8.2.15 Substance Misuse Work

Aim
Asset
Specialist Assessment
Issues of Confidentiality
Interventions
Consent
Review and Evaluation
Exit

1. Aim

1.1

To provide a service in Hillingdon YOS for all young people requiring an education, prevention or intervention plan when substance misuse has been identified.

1.2

In line with the Hillingdon Youth Justice Plan, activity is measured against the following targets.

Measure
% of young people screened for substance misuse	100
% of young people with identified needs receive appropriate specialist assessment within 5 working days	100
% of young people accessing the early intervention and treatment services they require within 10 working days	100

2. Asset

2.1

All Asset scores of 0-1 would clearly indicate that substance misuse had either not been identified at all or had been identified at the experimental stage. In this instance, the case holder will undertake a Tier 1 intervention using the information pack provided by the substance misuse worker (SMW). This work will focus on providing basic education and awareness for the young person on substance misuse. This work will be recorded in the contacts.

2.2

All Asset scores of 2, 3 or 4 (from section 6 – Substance Use) would require further referral and assessment as this indicates a direct relation to the young person’s likelihood of further offending.

2.3

The Asset manual provides the following guidance for scores;

Examples of ratings of 1 or 2

Infrequent and/or minor offending linked to occasional substance use.

Examples of ratings of 3 or 4

a ‘yes’ response to the question about offending to obtain money for substances
All his/her offending occurs whilst under the influence of substances.
the young person’s attitudes and willingness to experiment with substances increases the likelihood of him/her being found in possession of illegal drugs

If there is any doubt the young person should be referred for a further assessment.

3. Specialist Assessment

3.1	The aim is to see the client within five working days of receiving the referral. Where possible the appointment will be backed onto an appointment with the case worker so appropriate introductions can be made.
3.2	The requirement to comply with an assessment can form part of the statutory reporting schedule. A referral to the YOS substance misuse worker from a case holder does not require any consent from the young person or their parent. The young person’s parents will have been informed of the proposed referral through the intervention planning process.
3.3	A first meeting, usually in the YOS office, will be conducted to assess the young person’s needs. This will take approximately half to one hour.
3.4	The Initial Assessment meeting will be a discussion based around the key areas previously identified in the Asset e.g. “Offending to obtain money for substances” “Practices which put him/her at risk” “Effect on education/relationships etc.”
3.5	The purpose of the assessment is to agree a plan to address substance misuse issues, where it is clearly linked to the likelihood of further offending.
3.6	Some young people with complex needs may have triggered an assessment to both the SMW and the primary mental health worker (PMW). In these cases it may be appropriate for one specialist worker to take the lead depending on where the priority concern lies. It is for the PMW and SMW to decide who will be the lead and the decision making will be recorded on Careworks.

4. Issues of Confidentiality

4.1	Young people are more likely to engage in the process if they are clear about why the assessment is felt to be necessary, who will have access to any information they provide and how it will be used. The SMW will encourage the young person to see the assessment as a positive mechanism by which their needs can be assessed and met.
4.2	The SMW will explain the extent and limits of confidentiality prior to the assessment and intervention. The SMW will seek to obtain written permission to share information disclosed with the rest of the YOS service. This decision must be reviewed regularly with the young person.
4.3	The SMW will have access to client information contained within the Careworks database and will add to the database as part of their daily duties where the young person has given authorisation for all information to be shared. Where they have not, the entry will be limited to confirmation that the appointment has been kept and what information or advice has been given. ‘Confidential’ information will be maintained in a paper file held by the SMW.

5. Interventions

5.1	The Initial Assessment will lead to one of the following; No further action (NFA) 1-1 basic alcohol and drug awareness session – there is no requirement for the young person or their carer to consent to this intervention and it will be delivered by the SMW. Group session on basic alcohol and drug awareness (age appropriate educational session) – there is no requirement for the young person or their carer to consent to this intervention and it will be delivered by the SMW. Brief intervention sessions on a 1-1 basis - there is no requirement for the young person or their carer to consent to this intervention and it will be delivered by the SMW. A referral to the SORTED project for a counselling intervention. There is a requirement for the young person or their carer to consent to such a referral. A referral to the SORTED project for a medical intervention or other treatment intervention. There is a requirement for the young person or their carer to consent to such a referral.
5.2	Where the service is delivered by the SMW the young person will be required to agree an action plan which details the work which will be undertaken. Parents will be notified of the intervention and its duration if this hasn’t already been discussed in the main intervention plan. As the young person’s authorisation is not required the sessions will form part of the statutory reporting schedule.
5.3	Where a referral is being made to SORTED the SMW will seek the authorisation of the young person or the parent to make the referral and to agree to the sharing of relevant case information. This authorisation will be obtained in writing.
5.4	SORTED staff will obtain the necessary authorisations for any treatment which follows the referral. Work undertaken by SORTED may be classified as statutory if the young person agrees but they may withdraw their agreement on at any time.

6. Consent

6.1	As noted above consent is not required for any interventions delivered by the YOS SMW as these are not classified as treatment; however consent is required for any referrals to the SORTED project and to any sharing of case information as part of that process.
6.2	Young people aged 16-18 are considered competent to give their consent to treatment and thus to a referral for treatment.
6.3	Young people under 16 are generally regarded as lacking competence to consent to medical treatment and thus a referral but they can do so if they have ‘sufficient understanding or intelligence to enable him or her to fully understand what is proposed’. The SMW will assess the young person’s understanding of the purpose of the referral using the Fraser Guidelines (Home Office (1999) Mental Health Act 1983. Code of Practice 1999); That the young person understands the advice and has the maturity to understand what is involved Their physical and/or mental health will suffer if they do not have treatment It is in the best interest to give such advice/treatment without parental consent The young person will continue to put themselves at risk of harm if they do not have advice/treatment They cannot be persuaded to inform those with Parental Responsibility, or allow the doctor to inform them.
6.4	The outcome of this assessment will be recorded on Careworks. It should be reviewed for any subsequent referrals or other planned interventions.
6.5	Where the young person is not considered competent to give consent to the referral the person or authority with Parental Responsibility needs to provide consent

7. Review and Evaluation

7.1	The case should be reviewed at least three monthly with all the relevant parties being engaged. The relevant section of the Asset should be updated.
7.2	The review is to evaluate the progress, relevance and effectiveness of the intervention plan

8. Exit

8.1

The referral will be closed when;

The intervention provided by the SMW is complete
where no further action is required

The SMW will record on Careworks that the case has been closed and the outcome. This information will also be recorded on the current Asset.

8.2

Where a referral to SORTED has taken place the SMW will monitor that the young person has accessed and received the service. This monitoring will continue through the life of the order held by the YOS and will be recorded on Careworks and updated on the ASSET.

8.3

In a minority of cases the need for continued intervention may exceed the length of the order. The SMW will take a view on each of these cases as to whether the work will completed in house by the SMW, or referred on to SORTED.

For further information on confidentiality issues see YOS Information Sharing Policy

End