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This policy has adopted a transitional and tiered approach to working with children, and young people and substance use. These tiers/levels of intervention are based on the healthcare tier definition of prevention, intervention and treatment (The Young People’s Substance Misuse Treatment Services – Essential Elements 2005).
Children, young people and their substance use may need a range of interventions at varying times. Workers should be aware of this when involved in interactions and making assessments. The following is a guide to tiers/levels of appropriate intervention relating to education, information, support and treatment, which workers may practice depending upon their level of knowledge, skills and legitimacy.
To facilitate effective transition between the tiers, services must clearly identify their role. Forward planning or through care and aftercare is required, including risk assessments and safeguarding considerations at every stage. This tier approach provides a structure to ensure a successful transition between services and that provision of information, education, support and/or treatment, is effective at every stage of engagement for children and young people.
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TIER 1 |
TIER 2 |
TIER 3 |
TIER 4 |
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Summary |
Universal and generic. Frontline of service delivery with direct access for young people and their families |
Frontline and specialist services. Youth oriented services delivered by practitioners with specialist youth knowledge and some knowledge of drugs and alcohol |
Services provided by specialist teams |
Very specialised services |
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Aims and Purpose |
To ensure universal access to all generic services for young people and to identify those vulnerable to substance use issues |
To reduce risks and vulnerabilities, reintegrate and maintain young people in mainstream services |
To respond to the complex and often multiple needs of the young person not just in relation to substance use problems. To reintegrate the young person into their family, community, school, training or work |
To provide specialist intervention(s) and setting for a particular period of time and for a specific function, as an adjunct to and backstop for the services provided in other tiers |
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Target Population |
All young people |
All young people, but in particular those with more problematic drug use or additional vulnerabilities |
Young people with tobacco, alcohol and drug problems that significantly interfere with other aspects of the individual’s life. Multiple underlying problems often also exist |
Young people with complicated substance problems requiring specific interventions and/or care and protection |
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Practitioners |
Include teachers, voluntary agencies, social services, police, school medical staff, GPs, nurses in primary care, potentially young people as confidantes and peer educators |
Includes CAMHS, voluntary youth services, and paediatric and psychology staff, connexions personal advisors, YOS drug workers and others with a specialist remit within universal services. Practitioners with additional skills must be incorporated into services and not work in isolation |
Multi-disciplinary teams tailored to meet the specific needs of the young person and capable of responding to problems of high complexity. Teams could include mental health, paediatric and addiction specialists working in close collaboration with education, social services and YOSs |
Include child/adolescent addiction and forensic psychiatry, social services, paediatrics and voluntary sector |
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Key Tasks |
Assessment of all young people for tobacco, alcohol, drug use and misuse and identification of those that are more vulnerable or at risk. Appropriate referral is necessary |
Holistic assessment of the young person, to clarify the degree of substance use problem in the context of other vulnerabilities. Clear referral pathways and links with tier 1 and 3 services. Case worker role, including maintaining contact with the young person during involvement with tier 3/4 services |
Comprehensive assessment and formulation of an overall care plan. Delivery of a spectrum of interventions. All substance interventions set within the context of integrated and comprehensive packages of care |
Particular interventions of focused work over short or temporary periods. Continuity of care to be maintained through the continued involvement of tiers 2 and 3 before, during and after admission. Responding to child protection and other dangerous situations. Adding further depth of understanding to comprehensive assessments carried out at tiers 2 and 3 |
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Interventions |
Information and advice, health promotion, drug prevention programmes, support for young people and their families |
Proactive outreach (including use of non-professional staff, young people and communities to conduct outreach work), information and advice, practical advice on associated issues (eg housing), crisis support, delivery of targeted prevention programmes, appropriate therapies (eg family therapy), generic counselling |
Provision of multi-component, multi-faceted and multi-agency interventions for complex problems facing young people and their families. Pharmacotherapy provision and ongoing monitoring, harm minimisation and uncomplicated detoxification |
Inpatient adolescent units or forensic units supported by specialist young people’s addiction teams, adolescent paediatric beds, intensive day centres, crisis management, specialist housing or fostering, multi-component or highly intensive therapies that have a residential component, complicated detoxification and pharmacological interventions |
Adapted by National Collaborating Centre for Drug Prevention from Health Advisory Service 2001
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Wednesday 19 November 2008
