This document constitutes the Institute's formal guidance on community-based interventions to reduce substance misuse among vulnerable and disadvantaged children and young people. The recommendations in this section are presented without any reference to evidence statements. Appendix A in the original guideline document repeats the recommendations and lists their linked evidence statements.
Community-based interventions are defined as interventions or small-scale programmes delivered in community settings, such as schools and youth services. They aim to change the risks factors for the target population.
For the purposes of this guidance, substance misuse is defined as intoxication by – or regular excessive consumption of and/or dependence on psychoactive substances, leading to social, psychological, physical or legal problems. It includes problematic use of both legal and illegal drugs (including alcohol when used in combination with other substances).
Recommendation 1
Who is the target population?
Any child or young person under the age of 25 who is vulnerable and disadvantaged
Who should take action?
Local strategic partnerships
What action should they take?
- Develop and implement a strategy to reduce substance misuse among vulnerable and disadvantaged people aged under 25, as part of a local area agreement. This strategy should be:
- Based on a local profile of the target population developed in conjunction with the regional public health observatory. The profile should include their age, factors that make them vulnerable and other locally agreed characteristics
- Supported by a local service model that defines the role of local agencies and practitioners, the referral criteria and referral pathways.
Recommendation 2
Who is the target population?
Any child or young person under the age of 25 who is vulnerable and disadvantaged
Who should take action?
Practitioners and others who work with vulnerable and disadvantaged children and young people in the National Health Service (NHS), local authorities and the education, voluntary, community, social care, youth and criminal justice sectors. In schools this includes teachers, support staff, school nurses and governors.
What action should they take?
- Use existing screening and assessment tools to identify vulnerable and disadvantaged children and young people aged under 25 who are misusing --or who are at risk of misusing – substances. These tools include the Common Assessment Framework and those available from the National Treatment Agency.
- Work with parents or carers, education welfare services, children's trusts, child and adolescent mental health services, school drug advisers or other specialists to:
- Provide support (schools may provide direct support)
- Refer the children and young people, as appropriate, to other services (such as social care, housing or employment), based on a mutually agreed plan. The plan should take account of the child or young person's needs and include review arrangements.
Recommendation 3
Who is the target population?
- Vulnerable and disadvantaged children and young people aged 11–16 years and assessed to be at high risk of substance misuse
- Parents or carers of these children and young people
Who should take action?
Practitioners and others who work with vulnerable and disadvantaged children and young people in the NHS, local authorities and the education, voluntary, community, social care, youth and criminal justice sectors. In schools this includes teachers, support staff, school nurses and governors.
What action should they take?
- Offer a family-based programme of structured support over 2 or more years, drawn up with the parents or carers of the child or young person and led by staff competent in this area. The programme should:
- Include at least three brief motivational interviews (see glossary) each year aimed at the parents/carers
- Assess family interaction
- Offer parental skills training
- Encourage parents to monitor their children's behaviour and academic performance
- Include feedback
- Continue even if the child or young person moves schools.
- Offer more intensive support (for example, family therapy) to families who need it.
Recommendation 4
Who is the target population?
- Children aged 10–12 who are persistently aggressive or disruptive and assessed to be at high risk of substance misuse.
- Parents or carers of these children.
Who should take action?
Practitioners trained in group-based behavioural therapy.
What action should they take?
- Offer the children group-based behavioural therapy over 1 to 2 years, before and during the transition to secondary school. Sessions should take place once or twice a month and last about an hour. Each session should:
- Focus on coping mechanisms such as distraction and relaxation techniques
- Help develop the child's organisational, study and problem-solving skills
- Involve goal setting
- Offer the parents or carers group-based training in parental skills. This should take place on a monthly basis, over the same time period described above for the children). The sessions should:
- Focus on stress management, communication skills to help develop the child's social-cognitive and problem-solving skills
- Advise on how to set targets for behaviour and establish age-related rules and expectations for their children.
Recommendation 5
Who is the target population?
Vulnerable and disadvantaged children and young people aged under 25 who are problematic substance misusers (including those attending secondary schools or further education colleges).
Who should take action?
Practitioners trained in motivational interviewing.
What action should they take?
- Offer one or more motivational interviews (see glossary), according to the young person's needs. Each session should last about an hour and the interviewer should encourage them to:
- Discuss their use of both legal and illegal substances
- Reflect on any physical, psychological, social, education and legal issues related to their substance misuse
- Set goals to reduce or stop misusing substances
