Effective Interventions Unit - Young people with, or at risk of developing, problematic substance misuse: A guide to assessment
Chapter 5: The Assessment Process
Assessment is a process, 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 the people in services and the young person. In this, and the following chapters, we set out the key messages from our evidence about an effective assessment process.
When should assessment take place?
From our evidence gathering and consultations with practitioners, we have identified the following key factors that should influence the timing of assessment:
risk assessment should start immediately, as soon as you meet the young person, and should be ongoing
in certain situations, crisis intervention should come before assessment, for example if the young person is at serious risk of harming themselves or harm by others. In these circumstances action to protect them, which may override the views of the young person, needs to be considered.
young people can have a different perception of time from adults. At the first meeting, explain the process and the likely time involved. Be aware that what the worker sees as 'urgent' may not be the same for the young person.
the assessment process has to be flexible to accommodate changes in the young person's life. Young people are often in situations that can, and do, change very quickly.
the assessment process should allow information to feed out to others at the appropriate times ( see Chapter 8, Information Sharing)
assessment can be a lengthy and ongoing process, although it need not be. It is important, however, to allow enough time for the assessment.
there has to be an end point (for example, an Action Plan, or a decision on no further work)
assessment should allow for regular review ( see Chapter 9)
How should the assessment process be conducted?
The assessment process should:
go at the young person's pace, rather than be bound by strict time-frames. However, in some cases assessment may have to operate to tight timescales, e.g. a report for a Children's Hearing or a report for a court.
be explained to the young person, so they understand what is happening. The initial contact is crucial. For example, the young person will be assessing the worker, so how the worker is perceived is crucial.
avoid too many questions at the initial meeting. Workers need to be familiar with the potential issues to be addressed with the young person. They also need to judge what is appropriate to ask and when.
empower the young person to be an active participant in the process
focus on strengths as well as weaknesses. No matter how difficult their circumstances, most young people have attributes and aspirations.
explore ways of offering assessment in a more creative way, rather than simply presenting a series of forms to complete. This can be particularly important when literacy is a barrier for the young person.
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 possible that the young people may feel the need to either underplay or overplay their substance use to influence the response. They may be looking to get a particular type of treatment, care or support. 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 will be.
Who should be involved in the assessment process?
From our consultations with practitioners and other evidence we have identified a number of people who may have a part to play in the assessment process. Exactly who is involved will depend on the individual needs and circumstances for the young person. This strongly suggests, however, that there should be one person who acts as a co-ordinator of the assessment process even if that person is not the main assessor.
Who | When |
Most importantly, the young person (interactive involvement, not passive) | Always |
Skilled, and trusted, individual(s) to undertake, and co-ordinate, the assessment | Always - although the main assessment role and the co-ordination may be carried out by different people |
A key worker | Where appropriate |
An advocate or a support person for the young person. This could be someone from an advocacy service, or a friend, a family member or a trusted worker. It is important that this is someone of the young person's choice. | When a young person asks for support or when it is clearly identified as a need for the young person. E.g. where a young person may have difficulty communicating or lacks confidence to express themselves. |
Parents and carers (and perhaps other family members) | Where appropriate. |
Other individuals/agencies such as: the young person's school, social work and psychiatry. | Where appropriate |
And input from workers with previous involvement with the young person | Where appropriate |
The young person
One of the key messages from our evidence gathering is that, if the assessment process is to be effective, it should be person-centred and client driven. The objective is to design treatment, care and support to match assessed needs of the young person. There are concerns across agencies and among families that often young people are referred to the services that are available.
It is important to make sure that the young person is 'on board' and continues to be 'on board'. The young person needs to see assessment as a process they are helped through and not a process which is imposed upon them. The young person should be at the centre of the assessment and feel ownership of the process. The challenge is to give the young person the opportunity to identify their own goals and aspirations while keeping assessment realistic and not creating expectations which cannot be delivered.
At the end of the assessment process, the outcome should be an Action Plan developed with the participation of the young person. It should set out the young person's assessed needs, attributes and goals, the agreed interventions and the support required to deliver them, and arrangements for review ( see Chapter 9). The final key step should be for the Action Plan to be signed both by the young person and either the worker who has taken the lead in the assessment or the key worker (depending on local protocols).
The person(s) conducting the assessment
As noted above, the relationship between the young person and the individual undertaking the assessment is crucial ( see Chapter 4, Effective Engagement with Young People). It may be that the young person forges a relationship with a particular individual who would not, in other circumstances, be responsible for the assessment. Within the service, or services, who are engaged with that young person, it may be worth giving consideration to the part the trusted individual could play in the assessment process. This might mean that someone takes responsibility for co-ordinating the assessment process and identifying and guiding the activities carried out by other workers. In some cases, there will be training and development issues to be addressed.
Key workers
A key worker can provide a single point of contact, offering the young person access to information, support and services to meet their needs. A key worker can be both a source of support for young people and their families/carers and a link by which other services are accessed and used effectively. Following assessment, a key worker will have responsibility for working together with the young person and their family, and with professionals from other services, and for ensuring delivery of a care plan.
The use of the term ' key worker', and the role performed by that person, varies. Sometimes the 'key worker' is referred to as the 'care co-ordinator'. These terms have specific meanings in different services. The terminology used is not as important as the role they play. A key worker can mean the person from a service who is responsible for specific treatment, care and support but he/she may not have the responsibility to co-ordinate a range of interventions. There is a corporate responsibility on all those involved in the care and support of a young person to ensure that the care and support provided is as seamless as possible. To operate effectively, the key worker needs to be aware of, and be able to communicate with, other agencies. There needs to be strong inter-agency support mechanisms to ensure that the respective roles of all agencies are clarified and delivered. The evidence suggests that there should be a care co-ordinator, who has been agreed with the young person and other agencies involved.
Advocates
Some young people will feel uncomfortable about speaking about their background, their situation and the problems they are experiencing. They may lack confidence or they may find it difficult to articulate their feelings for a number or reasons. In these circumstances it may be appropriate for the young person to be offered access to an advocate who could help them through the process and help them express their feelings and views. 'Advocacy for Drug Users: A Guide' (EIU 2004) sets out the principles of advocacy and who might take on an advocacy role. It also considers, although briefly, advocacy services for young people. The guide can be downloaded at http://www.drugmisuse.isdscotland.org/eiu/pubs/eiu_076.htm
Parents/carers
A parent, carer or other family can play an important role in supporting a young person (EIU 2003). They can contribute to the effectiveness of the assessment process. 'Integrated Care for Drug Users ' recognises that there may be additional information to be gleaned from family members, friends or other people in close contact with the individual. At the same time, however, there will be situations where they have contributed to the young person's problems and are unwilling to offer support. The views of the young person should be taken into account when establishing the potential role of parents and carers, and other family members. Also, there will be decisions to be made on when is the right time, in the circumstances, to involve parents/carers, and whether they should be present during the young person's assessment, or should be spoken to separately. There are various issues and considerations associated with parental/carer consent to treatment and their rights of access to information about the young person ( see Chapter 8)
If the young person wants his/her parent(s) and family to be involved , it is important that this starts as soon as possible and ideally at the time of the assessment. Parents and family are likely to be the key supports for the young person through treatment, care and support and long after that process has been completed. They need to understand what treatment is being given, the consequences and the expected outcomes. This will help the family to understand what their role is and what signs or symptoms to look for throughout the process.
Family and carers may themselves need support. The strains on the family and siblings of a young substance misuser are enormous. The family may be the source of support 24 hours a day and 7 days a week. 'Supporting Families and Carers of Drug Users: A review' (EIU 2002) identifies the needs of families and carers and the support which may be appropriate. The Scottish Network of Families Affected by Drugs (SNFAD) has been established to help address the needs of families affected by drug use.
SNFAD Recommendations share information between services to avoid reassessment involve parents and family if the young person wants this. Generally parents and families do want to be involved . Their support is crucial to a successful outcome. make services flexible e.g. different types of workers, range of treatments and 24/7 care and support is required with adequate holiday and weekend cover. set up a drop-in centre with a comfortable, welcoming atmosphere to encourage young people to relax and be at ease during the assessment process. Contact: p.krausen@btopenworld.com
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The SNFAD representatives reported some negative experiences of assessment processes. They reported that parents often feel excluded yet are expected to be the key supports for the young person. They also reported experience of multiple assessment because information was not effectively shared amongst services nor was information passed on to new workers.
Other individuals or agencies
Identify other individuals or agencies who should contribute to the assessment. The young person should know who will be involved in the assessment. For example, the young person ought to be aware if a teacher is to be approached. The young person's consent should be sought to the sharing of information about them with other agencies or individuals, except where child protection concerns override this ( see Chapter 8). Examples of other individuals/agencies are:
Teacher (e.g. form teacher or the teacher with whom they can relate best)
Educational Psychologist
Psychiatrist
Health Visitor
GP
Youth Worker
Social Work (including criminal justice social work)
Drug/Alcohol Support Worker
As well as identifying the agencies or organisations who should be involved, it is important to get the right person.
Agencies/individuals previously involved
It may, or may not, be appropriate to involve the referrer in the assessment. This may be important at the initial assessment stages. The referrer may already have built a good relationship with the young person who may feel more confident about meeting a new worker if there is a familiar face around.
Skills and knowledge of workers
Those involved in the assessment need to recognise that different people are going to have different views. For example, what a parent or carer sees as 'problematic' can differ from the views of a young person. Both views, however, are important. Similarly the worker's views may differ from those of the young person.
The person undertaking, or co-ordinating, the assessment should attempt to reconcile the different views (e.g. come to agreement on priorities and objectives for the young person). Differences in opinion should be recorded.
Chapter 4 provides a checklist of skills and knowledge required of all individuals working with young people. The checklist below (adapted from the SCODA guidance 'Assessing young people's drug taking: Guidance for drug services' to reflect EIU consultations) details the additional skills and knowledge that will be required of professionals involved in assessment of young people's substance misuse and wider needs.
'Integrated Care for Drug Users' highlights the need for staff to have "access to regular training in the competencies appropriate to the level of assessment they are engaged in" including opportunities for "multi-disciplinary training…… to support the development of joint working on information sharing". With regard to drugs and alcohol training, the Scottish Training on Drugs and Alcohol Agency (STRADA) delivers training across Scotland to all professionals in health, social, education, police and prison services, pharmacist and non-statutory organisations. See http://www.projectstrada.org/website/
CHECKLIST All professionals undertaking assessments must: be competent and trained to a standard which allows them to complete the task effectively have an in-depth knowledge of substances and substance-related problems take account of the rights and cultural and spiritual background of the young person have an understanding of issues of client confidentiality and consent, including local information sharing protocols be knowledgeable about local service provision for young people and be able to refer the young person on to these services. In Chapter 8, Information Sharing we describe how local directories of services can assist this process be able to liaise with colleagues in other agencies in order to identify the most appropriate service(s) for the young person.
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