Information and Learning. All rights Reserved.