From September 1 of last year to July 29 of this year, specialists examined 161 teenagers, and in July, 41 minors were waiting for outpatient assistance. According to a report prepared by the Ministry of Health on the progress of the project, during the specified period, 247 requests related to 161 minors were registered at the BKUS Emergency Medical Center. Of these, 59 teenagers were referred to a multidisciplinary outpatient team, 42 were hospitalized at BKUS, some of them multiple times. The remaining 60 minors were directed to receive other available services. The target group of the project consists of minors who have developed moderate or severe mental and behavioral disorders due to the use of alcohol or drugs. BKUS provides them with emergency assistance, assesses health and social risks, determines the further treatment plan, and coordinates the referral of teenagers for outpatient or inpatient treatment, motivational programs, or other assistance. ## Some Teenagers Returned to the Hospital Five Times Of the 42 hospitalized minors, 11 were admitted to the hospital twice during the project implementation. Two teenagers were hospitalized three, four, and five times, respectively. Among the reasons for repeated hospitalizations, the Ministry of Health cites unstable motivation for treatment, lack of consistent services, and absence of adequate support and supervision after the teenager returns to their familiar environment. Initially, it was assumed that 18 minors would undergo outpatient treatment as part of the project, but in fact, 59 individuals were accepted into the program. Instead of the planned 25 teenagers, 42 received treatment at BKUS. The ministry concluded that the high demand is, among other things, related to the insufficient availability of other services provided in the place of residence. ## The Queue Increased Almost Threefold From January to July, the queue for multidisciplinary outpatient assistance at BKUS grew by 173%. At the beginning of the year, 15 minors were waiting for the service, and by July, that number had risen to 41. The Children's Hospital remains the only medical institution in the pilot project that provides such outpatient assistance, including home visits by specialists. At the same time, the team can effectively work with 30 minors. The Ministry of Health acknowledges that the service's capabilities need to be expanded, and similar services should be made available in the regions. Since January of this year, the project has become permanent and is funded from the Ministry of Health's budget. Starting in 2027, additional funds for its expansion are planned to be allocated as part of priority activities. Furthermore, starting in 2027, funding from the Norwegian Financial Mechanism is expected to improve the content of the motivational program. It should strengthen teenagers' desire to continue treatment, increase their engagement, and facilitate the transition to the next stage of assistance. ## Nineteen Teenagers Completed Motivational Programs As part of the pilot project, motivational programs are conducted by the Ainazi Children's Psychoneurological Hospital and the Gintermuiza Hospital. In Ainazi, ten patients completed the full course. One of them was referred to the program by court order. In Gintermuiza, 11 participants from the pilot project were accepted into the program, nine of whom completed it fully. Another 19 children were admitted there through regular referrals from a narcologist and were not participants in the pilot project. To coordinate treatment and further assistance, interagency meetings were held. BKUS organized 57 meetings concerning 29 minors, Ainazi Hospital held ten meetings regarding five teenagers, and Gintermuiza conducted five meetings concerning three minors. At such meetings, representatives from various institutions agree on a plan of action, determine responsibilities, and outline further steps for providing assistance. ## No One to Help the Teenager After Treatment The Ministry of Health draws attention to the insufficient availability of social rehabilitation and services provided in the place of residence. In Latvia, a unified system of mandatory and consistent social rehabilitation after treatment has not yet been established. There is also no permanent mentor who would accompany the teenager at all stages of assistance and continue to support them after returning home. It was assumed that the mentoring service would be provided by the Child Protection Center as part of the co-financed project by the European Social Fund, "Support Measures for Children with Behavioral Problems or Addictions and Their Families." However, this service could not be implemented. The report does not specify the reasons. ## Some 16-Year-Olds Have Not Even Completed Primary School The ministry also acknowledged that there are insufficient opportunities to continue education after treatment for addiction. Of the 21 examined minors, seven studied only remotely, and six 16-year-olds had not yet completed primary school. In some cases, the teenagers' knowledge levels significantly lagged behind the educational stage appropriate for their age. For example, one 16-year-old had only completed four grades. Two others were formally promoted to the ninth grade, although they had only mastered the curriculum of seven grades and did not attend school. The Ministry of Education and Science has been tasked with developing systemic solutions by June 1, 2028, to ensure adapted education for minors who have interrupted their studies due to disorders related to the use of psychoactive substances. The Ministry of Welfare, together with the Ministry of Justice and the Ministry of Health, must prepare solutions by December 31, 2028, to ensure mandatory consistent social rehabilitation for teenagers after compulsory inpatient treatment for addiction. ## The Treatment System is Set to Change The Ministry of Health intends to update the rules for providing narcological assistance, clarifying the responsibilities of participating institutions, the procedure for exchanging information, referrals for necessary services, and monitoring further assistance. The coordination of the new Cabinet of Ministers rule project has already begun, but its further advancement is scheduled for the second half of 2027. Starting in 2027, it is also planned to improve the skills of specialists in the fields of health care, social protection, and education, as well as employees of the State and Municipal Police and the State Probation Service working with teenagers who have problems with the use of psychoactive substances. It is planned to organize intersectoral training on the application of the A-CRA method and to exchange experiences regarding the interaction of institutions and the provision of continuous assistance. The pilot project "Integrated Approach — Improving Access to Services for Minors with Substance Use Disorders" aims to create a patient-centered model of assistance. It should ensure continuous treatment and support for teenagers after the acute phase of therapy is completed. The project's results showed that the problem is significantly larger than anticipated: more than three times as many teenagers received outpatient assistance than planned, and the queue grew by 173% in six months. At the same time, the main gap arises after treatment — teenagers return to their previous environment without a permanent mentor, consistent rehabilitation, and suitable opportunities to continue their education.
