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 Further, it is widely  understood and used  by Australian AOD  practitioners and is yet to be superseded.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.