The complexity of youth AOD practice requires overarching frameworks that enable practitioners to make accurate assessments and apply effective, timely interventions that suit the goals of clients and others involved in their care.
Browning and Thomas (2005) identify that behaviour change models or frameworks in social and public health are focused either on the individual or broader environmental influences. Individual models emphasise perceived behavioural control or self-efficacy concepts as a predictor of action. In contrast, health promotion models tend to focus on the role of social, economic, cultural and environmental influences on health and illness.
Youth AOD services seek to address the harmful substance use of clients as an individual health- comprising behaviour while also responding to the developmental vulnerability of clients, which is largely determined by social/ecological factors. No one behaviour change theory or model adequately incorporates these aspects. As such, any individual health behaviour change framework used to guide youth-specific AOD assessment and intervention planning must be augmented by a developmentally attuned, social-ecological framework that addresses client vulnerability and the determinants of AOD problems. The ‘Framework for Resilience Based Intervention’ is recommended for the purpose.
The individual health behaviour change framework found to be most relevant and applicable for youth AOD work in Australia is the ‘Transtheoretical Model of Change’, The reason for recommending a model conceptualised well over 30 years ago, that has several limitations, is that the ‘Stages of Change’ (The model’s construct) continues to be recognised by critiques and advocates alike as a useful way to understand the change process and how people are positioned in relation to change. This can enhance a practitioner’s ability to be client-centred, which is a key characteristic of effective youth AOD programs (see section 3). Further, it is widely understood and used by Australian AOD practitioners and is yet to be superseded.
The Transtheoretical Model
The Transtheoretical Model of Change (Prochaska & DiClemente, 1984; Prochaska, DiClemente & Norcross, 1992; Prochaska & Velicer, 1997) describes how people either modify problem behaviours or adopt new, more healthy behaviours. The model provides youth AOD practitioners with a framework for understanding the dynamics of behaviour change.
Change is viewed as a process that unfolds over time rather than an event, and the focus is on the decision making of each individual. The Transtheoretical Model enables practitioners to assess each young person’s motivation and readiness to change and informs the composition of meaningful interventions that can be used to assist change.
The model has three integrated dimensions. The first is the ‘Stages of Change’, which delineates a series of five stages that people move through as they change. Second, the ‘Processes of Change’ are 10 cognitive and behavioural activities that facilitate the movement of people through each of the stages. Third, the ‘Levels of Change’ consist of interactive areas of an individual’s life (i.e. intrapersonal, interpersonal and/or situational) that influence and are influenced by changes. The ‘Levels of Change’ represent complicating problems that can hinder change, but if worked through can reinforce healthy change over the long term.
Two further constructs are integrated within the Transtheoretical Model: ‘Decisional Balance’ and ‘Self- Efficacy’. Both are integral in determining how change is initiated and maintained.
‘Decisional Balance’ is a state that individuals find themselves in as they weigh their positive and negative valuations of substance-using behaviour together with the perceived costs and benefits of change.
‘Self-Efficacy’ is an individual’s impression of their own ability to complete the tasks and meet the challenges involved with changing the target behaviour. Self- efficacy is thought to be predictive of the amount of effort an individual will expend in initiating and maintaining a behavioural change. Self-efficacy is an important element of many behaviour change theories (see Browning & Thomas, 2005). It is also a key component of the Framework for Resilience Based Intervention.