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Effective Interventions Unit - Young people with, or at risk of developing, problematic substance misuse: A guide to assessment
Chapter 9: Outcome of the Assessment
As highlighted in
Chapter 1, the assessment process is not an end in itself. Its purpose is to inform decisions about future treatment, care and support, with a view to
matching services to the individual's assessed needs.
The scope and duration of the assessment process will vary according to the nature and extent of the needs of the young person. In some cases, the assessment process may be relatively short and focus on one or two areas of the young person's life. At the other end of the spectrum, it may happen over several weeks and involve a number of different areas of need and, therefore, a number of workers. Whatever the nature of the process, the outcome should be an
Action Plan setting out the assessed needs, the agreed goals of the young person and the (clearly identified) agencies/service providers who will be responsible for carrying through the components of the Action Plan.
Developing an Action Plan
There may be a need for agencies and service providers working with young people to develop effective action planning tools ('a National Evaluation of the Inclusiveness Projects- Interim Report' (SE 2003)). It may also be a helpful first step to consider creating a
Profile of the individual from the information gathered during the assessment process that could cover:
(Integrated Care for Drug Users, EIU 2002, adapted from the Beattie Report's 'Personal or Individual Profile')
'Integrated Care for Drug Users' also sets out the components of an Action Plan, again adapted from materials in the Beattie Report. These comprise:
the goals
the agreed treatment approach for drug use and the service provider
the actions to address other problems e.g. housing, family support, offending behaviour, personal and social skills, education and training needs
what will constitute progress and how it will be measured
dates for reviewing progress, who will be involved and the format
the main contact
'Assessing Young People's Drug Taking: Guidance for drug services' (SCODA 2000) also recognises that "
planning should be an intrinsic part of completing an assessment". The SCODA guidance suggests a slightly different plan outline:
The SCODA guidance highlights that "plans are particularly important when
inter-agency work is required, determining which services and individuals are responsible for delivering specific parts of a package of care". It also states that "plans should be utilised in the review to ascertain which needs have been met and which need further work".
Example Action Plan, using the SCODA headings:
Identified Need | How need will be addressed | Person Responsible | Desired outcome | Review Date |
Problematic use of alcohol | Harm reduction information
Education on substances
Goal setting | Service user
Key worker | Reduction in use of alcohol | 8 weeks |
Offending behaviour relating to substance use | Attendance at probation
Managing Behaviour programme | Service user
Social worker
Key worker | Reduction of risky behaviour and offending | 12 weeks |
Family relationships | Family work programme (communication, boundary setting and relationship building) | Service user Social worker | Improved family communication and relationships | 8 weeks |
Education and employment | Links to Careers service | Service user
Careers officer | Attendance at Careers and Links to employment | 8 weeks |
As noted in
Chapter 4, workers need to be
realistic about what services can be offered. An example of this is the availability of substitute prescribing to young people. Substitute prescribing to young people under 16 is very rare and would be the subject of very careful consideration (EIU 2003).
The Action Plan should be produced
after discussion between the young person and the worker, and services who will input to the young person's treatment, care and support. We have already highlighted the importance of
listening to young people. It is important also for
their views and experience to influence actions.
The Action Plan should recognise the young person's needs, attributes and aspirations. It should also offer a systematic way to support them to make progress towards agreed goals at a suitable pace.
Finally, and importantly, the young person should receive a copy of their Action Plan.
" Action plan helped, as it gave me a plan"
" … the last assessment helped, it made me stop drinking and start doing things"
" Helped me realise I was drinking too much"
Young people's consultations |
CASE STUDY EXAMPLES |
Rushes, in Lanarkshire, has been developing an assessment framework (including a paper-based specialist assessment and action plan), utilising, and adapting, components of the SCODA methodology. The project believes
it is imperative that planning is a key component in the assessment process, with the young person at the centre of the plan.
They have modified the SCODA Action Plan headings and developed standardised code-lists of identified needs, interventions and objectives. In doing so, one of their considerations has been the development of a baseline to measure service delivery for monitoring and evaluation purposes. This includes the wider collation of information that requires to be submitted to the Lanarkshire ADAT and Social Work Services. At the same time they recognise that it is essential this does not compromise on the services available to meet the needs of young people attending the project (an example action plan is included at
Appendix 9).
As part of the plan young people's needs are reviewed to determine if they are being met, what progress they have made and to identify future work. Rushes has utilised the EIU's Evaluation Guide 12 ('Intensive Interventions with Young People') to develop a review process that will support the young people identify if they have made progress towards their agreed plan.
Contact:
TurnerG@northlan.gov.uk
NCH Scotland Gael Og Mentoring Project's Action Plan has space for the young person to express their views on their strengths, attributes, their goals and areas where they feel they need help:
A wee bit about you (please be as honest as you can)
Strengths:
Interests:
Talents:
Qualifications:
What's important for you?
(asks the young person to select, from a choice of around 20 tick boxes, things they want to improve in their life/issues they want help with. Options include: advice on drugs, stop offending, get involved in sport, improve self confidence, get information on benefits, get on better with family……..)
Dream Page
What would you do if you won a million pounds?
Where would you like to be living in five year's time?
What would be your dream job?
How would you view yourself as being successful in life?
Contact:
mikemawby@nch-gaelog.fsnet.co.uk
Graeme Mollon of the Royal Edinburgh hospital works within a
person-centred planning model with his clients who have mental health and substance use issues. There are many tools available within this model, one being an
essential lifestyle plan. This can be used as an empowering tool for service users to articulate their future outwith hospital and a voice to express what supports they feel would enable them in any transition. The process enables people to feel central to the assessment and creates more choice for them in identifying who they believe to be the main supports in their life. The clients create a simple map of their life experiences and their contacts and relationships. They are encouraged to think about
what they would like to have in their lives and what they would like to achieve. This approach is particularly helpful for people who have been traumatised or who for other reasons, for example disability, have difficulty in articulating their thoughts and feelings. (See example below).
Contact:
Graeme.Mollon@lpct.scot.nhs.uk |
Review
The importance of 'review' has been highlighted already. It should be recognised also that given the higher risk and possibly more fluid circumstances surrounding their lives
young people may need to be reviewed more often than adults. A planned review should take place at regular intervals to ensure that the young person's care plan is revised to take account of changing needs and circumstances and that service providers are meeting needs appropriately.
There may be a tendency to re-assess rather than review.
Reviewing progress/monitoring change can show to the worker and young person that progress is being made.
According to the SCODA assessment guidance, review should include the following components:
areas of
achievement for the young person
the
progress that has been made towards meeting the desired outcomes
changes in drug-taking behaviour
deterioration or improvement in
health
compliance with treatment programme
changes in
competence to consent (where appropriate)
change in circumstances, including possible child protection concerns
young person's
views about the treatment
new or unmet needs
'Integrated Care for Drug Users' also suggests
areas of progress that could be part of
ongoing assessment and review:
improvements in health
improvements in family and social functioning
reducing criminal behaviour
reduction in drug use
improvements in self esteem and motivation
movement towards employability
The EIU's 'Evaluation Guide 12: Intensive Interventions with Young People' (EIU 2003) may be another helpful resource.
Finally, and very importantly, one of the suggestions from our consultations with practitioners was:
"
You could get the young person to assess the worker - get their views, as well as the worker assessing the young person".
CHECKLIST Have you developed and
agreed an action planning and review process with
other key agencies and service providers? Have you identified suitable
action planning tools? How will you
measure progress?
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