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L431 Public Health Question: This Strategy sets out how we and our partners, at local, national and international levels, will take new action to respond to these challenges.   Taking a smarter, coordinated partnership approach;  Enhancing our balanced response across the four core strands of the Strategy (reducing demand, restricting supply, building recovery and global action).   Expanding on the two overarching aims of the 2010 Strategy: to reduce illicit drug use and increase the rate of individuals recovering from their dependence by going further to measure both the frequency and type of drug used, and using recovery data to segment the treatment population, to better personalise support and recovery ambitions.     This Strategy sets out how we and our partners, at local, national and international levels, will take new action to respond to these challenges     Developing a new set of measures to better capture the joint ownership required to drive action across local authorities, health, employment, housing and criminal justice partners.   Providing stronger governance for delivering the Strategy, including a Home Secretary chaired Board and the introduction of a national Recovery Champion.   Answer: Introduction: Community refers to the sense of belongingness or identification in a particular area. With the change in the demography and the integration of different types of people in the community, the contemporary needs of the community have changed. Nowadays, community represents people from different ethnicities, a vibrant diversity of racial and cultural backgrounds with varying religions and socio economic background (Barr et al. 2012). Thus different people have different beliefs, way of living and different challenges. Different socio-economic status gives rise to different social classes powered by an unequal distribution of wealth and privileges. Owing to this diversity of people, the community faces certain problems that can affect the human society as the whole (Kelly et al. 2010). Among the different social issues that a community faces, one of the important social issues is drug use and homelessness. This paper will discuss about a public health community initiative that prevents drug addiction and manage such conditions in United Kingdom. The community based initiative that has been chosen for this report is Turning Point Drug and alcohol support. Issues Of Social And Cultural Diversity Within The Context Of Community Cohesion The communities in United Kingdom are culturally diverse with different beliefs and the values. Embracing each other’s culture and respecting each other’s differences has always been an important aspect of community cohesion (Barr et al. 2012). It has to be noted that socio- cultural beliefs can design the approach towards the substance use and abuse (Kelly et al. 2010). Culture plays the central role to form the expectations of the individuals about potential problems that people might face with substance abuse (Kendler et al. 2016). Some culturally diverse population might have some ceremonial use of alcohol while the other might consume them for fun. Drug Use And Homelessness Problems with drugs or alcohol can be one of the predisposing factors for homelessness. Not every person having problems with alcohol or drugs becomes homeless (Fitzpatrick et al. 2013). However the intake of drug and alcohol has been found to be relatively high among the homeless population. Being homelessness can be stressful and can even lead to high prevalence of mental health problems (Thompson et al. 2013). As per the researches, people associated with drug abuse are linked to low education and unemployment and poverty, which might ultimately lead to (homelessness Fitzpatrick et al. 2013). Statistics As per the statistics, out of the total number of people receiving treatment for substance abuse, 7% reported an urgent housing problem, 12 % having current housing problems, like staying with friends of families or hostel at a short term (GOV.UK. 2018). The vulnerable group of population that has long been the victims of drug abuse are the adolescents and people of ethnic minorities. Women and the members of the ethnic minority groups are considered as to be the hidden clients as in most of the time they are unable to access the services, placing them in a dangerous position in the society of becoming victims to substance abuse (GOV.UK. 2018). There are several social determinants of substance abuse among the youths that includes ages, gender, poverty, social deprivation,, poor performance at school,depression, personality disorder, peer pressure, family structure, relations, affordability and the accessibility of the drugs (Galizio, M. and Maisto. 2013). Prolonged stress and early childhood problems might be an important factor, as this the critical period of brain development. Social categories like age, gender, race influences the access to healthcare, exposure to stigmatisation and marginalisation. As a result the drug outcomes are guided by social categories. People who are drug dependant are more likely to be unemployed and become exposed to marginalisation (Galizio and Maisto, 2013). The socio-economic environment is also an important social determinant of drug use. This is due to the fact that people belonging to low socio-economic status might cause stress causing negative impact on the mental health of the individual. Children brought up in low socio-economic status families get less care and supervision and hence are likely to fall prey to drug uses (Galizio and Maisto, 2013). Again it has also been found that the percentage of children who face peer problems or leave school prior without getting proper education are likely to be present among the ones with drug related issues. Impacts Of Substance Abuse On Community Cohesion Community cohesion describes the ability of the community to grow in harmony, having a common vision and a sense of belongingness. Drug abuse disturbs the community cohesion. Drug abuse presents challenges to the stability of a family. Families and communities are often termed as the strength providing nurturance to the individual members. Alcohol abuse and homelessness not only impacts the health of the individuals, but also disrupts the family (Kendler et al. 2016). It disturbs the community attachment, such as withdrawal from community engagement due to emotional illness or lack of connectedness with the society or rights to vote. Drug abuse combined with homelessness is increasing the mortality and the crime rates worldwide. As per the reports, Hepatitis C and AIDS are more common among the homeless people who inject drugs. According to GOV.UK. (2018), substance abuse in the United Kingdom are associated with 46% rapes, 50 % assaults , 70 % teen suicides, 50 % murders and 65 % child abuse. Agencies And Their Roles In Promoting Health And Wellbeing In The Communities UK government and other non profit agencies had been trying their best to tackle drug misuse and harms. The National drug strategy is balanced over four strands-Reduction of the demand, restricting the supply and developing an appropriate recovery plan (HM Government.2017). In compliance with this four themes, the UK government has established collaborative partnership with several organisations or agencies, some of which have been discussed in this section.   The NHS England, PHE and the Clinical commissioning Groups Commissioners and the relevant health care providers are working together for preventing any alcohol and drug related problems (HM Government.2017). The organisations have also funded for innovative approaches to tackle homelessness among the substance users. In compliance to the National drug strategy, the government has launched £50 million Homelessness Prevention Program that will enable the local areas for developing an end to end approach for reducing and preventing the homelessness (HM Government.2017). Another approach to the prevention of substance abuse among the adolescents is the development of the local partnership boards’ arrangements, local profiles that has promoted the provision of a wide range of partnership activity, multiagency for the prevention of Serious and organized crime. These partnership approaches provides prompt responses to threats like alcohol trafficking (HM Government.2017). Public health England (PHE) also continues to work in partnerships with the local areas supporting them to understand and identify their needs. The government had also been working in partnership with the World Bank, World Health Organization to strengthen the health system. It also supports the comprehensive package mentioned in the World Health Organization’s 2014 consolidated guidelines on the prevention of HIV due to drug abuse (HM Government.2017). Turning point is an organization in UK that provides a wide range of health and wellbeing services to the individuals who are the victims of alcohol and drug abuse. They also provide suitable support to people having mental health concerns or learning disabilities (Turning Point. 2018). Turning point aids in recovery of the vulnerable individuals by providing assistance via peer mentors, who had overcome their addictions and are now working to support the ones suffering. There are provisions for resolution clinic to provide support to those who might not be able to access the traditional substance misuse services. The service also provides detoxification programs to both men and women having drug and alcohol dependence (Turning Point. 2018). The detox units are provided with nurses and support workers who provide 24 x7 services. Apart from the physical detoxification programs, the services also have been providing with regular group activities that shows that a great emphasis on the community is placed and also aids the patient to develop the sense of connectedness in the community. Proper rehabilitation is required for the affected individuals’ right after the detoxification, especially to the ones who are homeless, as they are extremely vulnerable to relapse, even when a substitute medicine is being used (Turning Point. 2018). Turning point Rehab services are provided at the Stanfield House and Leigh Bank centers, where one can embrace support and the challenges from the peer support group, participate in the daily structured activities, independent living and engage with the community. Community engagement helps in the recovery by challenging stigma. The key component of Turning point is to include supportive and cohesive family relationships at the entry of the treatment (Turning Point. 2018). Researchers have shown community engagement to be related to positive treatment outcomes. Turning Point also encourages peer relationships. A link between the involvement with the peer groups and engaging in the delinquency has also been reported in several studies (Turning Point. 2018). Mental health Illness is strongly linked to substance abuse and one of the approaches of the National drug strategies is to provide appropriate support to the drug addicted individuals suffering from mental health problems. One such organization in UK is MIND, which is a mental health charity in England founded in the year 1946; provides information and advice to people with mental health problems and lobbies the government and the local authorities on behalf of them (Minds. 2018). Services provided by this association are supported housing, care homes, self-help support groups. In the national level MINDs also takes sponsorships, donations and also operates charity shops and also organize campaigns for reducing stigma associated with psychiatric illness (Minds. 2018). New Horizons youth centre had been providing support to the homeless young people since 1969. They support the homeless people with food, shelter, shower and laundry and also help them in finding accommodation (New Horizons youth centre. 2018). They also offer counseling, health, drug and alcohol support communication skill workshops for creating a bright future for them. People with co-occurring mental health disorders are often unable to access the care they need. In most of the cases he substance misuse services, consider mental health as an exclusion criteria. In order to tackle this government is working with the PHE and the NHS supporting the local organization to address this issue (New Horizons youth centre. 2018). Mentor UK is a part of the group charities that has been made in collaboration with the World Health Organization (WHO), that develops evidence based youth development programs to empower them to abstain from substance abuse. Approaches To Community Development In Relation To Substance Abuse Some of the essential  community based approach for tackling substance abuse among the communities are- Taking smaller , collaborative partnership approach, augmenting the response across the core strands of the National drug strategy, reducing the use of the illicit drug use , developing some new sets of measures across the local authorities , employment, health and housing. Peer support is an essential component for the effective recovery (Monti et al. 2012). PHE continues to implement the mutual aid toolkit and would explore the potentials of the online peer groups that can be vital for those living in the sparsely populated rural areas  (Campbell et al. 2017). Other innovative service user led approaches include peer mentoring for the ones engaged in the treatment services, training for the ones working with the drug users. Another community based approach for the vulnerable people is the coordination between the drug and the alcohol rehabilitation services with other local services such as police, mental health services, youth offending teams; sexual health services (Monti et al. 2012). Multiagency working is necessary and should involve clinical commissioning boards, local boards for safeguarding children and the youth offending teams. Police needs to be involved as the drug victims are often associated with antisocial activities and violence. Colleges, universities and other education providers also play a key role as they work with millions of young people at the most critical transition phase of their lives. For examples the programs like UK Anti doping’s clean sport university accreditation scheme promoting drug prevention by providing a drug free and a positive culture for the students (HM Government.2017). Alcohol and Drug Education and Prevention Information Service is a platform for sharing the evidence based information to the schools and the professionals working to reach out to the young people (HM Government.2017). Conclusion: In conclusion it can be said that although government and the associated agencies had been trying their level best to address the social issues of substance use among the communities, ambiguities are still present in terms of funding and dissemination of the resources. In order to mitigate the problem from the grass root level it is necessary to recognize the challenges ahead and encourage the local organizations to embrace a more coordinated response to drug misuse that will reduce the crime, improve the life chances, promote better health and protect the vulnerable population of the community. By working together with the wide range of stakeholders, a healthier drug free community can be obtained. References: Barr, S.C., Hanson, R., Begle, A.M., Kilpatrick, D.G., Saunders, B., Resnick, H. and Amstadter, A., 2012. Examining the moderating role of family cohesion on the relationship between witnessed community violence and delinquency in a national sample of adolescents. Journal of interpersonal violence, 27(2), pp.239-262. Campbell, A.N., Nunes, E.V., Matthews, A.G., Stitzer, M., Miele, G.M., Polsky, D., Turrigiano, E., Walters, S., McClure, E.A., Kyle, T.L. and Wahle, A., 2014. Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. American Journal of Psychiatry, 171(6), pp.683-690. Fitzpatrick, S., Bramley, G., Pawson, H., Watts, B. and Wilcox, S., 2015. The homelessness monitor: England 2015. London: Crisis. Galizio, M. and Maisto, S.A. eds., 2013. Determinants of substance abuse: Biological, psychological, and environmental factors. Springer Science & Business Media. GOV.UK. 2018.Statistics on Drug Misuse, England 2018 .Access date: 2.12.2018. Retrieved from: https://www.gov.uk/government/statistics/statistics-on-drug-misuse-england-2018 HM Government.2017. Drug Strategy July 2017.Access date: 2.12.2018. Retrieved from: https://assets.publishing.service.gov.uk Kelly, S. M., O’Grady, K. E., Schwartz, R. P., Peterson, J. A., Wilson, M. E., and Brown, B. S. 2010. The relationship of social support to treatment entry and engagement: the Community Assessment Inventory. Substance abuse, 31(1), pp. 43-52. Kendler, K.S., Maes, H.H., Sundquist, K., Ohlsson, H. and Sundquist, J., 2014. Genetic and family and community environmental effects on drug abuse in adolescence: a Swedish national twin and sibling study. American Journal of Psychiatry, 171(2), pp.209-217. Mentor UK .2018. Access date: 2.12.2018. Retrieved from: https://mentoruk.org.uk/about-us/ Minds. 2018.Access date: 2.12.2018. Retrieved from: https://www.mind.org.uk/about-us/ Monti, P.M., Colby, S.M. and Tevyaw, T.O.L. eds., 2012. Adolescents, alcohol, and substance abuse: Reaching teens through brief interventions. Guilford Press.  New Horizons youth centre. 2018. Access date: 2.12.2018. Retrieved from:https://nhyouthcentre.org.uk/ Somani, S. and Meghani, S., 2016. Substance Abuse among Youth: A Harsh Reality. Emerg Med (Los Angel), 6(330), p.2. Thompson Jr, R.G., Wall, M.M., Greenstein, E., Grant, B.F. and Hasin, D.S., 2013. Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. American Journal of Public Health, 103(S2), pp.S282-S288. Turning Point. 2018. Drug and Alcohol support. Access date: 2.12.2018. Retrieved from: https://www.turning-point.co.uk/drug-and-alcohol-support.

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