The Scottish Government

Listen

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

This document is also available in pdf format (96k)

Introduction

The Effective Interventions Unit (EIU) produced evidence on effective practice in assessment as part of 'Integrated Care for Drug Users: Principles and Practice' (EIU 2002) and published a 'Digest of Tools used in the Assessment Process and Core Data Sets' (EIU 2003). These materials deal with adults and we recognise that it may not be appropriate to apply assessment processes or tools that were developed for use with adults to young people.

There are important differences between the needs of young people and adults: for example, in terms of their vulnerability, the circumstances of their substance misuse, methods of use and perceptions of risk. The guide to assessment addresses young people's drug and alcohol use. Both are problematic for young people and are often inextricably linked.

There is wide agreement on the need for different levels of assessment although currently there are no common definitions. Consultations on the content of the guide suggested that it should address 'initial identification of substance related needs' (or initial assessment) and what might be involved in a more in-depth assessment. The guide recognises wider work on assessment for children and young people being undertaken by the Scottish Executive and others. The EIU have worked closely with colleagues in the production of this guide.

The guide aims:

• to identify how to engage effectively with young people and to build relationships with them

• to provide information and evidence to support the effective identification of substance related needs among young people

• to inform the design and delivery of effective assessment for young people with problematic substance misuse

The guide has been written for anyone working with young people. It is thought to be equally relevant for those in specialist substance misuse services as well as more generic services. The guide provides a number of case study examples to illustrate how a range of agencies and service providers carry out assessment.

What is Assessment?

There is a range of descriptions and definitions of assessment. The Scottish Executive is currently developing an integrated assessment framework for children and young people. For the purpose of this initiative the following working definition of assessment has been developed (note: this is work in progress and the definition may be further refined):

"Assessment is an ongoing process of gathering information, structuring it and making sense of it in order to inform decisions about the actions necessary to maximise children's potential. It is led and supported by professionals, working with children and those who care for them, who are actively involved in the process. This process assumes the sharing of information where the law, practice and policy allows or requires it. It identifies and builds on strengths, whilst taking account of risks and needs."

Effective Engagement with Young People

A key message 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. The assessment process can involve meeting on more than one occasion and information gathering over a period of time. It is important that the young person feels engaged and comfortable with, both the worker and with the process right from the start.

Workers seeking to engage with young people must be sensitive to their needs, feelings and their issues and recognise that engagement implies a commitment from all those involved. It is also 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.

The guide considers the potential barriers to engaging with young people and when and where young people might feel comfortable about meeting with services. Successful engagement is the first step in a process which requires a relationship to develop in order to achieve a successful outcome. This means building trust and respect between the young person and the person undertaking the assessment. The guide sets out a range of ideas to help engage effectively with young people and to encourage a positive dialogue.

The Assessment Process

Assessment is a process and not a one-off event. Although there may be a clearly defined starting point, the length of the process and the end point will be a matter of judgement by those in services and the young person. The guide sets out the key messages, from evidence gathered, about an effective assessment process. This includes: when assessment should take place, how the assessment is conducted, who should be involved in the assessment process and the skills and knowledge required of workers.

As part of the Scottish Executive's wider work to develop an integrated assessment framework for children and young people, the following acronym has been developed. The assessment process should be 'CASH'

C - Clear
A - Accurate
S - Simple
H - Honest

It is important that the assessment is as realistic as possible and that the information given by the young person reflects their situation at the time. It is the role of the worker to help the young person to understand what their needs are, the range of services that might be available to meet their needs, and to encourage them to have realistic expectations about what the outcomes might be.

Assessment Tools

The guide considers the use of assessment tools, but it does not recommend a specific tool or tools for use with young people. A table setting out the advantages and disadvantages of the use of tools is reproduced on page 4 of this summary. The guide contains a number of case studies which report use of tools in different settings and for different client groups. From the consultations it has been identified that the use of tools can aid the assessment process but they are not a substitute for engaging in dialogue, nor a substitute for a skilled and experienced worker who can relate to young people.

Levels of Assessment

The evidence shows that young people with, or at risk of developing, substance misuse problems, are likely to have other difficulties in their lives for which they will require support. It is essential therefore that assessment addresses these wider needs. The evidence also suggests a need for different levels of assessment in order to inform decisions about the right treatment, care and support at the right time for the individual. There is, however, currently no consensus about levels of assessment.

Information Sharing

One of the most important elements of an effective assessment is the sharing of information with young people and with other individuals involved in the assessment. This is a key area for action if the assessment process is to be effective for young people and lead to the appropriate and relevant treatment, care and support.

For the young person, poor information sharing can result in delays in getting access to treatment, care and support or referral on to inappropriate provision. This can lead to disillusionment and non-attendance or drop out from services. Agencies and service providers have concerns about how information is shared and how confidentiality will be handled. Commitment from partner agencies to the sharing and safeguarding of client information is essential to the provision of optimum treatment, care and support.

Outcome of Assessment

The assessment process is not an end in itself. The purpose of assessment is to inform decisions about future treatment, care and support with a view to matching services to the individual's assessed needs. The needs of the young person will influence the scope and the duration of the assessment process. In some cases, the assessment 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. Whatever the nature of the process the outcome should be an Action Plan.

An Action Plan should set out:

identified needs
how needs are to be addressed (including the goals to be achieved where appropriate)
a named individual who is responsible for addressing the need
desired outcome
the date of review

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.

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.