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Effective Interventions Unit - Young people with, or at risk of developing, problematic substance misuse: A guide to assessment

Chapter 4: Effective Engagement with Young People

One of the key messages from our consultations is that before you can work with young people to help them address their substance misuse, and other needs, you need to be able to engage effectively with them. Effective engagement is the key to any successful dialogue. The assessment process can involve meeting on more than one occasion and information gathering over a period of time. It is, therefore, particularly important that the young person feels engaged, and comfortable with, both the worker and with the process right from the start.

There are different levels of engagement, all of which have value. At the very first level, engagement is about attracting and drawing young people in to services.

There is no right or wrong method of engagement but those who are seeking to engage with young people must be sensitive to their needs, feelings and their issues. Any kind of engagement implies a commitment from those involved. The workers have a responsibility to manage the process and to try to meet the realistic expectations of the young person. The young person also needs to be committed. This can be challenging for young people, but without them being 'signed up' and willing to be a full participant then the process is flawed. The young person needs to be prepared to talk to the worker and discuss issues with him/her, to turn up for appointments, treat the worker(s) with respect and behave in an acceptable way at the service premises.

It is important to be aware that engaging with a service might be a very challenging step for a young person and in order to take up that challenge they may have needed to draw on considerable courage or be very desperate for help. First impressions of the service are very important and will influence whether or not the young person engages effectively.

There are a number of factors to think about when trying to engage effectively with young people:

• why they have come to you

• barriers to service engagement for young people

• when, and where, they might want to see you

• the individuals working in services

• building relationships with young people

1. Why they have come to you

Young people will often come to the attention of services for a reason other than their substance misuse. However, substance misuse may be an important factor among the problems for which they may be seeking help. There are a number of possibilities. The young person may not think that they have a problem with their substance use. Some young people make the decision themselves (or with encouragement from family/friends or another service) to make contact with services. Others may not get in touch voluntarily, but are referred by someone else and so may be reluctant to engage.

There are an increasing number of ways for projects to try to engage with young people. One example is sports-based activities which have proved to be popular in a number of areas and are seen as a diversionary opportunity. They can get young people to participate in an activity and then encourage them to follow a less risky lifestyle.

2. Barriers to service engagement for young people

The young people with whom a service is seeking to engage may face a number of real, or perceived, barriers to engagement. Often young people with substance misuse problems are ill equipped to articulate their apprehensions. These apprehensions, and potential barriers, need to be recognised by services.

'Drug Treatment Services for Young People: A Research Review' (EIU 2002) found that the young people in the study usually faced at least some of the following difficulties:

• lack of family and peer support to address their problems

• lack of awareness of the likely consequences of their actions (particularly of substance misuse)

• lack of knowledge of who to approach for help or how to get help

• distrust or fear of official agencies and staff, including social workers

• an assumption that they are disapproved of by most other social groups

• danger of victimisation or exploitation by others (including dealers and pimps)

• difficulty envisaging and committing to a positive course of action to help themselves.

3. When, and where, they might want to see you

Accessibility of services is crucial and there are a number of considerations:

• Services which are available during 'office' hours may not be the most accessible for young people. Some services that are located within a school or close to it and which young people can access before school, during break times, lunchtimes and immediately after school have been effective at attracting clients.

• Other services find that a school setting is inappropriate for some of their clients, particularly if they are excluded from school or are not attending. In these cases a service which is available away from the school vicinity and open during school times, late evening, or in the early morning may be more accessible.

• The EIU 'Guide to Services for Young People' sets out an 'accessible services checklist' of factors to think about when deciding where to site services and when to open. These factors are useful also in considering where and when to do an assessment (reprinted at Appendix 8 of this document for ease of reference).

• Safety for young people and workers, confidentiality and formality versus informality need to be considered. There are times when a more formal setting is appropriate and times when informal is better. Identify the right setting, perhaps in negotiation with the young person.

• A 'one-stop' shop drop-in facility for young people is advocated by representatives of the Scottish Network of Families Affected by Drugs (SNFAD) as an effective way to engage with young people. It is important that such a facility is available at times when young people are available to use it and that the ambience of the centre is young people friendly.

• There is growing recognition of the need to reach out to some young people on their terms and in their place. Outreach services have to be able to respond to vulnerable groups (some operate, for example, through a night shelter service) and address the needs of minority populations. Outreach services can have a role to play in bringing young people into diversionary activities (see Twilight Basketball initiative above). They can also help to sustain long term contact with young people.

4. The individuals working in services

The conduct and behaviour of the people working in services is crucial to their ability both to engage with the young people and to achieve a meaningful assessment for their clients. While the aim is to make the assessment process as participative as possible, in practice the worker will lead by his/ her approach. It is important that the worker:

• has an open, welcoming 'young person friendly' approach

• uses language young people can understand

• is not condescending or patronising

• right from the start, is upfront and honest. Be realistic about what can be done and what services can be offered. Be honest about child protection and the circumstances in which information has to be shared with others.

• tries to see things from the young person's viewpoint

• allows young people to see where they see themselves

'Step it Up: Charting Young People's Progress' (Scottish Executive 2003) describes the youth work approach to engaging with young people. This approach respects young people, listens to them, and encourages their participation. Effective youth work starts from the interests, hopes and aspirations of young people . It takes place in "a range of settings, including: youth clubs, outreach and detached projects, youth cafes, drug and alcohol projects and other health education groups. Key adults work with young people to create opportunities for them to meet, make friends, enjoy a range of experiences together and reflect on their personal and group development" ( see Chapter 6, Assessment Tools-Step it Up self-assessment materials for young people). The Step it Up report is available on the youthlink website at http://www.youthlink.co.uk/docs/Training%20docs/stepitupreport.pdf

Projects which are established as part of the culture of the community have a unique opportunity to engage effectively with young people. A service which has been well established and which has gained a reputation for providing a welcoming and inclusive atmosphere not only attracts and retains clients but has the opportunity to be influential within the life of the community. Often these projects retain staff for a substantial period and staff who leave to gain experience return to the project. Sometimes young people have participated in the project from childhood and are therefore more likely to maintain engagement as they get older. This allows the project workers to address the changing needs of the young people and to develop good relationships with other young people because they already have 'street cred' in the community.

5. Building relationships with young people

From all the feedback we have had on what makes 'effective assessment', it is clear that relationship building is key to a successful outcome. The relationship between the individual undertaking the assessment and the young person is central to the process. But it is also important to build good relationships with parents and carers and with other agencies ( see Chapter 8, Information Sharing).

Building relationships means building trust. This takes time. For some children and young people trust may be a difficult concept. Perhaps they have had bad experiences in the past or they have never had a trusting relationship with an adult. With trust comes greater willingness to share experiences and feelings and there is a better chance of establishing the 'real story'.

The National Children's Bureau, in partnership with PK Research, recently published a Handbook for those working with children and young people 'Building a Culture of Participation: involving children and young people in policy, service planning, delivery and evaluation' (Kirby, P et al 2004). This offers useful ideas on how to actively involve children and young people within services. The Handbook recognises that meaningful participation depends on the building of positive relationships (rooted in mutual trust and respect) between adults and children and young people. "Without shared respect, young people are unlikely to engage openly with adults. This requires positive worker attitudes, showing a genuine interest in them, as well as being interesting!".

The Participation Handbook offers the following ideas on how to demonstrate an interest in children and young people, and be interesting:

• be an active listener; take the time to sit down and really listen to what children and young people have to say

• when talking to younger children, sit or crouch down so that you are at eye level

• reflect back what children and young people communicate to demonstrate listening and check understanding

• do not pass judgement on what they say but offer your opinions

• find out what they are interested in

• create enjoyable experiences

Finally, "part of being respectful is recognising children and young people's individuality - ask what issues are of concern to them, rather than making assumptions".

The Participation Handbook also suggests "the best way for young people to communicate their needs and for adults to respond appropriately is through positive dialogue", which involves:

• listening to each other

• learning from each other

• attempting to understand each others' perspectives

• responding constructively to each other

• adults being open and upfront about what they can offer

Also, "to have meaningful relationships with children and young people adults need to share something of themselves (views, experience and knowledge, and offering appropriate direction)".

The importance of being able to relate well to young people has been highlighted already. The checklist below (adapted from the SCODA guidance 'Assessing young people's drug taking: Guidance for drug services' to reflect EIU consultations) explores further the skills and knowledge that will be required of individuals working with young people, including those involved in the assessment of their substance misuse and wider needs.

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