Zara Anderson

1
Alcohol-related violence in children
incident/referral/prevention
Zara Anderson Violence Researcher / TIIG
Analyst Centre for Public Health, Liverpool John
Moores University WHO Collaborating Centre for
Violence Prevention In collaboration with Dr
Mary Ryan, Kim Williams, Moya Sutton and Rod
Thomson


2
Contents

• TIIG Injury Surveillance System
• Alcohol and violence in young people
• Accident and Emergency data
• Alder Hey Childrens Hospital
• Use of AE data in violence prevention

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What is TIIG?

• Injury Surveillance System
• Intentional and unintentional injuries
• Inform local injury prevention initiatives
• Developed through multi-agency steering group
  including health, PCT's, academia, fire service,
  police and ambulance
• Objectives include
• Informing and advising local partners (e.g.
  health services, crime and disorder) on injury
  intelligence
• Informing injury prevention strategies through
  needs assessment
• Monitoring and evaluation of injuries and
  assaults
• Making available the best evidence

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What is the Merseyside model?

• Funding local health services/crime reduction
• Covers both intentional and unintentional
  injuries
• Brings together a variety of data sources
• Uses core data sets with local flexibility
• Phased approach to development

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Injury datasets
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What is the Merseyside model?

• Protocols developed for data exchange between
  partners
• Raw data provided to TIIG analyst based in
  Liverpool John Moores University
• Patient identifiers removed age, gender,
  ethnicity and area of residence
• Analysis conducted at university/ reports to all
  agencies

7
Alcohol consumption

• United kingdom
• 36 young people drunk before age 14.
• 27 16 years olds reported binge drinking 3 times
  during last 30 days.
• Negative experiences after drinking
• 15 injured, 15 argument, 11 fight, 10 trouble
  with police, 11 regrettably engaged in sex, 8
  engaged in unprotected sex.

• England
• One fifth pupils aged 11 to 15 drank in past
  week.
• Mean units boys 12.3 units girls 10.5
  units.

• North West
• 41.8 males and 34.6 females aged 15/16 binge
  drink.

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Violence

• 7th leading cause hospital admission 10-14 years
  olds 2nd 15-24 years olds.
• NSPCC
• 81 believe violence is 'a major problem for
  young people
• 42 been hit, punched or kicked 16 on the
  street.
• 9 attacked with a weapon or object at school 7
  in street
• ¾ been bullied at school 22 fear violence in
  school
• 59 witnessed violence/bullying between young
  people in street.
• Joseph Rowntree Foundation
• 1/10 boys in Year 7 and ¼ in Year 11 said they
  had carried a weapon in the past year.
• 1/5 boys in Year 11 admitted attacking someone
  intending to hurt them seriously.

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TIIG data
10
Alcohol-related violence
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Accident and Emergency data

• 6 AE departments across Merseyside FULL
  COVERAGE
• Full AE dataset, All injuries, All age groups,
  2002 onwards
• Assault
• Demography age, gender, area of residence/ time
  and date of attendance/ outcome
• Type of attack
• Number of attackers
• Relationship with attacker
• Weapon of attack
• Gender of attacker
• Location of assault (e.g. street/pub name)
• Alcohol consumption
• Last drink location (consume/purchase)
• Police informed

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Accident and Emergency data

• Across Merseyside there are nearly 3,000 assault
  attendances to AE made by young people each year

Royal Liverpool and Arrowe Park AE April 06
March 07
Males aged 14 to 16 years

• 16 drank alcohol prior to assault

• 1/3 attacked by gt2 people

• ¾ occur in public place (4 licensed premise)

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Accident and Emergencydata
Royal Liverpool and Arrowe Park AE April 06
March 07

• 58 attend Friday/Saturday/Sunday

1/10 admitted to hospital
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Alder Hey alcohol and assault audit tool

• Increasing number of attendances
• Numerous assaults had alcohol as a factor
• Inconsistent management
• Lack follow up support
• Audit Alcohol attendances (2004/5 full year)
• Assault Audit 2006 (full year)

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Alder Hey alcohol audit tool

• 253 alcohol-related attendances
• 71 female
• Majority aged 12 to 15 years

16
Clinical case

• 15 year old boy
• Found in street
• Arrived AE via ambulance
• ¾ litre vodka in 1 ½ hours (no drugs)
• Fell whilst running, banged head
• Purchased alcohol from shop
• Reason for drinking Friday night
• Drinks sometimes
• Treatment Airway support IV access Urinary
  Catheter CT Scan (300) and admitted to ITC
  (1900)

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Alder Hey assault audit tool

• 620 total assaulted (2006)
• 52 (8.3) had drunk alcohol
• 5050 Male Female
• Majority aged 14 to 16 years
• Vodka/lager
• Shop or friend (10 served in licensed premise
  e.g. pub)
• Majority (83) random attacks
• Third (38) attacked by 1 person (13 attacked by
  gangs of gt 10)
• Most attackers male
• 19 attackers described as friends
• Majority hit by fists / kicked (8 hit by blunt
  objects e.g. Stick / hammer / knuckle duster /
  metal bar)
• 63 occurred in street
• 37 not informed police

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Injuries

• Fractured Zygoma
• Arterial Bleed
• Depressed skull fracture
• Scaphiod fracture
• Rape
• 2 deep lacerations requiring surgery

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What next?

• Clinical care pathway
• Standardise medical assessment/treatment
• Standardise information given to patients
• Offer Brief intervention clinic (25 attendance
  rate)
• Establish links with existing Tier 2 Tier 3
  services (e.g. Referrals to Addaction (Tier 3),
  OK UK (counselling Tier 2)
• Links with education (School nurses, identify
  high use schools)
• Links with police (Assault hot spots, alcohol
  suppliers)

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Public Health

• Public Health Approach
• Extent
• At risk groups and communities
• Hotspot locations and problem premises
• Developed interventions/referral pathways
• Monitor and evaluate (e.g. Wirral SureStart)

21
Contact details

• Zara Anderson
• Tel [phone] Email
  z.a.anderson_at_ljmu.ac.uk
• Centre For Public Health
• Liverpool John Moores University
• WHO Collaborating Centre for Violence Prevention
• Castle House North Street Liverpool, L3 2AY
• www.nwpho.org.uk/ait