Services for young people

Young people's services are organised around a ‘four tier model’ of service provision beginning with basic interventions provided by non-substance specialist workers, (eg. Social Workers) and ending with specialist residential care (see ‘Assessment and Treatment’ section for further details).  The main implication of this for social work is the expectation that social workers are competent to assess substance use and associated risks in young people and refer on to specialist services where appropriate.  The other implication for social workers is that they commonly have access to young people who are already using substances or are vulnerable to developing problematic use (Aggleton 2006, Melrose 2006, Ward et al 2003). Thus they have a role in prevention, early identification and intervention.

Four tier model and young people
The HAS reports (1996, 2001) place social workers and social services within the first tier of service provision, alongside agencies such as school medical services, police and teachers.  However, there are differences of emphasis and some social workers working in more specialist settings, such as CAMHS (Children and Adolescent Mental Health Service) and YOT's (Youth Offending Teams), would be placed at Tier 2 where there is a greater expectation on their capacity to intervene in the young person’s substance use (according to training and agency remit) as well as assess and refer on.   

There is a concern to divert young people from problematic substance use as early as possible resulting in a greater emphasis on screening and recognition of all young people’s substance use, but particulalry those seen as vulnerable to becoming problematic users (see risk factors section for young people).  For example, the HAS report (2001 p82) emphasises that "In current UK circumstances [of increased substance use amongst young people], screening for drug and alcohol use should be central to any meaningful assessment of the health and well being of young people" (our emphasis).  This is supported by more recent guidance issued by the DfES (2005) under the Every Child Matters agenda.  It means that social workers are going to have to think carefully when using tools like the Common Assessment Framework about where substance use fits in (positively and negatively) with the overall picture of the young person, their family/friends and environment. 

Tiers 3-4 contain services designed to respond to young people's problematic use.  Tier 3 comprises specialist services based in the community and Tier 4 is residential care.  However, there is an overlap between services delivered in Tiers 2 and 3 and there are few residential beds available for young people (Tier 4).  It is therefore important to know what is available locally.

An advantage of the four tier system for young people is the clear expectation that the system is integrated and that workers at tiers 1 and 2 stay involved in the care plan for the young person (HAS 2001, NTA 2005).  This would seem to fit generally with the broad agenda of integrated children’s services and ideas around core, enhanced and intensive services (NTA 2005).

Philosophy and aims of young people's services
The influence of the harm reduction approach can be seen across the four tiers of services for young people.  For example, the HAS report (2001, 82) states that a key aim of tier 1 providers (including social work services) is to:

"Ensure easy availability, accessiblity and appropriateness both of information on drugs, tobacco and alcohol and available services in many forms". 

This fits nicely with the social model approach that attempts to support young people to take control of their use and relationship to substances, making choices about their goals, rather than insisting they don’t use at all. 

However, the HAS report (2001 p3) also takes note of debates in the USA and elsewhere where the view that ".abstinence from substances is 'the only defensible goal for minors'" is often expressed. This is not a debate that occurs only in the USA and the application of harm reduction strategies to young people's substance use is as politically and socially contentious in the UK (Melrose 2006).  Despite this, all specialist services (be they statutory or voluntary agencies) should work to the following ten principles laid out by SCODA/CLC (1999, see also NTA 2005):

• A child is not an adult (i.e. they have a different legal status and biological and emotional needs).
• The welfare of the child is paramount.
• The views of young people should always be sought.
• Parental responsibility must be respected.
• They must co-operate with the local authority in carrying out its duties to young people.
• There must be holistic approaches at all levels.
• Services must be child-centered.
• Services should be comprehensive.
• Services must have competence in responding to the needs of young people.
• Services should aim to operate, in all cases, according to the principles of good practice.

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