Transcript The Work of Child and Youth Mortality Review

The Risk Taking Years
CYMRC - To identify, address and potentially decrease the
numbers of infant, child and youth deaths in New Zealand
Nick Baker
CYMRC Process – Deaths 28 days to 25th Birthday
Database
Child or
Youth Death
Analysis
Literature
LCYMRG
DHB
Policy, Strategy, Systems
Change
CYMRC
Strategic
Partners
HQSC
Recommendations
Media
Public Opinion
Ministries
Health
Minister
Ministers
N = 5391
NZ Mortality by Age
Group 1979 - 2010
Deaths by Residence and Age group
250
200
150
100
50
0
4-52 weeks
1-4 years
5-9 years
10-14 years
15-19 years
20-24 years
Ref - Table J1 CYMRC Fifth Report
Unintentional death rate, by
age and gender 2003–2007
About 140 Transport Deaths per year 14-25
14% of the population having 33% of transport deaths
Typical Stories
–
–
–
–
–
–
–
–
–
–
Early parenting issues
CYF involvement
Problems at school - disengage
Not connected to parents
Strong influence of peer group
Escalating risk taking
Alcohol, Cannabis
Mental health issues
No one there for them
Disconnected from services
• Missed Opportunities to Intervene
• Only clearly identified as information linked after death
Cause of mortality in youth aged 15–
24 years (%), by category of death,
2003–2008 combined (2366 deaths)
Unintentional injury mortality, by
age group and injury type
2003–2007 (rate per 100,000)
[R.P.1]
Youth (15-24 years) transport mortality
rates per 100,000, by DHB of death,
200
2003–2007
Mortality rate per 100,000
180
160
140
120
100
80
60
40
20
0
DHB of death
South Island Land Transport Injury
Admissions 2006-10
Number:
Total per 5
Year Period
DHB
Number:
Annual
Average
Rate per
100,000
Rate Ratio
95% CI
Land Transport Injuries
Hospital Admissions in Young People Aged 15–24 Years, 2006–2010
Nelson
Marlborough
West Coast
442
88.4
561.2
1.54
1.40–1.70
171
34.2
935.2
2.57
2.21–2.99
1,114
222.8
305.4
0.84
0.79–0.89
South Canterbury
211
42.2
671.3
1.85
1.61–2.11
Otago
553
110.6
325.5
0.89
0.82–0.97
Southland
407
81.4
559.5
1.54
1.39–1.70
11,519
2,303.8
363.8
1.00
Canterbury
New Zealand
Drowning in New Zealand,
2003–2007 by Year of Age
Poisoning deaths (unintentional and undetermined intent) by
substance and age in children and young people aged 9 to 24 years,
New Zealand 2002–2008 (n=103) (draft CYMRC data 2012)
16
Number of deaths
All others
Recreational drugs
Psychiatric medicines
Methadone
Morphine and codeine
Alcohol
Other gases and volatile liquids
Butane, LPG and other hydrocarbons
14
12
10
1
1
2
8
1
1
4
0
1
1
1
1
1
7
2
1
9
1
1
1
1
1
1
1
6
1
1
4
4
2
3
5
1
1
1
1
1
2
2
1
4
4
1
1
1
1
4
2
10 Source:
11CYMRC12
13 Numerator
14 Sbstance
15 Group
16 determined
17 following
18 case review
19 of CYMRC
20 data
21
Data Collection;
Age in years
4
1
2
3
1
2
1
2
3
3
2
1
1
2
22
23
24
1
Teens burnt in explosion
allegedly sniffing gas
Spectrum of Prevention
Influencing policy and legislation
 Control legal access to substances and require warning labels
Mobilizing neighborhoods and communities
 Recognise abusers reduce sales and access
Changing organizational practices
 Voluntary control by retailers
 Warning labels on products
 Offensive odours, tastes, colouring - research needed
 Use alternate products and safer storage systems
Spectrum of Prevention
Fostering coalitions and networks
 Lead agency nominated with the development of coalitions
Educating providers
 Screen & support young people after risk taking related harm
Promoting community education
 School based, retailers, parents, caregivers
Strengthening individual knowledge and skills
 Strategies to build risk competence
 Connecting young people to supports
Assuring access to quality health care
 Identify users and connect to health services
All injury (intentional/unintentional)
Number of visits to Nelson Emergency Department by age at time of visit
2004-2009
2500
2000
Quite common for young people to suffer a
number of injuries before death
– “frequent flyers”
Count
1500
1000
500
0
1
5
9
13
17
21
25
29
33
37
41
45
49
53
57
61
65
69
73
77
81
85
89
93
97 101 105
Age
Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU
Number of visits to ED as a result of a motorvehicle incident by age
100
90
80
70
50
40
30
20
10
93
88
84
80
76
72
68
64
60
56
52
48
44
40
36
32
28
24
20
16
12
8
4
0
0
Count
60
Age(in years)
Acknowledgment Bronwyn White Injury Prevention Health Promoter - NMDHB PHU
Cost of Serious Injury by Year of Age When Claim First Registered 2009
18,000,000
16,000,000
14,000,000
Cost
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85
Thanks to ACC Lorna Blunt
AGE in Years
NZ intentional
NZ unintentional
Behaviours in Motor Vehicles
• during the previous month,
– 24% driven by someone driving dangerously
– 23% rode with drive who had been drinking alcohol
• 10% of 17yr olds had driven a car after more
than two glasses of alcohol in 2 hrs before
driving
• more than 26% of students do not always
wear a seatbelt when driving or being driven
in a car.
(Youth 2007)
Consequences of Risk
Taking
• Injury – physical health
• Antisocial behaviours
– Drugs alcohol tobacco dependency
– Violence crime
– Poor educational performance
• Unwanted pregnancy
• Costs
– Lost potential
– Injury $400,000,000 per annum direct to ACC
– Crime
Risk Taking
• Active voluntary behaviours associated
with high risk of injury or death
• Different sorts of risk taking cluster
• Across life domains, reckless use of vehicles, natural
hazards, alcohol, sex, violence, crime, drugs
– OECD uses teen births, youth smoking and
drunkenness as national index of risk taking
• NZ 24th out of 30 OECD countries
– Consequences can have major impact on future
potential
Risk Taking Developmental Determined
• An evolutionary advantage?
– Risk seeker – hero Risk avoider – coward
• Greater chance of success if resources are scarce
• males competing for a mate, finding new food sources
– Strong decision making under uncertainty
– Risk takers who survive may get high rewards
• Criminals, stock markets, racing car drivers
• Now imbedded in youth phenotype
–
–
–
–
a need for the stimuli risk taking creates
experiences that cross boundaries attractive to adolescents
risk taking leads to acceptance within peer group
rebellion and differentiation from adult norms
Safe
Timid
Risk
Avoider
Faint-hearted
Fearful
Diffident
Hesitant
Nervous
Anxious
Apprehensive
Careful
Circumspect
Far-sighted
Wary
Prudent
Sensible
Out-going
Pioneer
Adventurer
Plucky
Brave
Bold
Daring
Fearless
Courageous
Impulsive
Overconfident
Impudent
Irresponsible
Foolhardy
Risk
Seeker
“A
true
hero
knows
when
coward
hero
to be a coward!”
Wise
Dangerous
Reckless
Risk Taking
• Environmentally potentiated
– Social, physical, emotional
– Isolation from moderating mature influence
• Hazards increased by
– Opportunities – fast cars, dangerous rivers
– Alcohol
– Peers
– Media – you-tube, video games, violent
programs promote violence?
– Disconnection – parents matter still
Alcohol
• Alcohol contributes to
– 1: 3 injury deaths (15-24yr age group)
– More fatal crashes in the 15–24 age than older
groups
– a greater effect on driving performance at lower
levels for young people ( + peers!)
• Do not set young people up to learn to
drink at same time as learning to drive
– Zero tolerance for alcohol in young & novice drivers
– The greatest risk period for young drivers is in the first six
months of driving solo – graduated licence
Through the
Eyes of a
Child?
NZ Injury Deaths 2005-07 n=357
What do we know works?
• Telling young people about risk
• Telling young people what to do
– Explore why they might change target behaviour
• HUGE international disparities suggest
substantial change is possible
– Environmental, enforcement, legislation
– Building Risk Competence
• Need specific youth targeted interventions
across all risk taking and injury types
Building Risk Competence
• learn to manage complex and hazardous
situations and avoid harm
• develop emotional, social and cognitive resilience
– improve
• perception and assessment of risks
• coping with hazardous situations
• opportunities and environments
– explore and develop
• physical, psychological, social skills without
undue injury risk – “split the risk”
Kaikohe unicyclists
aim for the top
Exceptional Efforts from Exceptional People
How do we make it easier?
Risk Competence
Lower
•
•
•
•
•
•
•
•
•
•
Novice
Peer presence
Males
Disconnected
Alcohol
Drugs
Aimless
Mental illness
ADHD
Disability
Greater
•
•
•
•
•
•
•
•
•
•
Experience – transferability
Practiced decision maker
Perception of Risk
Values and Attitudes
Sense of control
Mentoring
Supervision
Connections
Purpose
Learn from Mistakes
Building Risk Competence
– Communities should
• reduce pathways to harm with more opportunities for
healthy development - without death!
• link environments of risk to support & supervision
– Joined up services support holistic care
– Role modelling
• separate alcohol and sport
– Support parents to understand role and stay
connected
Mitigate Impact of Risky
Behaviours
• Environmental modification
– road designs, urban design
• Product modification
Passive
– car design, air bags
• Legislation, regulation and enforcement
– legal limits for alcohol, graduated licensing
• Use of safety devices
– seat belts, condoms
• Community-based interventions
– mentoring, youth workers, employment
Youth Specific Prevention
• 15-24 yr issues lost in adult issues and
injury type specific interventions
• Same factors contribute to
– Vehicle, workplace, drowning, poisoning, assault
• No group with focus on youth injury
- cf SafeKids
• Developmental preventive interventions
• Need a common national approach
– Lead agency injury prevention 14-24 or 0-19?
The Role of Health Care
• Supporting Young People
– Connections communication – motivational interviews
– Recognise risk and intervene – ADHD repeats
– Develop care pathways – brief counselling
• Supporting Parents
– Stay connected – explore why change target behaviour
– Anticipatory guidance – understand the risks
• Community Change
– Youth at the centre
• environmental and attitude change
Acknowledgements
• CYMRC Workforce
– Local & National Coordinator
– Local Groups and Chairs
• 500 plus Agents – Police, CYF, Plunket, St Johns, MOE
– DHBs
– Coroners
– HQSC secretariat
• Gabrielle MacDonald and Mortality Data Group
• Bronwyn White NMDHB ED data
• Lorna Blunt ACC data