Assessment
(written by Dan Caruana)

In the ‘Background and Context’ section of the website the following areas are suggested as what social workers need to be able to achieve in their practice with substance users:

• confidently ask about substance use and its effects on our clients and families
• know what the response means and doesn’t mean (or if we don’t understand ask them to explain further)
• discuss with them the positive and negative aspects of their substance use
• assess the risk it poses to them and their family or partner relationships
• offer brief interventions (advice and information) around alcohol and drug use as appropriate
• know what specialist resources are available locally in order to refer people on as necessary.

This list is equally applicable to working with young people’s substance use.  However, there are an additional set of legal and policy issues in providing interventions to young people which need to be considered (Kaplan and McArdle 2004, SCODA/Children’s Legal Centre 1999, HAS 1996, 2001). 

The legal and policy framework
As noted in the ‘Policy Framework’ section of the site, the Children Act 1989 is applicable to assessing and intervening in young people’s substance use.  This is mainly in terms of the duties and powers under sections 17 and 47.  However, the new Children Act 2004 also has some potentially important legal requirements within it (eg. section 10).  As noted in the introduction to this section on young people, the Government has issued specific guidance, within its Every Child Matters policy framework, on how to improve the response of professionals working in non-substance specific roles and the need for partnership and multi-agency working between these professionals and specialist substance use services (DfES 2005).

Competence and Consent
The key difficulties that can come up when assessing and working with a young person’s substance-related needs, and risks, are generally around assessing the young person’s competence in relation to consent to treatment, and confidentiality and information sharing/giving with partner agencies (HAS 1996, 2001).  

Competence to consent is perhaps the crucial issue in providing assessment and treatment services to young people, particularly those under 16 (Kaplan and McArdle 2004, HAS 1996, 2001).  For social workers it is most likely to be an issue when considering a referral to a specialist service, particularly if the young person does not wish their parents to know.  It is unlikely that social workers would be expected to assess the young person’s competence to consent in isolation, but it is likely that they would be asked by specialist substance workers to contribute to an assessment. 

Specialist workers use the following criteria for assessing a young person’s (under 16) competence to consent to treatment (Drugscope/SCODA 1999):

• Does the young person understand the advice being offered and the main implications of this (i.e. the potential dangers of mixing a heroin substitute, eg. subutex, with alcohol). 
• They will not agree to inform parents or allow you to inform parents, after every effort has been made to persuade them. 
• They are requesting and need support with their substance use. 
• The young person will clearly continue using whether a service is offered or not.
• Without the provision of a service the young person is more likely than not to suffer significant harm through continued substance use. 
• It is agreed that it would be in the young person’s general ‘best interests’ to receive treatment without parental consent. 

It is important to note that if you judge that a young person needs advice and information, rather than a specialist service, it is not always necessary to have parental consent for this, even with younger teenagers.  The criteria to use would be:

• Is it age appropriate information (for example, don’t give a 12 year old a leaflet aimed at adult injectors)? 
• Is it relevant to the young person’s substance needs (eg. they are smoking cannabis but you give them a leaflet about cocaine)?
• Does it introduce new information to the young person about drugs they did not have before (for example, they hadn’t tried speed)?  (This question is difficult in terms of harm reduction but it is best to stick to information about the substances the young person tells you they have used.)

Confidentiality
Generally most young people’s substance services wouldn’t offer a confidential service to young people 13 and under.  It would be usual to seek parents consent to engaging young people in this age group in assessment and treatment of any kind.  Above this age limit the usual limits to confidentiality will apply:

• Where the young person or another young person or child is suffering, or is likely to suffer, significant harm.
• Where the young person is engaged in ‘serious crime’ or exploitation (eg. being encouraged to deal by an adult).
• Where under age sexual activity/sexual exploitation of a minor is a possible issue (as per recent guidance on sharing this with the police).

If information is shared then it would be done under the ‘need to know’ principle and should be discussed with the young person first, even if they don’t consent to the information sharing (unless this would cause harm by delaying the information sharing). 

Some General Points
Always bear in mind the following when working with a young person around substance issues, or considering referring them onto a specialist service:All the 'good practice' guidance issued to specialist substance workers emphasises the need to involve parents and carers and to encourage a 'competent' young person who initially refuses this to allow this to happen at some point.

• The principles and duties in the Children Act 1989 must be applied, particularly the 'welfare principle'.
• Young people do clearly have some rights to a say in their treatment, information sharing etc. but this is not as absolute or as clear as a set of rights as that which applies to adults.
• The expectation is that adults will take the responsibility to make decisions in the young person's interests, which may not always be the same as their wishes.
• Despite the complications and dilemmas, applying the harm reduction model to your work with young people misusing substances is appropriate and more likely to lead to young people accessing support and care they may need from you and others.
• Think about how substance related needs fit into the Common Assessment Framework.

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