Practitioner Guidance for Somerset Drug and Alcohol Assessment Tool for Young People. 2nd edition October Guide

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1 Practitioner Guidance for Somerset Drug and Alcohol Assessment Tool for Young People 2nd edition October 2014 Guide

2 Introduction This document provides practitioners with guidance on using the Somerset Drug and Alcohol Assessment Tool. It should be used alongside the additional tools that can be downloaded from Don t wait to act after any section of the assessment you may hear things that mean you need to act on them immediately. We ve added some shorthand symbols into the assessment tool symbol indicates a prompt for the worker Somerset Drug and Alcohol Assessment Tool for Young People indicates reflection and action by young person and the worker Drug And Alcohol Screening Tool For Young People S and Screening tools 16/05/ :51 The updated tool: places more emphasis on safeguarding young people who use substances prompts practitioners to act on what they are hearing and seeing at assessment and guides practitioners to engage with young people who may be at risk of, or experiencing problems with alcohol or drugs. Using the drug and alcohol assessment tool will start a process for a young person to help them make changes in their life. It will also help you identify the needs that the young person has, and make informed decisions on what interventions will be appropriate and what next steps to take. Where at all possible you should work alongside other agencies and the young person s parents / carers for the benefit of the young person. Throughout the 2nd edition of the assessment tool, you are prompted to reflect with the young person on what they have told you and consider what actions to take. 1

3 Overview on tiers of interventions Since the HAS review 2001, responses to young people s drug and alcohol use has been defined by 4 Tiers: Tier 1 screening using this tool advice, information and education about different substances signposting and referral for Tier 2 or Tier 3 interventions it would not cover doing any further specific interventions around the young person s substance misuse, but could mean you continue to support the young person while they are seeing another worker about their substance misuse. Refers to universal services available to any young person such as school nurse, a youth worker or a GP. They work with drug and alcohol issues as part of a broader range of issues dealt with. If you are using Somerset Drug and Alcohol Assessment Tool for Young people you will be delivering Tier 2 interventions Tier 2 using the drug/alcohol screening or assessment tools advice and information on drugs and alcohol brief interventions to support and help young people identify and make changes in their use of drugs/alcohol and find alternatives harm reduction advice making referrals to more specialist services to help a young person with their drug or alcohol use and providing them with the support to access those services continuing to support the young person while they are seeing another worker about their drug/alcohol misuse relapse prevention work to support a young person once in treatment or once they have been discharged from treatment (Tier 3) Support and help for non-using children and young people of substance misusing parents for details of what is available see Refers to youth orientated services offered by practitioners with some drug and alcohol experience and youth specialist knowledge. There are many services that this applies to but all the workers are in a role where they are able to develop a relationship with a young person and undertake 1-to-1 work over a period of time. This will include staff working with young people in the voluntary or statutory sectors such as youth workers, counsellors, student support, social workers, some specialist primary care workers, specialist teachers and school nurses etc. In Somerset there are also targeted services for young people who are commissioned to deliver an enhanced service for young people who need additional support with their drug or alcohol use. For contact details check the SDAP website 2

4 Tier 3 psychosocial interventions such as counselling, CBT or motivational interviewing harm reduction advice and information needle exchange substitute prescription detox and rehabilitation relapse prevention groupwork Refers to structured drug and alcohol interventions to support recovery and re-integration delivered by specific teams/workers. In Somerset this is Somerset Drug and Alcohol Service (SDAS). See for details on SDAS and how to refer a young person under 18 years old and young adults under 25 years. Tier 4 Referrals to very specialist drug and alcohol services like inpatient detox or residential rehabilitation. The Tier 3 services are responsible for making these referrals as these will be part of a package of care/ treatment agreed with the young person in a care plan. Why are some young people more at risk? National research indicates that the risk of problematic drug and alcohol misuse is particularly high for vulnerable young people. It is useful to know if the young person you are seeing is in a more vulnerable group, for example: young people who are, or have been, looked after by local authorities young people who have family members who misuse drugs and alcohol young people from disadvantaged backgrounds young people from some BME groups young people with behavioural and/or mental health problems young people excluded from school or truanting young offenders Not all young people from vulnerable groups will develop drug and alcohol misuse problems at all. This is due to a number of protective factors, for example: the young person has a positive temperament they have a supportive family environment they are linked into a good social support system they experience a caring relationship with at least one adult they are in education, training or employment they are able to learn from difficult experiences and are able to resist pressure 3

5 Preparation Pick a time that is appropriate. Make sure you have enough time to complete the assessment. Use a private location wherever possible. The tool should be used flexibly. You may already have a lot of the information about the young person, which you can complete before you start as part of your preparation, and review with the young person as you go along. Either you or someone else may have completed a Drug and Alcohol Screening Tool with the young person. Where possible make sure you have familiarised yourself with the completed Screening Tool before you use the Assessment Tool. Get hold of any leaflets, information or additional tools you might need as part of the session. The SDAP website has an up to date directory of services available for young people aswell as a range of tools and resources you can use when talking to young people about alcohol and drugs. Get information ready about referral to other services. Ideally, find out the name of someone who you could refer the young person to if they needed support from someone working in Somerset Drug and Alcohol Service (SDAS). This way if you need to refer on you can mention them to the young person by name. You can find the referral form to download at Consideration Ask their permission, get their consent this will make the young person much more receptive to answering the questions. Explain about confidentiality right from the start and make sure you are clear about your own agency policy. Be sensitive to the young person s culture, ethnicity, sexual orientation, gender and age. The young person may not be comfortable answering all the questions; but the more information you can get, the clearer the picture you will have of the risks involved in a young person s life and those factors which build or reduce a young person s resilience or might help or hinder them accessing services. Involving parents and carers All children and young people should be encouraged, wherever possible, to discuss their drug and alcohol use with their parents and carers. Evidence suggests that being able to discuss issues of drug and alcohol use openly with their parents is a protective factor against later drug and alcohol misuse. Where there is serious drug and alcohol misuse, and particularly if the young person lives with parents, outcomes are considerably improved where the parents can be constructively involved in any support or treatment plan. Drug and alcohol misusing young people can create many tensions and difficulties for their families. Parents, grandparents, carers and siblings may need support in their own right. Find out what s available for carers and families at and see the Carers, Families & Friends section. 4

6 Confidentiality The 2nd edition of the assessment tool has an updated confidentiality statement: You will need to be alert to safeguarding concerns as you go through the Drug and Assessment Tool. If you have any concerns follow your agency s safeguarding policy and procedures. You will need to have the agreement of the young person to go through the Drug and Alcohol Assessment Tool with them. You need their co-operation and engagement for the process to work. You must explain your agency s policy on confidentiality, consent and information sharing. You need to check the young person s understanding, and make sure the information you give is appropriate to their age and level of maturity. The boundaries of confidentiality must be explained, in terms of limits with regard to balancing confidentiality and the agency s duty to safeguard the well-being of the young person and others. Page 1 of the assessment tool has a simple form that we recommend you use (unless your own agency has a similar document) that covers: confidentiality and consent to share information with named other people and anonymised information for research to improve services. If the young person does not consent to either of these it does not affect your ability to assess and deliver interventions at Tier 2. However all services should have clear policies on confidentiality, consent and information sharing which are in line with local safeguarding children board procedures. All workers need to be able to explain these to a young person in an understandable, relevant, honest and engaging way. Consent You will need to have the agreement of the young person to go through the assessment questions with them. You need their co-operation and engagement for the process to work. You should have their agreement before you refer them for any specialist help. You should also, as good practice, make sure that when you give any advice or information to young people, that you check the young person s understanding, and make sure the information you give is appropriate to their age and level of maturity. The Department of Health (2001) guidelines clearly define where consent is required: Consent (to treatment) is not required for advice and information relating to drugs and alcohol and their use, as this is not treatment. Consent is required for treatment, which includes counselling or other psychological intervention, physical [medical] interventions including the provision of medication. Therefore, advice, information, assessment and referral to an appropriate agency does not require a formal consideration of consent to treatment. Carrying out this assessment and delivering information, advice, education or support work does not need informed consent beforehand. Before any treatment intervention can be delivered, informed consent to that intervention must be gained. Examples of interventions that do not need informed consent: Advice and information such as that contained within widely available leaflets and other public information sources on substance misuse Encouragement to attend appointments and progress with the assessment and treatment plan Advice on risks and harms of substance misuse that allow young people to reflect on their substance misuse. Examples of interventions that do need informed consent: Advice and information about safe injecting techniques and access to injecting equipment The use of counselling, regardless of the technique, conducted over a series of planned sessions Any invasive procedure that could be, without informed consent, be described as actual bodily harm. Examples include prescribing medicines, massage methods, acupuncture and removal of clothes to inspect injecting sites. 5

7 Young people s drug and alcohol treatment For details of the drug and alcohol treatment and recovery services for young people see If you make a referral to drug and alcohol treatment services, you need the young person to consent to this. If the young person does not consent to the referral and you are concerned for their safety, continue to use your skills to encourage the young person to agree to a referral. Discuss with your manager as you may need to consider this as a safeguarding issue. Ensure you offer them a number of access options and re-emphasise the importance of their safety and wellbeing. If the young person continues to refuse a referral and you and your manager assess them at considerable risk, the wishes of the young person may have to be overridden and it is importanct you contact a member of staff in a targeted service working with young people and / or staff in the Somerset Drug and Alcohol Service (SDAS). With the agreement from the young person, it is good practice to inform the person with parental responsibility of the referral as long as this would not cause any harm to the young person (see Page 4 on involving parents and carers). If they are under 16 you almost certainly need to inform the person with parental responsibility unless you can prove, with guidance from your manager and the drug and alcohol service, that the young person is competent enough to attend without parental involvement; and if the young person states clearly why it would not be beneficial for their parent or carer to know. A note about data and outcomes Somerset Drug and Alcohol Partnership (SDAP) is keen for agencies to share data from their work with young people around drugs and alcohol by submitting data to Somerset Intelligence (in Somerset County Council). This will help us: to gain a better understanding of the local picture for drugs and alcohol and how it affects young people; to better meet the needs of young people in Somerset by informing planning and resource allocation; to measure the success of early intervention work with young people. It will also help your agency understand the needs of the young people it is working with and help shape the way you work. All agencies that share data with SDAP do so via Somerset Intelligence and will be governed by an information sharing protocol. Any organisation using this will have discussed and agreed the process by which they will collect and share this data with SDAP. Any agency contracted by SDAP will have the dataset from the assessment tool included as part of their performance reporting. Your agency will also have clear guidance on the protection of personal information. The drug and alcohol service will carry out a comprehensive assessment with the young person and the involvement of the young person s parent or carer will be explored further as part of this. 6

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