The primary focus of the YSAS Research Team has been the development and documentation of a Comprehensive Therapeutic Practice Framework for YSAS.
A therapeutic practice framework is a coherent set of ideas about the targeting, approaches, content, techniques and modalities of therapeutic practice that is endorsed and shared by practitioners within a particular service and which can be communicated in terms that are understood by stakeholders in an organisation’s authorising environment.
The process has been informed by a multi-method research strategy incorporating four phases:
Qualitative research with staff aimed at describing the values and principles guiding service provision, needs of clients, therapeutic intentions, and views about appropriate outcome indicators
Qualitative research with clients exploring their understandings of their needs, their experiences of service provision, and their views of the links between services received and outcomes
A comprehensive review of literature relevant to service provision for young people with multiple and complex needs including theory, research evidence, and practice-based literature
Consultation with stakeholders in the wider environment including practitioners and policy makers.
Although not yet complete, the Practice Framework Development process is already informing practice enhancement within the organisation and strong interest is being expressed by youth AOD practitioners and service developers in other states.
The YSAS Practice Framework Development has been led by Mr Andrew Bruun and Dr Penny Mitchell. Ms Rachael Green conducted the Client Perspectives study.
This work has been supported by several stakeholders and funding bodies. These are:
Victorian Department of Health
Victorian Department of Human Services
The first phase of the work conducted from late 2008 to late 2009 was funded by FebFast and the Alcohol Education and Rehabilitation (AER) Foundation. This involved group interviews with a total of 72 YSAS managers and staff exploring the values and principles that drive their work, beliefs about the needs of clients, therapeutic intentions, and key domains of outcome.
A key product from the first that has been endorsed by the YSAS Executive is: YSAS Comprehensive Practice Framework - Statement of Values, Commitments and Orientations
Key findings from Phase One:
Values and commitments
Domains of client need
(1) Social justice and human rights
(2) Acceptance and respect
(3) Integrity and authenticity
(4) Harm reduction
(6) Learning and evolving
(1) Client-centred and holistic
(3) Developmentally appropriate and conducive
(4) Accessible and continuous
(5) Actively responsive
(6) Experiential and participatory
(7) Emphasis on strengths and solutions
(8) Ecological and systemic
(9) Comprehensive and collaborative.
(1) Protection from harm and the capacity to respond to crisis;
(2) Stability and the capacity to meet basic needs
(3) Participation in constructive activity
(4) Developmentally conducive connections
(5) Greater control over health compromising issues and behaviours.
Key objectives of this study were to:
Assess the extent to which values, intentions, and important outcome domains described by staff are shared by young people
Identify additional areas of need and outcomes valued by young people
Ensure that young people’s ways of talking about needs and outcomes are represented in the documents comprising the YSAS Practice Framework
The data gathered during this study will inform practice enhancement activities and resources such as staff induction, training, supervision materials.
The qualitative research with clients has also informed the work funded by the Victorian Department of Health, and the current research proposal. YSAS intends to make the exploration of client perspectives a permanent stream within its ongoing service development research program, and the current project is the next step in this commitment.
Key findings from Phase Two:
The interviews with young people confirmed the general validity of the five ‘domains of need’ identified in the Phase One research with staff. Most of the needs and goals described by young people could fit readily within at least one of the five ‘domains of need’ that were first discerned in the staff interviews.
The data collected in discussion with young people contained particularly rich information pertaining to the 3rd and 4th domains of need. Young people spoke at length about the value they placed on connections with family and peers, and at the same time, the great difficulties they experienced in these relationships. Many young people had been exposed to considerable neglect and abuse within their families. Nevertheless young people continued to seek emotional and material support from family members. The support they received was often perceived as inadequate but was highly valued.
Relationships with peers were also vitally important to the psychosocial wellbeing of participants in this study. But as with family, these relationships were often fraught. Young people identified that their existing peer groups were often involved in AOD use or offending and that ‘hanging out’ with their friends generally involved these activities. Young people who were homeless were especially vulnerable to forming relationships with others who had similar sets of problems (see also Kidd 2003). The maintenance of these networks, while vital to wellbeing (indeed to survival for some), also reinforced their continued involvement in problem behaviours and reinforced social marginalisation from mainstream society.
The frequent identification of “workers” (i.e. youth service providers) by young people in this study as among those to whom they felt the “closest”, reflects the inadequacy of support, care, and resources that they were able to draw from naturally occurring networks, among which intergenerational processes of disadvantage were apparent.
This work also identified exclusion from mainstream institutions and lack of engagement meaningful activity as key to marginalisation. Young people spoke about the effects of boredom and lack of structure to days as integral to problematic drug use and behaviours such as stealing. They spoke about the importance of day programs and the structured environments of residential services in stimulating them and keeping them occupied. However, young people spoke very little about receiving assistance in dealing with the underlying issues such as identifying their interests and talents, helping them return to study, building up study or work skills, or making new connections that could help them to find work.
It is possible that the interviews in this project were not sufficiently focused on the issue of participation and connection in order to elicit detailed responses, however, it is also possible that YSAS is not providing appropriate or sufficient intervention in this area.
The qualitative research with clients has also informed the Phase Three work funded by the Victorian Department of Health.
A third phase of the research was supported with funding from the Victorian Department of Health received from July 2009 for a project called “Strengthening Practice in the Victorian Youth AOD Sector” as well as FebFast.
The stated aim of this project was “to develop a stronger therapeutic framework for all aspects of youth alcohol and other drug treatment service delivery to help young people cease or reduce their substance use and better support longer term behaviour change”.
A key product from this is a resource document to guide individual services across the Victorian youth AOD service sector in developing their own therapeutic practice frameworks. This resource describes a set of dimensions that should ideally be included within therapeutic practice frameworks for youth AOD services, and surveys a broad range of domains that could be included within these dimensions, depending on the positioning of the particular service. The intention is not to prescribe a uniform approach to service provision across the sector, but to provide guidance on the range of issues that need to be considered in supporting practice that is as therapeutic as possible. Dimensions covered in this resource are:
The transtheoretical model of change
Resources and assets that all young people require for resilience
Domains of need for young people with AOD issues
Characteristics of effective services and programs
Effective psychosocial therapeutic interventions
Aspects of this work have been presented at the 2010 APSAD Conference (Mitchell & Bruun, 2010), and the 6th International Conference on Drugs and Young People (Mitchell & Bruun, 2011).
Click here to view publications page
As of June 2011 YSAS embarked on the fourth and final phase of its Practice Framework Development. Supported by FebFast and the Victorian Department of Health this phase of work is merging with the second phase of the Mental Health Capacity Building Project, supported by the Australian Government Department of Health and Ageing, to finalise, refine and endorse a Comprehensive Practice Framework that will guide our practice for the next five years. Particular attention is being paid to ensure that our practice framework is consistent with YSAS becoming dual-diagnosis capable service.
Drawing from the resource documents produced during Phase Three, a leadership group comprising senior staff members representing all service types within YSAS will choose and define domains of theory, resources and assets, need, program characteristics, and effective psychotherapeutic interventions that will inform our practice and be supported at an organisational level through workforce and organisational development. We will also define a set of broad Therapeutic Intentions.
A variety of practical tools will be developed to facilitate practice consistent with our framework including tools to assist with:
individualised care planning;
case review, and
Phase Four will also involve identification and definition of a set of Therapeutic Practice Elements drawn from therapeutic models that have demonstrated effectiveness in enhancing resilience and improving well-being for young people with multiple and complex needs. This work is laying the foundation for a new project which will examine the recognition, understanding, and use of thesePractice Elements by YSAS practitioners.
A formative evaluation of the reach of the Youth Support Service at the Youth Support & Advocacy Service (YSAS), (2011)
Rebecca Stanley, Master of Public Health Research Project
The University of Melbourne, Melbourne School of Population Health, Centre for Health Policy, Programs and Economics
The Youth Support Service (YSS) is a recent addition to the YSAS program portfolio and is designed to intervene early and divert young people, aged 10 to 17, away from the youth justice system by addressing the underlying causes of their offending and risk taking behaviour.
The aims of the formative evaluation of the YSS conducted was to define the characteristics of the intended high risk target client and assess whether the youth being referred and engaged actually fit into this target group; assess whether the current system of referrals is an effective way to gain access to the intended client population; and ascertain whether and how parental consent is impacting on programs reach. Based on a literature review, four themes emerged as key indicators of later life offending and therefore ideal early intervention clients for the YSS: family variables, behaviours and attitudes, peer group associations and school functioning.
The evaluation was conducted by means of interviews with YSS case workers, and a focus group with volunteers from the referral body the Youth Referral and Independent Person Program (YRIPP). The qualitative data was then coded and analysed, results were compared with findings from the literature review of the intended client profile and themes in responses from participants were addressed. The evaluator concluded from these findings that case workers are currently engaging with a significant proportion of young people that fit the intended client profile, and that the process of consent is not currently affecting the reach of the service. Lack of involvement from Victoria Police and Youth Resource Officer’s (due to their inability to refer to the service) was found to influence the reach of the program.
Recommendations included: employment of an intake worker, further community awareness on the YSS, additional training for referral bodies and inclusion of select schools as a referral body, and finally the inclusion of the Department of Human Services child protection clients in the eligibility criteria.
Since 2008, the Department of Health and Aging has funded 127 agencies across Australia to build mental health capacity within their organizations. YSAS has utilized this funding to register with the National Training Authority to deliver mental health competency units, deliver professional development for 120 staffs, develop literature/website resources to incorporate dual diagnosis practice, developed and trialed a mental health screening and enhanced assessment tool, developed a desktop resource to support the screening and assessment tool, engaged a psychiatrist for a six month pilot, completed a case management project with Turning Point, reviewed and developed recommendations for mental health linkages and partnership across the organization and collaborated with Melbourne University Masters department in reviewing the usefulness of the DDCAT. We have also been part of the state wide Improved Services Initiative (ISI) network. This network has supported all Victorian projects by developing opportunities to review best practice and share resources, including oversea dual diagnosis experts John Challis, Minkoff and Cline.
In 2012, the project will implement the new mental health desktop resource, screening and adapted assessment tool across the organization. This will include upgrading YSAS’s client database to support new practice. The project will also review and enhance practice relating to case work, including therapeutic assessment case planning, review and documentation.
Content in development
Please contact YSAS for a full report on 03 9415 8881.
Project collaborators: Turning Point Alcohol and Drug Centre, YSAS, Key Centre for Women’s Health, University of Melbourne
The YDRS is a major research initiative funded by the Victorian State Government’s Premier's Drug Prevention Council. YSAS partnered Turning Point Alcohol and Drug Centre and the University of Melbourne, Key Centre for Women’s Health in conducting this project. The aim of the project was to inform social policy in relation to young people, aged 13 to 24 years, and known to be regular substance users. The YDRS incorporated four interlinked studies which were conducted in Melbourne between November 2006 and September 2008. These include:
1. A review of relevant secondary data sets
2. A structured survey research involving 163 vulnerable young people aged 13-24 years (referred to as “YDRS survey”)
3. Semi-structured interviews involving 45 key experts (referred to as “KE study”)
4. Thematic qualitative interviews with 20 vulnerable young people aged 13-15 years (referred to as “YDRS qualitative study”).
The YDRS project was originally modeled on the Illicit Drug Reporting System (IDRS), an early warning system for drug use patterns in Australian adult substance using populations. Significant modifications were made to the IDRS research design and measures to capture the experiences and needs of vulnerable young people aged 13 to 24 years.
YDRS research findings are informed by a review of the available research evidence about young people’s substance use in developed countries, including Australia. Our review of the literature demonstrated that little evidence is available about the meaning and context of alcohol and other drug use among vulnerable 13 to 15 year olds. This report addresses this gap in the literature by focusing our qualitative research findings on the needs and experiences of those young people in this age group who are using substances.
MacLean, S., Bruun, A., Mallett, S., Green, R. (2009) Social contexts of substance use for vulnerable 13–15 year olds in Melbourne: Youth Drug Reporting System, Turning Point Alcohol and Drug Centre, YSAS, and Key Centre for Women’s Health, University of Melbourne. Funded by Victorian State Government, Premier's Drug Prevention Council.
View final report
here [Adobe Acrobat PDF - 1.42 MB]
This study has evaluated the therapeutic impact of the Youth Drug Withdrawal Program being run at the Barwon Youth Residential Withdrawal Unit. The Residential Withdrawal Pathways Project supported a psycho-educational, therapeutic and recreational approach to youth residential withdrawal that is client-centred, client-focused and client-driven. Feedback from service-users and a review of the evidence regarding effective practice was incorporated to identify and implement strategies and interventions that reduce the risk of harm from problematic substance use and enhance general health and wellbeing.
This project arose from the recognition of the need for young people accessing this service to be involved in program conception, development and evaluation and, by doing so, to empower young people and foster a sense of value and active participation as a service user.
Feedback from young people using surveys, questionnaires, suggestion boxes, focus groups and in-depth interviews has been and will continue to be translated into practice using the social model of health framework. In addition, an ex-resident/peer leader has been engaged as a consultant to assist with program development in the areas of peer education and life skills.
As a result of this project, it has become obvious that:
youth engagement in our service is vital if we are to remain “cutting edge” and focused on young people’s needs
young people have so much to offer – they themselves advocate for the social model of health without having any concept of the framework
we need to constantly look at new ways of integrating young people into service evaluation, program development and service delivery.
View final report available [clickhere]
This study examined the characteristics and circumstances of young people who are seeking residential withdrawal support to address problems arising from their drug use. It provides a picture of the first 100 heroin dependent young people who accessed the YSAS Residential Service in Fitzroy to assist their withdrawal.
View 100% Dependant Report[click here]