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Local Policy Documents and Evidence-Based Reviews Relevant toSubstance Use in Young PeopleLocal policy documents and evidence-based reviews relevant to the management of mental healthissues in children and young people are reviewed in the Access to Mental Health Services:Introduction section commencing on Page 351. In addition, Table 112 (below) provides anoverview of New Zealand policy documents and evidence-based reviews which focus onpreventing drug use in young people, while Table 48 on Page 234 provides an overview ofpublications relevant to the prevention of alcohol-related harm in young people (which alsofrequently address alcohol and other drug use in the same publication). Finally, the In-Depth TopicMental Health Issues in Children commencing on Page 368 provides a more detailed review ofthe literature as it relates to children aged 0–14 years.Table 112. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention andManagement of Drug Use in Young PeopleMinistry of Health Policy DocumentsMinistry of Health. 2010. Mental Health and Addiction Action Plan 2010. Wellington: Ministry of Health.http://www.health.govt.nz/publication/mental-health-and-addiction-action-plan-2010This document builds on policy documents Te Tāhuhu (2005) and Te Kōkiri, (2006), the national strategy and action planfor mental health and addictions to 2015. It identifies the key priorities for Ministry-led activities. Tackling alcohol andother drug-related harm is one of four prioritised actions and includes increasing the number of community youth alcoholand other drug (AOD) treatment places available to give young offenders access to court directed community AODtreatment programmes.Ministry of Health. 2007. Te Raukura. Mental health and alcohol and other drugs: Improving outcomes for childrenand youth. Wellington: Ministry of Health. http://www.health.govt.nz/publication/te-raukura-mental-health-and-alcoholand-other-drugs-improving-outcomes-children-and-youthThis report identifies continued improvement in child and adolescent mental health (CAMHS) and alcohol and other drug(AOD) specialist services as a priority for the mental health and addiction sector. The key issues are identified, includinginequalities, access to services, child and youth AOD services, intersectoral collaboration and primary mental healthcare. Priorities for action are defined, including improvement in understanding and recognition of AOD issues in CAMHS;improvement in the gaps in availability of AOD service provision within CAMHS; and identification by DHBs of gaps inAOD service provision for children and youth, and development and implementation of plans to address improvement inunderstanding and recognition of AOD issues in CAMHS.Ministry of Health. 2005. Te Tāhuhu – Improving Mental Health 2005–2015: The Second New Zealand MentalHealth and Addiction Plan Wellington: Ministry of Health.Ministry of Health. 2006. Te Kōkiri: The Mental Health and Addiction Action Plan 2006–2015. Wellington: Ministry ofHealth.http://www.health.govt.nz/our-work/mental-health-and-addictions/mental-health/mental-health-strategic-directionTe Tāhuhu sets out Government policy and priorities for mental health and addiction for 2005 to 2015. Te Kōkiri sets outthe action plan and includes a mixture of high level initiatives and specific operational actions. Addiction was identified asone of ten leading challenges, and a number of actions to improve access to, and quality of, addiction services andbroaden the range of services available are included. Young people are identified as at increasing risk of substanceabuse and specific attention to services for this group is recommended.Todd F. 2010. Te Ariari o te Oranga: the Assessment and Management of People with Co-existing Mental Healthand Substance Use Problems. Wellington: Ministry of Health. http://www.health.govt.nz/publication/te-ariari-o-teoranga-assessment-and-management-people-co-existing-mental-health-and-drug-problemsThis clinical framework aims to assist health professionals working with people with co-existing substance use andmental health problems (CEP) and is a companion document to ‘Service Delivery for People with Co-existing MentalHealth and Addiction Problems - Integrated Solutions 2010’.Ministry of Health. 2010. Service Delivery for People with Co-existing Mental Health and Addiction Problems:Integrated Solutions. Wellington: Ministry of Health. http://www.health.govt.nz/publication/service-delivery-people-coexisting-mental-health-and-addiction-problems-integrated-solutions-2010This service delivery guidance document provides advice to assist mental health and addiction services to enable theprovision of more integrated care for people with co-existing mental health and addiction problems. It is designed as acompanion to the clinical guidance document Te Ariari o te Oranga: The Assessment and Management of People withCo-existing Mental Health and Addiction Problems.Access to Mental Health Services in Young People - 414
Cochrane Systematic ReviewsThomas RE, et al. 2011. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database of SystematicReviews doi:10.1002/14651858.CD007381.pub2http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007381/frame.htmlThis review assessed the effectiveness of structured mentoring programmes to prevent alcohol and drug use. The reviewincluded 4 RCTs with 1,994 participants (aged 12 years in two trials and 9–16 years in two trials), conducted amongdeprived populations in the US. Two RCTs found mentoring reduced the rate of initiation of alcohol (pooled RR formentoring compared to no intervention 0.71, 95% CI 0.57 to 0.90) A third trial found no significant difference and thefourth trial did not assess alcohol use. One RCT found significantly less “illegal” drug usage (RR 0.54, 95%CI 0.35 to0.83). No adverse effects were detected. There was limited scope for the interventions to be effective due to low rates ofcommencing alcohol and drug use during the intervention period, probably reflecting the relative youth of the samples.Gates S, et al. 2009. Interventions for prevention of drug use by young people delivered in non-school settings.Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD005030.pub2http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005030/frame.htmlThis review assessed the effectiveness of interventions delivered in non-school settings intended to prevent or reducedrug use by young people under 25. Seventeen studies were included (8 RCTs with 1,230 participants and 9 clusterRCTs, with 253 clusters), evaluating four types of intervention: motivational interviewing or brief intervention, educationor skills training, family interventions and multicomponent community interventions. The small number of studies, andmethodological problems including high loss-to-follow-up, limited the ability to draw conclusions. One study ofmotivational interviewing suggested that it was beneficial on cannabis use, identifying a large and statistically significantdecrease in the frequency of self-reported cannabis use in the intervention group. Three family interventions assessed insingle studies, suggested that they may be beneficial in preventing cannabis use. The studies of multi-componentcommunity interventions did not find any strong effects, and the two studies of education and skills training did not findany differences between the intervention and control groups. The authors conclude that while motivational interviewingand some family interventions may have some benefit, cost-effectiveness has not yet been addressed in any studies,and further research is needed to determine whether any of these interventions can be recommended.Faggiano F, et al. 2005. School-based prevention for illicit drugs' use. Cochrane Database of Systematic Reviewsdoi:10.1002/14651858.CD003020.pub2http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003020/frame.htmlThis review evaluated the effectiveness of school-based interventions to improve knowledge, develop skills, promotechange and prevent or reduce drug use. The review included 29 RCTs and three controlled prospective studies (46,539participants in total), the majority of which were conducted in the USA. Three programmes focussed on improvement indrug knowledge found non-significant improvements in drug knowledge post-test (standardised mean difference (SMD)0.91; 95% CI 0.42 to 1.39). Social skills based interventions were assessed in 25 RCTs and associated withimprovement in drug knowledge (weighted mean difference (WMD) 2.60; 95% CI 1.17 to 4.03), decision making skills(SMD 0.78; 95% CI 0.46 to 1.09), self-esteem (SMD 0.22; 95% CI 0.03 to 0.40), peer pressure resistance (RR 2.05; 95%CI: 1.24 to 3.42), drug use (RR 0.81; 95% CI 0.64 to 1.02), marijuana use (RR 0.82; 95% CI 0.73 to 0.92) and heroin use(RR 0.45; 95% CI 0.24 to 0.85). The authors concluded that skills based programmes appear to be effective in deterringearly-stage drug use. However, the authors comment that the results may not be generalisable to non-US populationswith differing social contexts and drug policies.Other Systematic ReviewsTanner-Smith EE, et al. 2012. The comparative effectiveness of outpatient treatment for adolescent substanceabuse: A meta-analysis. Journal of Substance Abuse Treatment, in press, available online 2 July 2012.This review which assessed the effectiveness of different outpatient treatments for adolescents with substance usedisorders identified 45 experimental or quasi-experimental studies for meta-analysis. Treatment types were divided intofour groups: no treatments and placebo control conditions; psychoeducational therapy (PET), group/mixed counsellingand practice as usual (PAU); cognitive behavioural therapy, motivational interviewing and other individual therapies andpharmacological treatment; and family therapy. Family therapy programmes were found to be consistently more effectivethan their comparison conditions, and no treatment programmes were generally less effective. PET/groupcounselling/PAU compared unfavourably with most comparator treatments. A second analysis, measuring changes insubstance use, found that almost all types of treatment showed reductions in substance use. The greatest improvementswere for family therapy and mixed and group counselling. The authors conclude that while family therapy is the treatmentwith the strongest evidence of comparative effectiveness, most types of treatment appear to be beneficial in helpingadolescents reduce their substance use.Jensen CD, et al. 2011. Effectiveness of motivational interviewing interventions for adolescent substance usebehaviour change: A meta-analytic review. Journal of Consulting and Clinical Psychology, 79(4), 433-40.This review evaluated the effectiveness of motivational interviewing (MI) in promoting behavioural change in adolescentsubstance use. Twenty-one controlled trials (randomisation not specified), assessing mainly single treatments and avariety of substance use outcomes, were identified (5,471 participants). Meta-analysis found a small but statisticallysignificant effect size (mean difference 0.173, 95% CI 0.094 to 0.252), maintained at follow-up (maximum follow-up 24months). While further research is needed, the authors suggest that these findings support the use of MI for adolescents,at least as part of a treatment programme.Access to Mental Health Services in Young People - 415
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Table 15. Enrolments in Māori Medi
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Table 16. Number of Students (Māor
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Local Policy Documents which Consid
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HIGHEST EDUCATIONAL ATTAINMENT AT S
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Figure 43. Highest Educational Atta
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Figure 46. Highest Educational Atta
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SENIOR SECONDARY SCHOOL RETENTION A
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Participation in Tertiary Education
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Midland Region Distribution and Tre
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The following section uses informat
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Figure 54. Age-Standardised Rates o
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Figure 56. Age-Standardised School
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TRUANCY AND UNJUSTIFIED ABSENCESInt
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Figure 60. Total Unjustified Absenc
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Figure 63. Total Unjustified Absenc
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Table 22. The National Immunisation
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Figure 64. Immunisation Coverage by
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Figure 67. Immunisation Coverage by
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Figure 71. Immunisation Coverage at
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Soares-Weiser K, et al. 2012. Vacci
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Briss PA, et al. 2000. Reviews of e
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Data Sources and MethodsIndicatorPr
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Figure 75. Proportion of New Zealan
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Proportion Receiving Core Contacts
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Figure 81. Proportion of Babies who
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The B4 School CheckThe B4 School Ch
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Other Relevant EvidenceThe Scottish
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185SUBSTANCE USE
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Notes on InterpretationNote 1: The
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Maternal Smoking at First Registrat
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Table 32. Number of Cigarettes Smok
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National Institute for Health and C
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2. Proportion of babies born to mot
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Table 37. Number of Cigarettes Smok
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Figure 93. Proportion of Year 10 St
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Figure 95. Proportion of Year 10 St
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TOBACCO USE IN YOUNG PEOPLEIntroduc
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Figure 96. Daily Smoking Rates in Y
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2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Table 45. Listed External Causes of
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Shults RA, et al. 2009. Effectivene
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Mortality from conditions with a so
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Table 50. Mortality from Conditions
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Figure 105. Hospital Admissions for
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Table 55. Hospital Admissions for C
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Table 57. Hospital Admissions for C
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Midland Region Distribution by Caus
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INFANT MORTALITY AND SUDDEN UNEXPEC
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New Zealand Distribution and Trends
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Figure 111. Total Infant Mortality,
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Table 62. Neonatal and Post Neonata
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Table 65. Neonatal and Post Neonata
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Distribution by Ethnicity, NZ Depri
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Figure 116. Sudden Unexpected Death
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Vennemann M, et al. 2007. Do immuni
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with a review of interventions aime
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deprivation in some parts of the wo
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who delay a second pregnancy by two
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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In ConclusionWhile it is hoped that
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Data Source and MethodsDefinition1.
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Other Systematic ReviewsLouwers ECF
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INJURIES ARISING FROM ASSAULT IN YO
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New Zealand Distribution by Age and
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Flood M & Fergus L. 2008. An Assaul
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Note 2: The numbers in this section
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Table 78. Number of Notifications t
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Table 80. Outcome of Assessment for
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Table 82. Number of Notifications R
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Table 84. Outcome of Assessment for
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Data Source and MethodsDefinition1.
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Family Violence Investigations Wher
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Table 90. Local Policy Documents an
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Stover CS, et al. 2009. Interventio
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oader contextual influences on the
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In addition, Table 112 on Page 414
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Williams SB, et al. 2009. Screening
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Ministries of Education, Health, Ju
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Figure 129. Children and Young Peop
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Table 92. Children Aged 0-14 Years
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Page 450 and 451: REFERENCES1. Children's Commissione
Page 452 and 453: 33. Mackay R. 2005. The Impact of F
Page 454 and 455: 71. Ministry of Health. 2011. Immun
Page 456 and 457: 107. ASH New Zealand. 2011. Nationa
Page 458 and 459: 141. Child and Youth Mortality Revi
Page 460 and 461: 175. Pihama L. 2011. Overview of M
Page 462 and 463: 208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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