SERVICE SPECIFICATION

FOR 

THE PROVISION OF A COMMUNITY BASED YOUNG PEOPLE’S SUBSTANCE MISUSE TEAM ON THE ISLE OF WIGHT

2010 – 2012

COMMISSIONED BY

THE ISLE OF WIGHT 
DRUG AND ALCOHOL ACTION TEAM 

TABLE OF CONTENTS

		Page	
1.		Aims and desired outcome of the service	3.	
2.		Service Principles	5.	
3.		Aims and Objectives 	6.	
4.		Eligibility Criteria 	7.	
5.		Service Philosophy 	9.	
6.		Services to be Provided 	9.	
7.		Operation of the Service 	11.	
8.		Diversity, Ethnic and Cultural needs 	17.	
9.		Direct Service Provision 	18.	
10.		Staffing 	22.	
11.		Quality of Service 	23.	
12.		Record Keeping	23.	
13.		Outcome domains 	25.	
14.		Performance targets 	26.	
Schedules and Appendices 	
Appendix 1	Service User Rights 	27.	
Appendix 2	Legislative Requirements	28. 	
Schedule 1 	Young Persons Drug Strategy Targets	30.	
Schedule 2 	Monitoring of the Service	31.	

SERVICE SPECIFICATION

FOR THE PROVISION OF COMMUNITY BASED SUBSTANCE MISUSE TEAM ON THE ISLE OF WIGHT

1.0).	AIMS AND DESIRED OUTCOMES OF THE SERVICE

1.1	In November 2008 the National Treatment Agency (NTA) published “Guidance on commissioning young people’s specialist substance misuse treatment services” which set out a new definition of young people’s specialist substance misuse support to be applied across all local areas.

The key message within the document is that: 
“The evidence is clear that young people’s substance misuse contributes to a wide range of other serious problems experienced by teenagers, such as failing or falling behind at school, involvement in crime and anti-social behaviour, becoming a victim of crime, teenage pregnancy, mental health problems, as well as risks of overdose and future drug dependency.”

1.2	The drug strategy and the children’s plan together with the Youth Alcohol Action Plan and Youth Crime Action Plan support the ambitions set out in Public Service Agreements: PSA 14, to “Increase the number of children and young people on the path to success”, this target sets out in more detail how local areas can best approach reducing young people’s substance misuse, alongside other linked issues for young people.

1.3	As patterns of drug, alcohol and volatile substance misuse by young people vary greatly from place to place, the government is moving towards a flexible approach driven by local needs. The achievement of the above PSA will be supported by the following main delivery levers:
o	The substance misuse indicator in PSA 14 (NI 115)
o	The effective treatment indicator in PSA 25 (NI 40), which also applies to those aged 16 and 17
o	Performance management of local areas by government offices against designated targets within Local Area Agreements
o	Performance management of Primary Care Trusts (PCT) by Strategic Health Authorities against indicators in local PCT delivery plans

1.4	Most young people can have their needs met in universal or targeted services. However, access to specialist substance misuse support is required for all young people whose functioning is greatly impaired by substance misuse, and who have been assessed as requiring specialist substance misuse interventions to meet their needs.

1.5	Government departments recognise that only a small proportion of young people require specialist substance misuse interventions, nevertheless these young people are unlikely to achieve the five Every Child Matters outcomes without effective and accessible specialist treatment in place. The integrated children’s system requires clear criteria for specialist services to distinguish which children and young people require these services. In order to achieve a more consistent approach to provision across the country, the following definition has been developed:

“Young people’s specialist substance misuse treatment is a care planned medical, psychosocial or specialist harm reduction intervention aimed at alleviating current harm caused by a young person’s substance misuse.”
 	
1.6	The Children’s Trust partnership is key to integrated commissioning across children’s health, and to encouraging collaboration between commissioners and an increased efficiency in the use of budgets and resources. Some specialist substance misuse interventions for young people could yield genuine cost and resource savings with improved integration.

1.7	Effective substance misuse strategies will both contribute to and benefit from other strategies, agendas and indicators locally including:
o	Targeted Youth Support
o	Participation in positive activities
o	First time entrants to the youth justice system
o	Community safety
o	Parent and family support
o	Not in Education, Employment or Training (NEET) 
o	Permanent school exclusions
o	Staying safe.

1.8	Young people who require specialist substance misuse interventions often have a range of other problems and may be difficult to engage in services. Substance misuse can impact on all five of the outcomes for children (DfES, 2006) and it is therefore vital to engage young people with services to alleviate the harm that substance misuse can have on a young person’s life.

1.9	Some young people with substance-related issues have a number of complex needs that require services from other specialist teams and integration is essential. If commissioning is not effectively integrated it can fail to deliver the right outcomes; not meet the young person’s needs; and use resources and services inefficiently. If commissioning is isolated it may form an inadequate picture of an individual’s difficulties and identify a limited range of responses and treatments. The integration between specialist services, targeted support and universal services provides opportunities to intervene earlier and provide focused, effective support.

1.10	A sound local needs assessment and a strategic plan, occurring on an annual cycle are the basis of sound commissioning processes and the DAAT work with other key partners and agencies each year to develop a detailed Young Person Needs Assessment to inform the Young Peoples Treatment Plan for submission to the National Treatment Agency (NTA).   

1.11	The performance of the Isle of Wight DAAT is to be measured against targets set by the NTA and set out in Section 14.0 below. In response to meeting the national and local agenda the DAAT wishes to commission a Young People’s Tier 3 service to meet the targets of the national strategy at a local level.

1.12	As set out in Outcome Domain (Section 14.0) below, the emphasis for an effective Substance Misuse support system is around the achievement of both planned exits and successful outcomes. Therefore the attainment of these will be a key delivery target for the Commissioner in 2010 to 2012 and beyond and a performance target for the NTA and other funding agencies.  

2.0	SERVICE PRINCIPLES
2.1	The Service is underpinned by the following 10 key Policy Principles (SCODA/CLC, 1999. Young People and Drugs: Policy Guidance for Drug Interventions)
o	A child or a young person is not an adult.
o	The overall welfare of the individual child or young person is of primary importance.
o	The views of the young person are fundamental and should always be considered.
o	Services need to respect parental responsibility when working with a young person.
o	Services should recognise the role of, and co-operate with, the local authority in carrying out its responsibilities towards children and young people.
o	A holistic approach, taking account of psychological, physical and social factors that can affect a person, is vital at all levels as young people's problems tend to cross professional boundaries.
o	Services must be child centred.
o	A wide range of services should be provided.
o	Services must be competent to respond to the needs of the young person.
o	Services should aim to operate according to the principle of good practice.
 
2.2	Information on the Services provided will be made available to eligible residents of the Isle of Wight in such a way as to promote equality of access across all Young People in the community.

2.3	The support and intervention process shall be underpinned by full and effective assessment of need, continuous monitoring and review and take into account Service Users individual health needs within a holistic context.

2.4	The Services provided will primarily aim to minimise the harm of substance misuse to service users and others.

2.5	Care and support shall be evidence based and monitored through robust clinical governance arrangements to ensure the effectiveness and quality of Services.

2.6	Services shall be provided in a non-discriminatory, non-patronising and professional manner in a way that demonstrates courtesy and respect for individuals misusing substances, and empathy with their personal situation and experiences and will deal sensitively with the issues relating to confidentiality, harassment and discrimination

2.7	Services shall positively respond to cultural, religious, language, gender, sexuality, and disability, age and communication needs of service users 

3.0	AIMS AND OBJECTIVES OF THE PROJECT

3.1	The main aim of the Service is to provide a comprehensive and integrated Tier 2 and Tier 3 Substance Misuse Service offering comprehensive assessment, individualised packages of care and interventions based on the needs of Young People.  

3.2	The main objective of the Service is to decrease the level of substance use among young people under 19 (and where applicable Young People up to the age of 24 – as set out in Section 4.1 below) on the Isle of Wight, and reduce the level of harm related to substance use amongst this group.

3.3	Additional objectives of the Service are to:
o	contribute towards a partnership approach with other stakeholders in delivery of an integrated substance misuse service, crosscutting levels of need, for Young People on the Isle of Wight
o	maintain a holistic approach to working with Young People, addressing complex and often multiple needs, not limited to substance misuse problems
o	re-integrate and include the young person into his/her family, community, school, training or work 
o	seek to attract; engage; assess; develop programmes; and retain in treatment those Young People who are most at risk of harm due to their substance misuse 
o	work towards reducing the harm and potential for harm of substance misuse by Young People and encourage or promote abstinence where appropriate
o	work with Young People from diverse communities within the Isle of Wight and their parents or carers in relation to their needs
o	develop and maintain referral and liaison arrangements including, where necessary, the undertaking of appropriate training and protocols with mainstream agencies responsible for providing tier 1 and 2 advice and information services to Young People
o	respect the wishes and views of Young People insofar as this is consistent with the principle of harm reduction
o	at all times recognise, respect and maintain professional boundaries when working with Young People and/or their families and carers
o	continuously monitor and evaluate service provision to ensure, as far as possible, that the service is appropriate and accessible
o	provide training and advice for Tiers 1 and other tier 2 substance misuse service providers who provide services for Young People
3.4	The desired outcome of the Service will be to reduce the adverse affects of substance misuse on the development of Young People’s social, education and emotional growth and progress 

4.0	ELIGIBILITY CRITERIA

4.1	The Service will be available for all children and young people who meet the following eligibility criteria:
o	They are under 19 years of age
o	It is accepted, however, that in some circumstances the transition to adulthood may not occur in line with the standard age range and for some Service Users maturity will be delayed e.g. those with learning difficulties; mental health issues or for those young people not emotionally ready to engage in adult services. For these individuals support may need to be provided until the age of 24     
o	They shall be resident in or have a significant connection with the catchment area.  Significant connection will be based on the local authority definition of ‘ordinarily resident’. The catchment area covers the Isle of Wight DAAT area.
o	They have mild – moderate, or moderate to severe problems related to substance misuse, best addressed by a Tier 2 and Tier 3 service. Substance taking, which harms health or social functioning, is described as drug misuse. It may cause dependency (physical or psychological) or drug taking which is part of a wider spectrum of problematic or harmful behaviour (HAS 1996). Substance misuse will require support and appropriate interventions.

4.2	The term ‘drug’ is used to refer to any psychotropic substance, which includes illegal drugs, alcohol, illicit prescription drugs, and volatile substances (HAS 2001). Drug taking is the consumption of any legal or illegal drug (SCODA/Children’s Legal Centre 1999) and refers to both drugs and alcohol. 

4.3	Any Young Person can access the Tier 2 service if they have a drug problem or are concerned about a drug problem. A Young Person will be considered eligible for a Tier 3 services if their needs meet more than one of the following criteria:
o	The Young Person regularly presents as incoherent following use of drug and/or alcohol
o	The Young Person perceives that drug use is affecting their daily life
o	Their substance use is dangerous, i.e. likely to lead to overdose
o	Cannabis use is affecting daily life
o	They participate in heroin, crack, cocaine, amphetamine or volatile substance using
o	They are injecting drugs
o	The Young Person is only receiving needle and syringes from a pharmacist
o	The Young Person requests safer injecting advice
o	Their substance use is causing or contributing to health problems
o	Their substance use is contributing to mental health problems
o	There is a need for comprehensive assessment of substance misuse
o	Pregnant young women
4.4	Transition to Adult Services 
If the transition to adult services is not readily available when a Young Person reaches the age of 19, the Service will continue to support the Young Person until such time a smooth introduction into adult services is planned. Alternatively, if this is not acceptable to the young person their choice to remain with the service will be extended up to a maximum of 12 months by agreement with the Service Lead
During 2010-11 the DAAT is to recruit to a designated Transition Worker post located within the Young Peoples Substance Misuse Service. This post will work with the Service and Adult Providers to enable a smooth and easy transfer between Services. This post is time-limited and will cease in March 2011 unless alternative funding streams are identified. 
4.5	Exclusions to the Service
o	Young people approaching the Service aged over 19, and Young People who have no significant connection with the Isle of Wight. 
o	Service Users from outside the catchment area will be referred to their respective specialist agencies.  
o	In exceptional cases, Service Users from outside the catchment area may be accepted, dependent on their particular circumstances, and with the agreement of the Commissioners

5.0	SERVICE PHILOSOPHY 

5.1.	Privacy, dignity, independence, choice and rights of every Service User should be taken into account at all times (Appendix One).  The Provider will ensure the Service is provided to the Service User in accordance with the rights of the individual bestowed by the Human Rights Act.

5.2.	Independent – The Service should be free from influence from the providers of health or social care and have no conflict of interest.

5.3.	Empowering – The service should always support the Service User, which would involve support to enable them to speak for themselves, or (if the Service User is not able to do this) represent Service User’s views as if they were their own.  This should enable Service Users to grow towards advocating for themselves.

5.4.	Inclusive – The Service should recognise the diversity of eligible Service Users and ensure no-one is prevented from accessing the Service because of a difference in language, culture, disability or capacity.

5.5.	Confidential – All discussions should be treated confidentially.  Confidentiality should only be broken when a Service User discloses information that puts them at risk of harm to themselves or others 

6.0	SERVICES TO BE PROVIDED

6.1	The Service will comprise a multi-disciplinary team, providing a Tier 2 open access and Tier 3 specialist service for Young People offering a range of community based initiatives and interventions. 

6.2	Treatment is defined as an intervention which is intended to remedy an identified problem or condition in relation to an individual’s physical, behavioural and psychological well being. Treatment and Assessment will be undertaken in line with the guidance and principles as set out in “Assessing Young People for Substance Misuse”

6.3	The Common Assessment Framework (CAF) for young people has been designed by DfES (2006a) to help deliver frontline services that are integrated and focused around the needs of Young People. The CAF is intended to promote early and more effective identification of needs, particularly in universal services. It is intended to provide a simple process for a holistic assessment of young people’s needs and strengths, taking account of the roles of parents, carers and environmental factors on their development. However, it is not intended that all young people are assessed with this tool; rather it can help practitioners assess young people with a range of needs that prevent them reaching their potential in terms of the Government’s five outcomes.  The CAF is a shared assessment tool used across agencies in England. It consists of:
o	A pre-assessment checklist that practitioners may use to help decide who would benefit from a common assessment
o	A common process to enable practitioners to undertake a common assessment and act on the result
o	A standard form to help practitioners record and, where appropriate, share assessments, plans and recommendations for support.

6.4	Substance misuse, along with many other specific behavioural and medical conditions, is not specifically mentioned in the tool. It is, however, expected that any issues young people may have will be discussed, as the tool leads the practitioner through aspects of their lives. Where explicit issues have been identified through the CAF (such as a mental health or substance misuse problems) it is expected that a specialist assessment will take place.

6.5	The Service will work closely with Young People and with partner organisations in the delivery of an integrated care pathway approach in providing appropriate services for young people at all levels of need.

6.6	A specialist substance misuse assessment is not a holistic assessment, but may form part of one. Specialist assessments are defined by Models of Good Practice in Joined-up Assessment: Working for Children with Significant and Complex Needs (DfES, 2006c) as:
o	Having a much more specific purpose (for example, assessments under section 17 of the Children Act (1989), where the main purpose is to determine whether children are in need and if they and their families require services; and Asset, where the main purpose is to assess the risk of offending)
o	Undertaken by staff from a particular service or sector
o	Generally performed only by staff of a particular occupational or professional group
o	Done with children with known issues or where there are specific or acute concerns.

6.7	Unless a young person contacts a specialist substance misuse service directly, or via a parent, specialist substance misuse assessments should only be undertaken where a substance related screening has identified needs that cannot be met by the agency conducting the screening.

7.0	OPERATION OF THE SERVICE

7.1	The Service will be managed by the Isle of Wight DAAT and will have an identified base. The preference is that this base will allow access by Young People at all times however dependent upon circumstances it is accepted that such access will not be possible e.g. through co-location with an Adult Service. 

Premises will comply with fire, health and safety requirements. The Service will also be responsible for the furniture and fittings and environment of the premises, which will be kept clean and maintained to a high quality standard. The general environment of the accommodation will be young person centred and age relevant.

7.2	In addition to the services provided from the Service base, the Service will work from selected satellite sites within the catchment area to improve access to services by young people in the community who are currently geographically or socially excluded from existing provision.

7.3	The Service will provide the following interventions: 

•	Multi-disciplinary assessments
•	Co-ordinated care pathway plans
•	One to one specialist key work support as a vehicle for change
•	Access to motivational structured therapies
•	Age appropriate information and advice
•	Health screening (with a referral to health agencies / professionals as appropriate)
•	Mental health support
•	Health promotion
•	Relapse prevention 
•	Child Protection service
•	Offending behaviour
•	Co-working with providers from other tiers or disciplines
•	Onward referral 
•	Outreach targeting social exclusion
•	Information and training for other front line workers providing substance misuse services for young people and for allied services

7.4	The Service will work  closely in partnership with the following services:

•	Tier 1 and 3 local substance misuse services for young people
•	Local substance misuse services for adults
•	Children and families services (Social Services)
•	Child and Adolescent Mental Health Services (CAMHS)
•	Local Safeguarding Children Board (LSCB) and Child Protection services
•	Youth services and youth workers
•	Connexions
•	Young people’s advocacy services
•	Youth Offending Team and Youth Offending Institutes
•	Schools and colleges	
•	Police
•	Secure Units
•	Local allied voluntary organisations
•	Sexual Health Services
•	GPs and primary care services
•	Housing Dept.

7.5	Management of the Service
The Service will be managed by the DAAT Commissioner, who will support the strategic development and governance arrangements within the Service.

	The day to day management of the service will be overseen by the Young People’s Substance Misuse Service Leader who will: 
o	Take the operational lead for the integrated Service
o	Provide day to day operational line management of all staff, 
o	Provide or ensure appropriate professional supervision for team members
o	Support the goals, targets and objectives of the Service

7.6	Integrated working
 The Service provided will comprise of a multi-disciplinary team of specialist drug workers including staff from the YOT. The Service will work towards the objectives of an integrated service which are:
o	Reduction of duplication; increases in efficiency;  increases in productivity
o	One stop shop for service users
o	Elimination of multiple lines of responsibility 
o	Provision of whole systems approach focussing on young people’s needs

This service specification relates to integrated service as a whole, and is generic in application to all aspects of the service delivery and staff who are team members from the different disciplines and professional backgrounds. There will be secondments from the team to the YOT.

7.7	Service opening times
The Service core operating times / administration hours will comprise:

9.00 a.m. – 5.00 p.m. Mondays to Fridays

Hours will be extended flexibly to include home visits and occasional weekend working, in response to need. Should regular out of hours working take place and deemed worthwhile, the resource implications will be discussed with the Commissioner. 

7.8	Satellite working hours shall fit in with the contingency needs of young people and the opening hours of site host agencies. Sessions will be planned to run at a time which optimises uptake by target groups.
 
7.9	Reception
The Service base should provide a warm, user-friendly, informal reception area for Young People who call in or arrive for appointments. The reception will be staffed during the Service’s opening times by trained and informed staff members who are aware of problematic substance misuse and who have an understanding of Young People. 
 
7.10	The management of the reception area will ensure that conversations are confidential and any follow up assistance remains discrete.

7.11	The Service will stipulate that substances will not be allowed inside the building, and that there will be respect shown for others. The Service will retain a flexible approach to Young People accessing the Service base and will also have the discretion to exclude young people who are putting others attending or working at the Service at risk and make alternative arrangements for their ongoing support. The Service will clearly communicate that any Young Person presenting to the Service in an intoxicated state, and/or under the influence of drugs, will be denied engagement on that occasion. 

7.12	Referrals
Tier 2 services will be provided on an open access basis. Tier 3 services will accept in-house referrals only. Referrals to the Service will have been completed on a standardised referral form by the referring agency. This will also act as a screening assessment and provide information to the Service for an ongoing assessment of need to determine their level of care. Referrals should include the Young Person’s consent to the referral.

7.13	Following the receipt of an appropriate referral, including the informed consent from the Young Person for contact by the Service to be made, efforts will be made to make contact within 5 working days either by phone - if a number is available - or by post if not. 

7.14	Once contact has been established the Service will endeavour to engage with them and make an appointment for an assessment

7.15	Should a Young Person not respond to an initial contact for engagement, then at least two further attempts should be made using several different contact mechanisms (dependent upon information received)

7.16	Should a Young Person be using substances problematically, or if other risk factors are identified, then ongoing efforts at engagement must be continued.  Should their needs be considered lower risk,  a final letter will be sent to the agency who referred them asking them to pass on an ‘an open door’  invitation to contact the Service at a later date.  

7.17	Appointments
Generally, initial appointments will be made at a venue chosen by the Young Person. This could be at a satellite venue, or other community base, custodial setting or at the Young Person’s home, when it is considered safe to do so.

7.18	Waiting list
As the ethos of the Service is to provide timely access for Young People then should demand for assessments outstrip capacity the Service will inform the DAAT Commissioner immediately, so that remedial action may be jointly considered. 

7.19	Triage Assessment
At the initial appointment, the worker, with the Young Person’s consent, will undertake a triage assessment to determine: 
o	Their levels of risk and priority
o	Brief assessment of their drug misuse problem
o	Brief assessment of their motivation to engage in treatment
o	Whether they are suitable for partner agency drug services
o	Whether they are suitable for a service other than substance misuse
o	Discharge completely 
7.20	Multi-disciplinary team meetings and allocation
Completed triage assessments will be discussed at key worker meetings. At these meetings, key workers will be matched with Young People needing a further full assessment. Appropriate onward referrals will be made (with the consent of the Young Person) to other agencies, and, if necessary, the referring agency informed. 

7.21	Full Assessment
The Service will attempt to commence the full assessment within 15 working days following referral. The key worker will discuss with the young person issues over confidentiality and consent for under those 16 year old; and the Service expectations / requirements; prior to the assessment taking place.

7.22	The completed assessment will indicate:
o	The support needed by the Young Person
o	What the Young Person wants from the Service
o	Changes the Young Person wants to make/areas of concern
o	Immediate needs
o	Long term needs

7.23	The full assessment will be discussed at a further  multi-disciplinary team meeting and will lead to one of three outcomes:
o	Contact will terminate
o	Onward service referral elsewhere
o	Taken on by the Service for goal setting, care planning and package of care
If appropriate at this stage, onward referrals will be made (with consent of the Young Person) to other appropriate agencies, and the referring agency informed. 

7.24	Care Planning
The goals of the care plans will be set with the young person. Care plans will be person centred and cover: harm minimisation with substance using; awareness raising; keeping safe; reducing parental anxiety where appropriate; and will set targets.  A core goal will be to tailor the care plan to individual objective around substance using, and then to look at other individual needs. Care plans will seek to improve the Young Persons care pathway journeys and may include:
o	Harm reduction / Reduction of risks to health
o	Engagement in primary care services/health promotion
o	Promotion of self esteem
o	Social and interpersonal relationship
o	Engagement into social/educational re-integration
o	Aftercare support

7.25	Key working
Key workers will be experienced team members able to provide solution-focused interventions (cognitive behavioural therapy), motivational interviewing, and give support with goal achievement and review and monitor progress.  

7.26	Key workers will aim to meet with the Young Person initially at weekly, as appropriate, according to need.  Sometimes this will be more if they are chaotic; this will tend to apply to those who are over 19 and engaged with the Transition Worker and on a script. 

7.27	Key workers shall receive regular training and clinical supervision, based on NTA guidelines, from an appropriately experienced, qualified senior working in, or contracted to the Service. 

7.28	Care Programme Approach – Mental Health
Where a Young Person has been assessed as needing an enhanced care co-ordination approach because of mental health needs, it is expected that they will be under the care of a team member of the Child and Adolescent Mental Health Service (CAMHS), who will have a legal responsibility for care-co-ordination.  The services will then work in an integrated way according to the needs of the Young Person. 
 
7.29	Reviews of care plans
The frequency of review of care plans will be dependent on the intervention and support programme but shall occur not less than three-monthly. In general, reviews will be conducted shortly after commencement of the care plan and midway through any intervention.  A review will also be conducted prior to attainment of goals, and the timing will take into account the need to set up aftercare arrangements. Young people with Dual Diagnosis on a Care Programme Approach (CPA) will be governed by CPA regulations. 

7.30	Key workers will co-ordinate multi-agency reviews, and will attend reviews for the young person, set up by other professionals.

7.31	Early discharge
Where a Young Person decides to leave the Service against medical advice, an assessment shall be made to determine if they are fit to be discharged, and if necessary, a mental health assessment may be required.  If a Young Person exits the Service themselves, they should be given information on harm reduction and their GP should be informed immediately it is known that they are leaving the Service.

7.32	Service Users who breach their contract with the Service, and as a result are required to leave the programme, should not be left in a vulnerable situation. The Service must ensure that co-workers, their GP (if appropriate) and any other requisite agency are contacted, and action is taken to ensure the Young Person is, as far as possible, in a safe environment. 

7.33	Child Protection 
All workers in the Service will be trained and familiar with the current locally agreed child protection policies and procedures and will, at any time during a Young Person’s assessment or interventions notify child protection services should any concerns be identified.  Any operational policies drawn up by the Service relating to child protection will need to be agreed by the Children’s Board and be in line with HAS and policy standards.

7.34	Parental/legal guardian involvement
  The Service should have policies and procedures relating to the involvement of parents and legal guardians for all aspects of service provision. These polices shall be based on legislation regarding legal parental/guardianship; consent issues; competency to consent to treatment; child protection; and good practice in involving parents and guardians in the assessment and care planning process. 

7.35	The Service shall provide substance misuse related information and advice to families, parents and others closely involved with the Young People, to equip them to manage and support the Young Person with their care plan and encourage the development of protective factors against relapse. General advice, information and support for parents and carers for their own needs will be provided through a Tier 2 services.

8.0	DIVERSITY, ETHNIC AND CULTURAL NEEDS

8.1	The needs of a Service User arising from specific ethnic, religious or cultural requirements must be identified in his or her plan.  The services of an interpreter must be used at initial meetings wherever English is not the first language and there is any doubt that the Service User understands what is said.

8.2	If requested the Provider must ensure Service Users are put in contact with an appropriate representative of the religion of their choice.

8.3	The Provider is expected to take positive action to combat discrimination on the grounds of:
•	race, colour, ethnic or national origins
•	disability
•	gender 
•	HIV status 
•	age
•	income level 
•	marital status
•	religious beliefs 
•	responsibility for children or dependants
•	sexuality  

8.4	The service shall operate an Equalities Policy Statement with regard to service users, which covers discrimination on the basis of gender, disabilities, age or sexual orientation. This list is not exhaustive and must also cover those young people who experience discrimination in areas such as ill health or social exclusion.

9.0	DIRECT SERVICES PROVISION

9.1	Workers within the Service may include a range of practitioners from the following disciplines:  Mental Health, paediatrics, education, YOT and social services - competencies will be aggregated 

9.2	Partnership working
It is essential to the provision of a comprehensive care plan for Young People that in addition to the multi-disciplinary team, the integration of services from different agencies will contribute jointly to the pathway of care. The Service will participate in partnership working with other agencies and endeavour to make their services transparent and ‘user friendly’. This may involve:
o	Development of closer working protocols with Children’s Services, Youth Services and Connexions within the catchment area
o	Working towards the development of consistent screening processes and working protocols with the YOT 
o	Joint working with individual cases with the core CAMHS service
o	Two way referrals and cross working with relevant voluntary sector organisations
o	Co-operation with the Police and ‘non secure’ agencies in addressing change
o	Working in conjunction with Sexual Health Services, Teenage Pregnancy and GPs towards sustained Improvements in sexual health, physical health and life styles 
o	Development of shared care with local GP services

9.3	Interventions modalities
Open access services will be provided on a demand led basis. Structured intervention programmes will maintain a solution focussed brief, will be evidence based and will be proactive with the Young Person  

9.4	Motivational interviewing and brief solution focussed therapy 
The Service shall make clear distinction between 1-1 motivational interviewing and solution focussed interventions using cognitive behavioural therapy, necessitating counselling skills.  The Service will provide brief interventions using these tools as the primary therapy 

9.5	Advice and Information service
The Service will, through the open access service and within the key-worker role, provide both verbal and written age appropriate information and advice routinely and responsively to Young People on a range of substance misuse issues. These will include reduction of health risks, physical and psychological health improvement and promotion, and improvement in social functioning and life context.  The key objectives of this service are to:
o	provide objective and accurate information to Young People in order to engage and motivate them to make informed decisions and address their substance misuse; 
o	facilitate and motivate them to engage in substance misuse treatment programmes, where appropriate, 
o	support parents, families and others in helping the young person.

9.6	The advice and information service will be available to Young People and for their concerned parents and families. Advice and information will also be available during working hours for Young People, their parents and other professionals through telephone access. The Service will display and distribute age appropriate literature on the risks and consequence of substance misuse.  

9.7	Relapse prevention
The Service shall utilise prevention and management strategies appropriate to Young People to maximise the possibility of maintaining successful change. These will be based on relapse management steps which enhance resolution to change, maximise the possibility of change, manage high risk situations, manage cravings and develop impulse control to those assessed as needing it in their reviews.  The Service will also, within the key-worker role, provide skills training to deal with negative symptoms and develop refusal skills to deal with social pressure. 

9.8	Practical help and support
The Service will provide practical help and support in line with the needs of each Young Person and their families or those involved with them. The expectation is that the Service will empower the Young Person to undertake practical actions regarding such actions as accommodation; accessing other substance misuse services; accessing transport; support, via their Connexions worker, with benefits application; support with Court appearances and legal obligations; registering with health services; etc

9.9	Harm reduction, health promotion and safer injecting
The Service will incorporate harm reduction and promotion of health within its direct service provision. Providing advice and information on the prevention of the spread of blood-borne diseases when disclosure of injecting is identified will be an important role within the treatment services. 

9.10	As part of risk assessment procedures, where it is known the Young Person is injecting, the Service will assess all Young People on their risk behaviours associated with substance misuse. This should include a full assessment of the following:
o	age at first injecting
o	history of sharing injecting equipment (using other people’s equipment, passing on equipment to others)
o	history of sexual risk behaviours
o	history of any previous testing for hepatitis B and C and HIV
o	Young Person’s understanding about contracting or transmitting blood-borne viruses
o	Young Person’s concerns about contracting or passing on blood-borne viruses to others
o	previous contact with other healthcare professionals relating to screening for hepatitis B and C and HIV

9.12	The Service will:
o	enable Young People to explore issues relating to their health as a result of substance use/misuse and identify ways of achieving a healthier lifestyle

9.13	It is important that the Service has a clear local protocol about the provision and access of such services and the referral pathways 

9.14	The goals of the Service’s risk reduction programme will follow Department of Health guidance which is that drug users:
o	do not start injecting
o	stop any current injecting
o	avoid initiating others
o	do not share injecting equipment or paraphernalia with others
o	pass on safer injecting advice to others.
o	link with partner agencies to identify and reduce the risks associated with young people injecting drugs

9.17	Treatment for stimulant users
The Service will develop Services for stimulant users; options to be considered for users with complex needs should cover support services which include psychosocial support, education, and advice and relapse prevention. 

9.18	Resettlement support
The Service will provide substance misuse focussed resettlement support for Young People returning into their community from custody or hospital. Programmes shall be developed in conjunction with the relevant key workers from the statutory agencies working with the Young Person and a joint work approach will be adopted.  The lead agency for the Young Person’s care plan will be established prior to the Young Person’s discharge from the establishment they have been in.

9.19	The Service will:
o	Provide a service for those individuals being released from a Young Offender Institute (YOI) or hospital and who reside in the catchment area
o	Prioritise Services for young offenders serving less than 12-month sentences 
o	Joint work with statutory drug services, YOT’s, CAMHS, and social services to prevent and address relapse, harm to the public and repeat offending
o	Deliver treatment and relapse prevention programmes which address substance misuse, improve physical and psychological health, social functioning and life context, including social inclusion and reduction of re-offending.
o	Provide support, advice and information for families, partners and others involved with the Young Person being released, leaving care or being discharged 
o	Participate in post custodial planning, where relevant with appropriate agencies

9.20	Access to Tier 1 and other Tier 2 services
Where, following assessment, it is considered that a Young Person would benefit from support from a Tier 1 or another Tier 2 service, the Service will facilitate the Young Person’s access to these, with their consent. 

9.21	GP liaison and shared care
The Service will be liaise closely with GPs in the catchment area and will try to ensure that Young People who are presenting to the Service are registered with a local GP, for health care support with their primary care needs.   

9.22	Training and advice for other services
Where opportunities and capacity permit, the Service will provide training courses for Tier 1 and Tier 2 substance misuse services for young people. The Service will also provide specialist advice in response to queries made from these services and other general enquiries from other allied services in the catchment area needing guidance. 

10.0	STAFFING

10.1	Staffing of the Service shall conform to NTA and Department of Health (DoH) standards and guidelines. Staff shall be employed under their respective nationally agreed and negotiated conditions and grades, be suitably competent and experienced and be employed in sufficient staffing ratios to permit sound professional practice and enhance the health, safety and  well-being of all Young People referred to them. 

10.2	Staff engaging in the delivery of additional services must be appropriately qualified and experienced. All staff competencies will conform to the Drug and Alcohol National Occupational Standards (DANOS) or the Common Knowledge and Skills Framework, which is accepted as DANOS compliant.

10.3	Staff recruited to the Service shall be appropriately experienced and skilled in working with Young People.

10.4	The Rehabilitation of Offenders Act does not apply and therefore all staff working in the service are required to declare any previous convictions. All staff employed by the service provider shall have been subject to an Enhanced Criminal Records Bureau (CRB) check and details shall be available for inspection by the Commissioner. If a member of staff declares or is found to have previous convictions, their employment/continued employment must be agreed with the commissioners. 

10.5	All staff must be given a structured induction into the Service, receive regular supervision and ongoing management support. They will be given opportunities for training in order to assist them in their professional development and acquisition of relevant skills.  At no time should staff exceed their level of professional ability by performing tasks or part of the service for which they are not qualified or trained

10.6	Staff who are part of the Core Service may only be used for training purposes (i.e. to give training to others) if the Service has in place full and adequate contingency cover arrangements to maintain the Service at its optimum level.  This will also have to be agreed with the Commissioners beforehand.

11.0	QUALITY OF SERVICE

11.1	The service will utilise the Quality in Alcohol and Drug Services (QUAD’s) quality assurance system to guarantee quality of provision. It is expected that the Provider will evidence compliance with this system or be able to demonstrate a programme for achieving compliance.

11.2	   The Service is required to have in place effective operational policies and procedures, which promote the well-being and safety of service users and staff. These will comply with Child Protection requirements, and, in addition, include a ‘parental involvement policy’.  Copies of all operational policies will be available for viewing by the Commissioner as and when requested. 

11.3	Policies and procedures must have clearly stated objectives; stipulate   who is responsible for the implementation of the policy/procedure and    arrangements for monitoring, review and development.

11.4	The Service is expected to comply with all relevant legislation,    regulations and statutory circulars in so far as they are applicable to the service.  

12.0	RECORD KEEPING

12.1	All service records shall comply with clinical governance audit standards. The Service will keep secure, up to date and confidential individual files on each Young Person. These should contain all relevant information such as assessment; personal plan and goals, treatment and services take up, progress reports, reviews and repeat episodes of care. The file shall be maintained in partnership with the Young Person concerned and give sufficient detail to be useful in a positive and proactive way as a tool for goal planning and key-working. 
 
12.2	The individual files shall include a record of reviews, medical details, structured care service details and services taken up, correspondence/ communication with relevant others, links with organisations and practitioners, incidents, etc.  Young People must have access to their individual records on request, in accordance with the Data Protection Act. Individual records will be kept in a neat, accurate and timely manner and will be maintained to a high standard

12.3	In addition, a suitable database, compatible with NDTMS shall be maintained and submitted monthly comprising ‘Service User’ information and an activity database. A user ID number will be allocated to each new registration, which will remain with that person throughout their current and any future Service involvement. The database for people entering into treatment with the Service provide the following quarterly dataset detail:

Service user database
o	Number of new referrals during quarter
o	Number of return referrals during quarter
o	Referral source of quarter’s referrals
o	Gender breakdown of YP attending the Service
o	Ethnicity breakdown of YP attending the Service
o	Number of young people in Tier 3  Treatment
o	Number with dual diagnosis 
o	Drugs used (primary; secondary and tertiary where appropriate; poly-drug; method of administration; stimulant use; prevalence of IV users sharing)
o	Number registered with a GP 
o	Waiting times for Services  (minimum, maximum and  average)

Activity database
o	Number receiving triage assessment from Service
o	Number assessed 
o	Number and detail of onwards referrals
o	Number with care plans drawn up
o	Numbers and types of outcomes (planned exits, disciplinary exits, self exits, number remanded to custody, referrals to inpatient care, referral to more appropriate services etc.)
12.4	Quarterly monitoring returns will be maintained and provided to the Commissioners on a quarterly basis on a workforce analysis, to comply with NTA monitoring requirements:
o	Number of  full time staff / part time staff
o	Number on permanent contract
o	Number on temporary contract or agency working
o	Number of staff vacancies
o	Case load per staff member
o	Hours of clinical supervision received per staff member
o	Hours of training received per staff member

13.0	OUTCOME DOMAINS

13.1	Outcome domains for working with Young People and substance use will be introduced in 2010/11 based on TOP Level 3 outcome data. Data around the following outcomes will be gathered for an initial period of six months, to allow baselines to be agreed with the Provider. 

TOP Based Local Outcomes 2010/11	
Required Outcomes
‘What we want to achieve’	How this will be achieved in the Treatment System
‘	
A reduction in the harm caused by substance misuse (drugs and alcohol) to individuals, families and communities 	•	Improved in TOP profile scores in relation to injecting risk behaviour and criminal activity 
•	Decrease in alcohol/drug consumption
•	Increase in psycho-social interventions
•	Develop recording around Domestic Abuse	
Improved access to treatment and care	•	A treatment system which has clear referral pathways 
•	A treatment system that supports recovery
•	Improvement in the level of access to alcohol services
•	Reduction in drug and alcohol consumption by service users 
•	Increase referrals from District General Hospitals	
Improved quality of care	•	Increased GP registration
•	Contact hours per WTE drug workers (care plan coordinator) 
•	Compliance with NICE guidelines
•	Ongoing training for both staff and partnership agencies	
Improved social functioning and reintegration for service users
including: improved employment outcomes for individuals in treatment  and improved housing status	•	Improve in TOP profile scores with reference, to health and social functioning
•	Joint working protocols with stakeholders to include housing and employment
•	Increased numbers of service  users obtaining paid work / participating in paid work or participating in voluntary work / activities
•	Improved access to training  opportunities
•	Increased opportunities to access Accredited Volunteer support programme
•	Participate in training and / or education, and where applicable achieving desired qualifications
•	Improvement in TOP housing score, where appropriate. Maintain accommodation and avoid eviction.

APPENDIX ONE

SERVICE USER RIGHTS - ISLE OF WIGHT SAFER COMMUNITY SERVICES DIRECTORATE CONTRACTS

The Provider must ensure that services are provided in accordance with the following Service User Rights:

1.	to be fully involved and informed regarding the assessment process and the provision of care in accordance with the assessed needs

2.	to retain independence and the right to make choices, to participate (or not) regarding all aspects of service delivery

3.	to privacy and dignity

4.	to a confidential service

5.	to freedom of expression, including the right to complain, request an alternative Advisor without assigning a reason, and to hold an opinion regarding the method of service delivery

6.	to a service free from discrimination, inappropriate language and bad practice

7.	to access personal information retained on file by the Provider, in accordance with the Access to Personal Files Act 1987 and the  Freedom of Information Act

8.	to facilitate access to independent Advocacy support services

APPENDIX TWO

Legislative Requirements

The Provider is expected to comply with all relevant legislation, regulations and statutory circulars insofar as they are applicable to the Services.  These include, but are not exclusive to:
Key Policy and Guidance 
•	National Drug Strategy – Drugs: protecting families and communities: 2008 (Home Office)
•	Guidance for the Pharmacological Management of Substance Misuse among Young People 2009 (NTA)
•	Young People’s Specialist Substance Misuse Treatment – Exploring the Evidence: 2009 (NTA)
•	Guidance on Commissioning Young People’s Specialist Substance Misuse Treatment Services: 2008 (NTA) 
•	The role of CAMHS and Addiction Psychiatry in Adolescent Substance Misuse Services: 2007 (NTA)
•	Assessing Young people for Substance Misuse: 2007 (NTA)   
•	Standards for Better Health: 2004 (DoH)
•	Good Practice in Harm Reduction:2008 (NTA)
•	Immunisation Against Infectious Disease: 2006 (DoH)
•	Reducing Drug Related Harm – An Action Plan : 2007 (DoH)
•	Safe Sensible Social: next steps in the national alcohol strategy: 2007 (DoH)
•	Review of the effectiveness of treatment for alcohol problems : 2006 (NTA)
•	Alcohol Needs and Assessment Research project (ANARP): 2004 (national alcohol needs assessment for England) 
•	Supporting and involving Carers: 2008 (NTA)
•	Joint Guidance on Development of Local Protocols between Drug and Alcohol Treatment Services and Local Safeguarding and Family Services: 2009 (DCSF, DoH and NTA)
•	Every Child Matters: next steps: 2004 (Department for Education and Skills) 
•	Think Family: Improving the life chances of families at risk: 2008 (Social Exclusion Task Force, Cabinet Office) 

Key legislation
•	Fair Access to Care Services (2002)
•	Medical (Professional Performance) Act 1995
•	Health and Social Care Act 2001
•	NHS and Community Care Act 1990

Local Policy
•	Isle of Wight DAAT Adult Treatment Plan: 2010-11 
•	Isle of Wight DAAT Young Peoples Substance Misuse Action Plan 2010-11

SCHEDULE ONE 

YOUNG PEOPLE’S DRUG STRATEGY TARGETS

2010/11 Young People’s Treatment Plan

Overall aim:  To reduce the harm that drugs cause to society, including communities, individuals and their families.

Young People aim: Preventing today’s young people from becoming tomorrow’s problematic drug users.

PSA target:  To reduce the use of Class A drugs and the frequent use of any illicit drug amongst all young people under the age of 25 and especially by the most vulnerable young people 

Areas for improvement
•	Continue development of links with Children Looked After Team for referral pathway and identify specific referrals from CLA Team and Children’s and Family Services for data collation 
•	Continue to build upon the gap in services with CAMHS and work with them on issues of common concern from the Independent Review of CAMHS
•	Develop on-line website locally to be more interactive for young people/parents/carers. 
•	A gap in service provision identified around the Hidden Harm Agenda where young people have highlighted they would like to engage with someone around concerns of their parents drug or alcohol use. We have had ten young people presenting to the service with requests.
•	Development of new guidelines for YRO and links with YOT and CAMHS to implement delivery of outlined requirements.

Priorities
•	Target training related to Hidden Harm
•	Continue to embed the CAF and links with locality satellites throughout the island
•	Research and develop training focusing on Legal Highs, due to the reported increased admissions to the mental health ward and other specialist mental health services and continue reporting of young people with their use of ‘legal highs’
•	Maintain links with Adult Treatment Providers for transition clients to ensure care planning and smooth transition is experienced by the Service User
•	Clinical Governance has been identified as a key area for future development and joint meetings with other relevant professionals will be taken forward as a priority
•	Continue to Young People with motivational support during and after Treatment, and working with Childrens Services to enable reintegration through support for Young People with Education, Employment and Training (EET) 

Key priorities for developing young people’s specialist substance misuse treatment interventions to meet local needs during the next financial year

1.	Address team capacity as a result of reduced funding through focussed Tier 3 only work and highlighting the deficit in service as a result of inability to undertake additional preventative and educational work

2.	Achieve targets for numbers in effective treatment and TOP completions

3.	Continue to be involved in strategies to improve outcomes for Young People and advocate for resources to be targeted at education and preventative work in schools around substance misuse.

4.	Continue to raise awareness of Hidden Harm Agenda and link with providers to deliver training to staff and support to young people

5.	Develop Get Sorted website with additional interactive web features

6.	Develop protocol with Adult Treatment Providers for Transition cases 

7.	Maintain and develop multi-agency approach to meeting the needs of families 

8.	Sustain initiatives which have started to make an impact on the level of Young People substance misuse and its harmful impacts

9.	Review and update clinical governance

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SCHEDULE TWO

MONITORING OF AGREEMENT

The DAAT Commissioner (“the Commissioner”) shall be: 
			
Heather Arni

The Young People’s Substance Misuse Service Lead (“the Provider”) shall be:  

 Yvonne Price		 

Monitoring Schedule

a)	Monitoring meetings between the Commissioner and the Provider shall be held quarterly, or at the request of the Commissioner, to review performance

b)	All or some of these monitoring meetings, will take place at the Service base, when the Commissioner may choose to interview staff, review individual and relevant files which relate to the business of the organisation, within the context of this agreement

c)	The database (maintained in accordance with Clauses 11.4 of the Service Specification) will be submitted on a regular basis, in line with NDTMS guidance. Any additional performance data shall be submitted at each Quarterly review by the Provider 

d)	The Commissioner shall liaise with the Provider to make arrangements for an annual QUADS audit of to be undertaken; the results of which will be given to the Provider and the Joint Commissioning Group (JCG) for the DAAT