Demand for a Young People’s Substance Misuse Service
A tiered model of alcohol and drug services has been adopted for use for young people. The focus of this questionnaire is on Tier Three and Tier Four, an explanation of which is noted below.
Specialist substance misuse interventions are defined as:
‘A care planned medical, psychosocial or specialist harm reduction intervention aimed at alleviating harm caused by a young person’s substance misuse. The aim of specialist interventions should be to support all young people to work towards exiting services no longer using drugs or alcohol ’.
(Public Health England, (2013), Alcohol & drugs: JSNA support pack. Good practice in planning young people’s specialist substance misuse interventions. p11) http://www.nta.nhs.uk/young-people.aspx
The Tier Three Service
Alcohol and drug services for young people provided by specialist teams working with complex cases as part of multi-agency teams.
Create Consultancy: Needs Assessment: Young People’s Drug and Alcohol Services in Edinburgh City (2012) p73. http://edinburghadp.co.uk/Resources/EADPPublications/Documents/NeedsAssessmentFinalReport.pdf
Tier Three Threshold
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Evidence of regular drug or alcohol use
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Evidence of escalating substance use
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Dangerous patterns of substance use
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Using substances that have a high risk of dependency
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Substance misuse has led the young person to be at risk of harm, or is already causing harm
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Using drugs under age 14
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Using solvents and volatile substances at any age
Indicators of Potential Risk
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Short-term exclusions or at risk of permanent exclusions from school
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Persistent truanting
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Not in education, employment or training
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Evidence of risk of harm due to parental, family or peer substance misuse
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Mental health problems (including psychiatric disorders, ADHD, depression and anxiety)
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Poly-drug use
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Multiple risk factors
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Offending behaviour; known to YOT or the police
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Young carer
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Looked after child (current/historic) including care leavers
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Homeless or living in temporary accommodation
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Injecting drugs
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Binge drinking
 Referral from young people’s secure estate
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Previous substance misuse intervention within the last 6 months
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Early substance misuse (before 13-14 years old)
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
Solvent or volatile substance misuse
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A&E admissions for substance misuse
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Continual low aspirations and lack of self-belief
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Use of New Psychoa ctive Substances (‘Legal Highs’)
(Public Health England, (2013), Alcohol & drugs: JSNA support pack. Good practice in planning young people’s specialist substance misuse interventions. P20 - 21) http://www.nta.nhs.uk/young-people.aspx
Tier Four Service
Highly specialised alcohol and drug services for young people which will provide specialist medical interventions for those young people with complex care needs.
Tier Four Threshold
Young people are experiencing current harm through their use of substances, impacting on other aspects of their lives
Young people have complicated substance misuse problems requiring specific interventions and/or child protection responses
Young people have complex needs and their problems are exacerbated by substance use
Create Consultancy: Needs Assessment: Young People ’s Drug and Alcohol Services in Edinburgh City (2012) p73. http://edinburghadp.co.uk/Resources/EADPPublications/Documents/NeedsAssessmentFinalReport.pdf
Indicators of Potential Risk
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Substance misuse that needs a clinical intervention
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Meet local threshold for safeguarding or complex care arrangements
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Chronic non-attendance, truanting, permanently excluded, frequent exclusions or no education provision
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Not in education, employment or training
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Complex mental health problems requiring specialist interventions
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Failure to address serious re-offending behaviour
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Child at risk or on a child protection plan
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Evidence of risk of harm due to parental, family or peer substance misuse
 Needs to be ‘looked after’ outside the family home or is a care leaver with support concerns
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Suspicion of physical, emotional and sexual abuse or neglect
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Family mental health problems
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Is homeless or living in temporary accommodation
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Young carer
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Class A user including opiates, crack cocaine
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Drug user under the age of 13
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High level drinking
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Overdose risk including use of solvents/volatile substances
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Injecting drugs
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Pregnant or a parent
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Being abused, sexual exploitation
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Continual lack of aspirations for the future
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Dangerous use of New Psychoactive Substances (‘Legal Highs’)
(Public Health England, (2013), Alcohol & drugs: JSNA support pack. Good practice in planning young people’s specialist substance misuse interventions. P22-23) http://www.nta.nhs.uk/young-people.aspx
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