Samenspel tussen jongerenwerk en specialistische jeugdzorg

Een deel van de jongeren die in het jongerenwerk partici- peert ontvangt specialistische jeugdzorg, vanuit bijvoorbeeld verslavingszorg, jeugdreclassering, jeugd-ggz of intensieve gezinsbehandeling. Hoewel profes- sioneel jongerenwerk voor een brede groep jongeren in kwetsbare situaties positief bijdraagt aan hun persoonlijke ontwikkeling en maatschappelijke participatie, is er weinig bekend over de betekenis van het jongerenwerk voor jongeren die specialistische jeugdzorg ontvangen. Voor dit verkennende onderzoek zijn interviews afgenomen met: 1) zeven jongeren (16+) die specialistische jeugdzorg ontvangen en in jongerenwerk participeren; 2) zeven jongerenwerkers en 3) zes jeugdhulpverleners werk- zaam in specialistische jeugdzorg. Een thematische analyse maakt inzichtelijk dat het jongerenwerk op vijf manieren van betekenis is voor jongeren in specialistische jeugdzorg. Jonge- renwerkers zijn ten eerste toegankelijke gesprekspartners die deze jongeren motiveren om problemen serieus te nemen en daarbij professionele hulp te accepteren. Het jongerenwerk biedt deze jongeren daarnaast een omgeving om 2) betekenisvolle relaties op te bouwen, 3) hun zelfbeeld en eigenwaarde te versterken, 4) hun maatschappelijke participatie te vergroten en 5) onder- steuning te vinden om hun zelfstandigheid te vergroten. De resultaten maken inzichtelijk dat het jongerenwerk ook voor deze specifieke groep jongeren groeikansen biedt voor hun persoonlijke ontwik- keling en maatschappelijke participatie. Daarnaast leert dit onderzoek dat participatie van deze doelgroep in het jongerenwerk een positieve invloed kan hebben op de jeugdhulpverleningsprocessen en -resultaten. Hiermee bieden de resultaten gemeenten en de jeugdzorg een beter begrip van hoe het jongerenwerk als preventieve voorziening van betekenis is voor jongeren in specialistische jeugdzorg en een bijdrage kan leveren om de druk op de jeugdzorg te verlichten. Engelstalige versie van de samenvatting A substantial share of all young people who participate in professional youth work settings receive specialised youth-care services, such as addiction care, mental healthcare or intensive family treatment. Nevertheless, little is known about the unique value of youth work settings for young people who are receiving specialised youth-care services. In this exploratory study, we investigated the unique value of youth work for young people in specialised youth-care programmes. Interviews were conducted with: 1) seven young people (16 years of age and older) who were receiving specialised youth-care services and participating in youth-work settings; 2) seven youth workers and 3) six professionals working in specialised youth-care services. Thematic analysis demonstrates that participation in youth-work settings is significant for this group in five ways. First, youth workers provide these young people with accessible dialogue partners who can motivate them to take problems seriously and accept professional help for their vulnerabilities. Youth workers also offer an environment within which to 2) build meaningful relationships; 3) strengthen self-concept and self-esteem; 4) enhance social participation and 5) receive support that helps to increase independence. These findings thus suggest that youth work offers growth opportunities for this specific group. They further indicate that participation in youth work settings can reduce the duration and intensity of the youth-care services provided. The results can help municipalities and youth-care professionals to enhance their understanding of the importance of professional youth work to young people who are receiving specialised youth-care services and how youth work can contribute to reducing high healthcare costs.

Implementation of the Arizona Pain and Addiction Curriculum: Findings and Implications From a Statewide Evaluation

Purpose: The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education programs collaboratively created the evidence-based, comprehensive Arizona Pain and Addiction Curriculum which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state.Materials and Methods: Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities.Results: Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives.Conclusion: In < 1 year after creation of the Arizona Pain and Addiction Curriculum, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.

On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era

Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194).

Features of providing addiction medical care during the pandemic COVID-19

Patients with substance use disorders represent a vulnerable population who are at risk of getting coronavirus due to several factors related to their clinical, psychological, and psycho-social characteristics. The goal of this study was to examine the features of a medical condition in patients with alcohol use disorder who are admitted to the addiction hospital and to describe the specific issues of the addiction care RF region during a pandemic.Material and methods. The online survey has been distributed to 55 addiction psychiatrists from the third-level medical organizations of 4th federal districts (including Northwestern, South, Volga, and North Caucasian) from June 09 to June 20, 2020. The survey consists of 17 items (13 questions were focused on the features of progress and clinical signs of alcohol dependence in hospitalized, in-patient individuals during April-May, 2020; 4 questions were focused on the organizational issues of addiction care in the RF regions during the COVID-19 pandemic).Results. Based on the expert`s assessment, the number of admissions at inpatient and outpatient clinical settings was reduced during the pandemic. In addition, the intensity of alcohol withdrawal among patients who were hospitalized during April-May, 2020 were significantly more severe compared to patients who were hospitalized during February-March, 2020 (Pearson’s chi-squared test). Moreover, alcohol withdrawal was more severe and was associated with alcohol withdrawal delirium (4,7%) or seizures (4,7%) in 9,4% of cases among patients with COVID positive status, which exceeds the data of epidemiological studies. The intensity of alcohol withdrawal delirium among patients with COVID positive status was more severe compared to those who had COVID negative status. During April-June, 2020, the few addiction clinics were temporally closed due to quarantine but a majority of clinics were not (n = 14 (25,5%) vs. n = 41 (74,5%)).Conclusion. During the COVID-19 pandemic, the state of patients hospitalized for treatment of alcohol dependence may be considered more severe, compared to the period February-April 2020.

Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria

Background and aimEvidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe.MethodsWe investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status.ResultsWithin the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB.Discussion and conclusionOur study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

The state of harm reduction in prisons in 30 European countries with a focus on people who inject drugs and infectious diseases

Background People who inject drugs are often imprisoned, which is associated with increased levels of health risks including overdose and infectious diseases transmission, affecting not only people in prison but also the communities to which they return. This paper aims to give an up-to-date overview on availability, coverage and policy framework of prison-based harm reduction interventions in Europe. Methods Available data on selected harm reduction responses in prisons were compiled from international standardised data sources and combined with a questionnaire survey among 30 National Focal Points of the European Monitoring Centre for Drugs and Drug Addiction to determine the level of availability, estimated coverage and policy framework of the interventions. Results Information about responses to health harms in prisons is limited and heterogeneous. Cross-country comparability is hampered by diverging national data collection methods. Opioid substitution treatment (OST) is available in 29 countries, but coverage remains low (below 30% of people in need) in half of the responding countries. Needle and syringe programmes, lubricant distribution, counselling on safer injecting and tattooing/piercing are scarcely available. Testing for infectious diseases is offered but mostly upon prison entry, and uptake remains low in about half of the countries. While treatment of infections is mostly available and coverage is high for human immunodeficiency virus (HIV) and tuberculosis, hepatitis B and C treatment are less often provided. Health education as well as condom distribution is usually available, but provision remains low in nearly half of the countries. Post-release linkage to addiction care as well as to treatment of infections is available in a majority of countries, but implementation is often partial. Interventions recommended to be provided upon release, such as OST initiation, take-home naloxone and testing of infections, are rarely provided. While 21 countries address harm reduction in prison in national strategic documents, upon-release interventions appear only in 12. Conclusions Availability and coverage of harm reduction interventions in European prisons are limited, compared to the community. There is a gap between international recommendations and ‘on-paper’ availability of interventions and their actual implementation. Scaling up harm reduction in prison and throughcare can achieve important individual and public-health benefits.