Effective youth AOD services have useful approaches to engage and assist all young people with AOD related issues regardless of their readiness to change.
Many clients of youth AOD services first attend under coercion from either family members, guardians (statutory or otherwise) and/or the justice system. In fact, approximately one third of clients in youth AOD services first attend under coercion from the justice system.
While some of these young people may appreciate the opportunity to access AOD services, many will have no desire or motivation to change their AOD use and practitioners are likely to encounter resistance. There are two practice elements which are helpful in engaging this population: ‘Evoking and working with the client’s’ own views and experiences of change' and ‘Rolling with resistance’ (both of which are drawn from Motivational Interviewing).
Action Plan for engaging clients attending under coercion
The following are potential actions that youth AOD practitioners and services can adopt to maximise their potential for being engaged by young people who are attending for AOD treatment and support against their will.
Clarify shared interests and different roles with the referring person
Where a young person is being coerced to attend there will be a referring person.
Regardless of whether the referring person is the young person’s guardian or is acting on behalf of the criminal justice system, they have the power to require a young person to attend for treatment. This power is associated with a responsibility to act in the young person’s best interests and/or on behalf of the community, and as is the case with statutory workers.
Referrals for treatment are almost always made out of concern that a young person’s substance use is:
- Impacting negatively on their safety, health and well-being and ongoing development
- Putting others in their family or the community at risk
Youth AOD services and practitioners share common concerns and in most cases the common goals of both parties are to:
- Reduce the harms associated with substance use
- Build the capacity of the young person to find ways to live in the world without relying on substance use to meet their needs.
To maximise the potential for these goals to be achieved, it is critical that both parties:
- Put the emphasis on creating the conditions that support constructive engagement rather than behavior change (engagement and the development of a therapeutic alliance is precursor to facilitating any behavior change)
- Have clear expectations of each others different but complimentary roles
Engagement is the crucial first step in the groundwork needed for a youth AOD practitioner to become a facilitator of behaviour change. The careful, patient process of engaging may require that formal assessment tools be administered later in the relationship-forming process, as the young person is unlikely to respond with candour if attempted too early. Further, formal assessment processes may interfere or impede the engagement process.
In preparation for the first meeting with a coerced client, the youth AOD practitioner is advised to hold a discussion with the referring person to:
- Understand the reason for the referral and their major concerns
- Express a respect for their role in acting in the best interests of the young person and the community
- Establish that there is a common interest in the young person’s safety, heath and ongoing development
- Be clear that the emphasis in early sessions is on creating the conditions that maximize the likelihood that a young person will choose to engage; not behavior change
- clarify confidentiality arrangements and set up a process for ongoing communication, including a way of raising difficult issues and resolving disputes
- Let them know that it is preferable if they attend with the young person and be clear on what they should expect.
Clarify confidentiality arrangements
Organisation running the AOD services will generally require that the information shared by clients is kept private unless the withholding the information is likely to jeopardise the health and safety of the young person or others.
Some carers and statutory workers might request that information the young person discloses in sessions, particularly regarding substance use, be shared with them. This can be counterproductive even where clients give their consent for this information to be passed on. Unlike carers and statutory workers, youth AOD practitioners don’t have formal power to apply limits which increases the likelihood that young people will turn to them as a reliable source of information, support and guidance, particularly in relation to substance use and other potentially risky behaviours. If clients expect that information that they provide on sensitive subjects is being passed on automatically they are likely to be reluctant to share it. This requires the referring party to trust that the youth AOD practitioner or service will be appropriately discerning and pass on information when the young person’s safety, heath or development is seriously at risk.
Protocols between agencies at an organisational or managerial level can support collaborative practice and processes and minimise the chance that confidentiality will be problem.
Some organisations agree to let the referring party know whether or not the young person has attended and to provide feedback on how they are engaging, which the young person must be made aware of from the outset.
Have a clear plan for the first session and the initial phase of work
There will be variations in how practitioners in different service types structure initial contact and the early phase of work with a client under coercion. The stepwise process (outlined below) for conducting a first session and preparing for the initial phase of work with a young person who is forced to attend is most applicable for outreach workers or counselors working in clinical settings as these service types most commonly receive referrals of this kind.
1. Clarify roles and ground rules
- Welcome the young person and whoever is in attendance (includes the referring person) and invite them into a private space for a discussion
- Explain who you are and provide information on what your service offers and the range of ways you can assist
- Make all previous contact that you have had with the referring person overt, demonstrating that you are comfortable with being transparent and that there are no secret alliances
- Where the referral is from another worker, be clear that you work for a separate service and that you are not working for the referring organisation
- Be clear on the arrangements you have with the referring party on confidentiality and future communication and leave time for questions
2. Clarify referral details and invite input from the referring person and the young person
- Invite the referring person to explain why the referral is being made and their expectations of the treatment (this should include attendance at a minimum amount of sessions)
- Invite the young person to comment on what they have heard, including any points of clarification, and offer them a chance to talk about how they feel about being forced to attend
- When everything is clear, ask the referring person to leave and again invite comment from the young person
3. Give the young person control over how the specified number of sessions will be used
- Reiterate what you can help with and be very clear with the young person that you understand and respect that the decision to take up the offer of assistance is theirs
- Confirm that they understand that they are required by the referring party to attend for a stipulated number of sessions
- If they are not interested in taking up the offer of assistance, offer the young person a choice of activities that you are prepared to do with them during sessions. Ensure that one of the choices is sitting in silence but that participation in some form of activity be it recreational, artistic or educational is offered.
4. Close the session by clarifying arrangements with everyone involved
- When the predetermined time with the young person has elapsed invite the referring person back to the place where the session started
- Invite the young person to share any details of the session with the referring person
- Confirm arrangements regarding confidentiality and future communication and leave time for questions
- Ensure that the times for all specified sessions are locked in and finish the session with a reference to meeting again at the arranged time
When the referring person is not present at the first session the same stepwise process can be followed with modification to step 2 and 4. In this case:
- Step 2 can be modified by the youth AOD practitioner to explain in plain language the reasons that the referring person gave for making the referral and their expectations of treatment (including attendance at a specified number of sessions).
- Step 4 can be modified by the youth AOD practitioner either calling the referring person with the young person present or undertaking to make contact with them to confirm arrangements for future sessions; making it clear with the young person that confidentially arrangements will be respected.
Please note that practitioners are accountable for any approach adopted in engaging a client. The use of activity should be endorsed the practitioner’s organisation and comply with any relevant policies and procedures.
Where young people who are forced to attend for treatment make the choice to engage it is common for them to have continued involvement with a youth AOD service as a voluntary client.