Victoria is the only Australian State with a discrete, fully integrated youth AOD service system. It was established in 1998 according to a recommendation from the Premiers Drug Advisory Council (PDAC), an expert panel chaired by Professor David Pennington formed to undertake an intensive public investigation into illicit drugs and advise the State Government on how the problem should be tackled.
PDAC reported that “… there are large gaps in the network of services available to support young people, particularly those with serious drug abuse and related problems” (PDAC 1996 p.95).
Professor Pennington’s enquiry recommended that a specialist Youth Substance Abuse Service (YSAS) be established in Victoria. The state government did establish a service of this name but also a range of other regional services that evolved into the current youth AOD service system.
In addition to significant problems associated with substance use, YSAS service users were expected to be experiencing multiple and concurrent problems such as homelessness and a broad range of other health concerns (PDAC 1996). It was also anticipated that the majority of this population would have had either no history of accessing drug treatment services or had been unable to connect with services that were attuned to, and capable of, meeting their needs (See Success Works, 1998). The PDAC therefore stipulated the imperative of service accessibility and required youth AOD services to retain a capacity for “immediacy in response”. To this end, a flexible medium such as outreach was thought to have great utility. Outreach also maximised the potential to be proactive in taking services to young people and delivering them in settings in which they were comfortable.
PDAC also recommended that outreach services be integrated with “intensive supportive care”, provided in a residential setting (PDAC p.95). Residential services offered young people a safe and secure environment in which they could stabilise their circumstances and find space to consider their options for the future. The primary purpose of this service was to provide respite to young people whose substance use and associated lifestyle had become unmanageable and in some cases intolerable. Accordingly, the environment created would offer young people alternative accommodation that was age appropriate and drug free, with inbuilt capacity to support and medically supervise drug withdrawal.
YSAS service users were expected to be resource poor and living within socially marginalised contexts (Hunter 1995). PDAC further recommended that a “Flexible Funding Pool” be made available to ensure that young people’s efforts to stabilise and develop were not stymied by a lack of material support. Outreach workers could apply for these funds on behalf of individuals but not to resource programs. YSAS would also be equipped with the capacity to offer ongoing secondary consultation and professional development for both the YSAS workforce and others throughout Victoria dealing with young people and substance use issues.
The implementation of the new Victorian “Youth Alcohol and Other Drug (AOD) service system” saw an immediate and sharp increase in the number of young people being assisted. In 1997/8, the State government Alcohol and Drug Information System (ADIS) revealed that 9% of service users were 21 or under whereas in the following year, with the establishment of the youth AOD service system this figure grew to 26%.
By engaging young people who had previously not accessed AOD treatment provided service providers and policy makers developed greater insight into their needs. This prompted the State government to add a range of youth focussed services to compliment those already established. This included:
- More small scale youth residential withdrawal units, established in Melbourne and in some provincial centres.
- Youth residential rehabilitation, established as a ‘step up’ option from both outreach and youth residential withdrawal that provided the system with the capacity to offer better continuity of care for clients.
- Supported accommodation, added for the same reason as residential rehabilitation.
- The Koori Youth A&D Healing Service was eventually established to provide culturally sensitive, long-term residential option for Aboriginal young people.
- The addition of Day programs and ‘Home based withdrawal services’ that boosted the capacity of Outreach services to attract young people and offer provide primary health care for young people
- A range of what might be termed specialist programs such as ‘Counselling, consultancy & continuing care’, specialist therapeutic worker – Alcohol and Drug Youth Consultants for State Out of home Care services, Rural outreach diversion, Parent support and Reconnect (a FACSIA funded service that YSAS has oriented specifically for AOD clients).
Pharmacotherapy is also available for young people where appropriate but is not a youth specific service.
The subsequent iteration of the Victorian Drug Policy Expert Committee (2000) and a State Government commissioned ‘Youth Service System (Berins et al, 2004) review endorsed the need for a Youth Specific AOD service system response for Victorian young people and their families.
The Victorian Drug Policy Expert Committee (2000) were explicitly concerned about the risks involved with blending adults and young people together in AOD treatment. They reported that,
“Young people have particular needs that often mean placing them in a drug treatment service targeted at adults can have a detrimental effect and deter them from seeking out other treatment options. There is also the danger of exposing young people to more entrenched drug use if they are placed in an adult service. To avoid this, a range of youth-specific services was established to cater for the perceived need for drug treatment among young people (p.125)”
The potential for exploitation of young people by adult clients or anti-social role modelling is greatly heightened in residential environments. This is a particularly salient point when considering the VCOSS & YACVIC findings (Rose and Atkins, 2006) that young people’s experiences have an immediate impact on development and profoundly impact on their capacity “…to develop into healthy adults that can make a positive contribution to society” (p.7).
Therefore in youth AOD services deliberate consideration is given to the potential positive and negative impact of the experiences accumulated by young people as a result of participation in any of our service setting or programs. For example, youth residential withdrawal units typically control for this critical issue and in pre admission meetings and consider the potential for developmental harm associated with peer influence and mixing young people at different developmental stages. These issues can be managed because of experienced staff, fewer clients participating in programs at any one time and a lower staff to client ratio.
There are a number of other fundamental differences between youth specific AOD services and what may be called ‘adult services’. It is most helpful to use YSAS as an exemplar to make these points that follow:
- Youth AOD services are able to create environments and programs that are attractive and accessible for young people thus promoting the potential for treatment engagement and retention.
- Youth AOD services and programs are designed to offer clients experiences that promote progress towards achieving developmental tasks such as exploring their social and vocational identity, developing life skills, practicing contingency planning learning to make mature judgements, etc.
- Youth AOD practitioners are experienced in working with young people, have specific training pertaining adolescent development and can undertake developmentally targeted risk assessment and management
- Youth AOD services are intimately aware of the unique statutory provisions applying to children and young people. This includes understanding provision special considerations around privacy, duty of care and consent (e.g. determining “mature minor” status)
- Youth AOD services are embedded within youth specific service systems and networks and staff understand how different youth specific programs and services operate.
- Youth AOD intake processes feature proactive collaboration with referring agencies and practitioners from the youth health and community services sector that involves relationship development and training.