![Page 1: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/1.jpg)
© Crown copyright June 2008
CMK-22-04-045 (082)
D1430809
Guidance on Good Practice for the provision of services for Children and, Younger People who Use or Misuse
Substances in Wales
![Page 2: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/2.jpg)
© Crown copyright June 2008
CMK-22-04-045 (082)
D1430809
![Page 3: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/3.jpg)
1
Contents
PagePurposeofdocument 3
SectionA-examplesofgoodpractice1 Overview 5 1.1 Practicepoint1-deliveringeffectiveuniversaleducation 5 1.2 Practicepoint2-prescribing 6 1.3 Practicepoint3-needleexchange 7 1.4 Practicepoint4-conductingassessments 8 1.5 Practicepoint5-transitionplanning 9
SectionB-context2 Overview 11 2.1 ChildrenAct2004 13 2.2 Safeguardingchildren(section28) 13 2.3 Planning 14 2.4 TheNationalServiceFrameworkforChildrenYoungPeople andMaternityServicesinWales(NSF) 14 2.5 Childandadolescentmentalhealthservices 14 2.6 MentalCapacityAct 15 2.7 Serviceuserinvolvement 15 2.8 Childreninneedandtheirfamilies 15 2.9 Referralsandsharingofinformation 15 2.10 Assessmentframework 17 2.11 LookedAfterChildren 17 2.12 Suicide,attemptedsuicideandsubstancemisuse 17 2.13 Keycomponents 19
3 Scopeofdocument 20 3.1 Theclientgroup 20 3.2 Substancecoveredbytheframework 20
4 Patternsofsubstanceuseandmisuse 21
4.1 Pathways 21
4.2 Atriskgroups 21
5 Thefour-tierstrategicframework 23
SectionC-programmesandinterventions6 Universaleducationservices 25 6.1 Context 25 6.2 Accessandobjectives 25 6.3 Contentcharacteristics 25 6.4 Deliveryandstyle 26 6.5 Agencies,personnelandvenues 26
![Page 4: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/4.jpg)
2
7 Selectiveortargetedprogrammes 28 7.1 Definition 28 7.2 Servicesthatprovidemoredetailedinformationandadvice ondrugsandservices 28 7.3 Preventionservices 28
8 Indicatedprogrammes(includingtreatment) 30 8.1 Assessment 30 8.1.1Definition 30 8.2 Definition 30 8.3 Specialistinterventions 31 8.3.1Pre-treatmentservices 31 8.3.2Communitybasedspecialistinterventions andtreatmentservices 32 8.3.3Inpatientservices 32 8.3.4Residentialservices 33 8.4 Organisationofcomprehensivespecialisedinterventionservices 34 8.5 Keyissuesforservicedelivery 34 8.5.1Leadagencyandleadprofessional 34 8.5.2Integratingservices 35 8.5.3Substancemisuseliaisonfunction(linkworkers) 35 8.5.4Involvingparentsandcarers 36 8.5.5Handlingtransitions 36 8.5.6Actualandvirtualteams 37 8.5.7Childprotection 37
SectionD-planning
9 Purposeofsection 39
10 Background 40
11 Thesuggestedplanningmodel 41 11.1 PlanningTier1 42 11.2 PlanningTiers2and3 42 11.3 PlanningTier4 42
12 Goodpracticeinplanning 43 12.1 Strategy 43 12.2 Developingtheknowledge-base 43 12.3 Responsivenesstothelocalpopulation 44 12.4 Partnershipswithprovidersofservices 45 12.5 Effectivecollaboration 45 12.6 Effectivenessthroughcontractingorservicelevelagreements 46 12.7 Organisationalfitness/commissionerselfassessment 46 12.8 Performancemanagement 47 12.9 Animprovementcycleforservicesforyoungpeoplewhouse ormisusesubstances 47 12.10 Standardsandstandardsetting 47
![Page 5: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/5.jpg)
3
Purposeofdocument
Substancemisuseinchildrenandyoungpeoplepresentsamajorpublichealthchallenge.TheUKhassomeofthehighestratesofyoungpeopleaged15-16usingormisusingsubstancesinEurope.Currentlytherearerisingtrendsintheuseofalcohol(particularlybyyoungwomen)andbingedrinkinghasincreaseddramatically.
Thisdocumentaimstoassistplannersandserviceprovidersinestablishingeffectiveservicesforyoungpeopleinrelationtosubstancemisuse.Althoughevidencefortheeffectivenessofinterventionsinthisareaislimitedthereareemergingthemesofgoodpracticethatcanhaveapositiveimpact.Thisguidanceaddressesandhighlightstheseandpresentsaframeworkfororganisationsandagenciesthathaveresponsibilitiesandaninterestinthisarea.
Thedocumentisinfoursections:
SectionA-SummariesofGoodPractice
SectionB-Context
SectionC-Programmesandinterventions
SectionD-Planning
ThedocumenthastobereadinthecontextofpreviousgoodpracticeframeworksforsubstanceissuedbytheWelshAssemblyGovernmentparticularlythoseforneedleexchange,inpatientcareandresidentialrehabilitation.
SimilarlytheframeworkneedstobeconsideredinthecontextofstrategiesaimedatthehealthandwelfareofchildreninWalesandrelevantlegislationsomeofwhicharehighlightedbelow.ThisincludestheMentalCapacityAct2005.
TheFrameworkhasbeenproducedbyasubgroupoftheWelshAssemblySubstanceMisuseProjectBoardandisbasedonworkcommissionedfromtheWelshInstituteofHealthandSocialCarein2006.
![Page 6: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/6.jpg)
4
![Page 7: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/7.jpg)
5
SectionA-Summariesofgoodpractice
1 Overview
SectionAhighlightsspecificexamplesofgoodpracticeforprovidersinthefiveareasof:
Deliveringuniversaleducation•
Prescribing•
NeedleExchange•
ConductingAssessments•
TransitionPlanning.•
Thesearekeyareasforserviceprovidersandtheinformationbelowsummariseswhatiscurrentlyconsideredtobegoodpractice.
1.1 Practicepoint1-DeliveringEffectiveuniversaleducationTheprovisionofhighqualityuniversaleducationisakeyrequisiteofanysystematicapproachtothedeliveryofastrategyforsubstancemisuse.
Deliveringeffectiveuniversaleducationprogrammesrequires:
implementationofastandardnationally-agreedapproachthatretains•theflexibilitytorespondtodiverselocalconditionsandtochangingpatternsofuseandmisuse;
long-term,intensiveprogrammesdevelopedthatofferintegrationbetween•primaryandsecondaryschools;
programmesthataredevelopmentallyappropriate,sequentialand•contextuallyappropriate;
teachingtakesplacewithinastandardisedmodelofPSEasopposedto•asituationinwhichPSEissubjecttowidevariationindeliveryandoftenutilisesnon-specialisedteachingstaff;
programmesemployawhole-schoolapproachthatincorporatesmessages•onsmoking,alcoholanddrugeducation;
healthpromotionisdeliveredinthecontextoftherebeingactiveschool•policiesonsubstances;
localdeliveryislinkedwithstrategiessuchasthenationalhealthyschools•programme;and
informationisavailableaboutservicestowhichtheymightturnformore•detailedinformationandadviceandwithwhichtheycandiscussanyconcernsthattheymighthave.
![Page 8: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/8.jpg)
6
1.2 Practicepoint2-PrescribingWewouldadviseclinicianstorefertotheappropriatesectionsintheDrugMisuseanddependenceUKguidelines2007onclinicalmanagementforspecificpointsofpractice.
Pharmacotherapiesareavailabletotreatavarietyofsubstancemisuse-relatedproblemsincluding:
emergencies(e.g.afteroverdoses,fits,dehydration,hypothermia);•
detoxificationandwithdrawalsyndromes(e.g.buprenorphine,•benzodiazepines,chlormethiazole,lofexidine,methadone,);
substitution(e.g.,buprenorphine,bupropion,methadone,•nicotinereplacement);
relapseprevention(e.g.acamprosate,naltrexone,pseudoephedrine;•
comorbidpsychiatricdisorders(e.g.anxiety,depression,ADHD);•
comorbidphysicaldisorders(e.g.HIV,HepatitisC,diabetes);and•
vitaminreplacement.•
Pharmacologicaltreatmentsareusuallyreservedforpatientswhoaredependent.Theyareavailabletotreatwithdrawalsyndromes,tomaintainabstinence,topreventcomplications,andtotreatpsychologicalandphysicaldisorders.Onlybuprenorphineislicensedforusebyunder18yearolds,butnicotinereplacementtherapycanbeprescribedforunder18yearoldsifamedicalpractitionerdeemsitappropriate.Thishasveryimportantimplicationsforpractitionerswhoaretreatingadolescentswithsubstancemisuseproblemsbecausemostoftheirpatientswhorequireaprescribingservicedosobecausetheyaredependentandthisrequiresspecialistintervention.
Thereisgeneralconsensusthattreatingadolescentsbyprescribingshouldbeinitiatedbyaspecialistserviceandtheirtreatmentshouldusuallybesupervisedandmonitoredbythatservice.Whileitisimperativethatpharmacologicaltreatmentisadministeredsafely,itisequallyimportanttoseeitasonepartofaphasedtreatmentandmanagementprocess.
Somespecialistservicesprescribeforstabilisation,reductionanddetoxificationandtrytoavoidmaintenancetreatments.Titrationanddetoxificationmayalsobeprovidedforover16yearoldsbysubstancemisuseservicesthatareprimarilyintendedforadults.Thereshouldbeeasyaccesstobedsforthemostcomplexcases;ifnot,crisesmaydevelop.
Pharmacotherapyforunder16yearoldsrequiresconsiderableskillandthepractitionerswhosupervisesitmustbewelltrainedinaddictionpsychiatry.Plannersandserviceprovidersshouldalsorecognisethatthesearehighriskgroupsofyoungpeoplewhorequireverycarefulmonitoring.
Supervisedconsumption
Supervisedconsumptionofsubstancesthatareprescribedforyoungpeopleisessential.Pharmacistsshouldinformthespecialistserviceinvolvedifayoungpersondoesnotpickuptheirmedicationevenonce.Thereshouldbeaprotocol
![Page 9: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/9.jpg)
7
fortheclinicifclientsdonotpickuptheirscriptsdaily(i.e.forhowmanydayscanthey‘gowithout’)beforethescriptisstopped.TheDrugMisuseandDependencyUKGuidelinessuggestnomorethan3daysbutchildrenandyoungpeoplemayhavelowertolerancesoservicesshouldtakethisintoaccountandmakeappropriateclinicaldecisions.
1.3 Practicepoint3-NeedleExchangeWhenworkingwithinaharmminimisationframework,easyaccesstoneedlesandsyringesmightberegardedasgoodpracticeinservicesforadults.Thesameisnotnecessarilysoforyoungpeopleowingtothedifferentstatutoryandlegalrequirementsforminors.Therefore:
Full assessment and informed consent are essential• and,whereyoungpeopleunder16areinvolved,needleexchangeshouldonlybeprovidedinthecontextofacareandtreatmentplanthatisregularlyreviewed.
Injectingillicitsubstancesisdangerousandeveryeffortshouldbemade•toencourageclientstochangetheirrouteofadministrationtoasaferone,toengagewithservicesaseffectivelyaspossibleandtoreduceorstoptakingdrugs.
Theprinciplesofharmreductionshouldnotbelostwhendealingwith•youngerdrugusers.However,additionalharmfulfactorsandtheirdifferinglegalstatusmustalsobecarefullyconsidered.
Themajorityofyoungerpeoplewhouse‘harder’drugsareagedover16.However,thereisarequirementtoprovidealimitedvolumeofneedleorsyringeexchangeservicesforunder16s.Insuchcases,servicesmustensurethatstaffarecompetenttodealwiththefollowingmatters:
recognisethatthechild’swelfareisparamountineveryactivity;•
gainvalidconsentfortheintervention;•
involveparentsandcarers;•
ensuretheneedleorsyringesupplyispartofawidercareplan;•
assesseachyoungperson’sawarenessoftherisksofinjectingandtheir•abilitytounderstandtheserisks;
ensureeachyoungperson,familyandcarerisawareoftheboundaries•imposedbyconfidentialityandtheservice’sdutyinrelationtochildprotection;and
employchildprotectionprocedurestoensurethatchildrenandyoung•peoplearesafeguardedwhennecessary.
Inaddition,servicesshouldensurethatneedleexchangeprotocolsareacceptedbythelocalareachildprotectioncommittee(ACPC)andlocalchildrensafeguardingboards,whenestablished.
Specialconsiderations:
needleexchangeforyoungpeoplemustbedeliveredaspartofaplanned•packageoftreatment;
![Page 10: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/10.jpg)
8
independent,anonymousprovisionisnotgoodpracticeduetothelegal•statusofyoungpeople;
servicesmustensurethattheyareworkingwithinthefactandspiritof•theChildrenAct1989;thisincludespromotingchildprotection,takinganholisticapproachtoworkingwithchildrenandyoungpeople,andinvolvingparents/carers,ifpossible;
assessmentforneedleexchangemustbecomprehensiveandholisticwith•thebestinterestsofeachyoungpersonbeingparamount;also,children’sdevelopmentalneeds,parentalinvolvementandotherenvironmentalfactorsneedtobetakenintoaccount;
allneedleexchangeshouldbeprovidedwithinaharmminimisation•approach(i.e.advisingonalternativeroutesofdruguse,encouragingreductioninfrequencyofdruguse,providinginformationonpersonalsafety[forexamplenotinjectingalone,unsuitabilityofcertainsubstancesforinjection]);and
thestaffmemberhastodemonstratethateachyoungpersonhassufficient•knowledgeandunderstandingtoinjectdrugsassafelyaspossibleanditalsoneedstobeestablishedthatprovidingcleaninjectingequipmentlessensthepotentialriskstotheyoungperson.
1.4 Practicepoint4-ConductingAssessmentsAssessmentiscrucialinallsubstancemisusescenariosbuttheprocesshasaparticularimportanceinthecontextofyoungpeople.Goodpracticesuggeststhat:
Eachyoungerpersonshouldbemadeawarethat,iftheywouldprefer,•theymayseeadifferentpersonthantheonewhoisallocatedtothembytheservice(e.g.somefemaleclientsmayprefertoseeafemalememberofstaff).
Asinformationofasensitivenatureisoftendisclosedduringassessment,•itshouldtakeplaceinaprivateroom.
Itisgoodpracticetoreadandexplainastatementaboutconfidentiality,•anypointsnotunderstoodmustbeclarifiedandeachyoungerpersonshouldbeassistedtoaskquestions.Staffmustnotassumethatayoungerpersonisliterate.
Usually,assessmentsmustprovideanopportunityforeachyoungperson•totalkopenlyandwithoutanyadditionalpressures.Ifayoungerpersoncomesforanassessmentwithafriendorrelative,theusefulnessoftheotherpersonbeingpresentmustbecarefullyconsidered.
Wheneverpossibleandinordertopromotecontinuityofservice,•eachassessmentbythemorespecialisedservicesforyoungerpeopleshouldbecompletedbytheworkerwhoislikelytobecomethecasemanagerorleadprofessionalforthatyoungerperson.
Ifayoungerpersonappearstobeintoxicatedornotcoherentenoughto•proceed,heorsheshouldbeaskedtoattendatalaterdate.Iftheyoungerpersonseemstobeatriskoflossofconsciousness,orhasanyothersignsofoverdose(includingthatderivedfromself-disclosure),theassessmentmustbestoppedimmediatelyandanambulancecalled.
![Page 11: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/11.jpg)
9
Ifatanypoint,astaffmemberhasseriousconcernsaboutthesafetyof•ayoungerpersonoranotherperson,fromtheinformationdisclosed,theyshouldsharetheirconcernswiththeyoungerpersonandstateclearlythereasonsfortheirconcern.Itmaybenecessarytoseekguidancefromacolleagueormanager.Ifthissituationarisestheyoungpersonshouldbemadetofeelascomfortableaspossibleandnotmadeundulyanxious.
Allstaffmemberswhohaveormaybecomeawareofconcernsaboutthewelfareorsafetyofachildorchildrenshouldknow:
whenandhowtomakeareferraltolocalauthoritychildren’ssocialservices;•
whatservicesareavailablelocally;•
howtogainaccesstothem;•
whatsourcesoffurtheradviceandexpertiseareavailable;and•
whotocontactinwhatcircumstances,andhow.•
(NB At an early stage, substance misuse staff should determine whether they need to involve Social Services. Staff should have received training to assist them to identify indicators that a child may be ‘in need’ or where there are child protection concerns and how to refer appropriately)
1.5 Practicepoint5-TransitionPlanningTheinterventionelementoftheyoungpeople’sstrandofthisguidanceisfoundedonthehopethatearlyinterventionwillreducetheneedforyoungpeopletouseserviceswhentheyareadults.Goodpracticeinrelationtotransitionplanningsuggests:
allyoungpeoplereceivingassessmentcare,and/orinterventionsfor•potentialoractualsubstancemisuseshouldhaveatransitioncareplanthatisdevisedpriortotheireighteenthbirthday.Thisshouldidentifyanycontinuingneedsandtheorganisationsthatarebestabletomeetthoseneeds;
inordertoplantransitionarrangements,providersofservicesforadults•andforyoungpeoplewhoaremisusingsubstancesshouldworktogether;
transitionworkerscouldbebasedinservicesforadults,butalsoholdsome•sessionsinsubstancemisuseservicesforyoungpeople;
acareco-ordinator,whowecalltheleadprofessional,shouldbeidentified•inthecareplanfromwithintheleadagencyandensuretherearerobustlinkswithallotherappropriateprofessionals.Inmanycases,youngpeopleof18whorequireservicesinrespectoftheirmisuseofsubstancesmayalsorequireinterventionsfromothermainstreamservices,suchashousing,educationandprimarycare;and
transitionsofyoungpeopletoservicesforadultsmaytakeplaceatdifferent•agesordevelopmentalstagesdependingontheagenciesinvolvedandtheexpectationsthatfallonthem(e.g.YOTs,SpecialistCAMHSandservicesforchildrenwhoarelookedaftermayhavedifferentarrangements).Transitionarrangementsshouldensurethatthesedifferentarrangementsareincludedintheclientscareplan,whererelevant.
![Page 12: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/12.jpg)
10
![Page 13: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/13.jpg)
11
SectionB-Context
2 Overview
Substancemisuseinchildrenandyoungpeoplepresentsamajorpublichealthchallenge.TheUKhassomeofthehighestratesofyoungpeopleaged15-16usingormisusingsubstancesinEurope.Currentlytherearerisingtrendsintheuseofalcohol(particularlybyyoungwomen)andbingedrinkinghasincreaseddramatically.
Improvedoutcomesforchildreninrelationtosubstancemisusecanonlybedeliveredandsustainedwhenkeypeopleandbodiesworktogethertodesignanddelivermoreintegratedservicesaroundtheneedsofchildrenandyoungpeople.
Providingtherangeofeducation,preventionandtreatmentservicesforchildrenandyoungpeoplewhomisusesubstancesisakeycomponentofsafeguardingandpromotingthehealthandwellbeingofchildren.Safeguardingchildrenshouldnotbeseenasaseparateactivityfrompromotingtheirwelfareandshouldbeplacedwithinthecontextofwiderservicesforchildreninneedthereforeitisimperativethatsubstancemisuseservicesmaintaingoodcontinuingcollaborationwithsocialservicestopromotethebestinterestofthechildren.
TheChildrenAct,2004,providesthelegislativecontextforthisframeworkestablishingstatutoryChildrenandYoungPeople’sPartnershipsandthatarerequiredtopublishaChildrenandYoungPeople’sPlan(CYPP),settingouthowtheywillworktogethertoimprovethewellbeingofchildrenandyoungpeople.Thisisthekeystatementofplanningintentforchildrenandyoungpeopletowhichallotherplans,includingthosecoveringsubstancemisuseservicesforchildrenandyoungpeople,musthaveregard.TheCYPPalsoprovidesabasisforthejointplanningofservices.
SafeguardingChildrenWorkingTogetherundertheChildrenAct2004StatutoryguidanceissuedbytheWelshAssemblyGovernmentin2006statesthat:Allthosewhohavecontactwithchildrenandyoungpeople,includingeverybodywhoworkswithorhascontactwithchildren,parents,andotheradultsincontactwith,orseekingcontactwith,children,shouldbeabletorecognise,andknowhowtoactupon,evidencethatachild’shealthordevelopmentisormaybebeingimpairedandespeciallywhentheyaresufferingoratriskofsufferingsignificantharm.Practitioners,fostercarers,andmanagersshouldbemindfulalwaysofthewelfareandsafetyofchildren-includingunbornchildrenandolderchildren-intheirwork.
UniversalEducationservicesthatinformandhelpyoungerpeoplewithhandlingthepressurestousesubstancesshouldbeavailabletoeverychildandyoungpersoninWalesandtheirplanninganddelivery(followingidentifiedgoodpractice)shouldbeco-ordinatedonalocalbasisatCSPlevelandincludedintheCYPP.Safeguarding Children: Working Together under the Children Act 2004Chapter5refers.
![Page 14: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/14.jpg)
12
Universaleducationshouldbecomplementedbyselectiveortargetedprogrammesaimedatspecificatriskgroupsofchildren,youngpeopleoryoungadults.Theseshouldfocusonattendingtoriskfactorsandraisingresilienceandshouldbeco-ordinatedonalocalbasisatCSPlevel.
Trainingshouldbeavailableforallrelevantprofessionalsandadvancedtrainingisrequiredbydesignatedstaffsthathaveresponsibilityforeducatingyoungpeoplewhoattendtheirinstitutions/organisationsaboutsubstancesandsubstancemisuse.
Individualisedandplannedprogrammesofassessment,interventionandcareforcertainidentifiedchildrenoryoungpeoplewhoaremisusingsubstancesneedtobeavailablefromspecialistagencies.Theseprogrammesshouldincludeawiderangeofinterventionsor‘treatments’foryoungerpeople(andfortheirfamilies)includingpsychologicaltherapies,pharmacologicaltreatmentsandneedleexchange.
Comprehensivespecialisedinterventionservicesofthisbreadthshouldbedeliveredbycreatingsingleagenciesorbringingtogetherseparateagenciestoactasasingleentityorbycreatinganetworkofmorelooselyrelatedagencies.
Amuchsmallernumberofyoungerpeoplearelikelytorequireinpatientservicesorresidentialfacilitiessuchastherapeuticcommunitiesforpsychosocialrehabilitation,halfwayhouses,grouphomes,andspecialisedfostercare.Theseneedtohaveclearlydefinedoutcomesuccessfactors.
Assessmentisthekeyprocessthatinitiatesinterventionandthewayinwhichitishandledisoftenanimportantmatterindeterminingwhetheryoungerpeopleandtheirfamiliescontinuetousetheservicestheyareoffered.
Wherethereismorethanasingleagencyinvolved,theyshouldagreebetweenthemwhichistheleadagencyineachcaseasthispromotesclarityforclientsandfamilies.CSPSshouldalsoconsiderimprovinginteragencyliaisonbetweenthespecialistandgeneralistservicesbythecreationofasubstancemisuseliaisonorlinkworkerservice.
Involvingparentsandcarersinservicesforyoungersubstanceusersisnotonlyessentialforgoodpractice,butmayalsoimprovethetreatmentoutcomesthattheservicecanachieve.Anexceptiontothisiswhensomebodybelievesthatachildmaybesuffering,ormaybeatriskofsufferingsignificantharmwheresuchdiscussionandagreement-seekingtoreferringtosocialservicescouldplaceachildatincreasedriskofharm.
CSPplanningprocessesshouldensurethegoodpracticeidentifiedinthisframeworkforuniversaleducationprogrammes,prescribing,needleexchange,assessmentandhandlingtransitionsisputinplace.ThelocalCYPPprovidesabasisforthejointplanningofserviceprovisionacrossstatutorypartnersandvoluntaryproviders.
![Page 15: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/15.jpg)
13
2.1 ChildrenAct2004TheChildrenAct2004buildsonandstrengthenstheframeworksetoutintheChildrenAct1989.Thereareanumberofprovisionsinthe2004Actwhichrelatedirectlyorindirectlytoagencies’responsibilitiestosafeguardandpromotethewelfareofchildren.Sections25,26and28requirelocalauthoritiesandtheirpartnerstoco-operatetoimprovethewellbeingofchildren(includingphysicalandmentalhealthandemotionalwellbeing)andtosafeguardandpromotetheirwelfare.
Section25establishesstatutoryChildrenandYoungPeople’sPartnerships•andsection27requiresleaddirectorsandmembersforchildrenandyoungpeople’sservices,toleadcooperationinthestrategicdirectionanddevelopmentofservicesatalllevels.TheWelshAssemblyGovernmentissuedguidance“StrongerPartnershipforBetterOutcomes”onthesefunctionsin2006.
Section26ofthe2004ActrequireseachPartnershiptopublishaChildren•andYoungPeople’sPlan(CYPP),settingouthowtheywillworktogethertoimprovethewellbeingofchildrenandyoungpeople.TheCYPPisa3yearstrategicplanthatwillprovidestrategicvision,statetheagreedprioritiesthatwilldirecttheworkofallpartners,setagreedjointtargetsandprovideabasisforthejointplanningofservices.Itisthekeystatementofplanningintentforchildrenandyoungpeopletowhichallotherplans,includingthosecoveringsubstancemisuseservicesforchildrenandyoungpeople,musthaveregard.FurtherdetailscanbefoundinguidanceentitledSharedPlanningforBetterOutcomes,publishedontheAGwebsite.Firstplans,covering2008-11arerequiredtobeadoptedby31July2008andpublishedby30September2008.
2.2 Safeguardingchildren(section28)Safeguardingandpromotingthewelfareofchildrenisaboutprotectingchildrenfromabuseandneglect,preventingimpairmentoftheirhealthordevelopment,andensuringthattheyreceivesafeandeffectivecaresoastoenablethemtohaveoptimumlifechances.Improvedoutcomesforchildrencanonlybedeliveredandsustainedwhenkeypeopleandbodiesworktogethertodesignanddelivermoreintegratedservicesaroundtheneedsofchildrenandyoungpeople.
Providingtherangeofeducation,preventionandtreatmentservicesforchildrenandyoungpeoplewhomisusesubstancesisakeycomponentofsafeguardingandpromotingthewelfareofchildren.
Serviceprovidersmustensurethattheirworkingpracticescomplywiththestatutoryguidance,SafeguardingChildrenworkingtogetherundertheChildrenAct2004,issuedbytheWelshAssemblyGovernment,October2006.Thisguidancesetsouthoworganisationsandindividualsshouldworktogethertosafeguardandpromotethewelfareofchildren.
![Page 16: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/16.jpg)
14
2.3 PlanningTheAssemblyGovernmentwishestoseeincreaseduseofjointplanningtoprovideservicesforchildrenandyoungpeople.Section25(6)ofthe2004Actgivesthelocalauthorityanditsmainstatutorypartnersthepowertopoolfundingandshareresources.Chapter4ofguidanceonlocaldutiestocooperate-Stronger Partnerships for Better Outcomes (WAG 2006)-setsoutthebackgroundforthedevelopmentofsucharrangements.EachCYPPprovidesabasisforjointplanninglocally.Shared Planning for Better Outcomes (WAG 2007),reinforcestherequirementtoconsideropportunitiesforuseofpooledfunding(paragraphs12.24-12.26).Pooledfundingcanbeparticularlyvaluableinprovidingservicesforchildrenandyoungpeoplewithcomplexneedswhorequirepackagesofcarefromanumberofagenciesandpartners,suchassubstancemisuseservices.
2.4 TheNationalServiceFrameworkforChildrenYoungPeople andMaternityServicesinWales(NSF)TheNationalServiceFrameworkforChildrenYoungPeopleandMaternityServicesinWales(NSF)10-yearstrategysetsnationalstandardstoimproveandreducevariationinservicedeliveryforchildrenandyoungpeople.Itcontains21crosscuttingstandardsand203specificandmeasurablekeyactions,whichputchildren,youngpeopleandtheirfamiliesatthecoreofservices.Thestandardsandkeyactionsarebasedonthe42articlesoftheUNConventionontheRightsoftheChildandtheAssemblyGovernmentssevencoreaimsforchildrenandyoungpeople.
KeyactionsintheNSFuniversaltoallchildrendefinesstandardsfortheuniversalserviceswhichallchildrenandyoungpeopleinWalesshouldreceiveinordertoachieveoptimumhealthandwellbeing.
Para:2.46statesthatCYPPs(undercoreaim3)shouldcoverkeyelementsoflocalstrategies,includingsubstancemisuseservices.TheywillthereforeunderpinthedeliveryofaLocalSubstanceMisuseActionPlandevelopedbytheCommunitySafetyPartnerships.
2.5 ChildandadolescentmentalhealthservicesTheaimoftheChildandAdolescentMentalHealthServices(CAMHS)strategyistoensurethatservicesareeffectiveandefficientandwhich,aboveall,uniteallprofessionsinadeterminationtoputtheneedsofchildrenandyoungpeopleattheheartofourapproachtoCAMHSinWales.
Itisaimednotjustathealthservices,managersofhealthcareservicesatalllevelsandhealthprofessionals,(suchaschildandadolescentpsychiatrists,paediatricians,nursesandtherapists)butalsoatstaffandmanagementofsocialservices,education,youthjusticeagenciesandthevoluntarysector.Allhaveaparttoplayandallarevitaltothejointendeavourtotacklementalhealthproblemswhichaffectyoungpeople,theirfamiliesandcarers,andwhichcontributesignificantlytowiderproblemsinsociety.
Thisstrategyisissuedasguidanceagainstwhichserviceswillbemonitoredandassessed.
![Page 17: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/17.jpg)
15
2.6 MentalCapacityActTheMentalCapacityActislegislationthatisenablingandsupportiveofpeoplewholackcapacity,notrestrictingorcontrollingoftheirlives.Itaimstoprotectpeoplewholackcapacitytomakeparticulardecisions,butalsotomaximisetheirabilitytomakedecisions,ortoparticipateindecision-making,asfarastheyareabletodoso.
2.7 ServiceuserinvolvementThedevelopmentofsubstancemisuseservicesrequiresparticularattentiontotheviewsofserviceusers.Aspecialistsubgroupconsistingofkeystakeholdersandpartnershasproducedserviceuserinvolvementgoodpracticeguidance.Thisguidancewaspublishedin2008asamoduleoftheSubstanceMisuseTreatmentFramework(SMTF).
2.8 ChildreninneedandtheirfamiliesChildren’sneedsandcircumstancesarevariedandcomplex.Understandingwhatishappeninginachild’slifeandwhetherheorshewouldbenefitfromservicesisacoreprofessionalactivityforthoseworkingwithchildrenandfamilies.
Achildshallbetakentobeinneedif:
a) heisunlikelytoachieveormaintainortohavetheopportunityofachievingormaintaining,areasonablestandardofhealthordevelopmentwithouttheprovisionforhimofservicesbyalocalauthority;
b) hishealthordevelopmentislikelytobesignificantlyimpaired,orfurtherimpaired,withouttheprovisionforhimofsuchservices;or
c) heisdisabled.
And“family”inrelationtosuchachild,includesanypersonwhohasparentalresponsibilityforthechildandanyotherpersonwithwhomhehasbeenliving.
Allstaffmemberswhohaveormaybecomeawareofconcernsaboutthewelfareorsafetyofachildorchildrenshouldknow:
whenandhowtomakeareferraltolocalauthoritychildren’ssocialservices;•
whatservicesareavailablelocally;•
howtogainaccesstothem;•
whatsourcesoffurtheradviceandexpertiseareavailable;and•
whotocontactinwhatcircumstances,andhow.•
2.9 ReferralsandsharingofinformationAtanearlystage,substancemisusestaffshoulddeterminewhethertheyneedtoinvolveSocialServices.Staffshouldhavereceivedtrainingtoassistthemtoidentifyindicatorsthatachildmaybe‘inneed’orwheretherearechildprotectionconcernsandhowtoreferappropriately.
![Page 18: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/18.jpg)
16
Localauthoritychildren’ssocialservices,alongwithotheragencies,haveresponsibilitiestowardsallchildrenwhosehealthordevelopmentmaybeimpairedwithouttheprovisionofservices,orwhoaredisabled(definedinsection17oftheChildrenAct1989aschildren‘inneed’).Allagencieswithsucharesponsibilityshould:
agreewithLSCBpartnerscriteriawithlocalservicesandprofessionalsas•towhenitisappropriatetomakeareferraltolocalauthoritychildren’ssocialservicesinrespectofachildinneed;
haveanagreedformatformakingareferralandsharingtheinformation•recorded.
Ifsomebodybelievesthatachildmaybesuffering,ormaybeatriskofsufferingsignificantharm,thens/heshouldalwaysreferhisorherconcernsassoonaspossibletothelocalauthoritychildren’ssocialservices.Inadditiontosocialservices,thepoliceandtheNSPCChavepowerstointerveneinthesecircumstances.Whileprofessionalsshouldseek,ingeneral,todiscussanyconcernswiththefamilyand,wherepossible,seektheiragreementtomakingreferralstolocalauthoritychildren’ssocialservicesthisshouldonlybedonewheresuchdiscussionandagreement-seekingwillnotplaceachildatincreasedriskofsignificantharm.
Sharingofinformationaboutcasesofconcernwillenableorganisationstoconsiderjointlyhowtoproceedinthebestinterestsofthechildandtosafeguardchildrenmoregenerally.Furtherguidanceoninter-agencyinformationsharingisgiveninSafeguardingChildren:WorkingtogetherundertheChildrenAct2004chapter14.
Confidentiality
Manyprofessionalsareunderadutyofconfidentiality.Thisisimportantinmaintainingconfidenceandparticipationinservicesandtherebyhelpingtoprotectchildren’shealthandwellbeing.But,asrelevantguidelinesmakeclear,thedutyofconfidentialityisnotabsoluteandmaybebreachedwherethisisinthebestinterestsofthechildandinthewiderpublicinterest.Safeguarding Children: Working together under the Children Act 2004 chapter 8 and chapter 14 refers.
Whenayoungerpersonhasbeenidentifiedaspossiblyhavingneedsthatmightarise,atleastinpart,fromtheiruseormisuseofsubstances,itisimportantthatacomprehensiveassessmentofthoseandtheirotherneedstakesplace.Tothisend:
ifachildisfelttobeachild‘inneed’(asdefinedintheChildrenAct1989)•areferralshouldbemadetosocialservicessothattheycanundertakeanassessmentofthechild’sneeds.Iftheyfeelthechildisinneedtheyshouldco-ordinateaplanofsupportandinterventionforthatchild(drawingonotherservicestomeetspecificneedssuchasthesubstancemisuseservice).Thesameprocesswillapplyifthechildisinneedofprotectionorlookedafter.InthesecasesSocialServiceswillleadtheoverallco-ordinationofthecase.
Aspecialistsubstancemisuseassessmentistobecarriedoutbysubstance•misuseserviceproviderstoidentifyallthechild’ssubstancemisuseneeds.Ifsocialservicesareinvolvedthiswillformanelementoftheoverallplanforthechild.
![Page 19: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/19.jpg)
17
IfSocialServicesdonotfeelthechildisachild‘inneed’theymaynot•becomeinvolvedbutthechildmaystillhaveneedsthatcanbemetbyotheragenciesforexamplethesubstancemisuseservicesmaycontinueaninterventionplanforthatchild.
TheCommonAssessmentFramework(http://www.cafwales.co.uk)maybe•awayinwhichitmightbepossibletosupportmoreeffectivepreventionandearlyinterventionbyhelpingtoidentifychildrenwhowouldbenefitfromadditionalservicesatastagebeforereferraltosocialservicesisrequired.Itcanalsohelpworkersandagenciestodecidewhowouldbebestplacedtoprovidetheseservices.TheAssemblyGovernmentiscurrentlyrunningpilotprojectsinWalestotesttheeffectivenessofaneCAFITbasedsystemtoensurethatCAFcanworktoitsfullpotential.However,alllocalChildrenandYoungPeoplePartnershipsandtheirconstituentagencieswillbeestablishinglocalarrangementsthatjoinuptheplanninganddeliveryofservices.TheseshouldincludeotherrelevantPartnershipsintheprocessas,forexample,CommunitySafetyPartnershipshaveresponsibilitiesrelatingtosubstancemisuseforwhichtheCAFisrelevant.TheimplementationoftheCAFwillassistthisprocessbyprovidingintegrationattheearlieststagesofjointpractitionerledinterventionthroughtohigh-levelstrategicdevelopments.
Thespecialistsubstancemisuseassessmentmustinclude:
thelevelofuseofsubstances;•
therouteofuse;•
considerationofthepossibilitythatyoungerpeoplehaveormaybecome•dependentonoraddictedtosubstances;
themeaning,consequencesandcomplicationsforeachyoungerperson•andtheirfamilyoftheirpatternofsubstanceuseormisuse;
physicalandmentalissues;•
riskfactors-thiswillindicatewhetherthecaseneedstobereferred•toSocialServices.
2.10 AssessmentframeworkTheFrameworkfortheAssessmentofChildreninNeedandtheirFamilies(NAW,HomeOffice2001)wasdevelopedtoprovideallthoseworkingwithchildrenandfamilieswithasystematicwayofgathering,analysingandrecordingwhatishappeningtochildrenandyoungpeoplewithintheirfamiliesandwidercommunityinwhichtheylive.TheAssessmentFrameworkisinformedbytheory,researchfindingsandpracticeknowledgefromanumberofdisciplines.Thiswasusedtoidentifythekeyelementsthatinfluencedthedevelopmentofchildren,andwhichanyassessmentoftheirneedsmustconsider:
thechild’sdevelopmentalneeds;•
thecapacityofparentstorespondtotheseneedsand;•
thewiderfamilyandcommunitywithinwhichthechildlives.•
![Page 20: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/20.jpg)
18
Theanalysisofthesedomainsandtheirrelationshiptooneanotherprovidesprofessionalswithanunderstandingofwhatareinevitablycomplexissuesandinterrelationships,clearprofessionaljudgementscanthenbemade.Thesejudgementsincludewhetherthechildbeingassessedisinneed,whetherthechildissufferingorlikelytosuffersignificantharm,whatactionsshouldbetakenandwhichserviceswouldbestmeettheneedsofthisparticularchildandfamily.
Theneedsofchildrencannotbemetbyoneagencyalonetheassessmentframeworkwasdevelopedtoprovideacommonconceptualframeworkthatcouldbeusedbyallagencies.
Itshouldbenotedthatwhereachildisaccommodatedinahealthoreducationsettingforlongerthan3months(orhasbeenplanned),areferralismadetosocialservicestodeterminewhetheranholisticassessmentisrequiredunderthisAssessmentFramework.
2.11 LookedAfterChildrenChildrenwhoareaccommodatedbyorinthecareoflocalauthoritiesaredescribedas‘looked-afterchildren’.Theyareoneofthemostvulnerablegroupsinsociety.Themajorityofchildrenwhoremainincarearetherebecausetheyhavesufferedabuseorneglect.
Itisvitalthatalllookedafterchildrenwithproblemsarisingfromorrelatedtosubstancemisuseareidentifiedearlythroughtheirhealthassessment,reviewsandcareplanningprocessesandreceiveappropriateinterventionsasaresult.
Corporateparentingemphasisesthecollectiveresponsibilityofthelocalauthoritytoactasagoodparenttothechildrenitlooksafterandtheneedforallagenciesandprofessionalstocontributetoachievingthebestoutcomesforlookedafterchildren.Forlookedafterchildrentheroleoftheirdaytodaycarerse.g.fostercarerswillbeimportantinthiscontext.
2.12 Suicide,attemptedsuicideandsubstancemisuseServicesshouldbeawareoftheassociationbetweensubstancemisuseandattemptedandcompletedsuicide.Researchsuggestsastrongassociationwithcompletedsuicideafterprevioussuicideattemptsandthatsubstancemisusersweremorelikelythanothersuicideattempterstomakerepeatattempts.Disinhibitionproducedbyalcoholintoxificationprobablyfacilitatessuicidalideasandoftenonimpulseleadstothoughtsbeingtranslatedintoaction.
Youngpeoplewhohavemultipleproblemsarethosemostatriskofsuicide.Currentresearchsuggeststhatthestrongestriskfactorsforsuicideinyoungpeoplearementaldisorders,particularly,affectivedisorders,substancemisuseandantisocialbehaviours.Frequentlysuicidalbehaviourinyoungpeopleappearsasaconsequenceofadverselifeeventsinwhichmultipleriskfactorscombinetoincreasetheriskofsuicidalbehaviour.
Itisimportantthatservicesincontactwithvulnerableyoungpeopleriskassesstheyoungpersonwithappropriateadviceandsupportgiven,includingsupporttoaccessspecialistservices.
![Page 21: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/21.jpg)
19
ThisissuesuicidepreventionisaddressedinmoredetailintheWelshAssemblyGovernmentSuicidePreventionActionPlan.
2.13 KeycomponentsThisframeworkaddressesthekeycomponentsofacomprehensiveresponsetothethreatsposedtochildrenandyoungerpeoplebyavarietyofsubstances.Thesecomponentsare:
UniversalEarlyEducationProgrammes• -theseconveyaccurateandbalancedinformationaboutsubstancesandtheiruseandmisusetochildrenandyoungpeople;
TargetedProgrammes• -thatenablechildrenandyoungpeopletotakepartindiscussionsamongthemselvesandwithwell-informedadultsaimedatimprovingtheirunderstandingofhowtheycanrespondtotheendemicpresenceofsubstancesinourcommunities;
InterventionsToImprovePotential• -theseexisttopreventchildren,youngpeopleandyoungadultsmovingfromusetomisuseofsubstancesbyanticipatingtheimpactsofrisk/protectivefactorsandincreasingindividuals’resilience;
IndicatedProgrammes(generallyreferredtoastreatment)• -theseareprovidedasindividualisedandplannedprogrammesofassessment,interventionandcareforcertainidentifiedchildrenoryoungpeoplewhoaremisusingsubstances.
GoodpracticeisreferredtothroughoutPartBofthedocumentandanumberofmoredetailedappendiceshavebeenincludedformoredetailedspecificgoodpracticeinareassuchasprescribingandassessment.
![Page 22: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/22.jpg)
20
3. Scopeofdocument
3.1 TheclientgroupInthisframework,termsusedinrelationtoagearedescribedbelow:
Children: Peoplewhoareagedfrombirthtotheeveoftheir11thbirthday
Youngpeople: Peoplewhoareagedfrom11totheeveoftheir18thbirthday
Youngadults: Peoplewhoarebetween18yearsofageandtheeveoftheir25thbirthday
Youngerpeople: Agenerictermreferringtoallpeoplewhoareunder25yearsofagethat,therefore,encompasseschildren,youngpeopleandyoungadults
Thisframeworkcoversthese4groupings.
3.2 SubstancecoveredbytheframeworkThisframeworkcoversthefullrangeofsubstancesthataremisusedinWalesincluding:
illegaldrugssuchasheroin,cocaine,ecstasy,amphetamines,LSD,cannabis•
alcohol•
prescription-onlymedicinessuchasanabolicsteroidsandbenzodiazepines•
over-the-countermedicinessuchaspreparationscontainingcodeine•orephedrine
volatilesubstancessuchasaerosolpropellants,butane,solvents,glues.•
![Page 23: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/23.jpg)
21
4. Patternsofsubstanceuseandmisuse
4.1 PathwaysItisalsodifficulttoidentifywithconfidenceparticularpathwaystosubstancemisuse.
Althoughitseemslikelythatusingsubstancesisrelatedtonumerousriskfactors(familybackgroundandtheinfluenceofdrug-usingpeersaresomeofthemostimportant),itisstillimpossibletopredictwithanycertaintywhetherayoungpersonwilldecidetoinitiateuse,continueuse,ormaintainusesufficientlytodevelopdependenceand/orassociatedproblems.
Researchconfirmsthat,ingeneral,thereisacomplexinterplaybetweenthefactorsinyoungpeoples’livesthatmakethemmorelikelytodevelopproblemsandthefeaturesthatpromotetheirresilience.Forexample,asthenumberofoccasionsrisesonwhicheachchildoryoungpersonisexposedtodisadvantage,stressfullifeeventsandotherfactorsthatincreaserisk,thegreateraretheirchancesofdevelopingproblemsofavarietyoftypesincludingsubstancemisuse.Also,researchinotherareasrelatingtopoorhealthsuggeststhattheeffectsofriskfactorsandwhetherornotchildrenhavetheirneedsmetisusuallymediatedthroughtheircaregiversandthefactorsinclude:
povertyandfailuretomeetchildren’smaterialneeds;•
problemswithparentingpractice;•
unsatisfactoryattachmentpatternsandrelationships;•
parentalpsychopathology;and•
failureofservicestorespondtotherangeofchildren’sneedsand•tointervenepreventativelyinpotentiallyresolvablecircumstances(e.g.notprovidingadequateresponsestobullying).
Together,thefeaturescitedaresomeofthehallmarksofsocialexclusion,atermthathaslargelydisplacedtermssuchaspovertyanddeprivationindescribingthenatureofcontemporarypatternsofsocio-economicdisadvantage.Itisdistinctiveasaconceptinsofarasitemphasisesmulti-faceted,relationalanddynamicnatureofdisadvantage.
4.2 AtriskgroupsOnthebasisoftherisksandassociationspresenteditisprobablethatchildrenandyoungpeoplearemoreatriskofusingandmissingsubstancesiftheyhave/are:
learningproblems;•
learningdisabilities;•
persistenttruantsandyoungpeoplewhoareexcludedfromschool;•
youngerpeoplewhoarenotineducation,employmentortraining;•
youngerpeoplewholiveindeprivedandthelessaffluentareas;•
mentalhealthproblemsormentaldisorders;•
![Page 24: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/24.jpg)
22
physicalillhealth;•
teenageparents;•
childrenofparentswhomisusesubstances;•
childrenandyoungpeoplewhoarecarers;•
childrenofparentswithamentaldisorder;•
involvedwithcrimeandyoungerpeopleincontactwiththecriminal•justiceservices;
childrenlookedafterbylocalauthorities;•
homelessyoungerpeople;•
subjecttoprostitutionorsexualexploitation;and/or•
exposedtosexualabuse.•
![Page 25: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/25.jpg)
23
5. Thefour-tierstrategicframework
Theguidancecontainedinthisdocumentrequiresasubstantialnumberofsectors,agencies,organisationsandprofessionstocometogethertoproducethecomprehensiveservicesthatarerequired.Inthiscontextreferenceismadetothefour-tierstrategicplanningconceptwhichisbasedonthefunctionsrequiredofservicesinrelationtothelevelorcomplexityofyoungerpeople’sneedstheiropinionsandthelevelsofspecialisationoftheservicesthattheyrequire.
Thetiersare:
Tier1: Universalprimary-levelservices
Tier2: Youth-orientedservices
Tier3: Servicesprovidedbyteamsthatspecialiseintreatingyoungpeoplewhomisusesubstances
Tier4: Veryspecialisedservicesforyoungpeoplewhomisusesubstances
Thetieredconceptisintendedtobeaflexibleanddynamicstrategicapproachthatprovidesaframeworkwithinwhichtoconceptualisethefunctionsofcomprehensiveservicesandrelationshipsbetweentheirplannersandprovidersandbetweentheservicesbothhorizontallywithintiersandverticallyacrosstiers.Itemphasisesactivitiesandfunctionsratherthanthedisciplinesofprofessionalsortheidentitiesofsectorsandagenciesandpromotesintegrationbetweensectors,agenciesanddisciplines.Italsomapsbroadlyontothecategoriesadoptedfordescribingcomprehensiveservicesin2above.
Itisimportanttoemphasisethatmanyprovideragenciescanlegitimatelydeliverservicesofmorethanonetypeandwhichfallintomorethanonetier.
![Page 26: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/26.jpg)
24
![Page 27: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/27.jpg)
25
SectionC-programmesandinterventions
6. Universaleducationservices
6.1 ContextEducationservicesthatinformandhelpyoungerpeoplewithhandlingthepressurestousesubstancesthattheyarelikelytoexperiencearerequiredbyallyoungpeopleinWalesagedbetween11and18years.TheyremaincentraltothedeliveryofaneffectiveresponsebyallCSPs.
Theprimaryintentionofeducationprogrammesistoconveyaccurateandbalancedinformationaboutsubstancesandtheiruseandmisuse.Theyshouldbeuniversallyavailableandbegivenonacontinuinganditerativebasisthatfitswiththeeducationalcapacityofeachchild.
ThedevelopmentofaneffectivePSEcurriculumandsystemasanadjuncttoeducationaboutsubstancesisessentialtodeliveringprogrammesofthissort.
6.2 AccessandobjectivesAccesstoinformationaboutsubstancesshouldbeprovidedthroughthestatutoryeducationsystemandtherelevantstatutoryandvoluntarysectorbodies.Additionalfacilitiesarerequiredofthestaffofagenciesthatareengagedindeliveringservicesatallofthetiers.Thisisbecauseeducationaboutsubstancesandsubstancemisuseisapartofmostinterventionandtreatmentregimes.
Theapproachtakenshouldincorporatethefollowingobjectives:
Increasingknowledgeaboutsubstancesincludingalcoholandtobacco.•
Providinganenvironmentinwhichthenormistoremaindrugandtobacco•freeandrespectthesensibleuseofalcohole.g.bybecomingahealthpromotingschool.
reducingconsumptionand/ordelayingtheonsetoffirstuse.•
contributingtominimisingharmcausedtopeoplewhouseor•misusesubstances.
6.3 ContentcharacteristicsEducationalmaterialsshouldbedefinedbyadherencetokeyprinciples.Youngpeoplehaveindicatedthattheyrequirelearningmaterialsthatare:
factual;•
accurate;and•
non-judgmental.•
Theprimerequirementofyoungpeopleisforinformationinrelationtouseofsubstancesandfordetaileddescriptionsofeffectandriskfromtheuseofspecificsubstances.Theyalsoneedtobehelpedtodevelopvalues,attitudesandskillswhichwillhelpthemmakedecisionsrelatedtotheuseofsubstances.
![Page 28: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/28.jpg)
26
Teachers,youthleaders,etcshouldmakeacriticalevaluationofmaterialstoensurethattheyarenotcontradictingpupil’spersonalexperiencesorappeartobebasedonadultsexaggerations.Learningmaterialsshouldreflectthewishesofyoungpeopletobeabletoidentifythedifferentsubstancesthatareincirculationandroutestoservicesforhelp.Thus,thecontentoftheirteachingshouldreflectbothservicepatternsandprovidedetailsofpointsofcontact.
6.4 DeliveryandstyleGoodpracticeinprogrammedeliverysuggestsmethodsshouldbe:
interactive;•
participative-motivatingandconfidencebuilding;•
correctingoferroneousbeliefs;•
abletoprovidealternativediscursiveopportunitiestochallengepeerbeliefs•whilegivingvaluetoyoungpeoples’opinions;
relevanttoyoungpeoples’socialrealities;and•
innovativethroughemployingarangeoflearningstyles.•
6.5 Agencies,personnelandvenuesThefollowingagencieshavearoletoplayindesigninganddeliveringeducationregardingsubstancesandsubstancemisuse:
LEAPSEadvisers;•
thepolicethroughtheallWalesschoolsProgramme;•
WelshNetworkofHealthySchoolSchemesco-ordinators;•
voluntarysectorsubstanceuseandmisuseagencies(e.g.formore•specialisedadviceonsubstancesandinformationaboutotherrelevantservices);
localeducationauthoritiesthroughinitiativestoprovideanadequate•infrastructurewithinschoolsandyouthcentresthatarecompatiblewithdeliveringeffectiveandacceptableeducationonsubstancesandsubstancemisuse.
Additionally,itmaybehelpfultoinvolveotherstatutoryagenciesandorganisationsasandwhenthatisseenasrelevant(e.g.paramedicsfromtheambulanceserviceandstaffofHMPrisonService).
Schoolsareevidentlyimportantplacesfordeliveringeducationprogrammesandteachingstaffhaveasignificantroletoplay.However,theprimaryimportanceofschoolsasavenueisthattheyprovideopportunitiesforawiderangeofexternalagenciestoprovideexpertiseandspecialism.Thepoliceandvoluntarysectoragenciesbringexpertiseandperceivedcredibilitythatstudentsdonotnecessarilyascribetoteachingstaff.Teacherscansupportthisexpertisebyprovidingacontinuingeducationthatunderpinscontributionsmadebyvisitingexperts.
![Page 29: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/29.jpg)
27
Additionally,theyouthservices,socialservicesandothercareagenciesandcommunityorganisationsareimportantsecondarypointsofcontact.Theseagenciesmaybetheonlypointsofcontactforyoungerpeoplewhoaremostatriskincludingchildrenwhoareexcludedfromschool,lookedafter,and/oralienatedfromschool.Servicesarerequiredthatsupportdeliveryofconsistentmessagesacrossschoolsbyensuringthatyoungpeoplewhoarenotinregularattendanceatschooldonotfailtoreceiveeducationaboutsubstances(e.g.theGetSortedprogrammeinRhonddaCynonTaff).Creativityisrequiredtoensurethattheseservicesareavailable.
Thisapproachrequirestrainingandsupportforteachersandstaffinservicesforyoungpeopleonhowtodelivereducationaboutsubstancesandsubstancemisuseandwiderdisseminationofcurriculum-basedmaterialsthatprovideconsistentmessages.
Usingpeoplewhohaveahistoryofsubstancemisusetodelivereducationprogrammesmaybeusefulbutprogrammesofthiskindrequiremonitoringtoensuretheirqualityandconsistencyandtrainingshouldbegiventoex-usersbeforetheyareusedaseducators.
Peer-lededucationofferspotentialadvantageswithinauniversalandcomprehensiveplanthatlinksdifferentapproaches.Thismayhaveparticularvaluewithstudentswhoaredifficulttoreachandfor‘hidden’groups.Peer-lededucationalsooffersadvantagestotheyoungpeoplewhotraintobepeereducators;itraisestheirknowledge,awarenessandself-esteem.
Youngerpeopleshouldnotbeexcludedfromeducationprogrammesonaccountofanylearningdifficulties,problemsordisabilities.Therefore,noprogrammeshouldrelyonwritteninformationorfailtobeinformedabouttheimplicationsforeducationthatstemfromyoungerpeople’sproblemswithreading.Caremustbetakenindesigningpresentationformats,theircontentsandeffectiveaids.
Children who truant or are excluded from school are at much higher risk of substance use and misuse. No child or young person therefore should be denied access to a universal education service because they are out of or excluded from mainstream schooling for any reason. This calls for innovative community-based approaches to delivering a full universal education programme in which the roles, activities and messages transmitted by schools and other community agencies are well-coordinated.
Trainingshouldbeavailableforallrelevantprofessionalsandadvancedtrainingisrequiredbydesignatedstaffwhohaveresponsibilityforeducatingyoungpeoplewhoattendtheirinstitutions/organisationsaboutsubstancesandsubstancemisuse.
UniversalprogrammesshouldbeavailabletoeverychildandyoungpersoninWalesandtheirplanninganddeliveryshouldbeco-ordinatedonalocalbasisatthelevelsoflocalauthorities,localhealthboardsandcommunitysafetypartnerships.
![Page 30: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/30.jpg)
28
7. Selectiveortargetedprogrammes
7.1 DefinitionSelectiveortargetedprogrammesarethoseprogrammesthatareaimedspecificallyatgroupsofchildren,youngpeopleoryoungadultswhoseprofileofriskandresiliencefactorsisconsideredtoplacethematgreaterriskofeitherusingsubstancesormovingfromtheirusetomisuse.
Therearetwobroadtypesofselectiveortargetedprogrammes:
thosethatfocusonattendingtoriskfactorsandraisingresilience.•(Theseprogrammesanticipatetheimpactsofriskandprotectivefactorsbyactingtoenhanceindividuals’resilienceandtotackleandreducethefactorsintheirlivesthatputthematgreaterriskofsubstancemisuseby,forexample,promotingtheirsocialinclusionorassessingthemandarranginginterventionsforanyassociatedproblemsordisorders);
specificsubstancemisusepreventionprogrammes.•
Selectiveprogrammesmaybedeliveredasstandaloneinterventionsortheymaybeprovidedasdevelopmentsfromuniversalprogrammes.Goodexamplesofprogrammesofthiskindareschool-basedapproachestoreducingbullyinganditsimpactoncertaingroupsofyoungpeople.Themainintentionofthesetypesofselectiveprogrammeistoreducetheriskrunby,andtoincreasetheresilienceof,certainidentifiedgroupsofchildrenandyoungpeople.Similarly,someparentingprogrammesareofferedtoallasuniversalprogrammeswhileothersmaybemorefocusedinresponsetotheparticularneedsofchildrenandyoungpeopleandtheirfamilieswhoaremoreatrisk.
7.2 Servicesthatprovidemoredetailedinformationandadvice ondrugsandservicesTargetedorselectiveservicesarerequiredthatprovidesimilarfunctionsasthosethatareuniversallyavailable.Someagenciesthatofferinformationandadvicemayofferbothuniversalandselectiveadvisoryservices.
7.3 PreventionservicesThemainfocusofservicesthatofferpreventionprogrammesistodelayorreducetheprospectsofidentifiedchildren,youngpeopleandyoungadultsmovingfromusingtomisusingsubstances,ortodecreaseuseandparticularly,whererelevant,toavoidthemprogressingto‘dependentuse’.Broadly,theseprogrammesshouldbeoneoftwosorts:
primaryprevention• -programmesthatareintendedtoassistyoungerpeoplewhoareusingsubstancestoresistordelaymovingintomisuse;and
secondaryprevention• -programmesthatareintendedtoreducethelevelofmisuseorharminwhichayoungerpersonisengaged(i.e.returningtouseratherthanmisuse)ortoassistidentifiedyoungerpeoplewithreturningtoabstinence.
![Page 31: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/31.jpg)
29
Manypreventionservicesalsoincludeattentiontoreducingriskfactorsandbuildingresilience.Theyare,therefore,compoundsofthetwobroadtypesofselectiveortargetedprogrammers.Forexample,preventionpackagesmayincludesocialinclusionprogrammersthatofferarangeofsportsandotheractivities.Theparticularintentionistoensurethatchildrenandyoungpeoplestayengagedwiththemorespecificorspecializedcomponentsoftheprogrammedandarebetterabletore-engagewiththeirfamilies,educationandthecommunitywithoutrunningtheverysamerisksthatcontributedtothemmisusingsubstances.
Preventionservicesalsorequirethecapacityandcapabilitytofacilitatetheirclients’accesstoawiderangeofcommunityservices.Again,theintentionistoensurethattheyoungerpeopleinvolvedhaveaccesstocorehealth,education,housingandfamilysupportservicesandthattheyalsohavepromptaccesstospecialistsubstancemisuseservicesforyoungerpeoplewhentheresultoftheassessmentisthattheyarerequired.
Generallythekindsofinterventionprovidedbypreventionservicesareearlyinterventionservicesthatareaimedatyoungerpeoplewhohaveusedsubstancesbuttoalowlevelofseverity.Youngerpeoplewhoseneedshavegonebeyondtheselevelsusuallyrequiretheindicatedservicesofspecialisedsubstancemisusetreatmentagencies.
![Page 32: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/32.jpg)
30
8. Indicatedprogrammes(includingtreatment)
8.1 Assessment8.1.1 Definition
Assessmentistheprocessthatinitiatesintervention.Thewayinwhichitishandledisoftenanimportantmatterindeterminingwhetheryoungerpeopleandtheirfamiliescontinuetousetheservicestheyareoffered.
Assessmentisaprocessratherthananevent.Itsgeneralaimisthatitshouldleadtowell-integratedandwell-targetedservicesbeingprovidedbythevarioussectorscomingtogethertomeeteachyoungerpeople’sindividualeducation,work,developmental,social,relationship,recreation,healthcareandspiritualneeds.Thefocusedaimofassessmentistocapturetheextenttowhichsubstanceshaveanimpactonthehealth,care,educationandwellbeingofeachyoungerpersonwhoisbeingconsidered.
8.2 DefinitionIndicatedprogrammesareprovidedasindividualisedandplannedprogrammesofassessment,interventionandcareforcertainidentifiedchildrenoryoungpeoplewhoaremisusingsubstances.Theseprogrammesincludeassessingthefullrangeofeachchild’suniquearrayofneedsandprovidingresponsestomeetthoseneedswiththeintentionofremedyingcurrentproblemsandrestoringindividualstonon-useofsubstances.Wherethatisnotpossible,indicatedprogrammesareaimedatminimisingtheharmtotheyoungerpeopleand/ortoothersthatmayoccuriftheycontinuetomisusesubstances.
Often,indicatedprogrammeswillconsistofanumberofdifferentcomponents.Theprospectsofincompleteresponsestoindicatedprogrammesandofrelapsearegreaterifthebackgroundriskfactorsfacedbyeachchild,youngpersonoryoungadultarenotalsotackledasapartoftheirprogramme.
Comprehensiveindicatedprogrammesshouldincludeinterventionsthataredirectedatassistingyoungerpeoplewith:
thespecificordirecteffectsofthesubstancesthattheyaremisusing;•
reducingfactorsintheirlivesthatmaybemaintainingtheiruse•ofsubstances;
developingtheirresilience;•
healthcareneedsthatareassociatedwithsubstancemisuse;and•
meetingneedsthatareconsequentialontheirmisuseofsubstancesorthe•secondaryeffectsofbecominginvolvedinlifestylesinwhichsubstancemisuseisapart(includingpossibleinvolvementincrime,poorhousingandhomelessness,unemploymentandfailureatschool).
Onceapersonhasbeenassessedasinneedofindicatedprogrammesofintervention,theymayrequiretheservicesofaspecialisedsubstancemisusetreatmentagency.However,acomprehensiveresponsemayinvolvenotonlyspecialisedagencies.Someoftheservicesrequiredmayincludeactivitiesthat
![Page 33: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/33.jpg)
31
areincludedwithinthecategoryofselectiveandtargetedprogrammesbutalsotheservicesofavarietyofotheragenciesthatmaynotthinkofthemselvesasdealingdirectlywithsubstanceuseormisuse(e.g.schools,colleges,highereducationinstitutions,employersandhousingservices)indeliveringindicatedprogrammesthataremorelikelytobeeffective.
Indicatedprogrammesshouldbeavailabletoeverychild,youngpersonandyoungadultinWalesonthebasisofneed.
Protocolsshouldalsobeinplacewithotherstatutoryservicestoensureallchildren’sneedsaremet.(Safeguarding Children: Working together under the Children Act 2004 Chapter 8.19 refers)
8.3 SpecialisedinterventionsAwiderangeofinterventionsor‘treatments’shouldbemadeavailableforyoungerpeoplewhomisusesubstancesandfortheirfamilies.Theseinclude:
psychologicaltherapiesofferedinone-to-one,grouporfamilysettings,•dependingontheassessedindications
pharmacologicaltreatmentsthataretargetedatthesubstanceofmisuse•inthecasesofdependentusers(seePracticePoint2)
pharmacologicaltreatmentsthataretargetedatcomorbidmentaldisorders.•
Itisvitaltoengageandretainyoungerpeopleininterventionsofthekindthatareprovidedbyspecialisedsubstancemisuseagenciesbecausedurationoftreatmentislinkedtoimprovedoutcome.Interventionshouldencompassassessment,treatmentepisodes(howeverdefined)andaftercareandfollowthrough.Collaborativeworkingwithotheragenciesandprofessionalsisacorecomponentofeffectiveinterventionsforyoungerpeoplewhomisusesubstances.
Thecomponentsofspecialisedinterventionservicesmaybedescribedas:
pre-treatmentservices;•
community-outpatient-basedinterventionsandtreatmentservices;•
Inpatienttreatment;and•
otherresidentialservices.•
8.3.1 Pre-treatmentservices
Youngerpeoplewhoareassessedasrequiringtheservicesofaspecialisedsubstancemisusetreatmentagencymayrequire,inadditiontoafullassessmentandaccesstospecialisedinterventions,theservicesthathavealreadybeendescribedundertheheadingsofuniversalandselectiveortargetedprogrammes.Theyinclude:
primaryprevention,healthpromotionanduniversaleducationservices;and•
earlyinterventionservicesthatareaimedatyoungerpeoplewhohaveused•substancesbuttoalowlevelofseverity.
TheseaspectsofacomprehensiveresponseprovidedbysomespecialisedsubstancemisuseagenciesarecalledPre-treatmentServices.
![Page 34: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/34.jpg)
32
8.3.2 Communitybasedspecialistinterventionsandtreatmentservices
Therearethreelevelsofintensityofspecialisedinterventionservicethatshouldbeofferedtoyoungerpeopleoutsideofaninpatientsetting.Theyare:
non-intensiveoutpatientprovision(sometimesdefinedaslessthan10hours•perweekofattendanceatanagency);
intensiveoutpatientprovision(sometimesdefinedas10to20hoursper•weekofattendanceataservicethatisofferingastructuredprogramme);and
dayserviceintervention(whichmaybedefinedasmorethan20hoursper•weekofattendanceataservicethatisofferingastructuredprogramme).
Specialisedserviceswillneedtoprovidethefollowinginterventions:
screening/specialisedassessments;•
educationalgroups(e.g.ontheeffectsofdrugs);•
educationservices;•
self-helpprogrammes;•
relapsepreventionprogrammes;•
drugtesting;•
detoxification,substancereductionandmaintenancetreatments;•
mentalhealthservices;•
group,familyandindividualtherapy;•
recreationalactivitiesandpeersocialisationprogrammes;•
linkstospecialistsexualhealthservices;•
otherspecialisedgroupinterventions(e.g.culturalsensitivity;HIV,pregnancy•andparenting;tobaccocessation;independentlivingskills;healthandnutritionetc);
emergencyandout-of-hoursservices;•
home-basedservices,outreachservices,liaisonservices;•
liaisonsubstancemisuseworkerswhoserolesaretoprovideadvice,•signposting,training,consultationandco-workingwithotheragenciesandtothoseagenciesthatprovideotherservicefunctions;
HarmMinimisatione.g.needleexchange(SeePracticePoint3).•
8.3.3 Inpatientservices
Amuchsmallernumberofyoungerpeoplearelikelytorequireinpatientservices.
Theseservicesneedtohaveclearlydefinedoutcomesuccessfactors.
Threelevelsofprovisionforyoungerpeoplewhorequireresidentialservicesareidentified:
medicallymonitoredservices-forthoseyoungerpeoplewhohavesevere•substancemisusedisordersandwhoneed24-houradaysupervisionandmonitoring(usuallyovera7to45daystay);
![Page 35: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/35.jpg)
33
medicallymanagedservices-thatofferroundtheclockmedicalandnursing•services(e.g.byprovidinglifesupportorsecureservicesusuallyovera7to45dayperiodforeachyoungerperson);and
Medicallydirectedintensiveresidentialcare-foryoungerpeoplewhohave•complexproblemsincludingcomorbidity(maybeforupto6monthsineachcase).
Therangeofinterventionsofferedinresidentialsettingneedtobethesameasofferedincommunityanddayserviceswithanincreasedemphasisonvocationalservices.
ItisimportanttodrawattentiontoWelshHealthCircular(2002)125whichsetsouttheWelshAssemblyGovernment’spolicyontheagerangepatientstreatedbyCAMHS.TheWelshAssemblyGovernment’slongtermobjectiveisthatnochildoryoungpersonshouldneedtobetreatedinanadultfacility.
NSFkeyaction2.8states:‘Whenachildoryoungpersonrequiresadmissiontohospitalorresidentialplacement,eitherinoroutofcounty:
Theyareplacedinsettingswhicharemostappropriatefortheir•developmentaswellasclinicalneeds;
Theyareonlyadmittedtoadultsettingsinexceptionalcircumstances;•
Whenplacedinadultsettings,systemsareinplacetoprotectthem•fromharm.”
8.3.4 Residentialservices
Therangeofpotentialresidentialservicesincludes:
therapeuticcommunitiesforpsychosocialrehabilitation(maybeforup•to6months);
halfwayhouses;•
grouphomes;and•
Specialisedfostercare.•
Fewprovidersofspecialistservicesareabletoofferafullrange.
However,accesstoservicesofthesekindsislikelytorequireanationalapproachtoplanningandshouldincludethecapacityandcapabilitytoarrangeadmissionstothesefacilitiesifandwhenthatisnecessary.
NB Inpatient and residential settings may be more appropriate for younger people who:
have more serious disorders related to substance misuse together with •significant comorbid problems;
are at risk of significant withdrawal syndromes; and/or•
have failed to respond to community-based intensive or day interventions.•
![Page 36: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/36.jpg)
34
8.4 Organisationofcomprehensivespecialisedintervention servicesBroadly,therearetwopotentialmodelsinwhichcomprehensivespecialisedinterventionservicesofthisbreadtharedelivered:
creatingsingleagenciesorbringingtogetherseparateagenciestoact•asasingleentity;
creatinganetworkofmorelooselyrelatedagencies.•
Intheformercase,forexample,anNHS-fundedspecialistservicemightcometogetherwithavoluntarysectoragencytoprovidenotonlyindicatedbutalsoafullrangeofselectiveortargetedprogrammes.
Ineithercase,networksofrelationshipswithanumberofotherstatutoryandvoluntarysectoragenciesarerequiredinordertocreateopportunitiesforplanninganddeliveringbroad,individualised,needs-led,comprehensiveandwellco-ordinatedpackagesofassessment,intervention,treatmentandcare.
Therefore,Tier3isprovidedbymulti-disciplinaryteamsofstaffwhoareparticularlytrainedandskilledforworkwithyoungpeoplewhomisusesubstancesand/orhavesubstancemisusesyndromes.Workatthisleveloftenrequirescollaborationbetweenchildandadolescentmentalhealth,addiction,education,paediatric,socialandvoluntarysectorservicesandtherearemanyorganisationalpossibilities.
Approachestoensuringthisaggregationofknowledgeandskillsinclude:
creatingnewteamswithinasingleagencyeitherbybringingelements•ofseveralagenciestogetherorbysecondingstaff;
drawingonavarietyofagenciestogathertheappropriateskillsaround•particularyoungerpeopleandtheproblemstheypresentonaneeds-ledandcase-managedbasis(i.e.caseandcaremanagementareusednotonlytodelivercross-agencyactionplansorcareplansbutalsoasavehicletobringagenciestogetheratthestrategicandoperationallevels);
creatingservicenetworksorvirtualteams.Together,theteams,whether•withinasingleagencyprovidedbyseveralagenciesworkingtogetherorthroughvirtualteams,shouldbeabletoassessandmanagethecomplexneedsofyoungerpeoplewhohavemoreseriousproblemsanddisorders.
StafffromtheservicesthatprovidespecialistTier3functionsshouldbeavailabletoadvisestaffwhodeliverTier2functions.StaffwhodeliveractivitiesthatfallintoTier3shouldbeawareofthevariouslocalagenciesandofthereferralpathwaystothem.
8.5 Keyissuesforservicedelivery8.5.1 Leadagencyandleadprofessional
Integrationandcoordinationrequiretheagenciestosubscribetoagreedmodelsofcareand/orcasemanagement,particularlywheninter-agencyplanningisrequired.Providedbyeachoftheothers.Thisframeworkadvocatestheconceptthat,wherethereismorethanasingleagencyinvolved,theyshouldagreebetween
![Page 37: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/37.jpg)
35
themwhichistheleadagencyineachcaseasthispromotesclarityforclientsandfamilies.WhenSocialServicesareinvolvedbecausethechildisdeemedtobe‘inneed’,onthechildprotectionregister,lookedafteroracareleaverChildren’sServiceswillco-ordinatethecase.
Tothis,isaddedtheconceptofleadprofessional.Thisisthepersonfromtheleadagencywhoisresponsibleformanagingeachcaseandcoordinatingdeliveryofthecarethattheindividualpersonrequires.Localagenciesshouldcometogethertoagreemechanismsforcareorcasemanagement.
8.5.2 Integratingservices
Integratedservicesforchildren,youngpeopleandyoungadultsarethosethatcollaborateandarewellcoordinatedbothwithinandacrossagencies.Boundariesbetweendepartments,withinservicesandagencies,andbetweenagenciesshouldnotbeallowedtobecomefaultlinesintheexperiencesofyoungerpeopleandtheirfamilies.
Goodpracticeinintegrationsuggestsservicesshouldbe:
basedonlonger-termplansandsustainedrelationshipsbetweenagencies;•
consideredfromtheperspectivesoftheirusers;•
commissionedbytheresponsibleauthoritiesonacoordinatedbasistoavoid•replicationandgaps;
basedonawarenessoftherequirementofmanyyoungerpeoplefortheir•needstobedealtwithbyanumberofdifferentagenciesconcurrentlyorsequentially,andaccordingtoagreedplans,timetablesanddistributionsofresponsibilitybetweentheagenciesandsectorsofcare;and
linkedbygoodcommunication,careandcaseplanning,andinformation•sharingprotocolsthatareunderpinnedbylessformalmeansofencouragingprofessionalcontactsandrelationshipsbetweenstaff.
8.5.3 Substancemisuseliaisonfunction(Link workers)
Oneapproachtoimprovingliaisonbetweenthespecialistandgeneralistservicesisforthecreationofsubstancemisuseliaisonorlinkworkers.ThesestaffshouldbehighlyskilledandexperiencedandaremembersofaSpecialisedSubstanceMisuseService.Althoughmostoftheirworkmaybeconductedawayfrombaseandoutsidethephysicalpremisesofaspecialisedservice,theyarespecialists.
Theirrolesarelikelytoinclude:
providingadvicetostaffwhodeliverthefunctionsofTiers1and2;•
advisingonthecontentsofuniversaleducationandselectiveandtargeted•educationprogrammes;
providingadviceonoperationofthecarepathway;•
providingplannerswithadviceaboutsubstancesandtheservicesthat•arerequired;
providingconsultationtostaffwhodeliverthefunctionsofTiers1and2;•
![Page 38: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/38.jpg)
36
providingteachingandtrainingforthestaffwhodeliverthefunctions•ofTiers1and2;
linkingacrosstheagenciesinanareatoassistwithresolving•communicationproblems;
actingastheleadprofessionalforcertainyoungerpeoplewhohave•complexproblemsandrequirewell-coordinatedcareprogrammes.
8.5.4 Involvingparentsandcarers
Involvingparentsandcarersinservicesforyoungersubstanceusersandsecuringtheirsupportisessentialtoensurecoherentandconsistentmessagesarecommunicated.Familiesareprimaryinfluencesandtheiractiveparticipationislikelytoimprovethetreatmentoutcomesthattheservicecanachieve.
Therefore,servicesshouldworkinpartnershipwithyoungerpeopleand,ifappropriateaccordingtoageandcircumstances,withtheirparents,carersandotherclosefamilymemberstoaddresssubstance-relatedproblemsandtoprovideservicesnotonlyfortheyoungpeople,butalsofortheirfamiliesandfriends.
Mostparentsandcarerswishtobeinvolvedindecisionsmadeaboutinterventionsandtreatmentsandthattheirchildrenreceive.Thisframeworkrecognisesthevaluablerolesthatparents/carerscanplayinassistingyoungerpeoplewhohaveproblemsarisingfromsubstancemisuse.Servicesshouldactivelyencourageparentalinvolvementwithintheboundariesofpolicyandexistingstatuteandcaselawonconsentandconfidentiality.Theremayalsobecircumstancesinwhichparentalconsentismandatory.
Whileprofessionalsshouldseek,ingeneral,todiscussanyconcernswiththefamilyand,wherepossible,seektheiragreementtomakingreferralstolocalauthoritychildren’ssocialservicesthisshouldonlybedonewheresuchdiscussionandagreement-seekingwillnotplaceachildatincreasedriskofsignificantharm.
8.5.5 Handlingtransitions
Servicesshouldbeprovidedonthebasisofneednotonthecriterionofage.Therefore,ifapersonaged18oroverhasneedsthatcanbestbemetbyayoungperson’sservice,thenthisislikelytobethemostappropriateresponseaslongasthiscourseisnotdetrimentaltotheservicebeingofferedtootherclients.Thesamecouldbethecaseforyoungpeopleunder18whorequireaservicethatisbestprovidedbyaserviceforadults.Plannersshould,therefore,allowflexibilitywhenconsideringtransitionalarrangementsalthoughtheymustbeawareoftheregulatoryrequirementsrelatingtochildrenandanyservicesrequiringregistrationundertheCareStandardsAct2000.
Thefollowingpointsshouldalsobeconsidered:
theinterventionelementoftheyoungpeople’sstrandofthisframeworkis•foundedonthehopethatearlyinterventionwillreducetheneedforyoungpeopletouseserviceswhentheyareadults;
allyoungpeoplereceivingassessmentcare,and/orinterventionsfor•potentialoractualsubstancemisuseshouldhaveatransitioncareplanthatisdevisedpriortotheireighteenthbirthday.Thisshouldidentifyany
![Page 39: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/39.jpg)
37
continuingneedsandtheorganisationsthatarebestabletomeetthoseneedsandincludeneedsarisingfromsubstancemisuse;
inordertoplantransitionarrangements,providersofservicesforadultsand•foryoungpeoplewhoaremisusingsubstancesshouldworktogetherandwiththeotherserviceprovidersthatareinvolved;
keysubstancemisuseworkerswithtransitionalresponsibilitiescouldbe•basedinservicesforadults,butalsoholdsomesessionsinsubstancemisuseservicesforyoungpeople;
acareco-ordinator,whowecalltheleadprofessional,shouldbeidentified•inthecareplanfromwithintheleadagencywhichwillbeSocialServicesifthechildisinreceiptofservicesfromSocialServicesdepartments.Inmanycases,youngpeopleof18whorequireservicesinrespectoftheirmisuseofsubstancesmayalsorequireinterventionsfromothermainstreamservices,suchashousing,educationandprimarycare;and
transitionsofyoungpeopletoservicesforadultsmaytakeplaceatdifferent•agesordevelopmentalstagesdependingontheagenciesinvolvedandtheexpectationsthatfallonthem(e.g.YOTs,SpecialistCAMHSandservicesforchildrenwhoarelookedaftermayhavedifferentarrangements).Transitionarrangementsshouldensurethatthesedifferentarrangementsareincludedinthecareplan,whentheyarerelevant.
8.5.6 Actualandvirtualteams
Agenciesandtheteamswithinthemvaryinstructureandgovernance.Deliveryofimprovedservicecoordinationandintegrationcouldbeachievedbystructuralchangestotheconstructionofteams.Otherwise,secondmentacrossagenciesmightprovideamechanismbywhichspecificexpertisecanbebroughttoexistingservicesinordertobuildmulti-disciplinarysubstancemisuseteamsthatarecapableofprovidingservicesinanarea.
Anotheroptionisthatofdevelopingvirtualteamsororganisationsinwhichprofessionalsfromavarietyofagenciesworktogether,often,innetworkstodelivercareprogrammesforparticularindividuals.Secondmentandvirtualornetworkedteamscanbeextremelyusefulandforward-lookingmechanismsandresultin:
affordingaccesstosubstancemisuseservicesinmainstreamor•genericsettings;
takingopportunitiestodevelopcompetencyinsubstance-related•mattersofgenericpractitionerswhoworkwithchildren,youngpeopleoryoungadults;
developingthefunctionsofferedbygenericormainstreamagencies;and•
developingcloserandbetterintegratedworkingrelationshipsbetween•disciplinesandagenciestominimiseprofessionalrivalryandduplication.
8.5.7 Childprotection
Respondingappropriatelytopotentialandactualchildprotectionconcernsisvital,howeverchallengingandproblematicitistoapplyinsomeinstances.Therefore,itisimperativethatsubstancemisuseservicesmaintaingoodcontinuing
![Page 40: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/40.jpg)
38
collaborationwithsocialservices.Peoplewhoattendsubstancemisuseservicesarenotalwaysregardedashavingneedsthataresufficientwhentheyarecomparedwiththeproblemsfacedbyotheryoungpeoplethatthesocialservicesencounter.Effectivechildprotectionservicesareespeciallyimportantforyoungpregnantusersofsubstancesandtheremaybeanumberofyoungwomeninthissituationinsomeareas.
![Page 41: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/41.jpg)
39
SectionD-planning
9. Purposeofsection
ThissectiondescribesaWelshAssemblyGovernmentframeworkfororganisingplanningServicesforChildrenandYoungPeoplewhoUseorMisuseSubstancesthroughoutWales.
Itisrecognisedthattheplanningpartnershipsneededtomaintainanddevelopthecomprehensivepatternofsubstancemisuseservicesrequiredbyyoungpeoplerequirescloseco-operationbetweenhealthandsocialcareplanners.Theseplannersrequireclarityabouthowresponsibilitiesforplanningservicesistobeallocatedbetweenthevarioussectorsandaframeworkwithinwhichtheplanningauthoritiescancometogethertoagreelocal,regionalandnationalplans.
ThissectionsuggestsbringingtogethertheplanningbodiesintopartnershipsandusestheFourTierStrategicFrameworkasatooltodescribethis.
![Page 42: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/42.jpg)
40
10. Background
DeliveringthepatternofservicesthatimplementtheagreedprioritiessetoutinthelocalChildrenandYoungPeoplesPlan(CYPP)requiresthelocalauthoritiesandtheirpartnerstoco-operateintheplanningofservices.
TheAssemblyGovernmentwishestoseeincreaseduseofjointplanningtoprovideservicesforchildrenandyoungpeople.Section25(6)ofthe2004Actgivesthelocalauthorityanditsmainstatutorypartnersthepowertopoolfundingandshareresources.Chapter4ofguidanceonlocaldutiestocooperate-Stronger Partnerships for Better Outcomes (WAG 2006)-setsoutthebackgroundforthedevelopmentofsucharrangements.EachCYPPprovidesabasisforjointplanninglocally.Shared Planning for Better Outcomes (WAG 2007),reinforcestherequirementtoconsideropportunitiesforuseofpooledfunding(paragraphs2.24-2.26).Pooledfundingcanbeparticularlyvaluableinprovidingservicesforchildrenandyoungpeoplewithcomplexneedswhorequirepackagesofcarefromanumberofagenciesandpartners,suchassubstancemisuseservices.
TheWelshAssemblyGovernmenthasissued“FrameworkGuidanceforCommunitySafetyPartnershipstoCommissionSubstanceMisuseServices”whichemphasisestheimportanceofcomplementaryapproaches,namely:
takingastrategicandsystematicapproachtoplanningservices;•
promotingajointapproachbetweenagencieswithinCommunitySafety•Partnershipstoplanservices;
jointlyplanningacrossCSPboundaries.•
ThePoliceReformAct2002whichcameintoforceinWaleson1stApril2003requiresresponsibleauthoritiesinWalestoensurethataLocalSubstanceMisuseActionPlanisdevelopedandimplemented,theresponsibleauthoritiesarethecouncilforthearea,chiefofficersofpolice,thepoliceauthority,thefireandrescueauthorityandthelocalhealthboard.IndecidingwhattoincorporateintheirLocalSubstanceMisuseActionPlans,responsibleauthoritiesshouldworkinpartnershipwithothermembersofCommunitySafetyPartnerships.
CommunitySafetyPartnerships(CSPs)shouldensurethattheirplansreflectandinformthelocalCYPP.ThroughtheparticipationoftheirmembersinthelocalChildrenandYoungPeople’sPartnership,CSPswillcontributetothesettingofsharedprioritiesandbeabletoensurethattheirworktocommissionsubstancemisuseservicesisbasedonthem.Itisessentialthatbothpartnershipscooperateintheplanningofsubstancemisuseservicesforchildrenandyoungpeople-seeSharedPlanningforBetterOutcomesparagraphs1.27and1.28.
![Page 43: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/43.jpg)
41
11. Thesuggestedplanningmodel
Withregardstochildrenandyoungpeoplespecificallysomeservices,suchasuniversaleducation,information,healthpromotionandinitialscreeningandassessmentservices(inTier1),arerequiredbyallyoungpeoplewhereasthemostspecialisedcombinationsofservices(atTier4)arerequiredbyaverymuchsmallernumberofpeople.AccesstothespecialisedservicefunctionsofTier3isrequiredbyanintermediatenumberofyoungpeople.
Therefore,Tier1functions(andmanyofthefunctionsofTier2)arerequiredtobeeasilyaccessibleinallcommunities.Tier4functionsaresuchthattheyarelikelytorequireplanningbypeoplewhohaveveryspecialisedknowledge.InbetweenliethespecialistfunctionsofTier3whichalsorequirespecialistknowledge.
Therefore,thisframeworkproposesalayeredframeworkfororganisingplanningfortheseclientsinWales.Figure7.1summarisesthisapproach.
Figure7.1:Aframeworkforplanning
Community Planning Partnerships
National Planning Consortium
Tier 1
Tier 2
Tier 3
Tier 4
Planning Pathway
EducationServicesLASSDNHSYJBCJS
EducationServicesLASSDNHSCSPsYJBCJS
CSPs
EducationServicesLASSDNHSCSPsYJBCJS
Planning Tier 2 Functions
Planning Tier 3 Functions
Regional Planning Groups
![Page 44: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/44.jpg)
42
Thismodelprovidesaframeworkfororganisingandallocatingresponsibilitiesforplanningservicesinwhichtheindividualresponsibleauthoritiesfromacrossthesectorsarerequiredtocometogetherinlocal,regionalandnationalgroupings.Inthisway,itisbelievedthatexpertisecanbedevelopedacrossthesectorstoenableeffectiveplanningoftheincreasinglyspecialisedandcomplexservicesatTiers3and4.Moredetailisgivenonthisapproachbelow.
11.1 PlanningTier1TheplanningofthefunctionsofTier1shouldbeorganisedandconductedatCommunitySafetyPartnershiplevel.Atpresenttheseplannerscometogetherindifferentpartnerships.TheplanningofChildrenandYoungPeople’sserviceswillrequireco-operationbetweenCommunitySafetyPartnershipsandChildrenandYoungPeople’sFrameworkPartnershipsineacharea.ApossibleoptionforcollaborationcouldbeaCommunityCollaborativePlanningPartnershipthroughwhicheachoftheplannersthatholdsstatutoryresponsibilityagreestosharethedevelopmentanddeliveryofajointlyownedplanforTier1andthentoplaytheiragreedpartinplanningtheservicesthatfallstotheirsector.
11.2 PlanningTiers2and3EffectiveplanningofTiers2and3functionsrequiresthepoolingofexpertiseandcloseco-operationbetweenareas.TherearemodelsdevelopinginWalesforregionalplanningofservices.OneexampleistheplanningoftheDrugsInterventionProgrammebasedonthepoliceauthorityareasanotheristhenewregionalsystemofCAMHSPlanningNetworks(Cans).
Responsibleauthoritiescouldalsocometogethertocreateregionalplanninggroupsinwhichrepresentativesofeachofthelocalplannersorcollaborativeplanningpartnershipsarebroughttogetherundertheleadershiponeplanningbodycouldthenbeidentifiedastheleadfortheregion.ParticipantscouldpoolbudgetsandstaffresourcesandjointlyemploystaffwhoareabletodevelopsufficientknowledgeandexpertisetoeffectivelycommissionthefunctionsofTiers2and3intheirregion.
11.3 PlanningTier4TheservicesrequiredtodeliverTier4functionsmaybebestcommissionedatanallWaleslevel.TheleadpersonnelfromeachoftheregionalplanninggroupscouldcometogethertoconstituteanationalplanningconsortiumthatcouldberesponsibleforplanningandmanagingtheperformanceofagenciesthatprovidetheTier4functionsrequiredbyalltheyoungpeopleofWales.
Itisrecognisedthatthevarioussectorshaveadopteddifferentapproachestoormodelsforplanning.HowevertheWelshAssemblyGovernmenthaspublishedguidancetoCommunitySafetyPartnerships(FrameworkGuidanceforCommunitySafetyPartnershipstoCommissionSubstanceMisuseServices)andthisguidanceshouldbetakenaccountofwhenplanningservices.
![Page 45: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/45.jpg)
43
12. Goodpracticeinplanning
In1996,theNHSHealthandDrugsAdvisoryServices(HAS)publishedathematicreviewoncommissioningandprovidingservicesforchildrenandyoungpeoplewhouseandmisusesubstances1.In2001,theHealthAdvisoryService,asuccessorbodytotheHAS,reviewedtheHASreviewatthebehestoftheCabinetOffice.ThefirstHASreportcontainsasubstantialsectiononcommissioningservicesforyoungpeoplewhouseormisusesubstances.Thecontentsofthatsectionwereconfirmedinthereviewof2001.Theprinciplesofgoodpracticeinplanningservicesforyoungpeoplewhouseormisusesubstancesremainunchanged.Theyaresummarised,withupdating,below.
12.1 StrategyItisessentialthatagenciesthatareresponsibleforplanningservicesforchildrenandyoungpeoplebasetheirapproachonajointlyagreedstrategicapproachthatisunderpinnedbythelocalCYPP.Theyshould:
Build,whereverpossible,onexistingmachineryandpreviousstrategy;•
Aligntheirstrategicplanswiththeirbroaderstrategiesforbothchild•andadolescentmentalhealthservicesandforsubstancemisuseservicesforadults;
Includeabalanceofeducational,preventativeandintervention•andtreatmentorientatedapproachesintheirstrategicframework;
Ensurethattheirstrategicplansareagreedandownedbyallpotential•agenciesthathaveplanningresponsibilities,thereby,recognisingtheirinterdependenceinproducinganeffectivesystemofservices;and
Identifyandprioritiseintheirplansthehighriskgroups(e.g.intravenous•drugusers,pregnantdrugusersanduserswithahighriskofsuicide).
12.2 Developingtheknowledge-basePlannersofsubstancemisuseservicesforchildrenandyoungpeoplemusthavesoundknowledgeoftherequirementsofchildren,youngpeopleandyoungadultswhohaveproblemsarisingfromtheiruseormisuseofsubstancesandtheeffectivenessofpotentialinterventions.
Theinformationrequiredtodevelopsuchasoundknowledge-basefallsintoanumberofdifferentcategories.Theseinclude:theagreeddefinitionsofuseandmisuseadoptedbyWelshAssemblyGovernment;thenatureandextentofsubstancemisuseintheareatheycover;thenature,capabilitiesandcapacitiesofthenon-statutoryandstatutoryserviceprovidersintheirarea;andtheeffectivenessoflocalservices.JointneedsassessmentandmappingofcurrentprovisionareessentialtounderpinjointplanningandshouldbecarriedoutaspartontheintegratedprocessundertakenbytheChildrenandYoungPeople’sPartnershipinpreparingtheirCYPP.Theprocesswillbesupportedby:
1TheSubstanceofYoungNeeds,1996,HMSO.
![Page 46: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/46.jpg)
44
Consultationwithnon-statutoryalcoholanddrugagenciesonthenumbers•oftheirclients,theirpatternsofuseandmisuse,andthenatureofservicesthattheyoffer;
Engagementwiththeservicesthatareinvolvedinsmokingreduction;•
Informationgatheredfromschools,socialservicesdepartments,theyouth•justiceservicesandYOT,theprobationserviceandthepolice;
Consultationwithcommunityorganisations,includinganythatworkwith•differentethniccommunities;
Understandingthevariousdefinitionsofuseandmisuseadoptedbylocal•agenciesandrecognisingiftheyaredifferentfromtheWelshAssemblyGovernmentdefinitionsinordertoestimatethewaysinwhichthesedefinitionseffecttheprocessesofneedsassessmentandtheirperceptionsofpeoplewhorequireservices;
Awarenessoftheclinicalandsocialeffectivenessofparticularservicesand•methodsofeducation,preventionandinterventionthatareavailablelocallyaswellasnationally;and
ReviewingliteraturefromorganisationssuchasAlcoholConcernandthe•StandingConferenceonDrugAbuse(SCODA)andacademicinstitutionswithaninterestinthetopicareas.
12.3 ResponsivenesstothelocalpopulationPlannersshouldberesponsivetotheneedsoftheirlocalpopulationtodevelopaneffectiveclimatewhendevelopingtheirplansandservices.Theyshouldbeawareofthefollowingkeypoints:
Thebaselineofpublicunderstandingandempathymaybelowinthisfield;•Plannersmaychoosetoinvestinpubliceducationinitiativestocounterthis;
Theremaybeadifferenceofviewsbetweenyoungpeopleandtheircarers•andeachvoicemustberecognised;
Carers’(usuallyparents’)needsshouldbemetinadditiontothoseof•theirchildren;
Theroleofthemediaissignificantinthisfield;itscontributioncan•beunhelpfulby,forexample,stigmatisingindividualsorganisations,schoolsorlocalities;oritcanbehelpfulbyaidingpubliceducation;
Buildingcontactswithdifferentethnicgroupsisessentialinworkingtowards•trustingrelationshipswiththeacceptedleadersofthedifferentculturalgroupsandplannersmustbeawareofthedangersofracialorculturalstereotyping;and
Thepopulationofyoungpeoplewhomaybenefitfromservicesmaybe•transient,especiallyininner-cityareas,andpeoplewhoareathighriskmayrequireliaisonacrossgeographicalboundariesifservicesaretobetargetedeffectivelyonveryvulnerableyoungpeople.
![Page 47: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/47.jpg)
45
12.4 PartnershipswithprovidersofservicesDevelopingservicesforyoungpeoplewithproblemsarisingfromtheiruseormisuseofsubstancesdependsonthematurityofrelationshipsbetweenthevariousplannersandbetweentheplannersandtheprovidersofservices.Thefollowingissuesaresignificantinthisprocess:
Thereisawidevarietyofprovidersinthefieldandthismayresult•inindividualserviceshavingcontactswiththesameindividualswhethertheyknowitornot.
Therearemanyservicestowhichyoungpeoplewhoaremisusing•substancesmayturntoinemergenciesorformoreroutinecare.Stepsmustbetakentoensurethatpoorcontactsbetweenservicesorlackoffamiliarityofprofessionalswithsubstancemisusedoesnotjeopardisethecareofindividualsorreduceservicequality.
Manyprovidersareinthenon-statutorysector.Theorganisationalculture•oftheseagenciesisdifferenttothatofthestatutorysector.Plannersmustunderstandthesedifferencesinordertomaximisethecontributionofthevoluntarysector.
Itislikelythatdifferentprovideragenciesofferdifferentelementsof•theservicesrequiredbyyoungpeoplewhouseormisusesubstances.Plannersshouldleadbycreatingaclimateinwhichallprovidersoperatetogetherintheinterestsofyoungpeoplethrougheffectiveco-ordinationoftheircontributionsforacomprehensiveservice.
Appropriateinformationsharingisenabledbymutualorganisational•relationships.Providersofservicesshouldnotbeburdenedbyrequestsforinformationforwhichtheymaynotbeabletoseetherelevance.
12.5 EffectivecollaborationThelocalChildrenandYoungPeople’sPartnershipcansupportcooperationamongcommissioningauthorities,otherplannersandorganisations.Cooperationwillpromoteconsistentpoliciesprovidingintegratededucation,preventionandinterventionservicesforyoungpeople.Thefollowingshouldbenoted:
Thisfieldisparticularlyappropriateforjointplanning.Keyplannersare•localhealthboards,socialservicesdepartments,educationdepartments,housingdepartments,CommunitySafetyPartnerships,probationservices,andtheYouthOffendingService.Voluntarysectorprovidersalsohaveaparttoplayandcancontributeresourcestopooledfundingarrangements.
Anyplanforeducationandpreventionwill,ofnecessity,requireeffective•planningandserviceprovideralliancesthatinvolvehealth,socialandeducationservices,theyouthservices,theleisureservices,housingdepartments,theprisonservice,theYouthJusticeBoard,YouthOffendingTeamsandCommunitySafetyPartnerships.
![Page 48: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/48.jpg)
46
12.6 Effectivenessthroughcontractingorservicelevel agreementsCommissioningagenciesshouldagreeeffectivecontractsorservicelevelagreementswiththeorganisationsthatprovideservices.Theseshouldincludedetailsonthemonitoringandperformancemanagementprocesses.Thismeansthat:
Contractsorservicelevelagreementswithnon-statutoryprovidersshould•bebasedinarobustframeworkmaximisethecontributionoftheseproviders(thatis,theyshouldbelonger-termagreements,whichcontainnegotiatedandrealisticperformancemanagementprocedures);
Whereverpossible,contractsorservicelevelagreementsshouldbebased•onmainstreamfunding;
Contractshoulddetailnotonlythedirectserviceneedsofindividuals•butalsotheneedsofstafffortraining,adviceandconsultancyandresearch;
Plannersshouldcollaborateoncontractingforspecialisedservicesat•Tiers2and3;
Withinthecontextofthelowbaselineofthededicatedservicesat•Tiers3and4,itisimportantthatplannersestablishcontracts/servicelevelagreementsthatrecognisetherolesofservicesnotspecificallydedicatedtomeetingtheneedsofyoungpeoplewhomisusesubstancesbutwhichmaybeappropriatelyusedforthispurpose.Betweenthemtheyshoulddeviseandofferaneffectivesystemofqualitycontrolthatiscapableofsustaininghigh-costlow-volume,highlyspecialisedservices;
Agreementsshouldfollowapurposefulstructurethatstatestheintended•rolesofproviderandcommissionerofferingclarityaboutjointlyagreedinputs,outputsandoutcomes.
12.7 Organisationalfitness/commissionerselfassessmentInordertodevelopaneffectiveplanningapproachtotheservicesrequiredbyyoungpeoplewhomisusesubstances,thecommissioningauthoritiesmusthavetheappropriateorganisationalcapability.Inthisrespect,plannersmayfindithelpfultoundertakeaselfassessmentbasedonthefollowingquestions.
Whointheauthority/organisationhasanyknowledgeofthisfield?•
Istheorganisationawareofitsresponsibilitiesassetoutintheframework?•
Howlargeistheorganisationaldividebetweenservicesforyoungpeople•whosmoketobacco,useormisusealcoholanduseormisusedrugs?
Howseniorarethepeoplewhohaveplanningresponsibilitiesofservice•inthisfieldandwhatownershipdotheauthoritieshaveforyoungpeopleinneed?
Doestheauthorityshoworrespondtoleadershipinaddressingtheneeds•ofyoungpeoplewhouseormisusesubstances?
Areanyservicesforyoungpeoplewhouseormisusesubstanceslost•intheorganisationalstructureofcurrentproviders?
![Page 49: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/49.jpg)
47
Istheagencyclearastowhetheritisplanningeducationandhealth•promotionservices,preventionservicesand/orspecialistassessmentandinterventionservices?
Cantheagencyidentifytheresourcesthatitisininvesting,eitherdirectly•orindirectly,inservicesforyoungpeoplewhouseormisusesubstances?
12.8 PerformancemanagementPlanninginvolvesperformancemanagementaswellasdeterminingwhichservicesaretobedeliveredandbywhom.
Themostobviousroleinthissphererelatestothemeasurestakenbyplannerstoidentifywhetherornottheperformanceandqualityoftheagenciesthatprovideservicesisadequate.
However,itisimportanttoemphasisethatthequalityofperformanceofprovideragenciesisnotonlyrelatedtotheirowncapacity,capabilitiesandquality,butisaffectedsubstantiallybythequalityofperformanceoftheplanners.Experienceshowsthatthescope,qualityandvolumeofservicesdeliveredtothepublicarerelatedtothenatureoftheservicesthathavebeencommissionedandtheresourcesthatplannershavemadeavailabletotheirproviders.
Therefore,performancemanagementcanberelatednotonlytotheactivitiesofprovidersofservicesbutalsototheprinciplesofgoodplanningthataresummarisedinthissection.
12.9 Animprovementcycleforservicesforyoungpeoplewho useormisusesubstancesPlannersareprimarilyresponsibleforthemaindevelopmentsandchangescalledforinthisframework.ChildrenandYoungPeople’sPartnershipsandCommunitySafetyPartnershipssharecommonmembershipandshouldworktogethertoensurethattheirseparateandsharedplansdriveforwardtherequiredservicedevelopmentsinthefourtiersofserviceacrossawiderangeofactivities(i.e.ineducation,youthwork,housing,socialservices,healthservices,andemploymentsettings).ThisshouldleadtoappreciationofthesuccessesandthegapsinmountingservicesinWales.Thisinformation,takentogetherwiththisframework,shouldleadtheplannerstoidentifyannualimprovementcyclesorplansforservicesforyoungpeoplewhouseormisusesubstancesorareatriskofdoingso.
12.10StandardsandstandardsettingPlannersmaywishtoengageinconversationswiththeirproviderswithaviewtoexploringwhetheranetworkshouldbesetuptoestablishdevelopmentalstandardsforsubstancemisuseservicesforyoungpeoplethatreflectWelshpolicyandtheprinciplesofgoodpractice.Informationderivedfromsuchaserviceislikelytobehelpfulinensuringthatanincrementalapproachistakentodevelopingthequalityoftheservices.Thevalues,principles,aimsandobjectivesprovidedinthisframeworkalsoprovidesabaselinefordevelopinglocalstandardsagainstwhichservicesmightbeexpectedbytheirplannerstodevelop.
![Page 50: Guidance on Good Practice for the provision of services ...€¦ · This guidance addresses and highlights these and presents a framework for organisations and agencies that have](https://reader034.vdocuments.net/reader034/viewer/2022042209/5ead25259b5b3f46b06c8d1f/html5/thumbnails/50.jpg)
48
Onesuchserviceisalreadyavailable:QualityinAlcoholandDrugsServices(QUADS).‘OrganizationalStandardsforAlcoholandDrugTreatmentServices’2isahelpfuldocument.
2Drugscope,1999.