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Getting it Right for Every Child (GIRFEC) is the Scottish Government’s overall national approach to improving outcomes and supporting the well-being of children and young people by ‘offering the right help at the right time from the right people’.
GIRFEC outlines how organisations involved in delivering children's and young people’s services should work together and tailor their support to individuals in order to improve their well-being. To assess the quality of a young person's life and identify the support they need, GIRFEC lists eight well-being indicators. Those relating to young people’s health / healthy lifestyles and nutrition are:
- healthy - having the highest attainable standards of physical and mental health and access to suitable healthcare and support
- active - having opportunities to take part in activities which contribute to healthy growth and development.
GIRFEC is an ongoing approach. All services working with children and young people – primarily in education, health and social work – share responsibility for its implementation.
An all-age drugs strategy was issued by the Scottish Government in 2018, replacing the 2008 strategy. The Scottish Government, along with NHS Boards and local partners, were mainly responsible for its implementation. The 2020 programme for government outlined the government will take further action to tackle the issues associated with use of illicit drugs, reduce harm and stop the rising number of drug deaths through investment of an additional £20 million over two years to increase direct support for projects to test new and innovative approaches, improve services and save lives. It also commits to consulting on drugs law reform so that the Scottish Parliament is ready to implement innovative, evidence based, health focused approaches if and when it is given the power to do so by Westminster. An additional £20m to reduce the harm caused by drugs was included in the 2020/21 budget, meaning the Scottish Government is committed to spending up to £95.3 million on alcohol and drugs in 2020/21.
A key priority of the 2018 strategy (Rights, Respect, Recovery) has been to ensure all families will have access to services (both statutory and third sector) provided through a whole family approach, in line with the values, principles and core components of GIRFEC, and to involve children, parents and other family members in the planning, development and delivery of services at local, regional and national level. An action plan for this strategy was published in October 2019.
The 2018 strategy seeks to achieve an outcome which will ensure that fewer people develop problem drug use. It commits to revise and improve the programme of substance use education in schools to ensure it is good quality, impactful and in line with best practice; to take a comprehensive approach to intervene and help those at risk of developing problem substance use alongside services working with this group; and to develop the workforce to ensure services are prepared to support young people and respond to their substance use.
The strategy also sets out a shift towards a whole family and family inclusive approach to treatment. It seeks to ensure children, young people and families affected by a loved one’s drug or alcohol use are better understood and supported.
The Scottish Government, along with Alcohol and Drug Partnerships, which bring together local partners including health boards, local authorities, police and voluntary agencies, have been primarily responsible for implementing the all-age alcohol strategy, which was updated in 2018.
The commitments of the strategy, as regards young people, include:
- To press the UK Government to protect children and young people from exposure to alcohol marketing on television before the 9pm watershed and in cinemas – or else devolve the powers so the Scottish Parliament can act.
- To develop education-based, person-centred approaches that are delivered in line with evidence-based practice to aim to reach all of our children and young people including those not present in traditional settings, such as Youth Groups, Community Learning and Development, looked after and accommodated children, excluded children and those in touch with services.
- To continue to work with partners to reduce alcohol-related violence and crime, through a combination of enforcing legislation, prevention
- work and early intervention activity.
A tobacco control strategy was published in 2013. The strategy includes five-year milestones towards its aim of creating a tobacco-free generation by 2034. Although an all-age strategy, it has a necessary focus on young people and is based on three themes:
- prevention – creating an environment where young people choose not to smoke
- protection – protecting people from second-hand smoke
- cessation – helping people to stop smoking.
The strategy aims to maintain the continued downward trend in the take-up of smoking among young people. Its modelling work assumes prevalence rates among 15-year-olds will decrease by 2.5 percentage points every two years until reaching a floor of two per cent.
Actions for young people in the strategy include:
- continuing to ensure that young people are aware of the health harms of tobacco use
- continuing efforts to reduce the availability, attractiveness and affordability of tobacco to young people
- working with learning establishments and partner agencies to identify good practice and high quality resources to share on the GLOW schools intranet site
- working with the youth sector to support smoking prevention programmes
- exploring with relevant bodies, including higher and further education and vocational training providers, the measures that can be developed to support young people aged 16-24 in making decisions about smoking and other health behaviours.
Local tobacco control plans, developed on the basis of the national strategy, are expected to focus explicitly on vulnerable young people, such as looked after children and young offenders.
The main bodies responsible for delivery of the tobacco control strategy are the Scottish Government, local authorities, NHSScotland and the third (voluntary) sector, both individually and in partnership.
Monitoring of implementation is the responsibility of the Scottish Ministerial Working Group on Tobacco Control and its Prevention Sub-Group (the latter responsible for overseeing the implementation of the preventative actions in the strategy and for advising the Scottish Government on new actions to prevent the uptake of smoking among young people).
Evaluation is the responsibility of the Research and Evaluation Sub-Group.
The Public Health Priorities for Scotland, a 10 year strategy published in 2018, outlines 6 priorities covering mental wellbeing, alcohol, tobacco and drugs and physical activity. This strategy is not specifically for young people but prioritises early years as well as including young people as a target group for other areas also. You can read more about what is included in this strategy here.
The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 included measures aimed at reducing smoking among young people, such as:
- banning the sale of tobacco and Nicotine Vapour Products (NVPs) to under 18s
- banning the sale of tobacco and NVPs by under 18s without authorisation
- stopping people buying these products for under 18s
- requiring shops to seek proof of age for those who look under 25
- asking tobacco and NVP retailers to register.
The all-age Sexual Health and Blood Borne Virus Framework was issued in 2011. There was an update in 2015, covering the period up to 2020.
Prevention is a key focus of the framework, which seeks to help:
- support good relationships and sexual health
- prevent poor sexual health and resultant sexually transmitted infections and/or unintended pregnancies
- implement relationships, sexual health and parenthood (RSHP) education to ensure all young people across Scotland have the information and skills to make healthy choices regarding their sexual health.
It recommends that HIV and STIs (sexually transmitted infections) should form part of RSHP education, which should continue to be provided to all young people, in all schools and wherever learning takes place, with delivery in line with equality and diversity legal obligations.
The framework also identifies drug and alcohol misuse as risk factors for poor sexual health which young people may be particularly vulnerable to.
The framework also aims to achieve a reduction in the rate of teenage pregnancy. A separate strategy for young pregnancy and parenthood was issued in 2016, covering the period up to 2026.
Target groups of the strategy are young people who:
- are looked after and accommodated or care leavers
- have poor attendance at school
- have low educational attainment
- are living in poverty and/or areas of deprivation
- are disabled or who have a learning disability
- have experienced abuse and violence
- are in contact with the justice system
- have parents who had children when they were young
- are, or are at risk of, homelessness.
The strategy reiterates the importance of relationships, sexual health and parenthood (RSHP) education. Other actions include:
- developing appropriate and integrated routes into health and social agencies to respond to the health and social care needs of young people
- determining the appropriate provision of contraceptive services outside of the health environment, dependent on the needs of the local population
- making information on pregnancy available in places frequented by young people and which considers the needs and concerns of young people, particularly concerns about confidentiality
- making accurate and up-to-date information on pregnancy and local services available on local sexual health websites and other websites aimed at young people.
Local authorities, Community Planning Partnerships, the third (voluntary) sector, NHS boards, and the Scottish Government are mainly responsible for implementing the strategy. Local areas develop their own teenage pregnancy strategies to align with the national objectives, but which reflect their particular populations and circumstances.
Encouraging healthy lifestyles and healthy nutrition for young people
The Scottish Government funds Choices for Life, a diversionary and educational initiative delivered by Police Scotland and supported by Young Scot. Its main objectives are to raise awareness amongst 11- to 18-year-olds regarding the risks and dangers of substance misuse, including smoking, alcohol and drugs, and to empower young people to make informed decisions when faced with challenging situations.
Colleges and universities are encouraged to sign up to the NUS Scotland/Scottish Student Sport Healthy Body Healthy Mind Award, funded by the Scottish Government.
The award requires colleges and universities to work with their student associations and sports unions on health improvement projects. It focuses on the links between physical activity, smoking and mental health and encourages sport and recreational programmes as a means to support health and mental well-being. It also encourages signposting to student services and appropriate external organisations for mental health and stop-smoking support, and the development of creative approaches designed to discourage students from taking up smoking. Under the Schools (Health Promotion and Nutrition) (Scotland) Act 2007, there is a duty on government, local authorities and grant-aided (publicly funded) schools to adopt a whole-school approach to integrating health promotion into every aspect of school life.
The Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2008 were introduced in secondary schools in 2009. They contain nutrient and food and drink standards:
- Nutrient standards set out the proportion of nutrients that pupils should receive from an average day’s school lunch.
- Food standards and drink standards define the types of food and drinks that pupils should be offered in a school lunch, and their frequency, as well as setting nutritional requirements for specific types of food and drink which may be provided.
- There are also food standards and drink standards for school food and drinks served otherwise than for school lunch, e.g. breakfast clubs, tuckshops, vending machines, mid-morning services, community cafes and after-school clubs.
Guidance on implementing the regulations was issued by the Scottish Government
Beyond the School Gate provides guidance for local authorities, schools, retailers, caterers and other stakeholders on what they can do to influence the food environment around schools and support children and young people to make healthier choices.
Further guidance was issued in 2014 to support schools and stakeholders to work in partnership to make improvements in school food and food education
A key driver of diet and nutrition policy is the all-age policy document - Preventing Overweight and Obesity in Scotland: a Route Map Towards Healthy Weight.
Health education and healthy lifestyles education in schools
The senior (upper secondary) phase of education runs from years S4 to S6 (ages 15/16 to 18). School is compulsory to the age of 16. Although there is no statutory curriculum, ‘health and well-being’ is one of the areas that make up the Curriculum for Excellence (CfE). Along with the curriculum areas of literacy and numeracy, health and well-being is described in the CfE as being ‘recognised as …. particularly important’ and the ‘responsibility of all staff’. Schools are expected to provide health and well-being education in line with the ‘experiences and outcomes’ of the CfE. These are statements describing expectations for learning and progression and extend into the entire senior phase for those remaining at school.
Aspects of learning in health and well-being may be taught through ‘personal and social education’ (PSE). A review of PSE was undertaken in three phases and was completed in January 2019. The final PSE Review report and recommendations has been published, and it is proposed that the recommendations contained within the review are delivered within the current Parliamentary term (by March 2021).
The experiences and outcomes for the health and well-being curriculum area are structured around six organisers (themes). These are:
- mental, emotional, social and physical well-being (including behaviour, bullying, exclusions, attendance and absence)
- food and health
- substance misuse
- planning for choices and changes
- physical education, physical activity and sport
- relationships, sexual health and parenthood.
The main purposes of learning in health and well-being are described (p.1) as enabling learners to:
- make informed decisions in order to improve their mental, emotional, social and physical wellbeing
- experience challenge and enjoyment
- experience positive aspects of healthy living and activity for themselves
- apply their mental, emotional, social and physical skills to pursue a healthy lifestyle
- make a successful move to the next stage of education or work
- establish a pattern of health and well-being which will be sustained into adult life, and which will help to promote the health and well-being of the next generation of Scottish children.
The themes for the experiences and outcomes of health and well-being also include ‘relationships, sexual health and parenthood’. While embedded within the health and well-being curriculum area, there is no statutory requirement for sex and relationships education. Within this area:
Learners develop an understanding of how to maintain positive relationships with a variety of people and are aware of how thoughts, feelings, attitudes, values and beliefs can influence decisions about relationships, and sexual health. They develop their understanding of the complex roles and responsibilities of being a parent or carer (p.15).
- the influence of popular culture, the media and peer pressure on how young people may feel about themselves
- making informed decisions and choices that promote and protect the sexual health and well-being of the young person and of others
- how to access services, information and support, and rights and responsibilities in relation to sexual health
- the responsibilities of parenthood and its impact on life choices and options
- appropriate sexual behaviour
- commitment, trust and respect in relationships.
Resources and information on health and well-being are available through Education Scotland’s learning blog.
NHS Health Scotland (a national Health Board working to reduce health inequalities and improve health and part of NHSScotland), has produced an educational resource for use by teachers and others to support learning about the relationships, sexual health and parenthood outcomes and experiences of Curriculum for Excellence. Sexual Health and Relationships Education (SHARE): Safe, Happy and Responsible. Educational Resource is an evidence-informed resource focused on interactive learning for 13- to 16-year-olds.
The Scottish Government has also published guidance for teachers on the conduct of teaching relationships, sexual health and parenthood education.
Additional resources for the teaching of health and well-being education in Scotland are provided by the UK membership association for teachers of personal, social, health and economic education, the PSHE Association.
Peer-to-peer education approaches
The Scottish Peer Education Network (SPEN), run by the charity Fast Forward, is a group of peer education charities and other organisations who work with young people and adults on all kinds of issues from sexual health to illegal highs. It provides members with toolkits and resources, training and free consultations and advice. It also organises educational events and networking meetings. It has been endorsed by Education Scotland, with whom it produced a ‘Why peer education?’ video.
Fast Forward is supported by the Big Lottery Fund and the Scottish Government.
Sexpression:UK is a UK-wide, student-led independent charity that empowers young people to make decisions about sex and relationships through the provision by university students of sex education workshops in schools and community settings. The scheme delivers informal, near-peer lead sessions on bodily changes and puberty; safe sex, STIs (sexually transmitted infections) and contraception; sex and consent; relationships and abuse; sexual orientation and gender and sex and the media. The core offer focuses on 14- to 18-year-olds.
Collaboration and partnerships
Genuine participation of pupils, parents, staff, community representatives and partner agencies is essential to encourage, support and develop initiatives for promoting health (p.13).
The guidance goes on to say that it:
is important that schools engage with local partners to ensure that policies and activities which promote health are inclusive and consistent, and are embedded across schools and their communities. Such local partners include Alcohol and Drug Action Teams, specialist health promotion staff, local police, and community and voluntary sector organisations such as substance misuse support services. It is essential that work undertaken by partners in schools is reinforced on an authority-wide basis by other community services and local authority provision such as sports and leisure and community centres. (p.14)
Education Scotland’s Food for Thought Education Fund gives financial support to schools to develop food and health as a context for learning. The fund aims to improve educators' confidence in providing progressive, high quality learning experiences which help to embed food education into the ethos of their school. It also provides an opportunity to plan and implement learning experiences which build sustainability and capacity for future development.
It is a condition of eligibility that food-based projects include a business or community link. Business in the Community Scotland is a partner in the Food for Thought Fund and helps establishments to find a business / community link.
Raising awareness on healthy lifestyles and on factors affecting the health and well-being of young people
The Scottish Government funds SALSUS, the Scottish Schools Adolescent Lifestyle and Substance Use Survey, a national survey of tobacco, drug and alcohol use amongst secondary school pupils in Scotland. A range of reports are published using the survey data to monitor trends in teenage lifestyle issues and raise awareness.
ASH Scotland – Action on Smoking and Health (Scotland) - is an independent Scottish charity taking action to reduce the harm caused by tobacco. ASH Scotland works with a wide range of organisations to engage young people, from community youth groups and family support services through to schools and fostering agencies. Through the information and services it provides, it helps these groups and organisations to support the young people they work with to make positive and healthy choices on tobacco. ASH Scotland’s information service is funded by the British Heart Foundation and the Scottish Government.
The Scottish Government’s ‘Take Life On’ website provides all-age information on small, achievable lifestyle changes to improve health. The Scottish Government also maintains the ‘Know the Score' website and helpline which have information on drugs and their misuse, and funds the ‘Sexual Health Scotland’ website, which provides information on sexual health and relationships.
The British Nutrition Foundation runs an annual Healthy Eating Week and has developed resources in support of this. These are all-age, but there are separate sections for schools and for universities.
The NHS Inform website provides information for all ages on topics including alcohol, contraception, food and nutrition, and mental health and well-being.
The all-age ‘HIV Always Hear’ campaign has been funded by the Scottish Government and aims to provide the basic facts about HIV, dispel myths, provide statistics and end the stigma attached to HIV.