Children and young people's alcohol and drug services: framework

Question 1

Introduction

Accepted Answer

Children and young people may use alcohol or drugs for many different reasons, including experimentation, risk-taking and coping with difficult or traumatic experiences.

Certain factors increase the risk of harm and problems developing. These include:

mental health difficulties
neglect or abuse
parental substance use
other adverse childhood experiences

Timely, compassionate and effective support can help every child or young person who has, or is at risk of, alcohol or drug problems to prevent future harm and thrive.

This national framework was developed in consultation with stakeholders, including young people with lived experience. It sets out clear expectations for how local areas should design, commission and deliver high-quality alcohol and drug interventions. It covers interventions for:

children (aged 17 and under) delivered by children and young people’s specialist drug and alcohol treatment services
young people (aged 18 to 24) as part of transitional arrangements in children and young people’s alcohol and drug services or in adult alcohol and drug treatment services

The framework promotes an approach that is personalised, youth-friendly and trauma-informed. Trauma-informed practice means being sensitive to the trauma that service users may have experienced and actively seeking to prevent re-traumatisation. This framework places the voice and experience of children and young people at the centre of service design and delivery and recognises the crucial role of parents and carers.

It also emphasises the importance of:

a skilled and confident workforce
strong partnership working
effective safeguarding
appropriate support during childhood, adolescence and emerging adulthood

It is not a clinical guideline. For alcohol and drug clinical guidelines, refer to the children and young people’s sections of:

Children and young people’s alcohol and drug services have a fundamental role in protecting and promoting children’s welfare and supporting their healthy development into adulthood. Local council commissioners should ensure that service specifications for alcohol and drug services align with the requirements in this framework and that enough funding is available to deliver them.

Question 2

Target audience

Accepted Answer

This framework is for:

directors of public health
combating drugs partnership senior responsible owners and members (see Drugs strategy guidance for local delivery partners for recommendations on membership of combating drugs partnerships), including:
- education providers
- local safeguarding partnerships
- police
- youth offending teams
- mental health teams
commissioners of children and young people’s and adult alcohol and drug services
directors and area managers of alcohol and drug service providers, responsible for children and young people’s and adult services
service managers of children and young people’s and adult alcohol and drug services
strategic and service leaders across the children’s workforce

Question 3

1. Understanding local need and assets

Accepted Answer

Service commissioning and design should be based on a comprehensive understanding of:

local drug and alcohol patterns of use and related harm
local need and assets
the children and young people the services are for

Local needs assessments

Alcohol and drug service commissioners and providers should conduct a local needs assessment for children and young people with, or at risk of developing, alcohol and drug problems. This will help identify gaps in provision and make plans to address them.

The assessment should include how well the areas are:

identifying and supporting children and young people through targeted prevention
providing specialist community interventions
providing complex care support

Needs assessments should be informed by children and young people with lived and living experience. They should also be culturally sensitive in identifying, understanding and addressing the diverse needs of the local population.

Models of participation

Commissioners and providers can adopt models of participation that enable children and young people to influence local needs assessments, commissioning decisions and service design. For example, the Lundy model of child participation, which considers space, voice, audience and influence. For more information, see the Queen’s University Belfast case study on the Lundy model.

Data and intelligence

Needs assessments should include data and intelligence on changing patterns of drug use and harm, including synthetic drugs. This includes:

National Drug Treatment Monitoring System (NDTMS) data, available on the NDTMS website
education statistics on drug and alcohol related school exclusions
data from national and local drug harm surveillance systems, including local drug information systems, and Department for Education statistics on children in need where alcohol or drug use is identified

These data sources should be used to regularly monitor and evaluate activity and outcomes. They should inform a local understanding of need and the resultant strategic plans, service contracts and performance management. Any other relevant local data sets should also be used, such as children engaged in complex safeguarding team caseloads and child and adolescent mental health services (CAMHS).

Needs assessments should include data and intelligence on priority groups. In particular, this includes children and young people who:

are in care or are care leavers
have been criminally or sexually exploited, experienced violence or been abused or neglected
are not in mainstream education or not in education, employment or training (NEET)
have emerging or identified mental health problems
have special educational needs and disabilities

Local areas may decide that a full needs assessment is not needed every year. But as a minimum, every year commissioners should:

engage children and young people with lived and living experience to inform local commissioning and service delivery
update alcohol and drug treatment data to inform local planning
review other local data sources, intelligence and service performance

Needs assessments should inform and be guided by part of the local council’s wider strategic needs assessment for children and young people. They should be jointly owned by relevant local partners, including:

CAMHS
early help
children’s social care
multi-agency child protection teams
youth offending teams

Service plans

Service plans should be based on needs assessments, involving relevant commissioning and delivery partners. These include:

members of the local combating drugs partnership (see section 3)
the service’s nominated child protection lead (for a definition, see the National Society for the Prevention of Cruelty to Children (NSPCC) resource Nominated child protection lead or designated safeguarding officer)
children and young people with lived or living experience
parents or carers of children accessing alcohol and drug services

Identifying local assets

As well as identifying gaps in provision, commissioners should identify local assets. These are assets that are already supporting or could potentially support the health and wellbeing of children and young people. This includes those with, or at risk of developing, alcohol or drug problems.

‘Asset-based community development’ is a commissioning approach that uses community (and individual) strengths and resources, or assets, as the foundation for improving public health. It involves bringing together local associations, services, groups, networks and residents to identify, access and strengthen local assets that promote health and wellbeing.

In Bolton, the adult and children and young people’s drug and alcohol services were co-designed with local people with lived experience, alongside other local partners. This community-centred approach became part of the commissioning processes, to ensure that services reflected local needs, assets, priorities and insights. The services have continued to work closely with a network of trusted local organisations and stakeholders, providing individuals and families with accessible and familiar routes to advice, support and treatment. This approach aligns with the principles of community-based support and integrated family services in Best Start Family Hubs and Healthy Babies: guidance for local authorities.

In Northumberland, services have adopted an asset-based approach that builds on rural community networks. They use outreach in rural communities and peer workers to help people who are not in treatment access support. This helps connect isolated residents with harm-reduction support and mainstream healthcare.

Having identified local assets, commissioners should support children and young people to access them. Where appropriate and safe to do so, they should also support the development of those assets, following an assessment of safeguarding and other potential risks.

Improving access to specialist interventions in London: case study

The London region of the Association of Directors of Public Health (ADPH), in partnership with the Department of Health and Social Care’s national and London regional teams, hosted a London regional practice improvement event on 11 July 2024. The event brought together 98 professionals working with children and young people in relation to alcohol and drug use across the capital, including public health leads, commissioners and providers.

The event focused on what could be done to improve children and young people’s access to specialist alcohol and drug interventions in London. There were presentations on research, London data and local case studies, each informing improvements to service effectiveness. Delegates were invited to suggest themes to be considered in future national, regional and local policy.

Several themes emerged as priorities, including the need for:

more intensive support for complex cases
better data recording and sharing among services
services to be welcoming, non-stigmatising and designed with input from children and young people

The ADPH region then developed a Practice improvement self-assessment checklist. The checklist helps areas to have discussions about current provision, and identify barriers, opportunities and actions to improve services. Commissioners of children and young people’s drug and alcohol treatment services should complete this checklist with their service providers, and in consultation with:

children’s social care
education providers
youth justice
other relevant sectors, including mental health and family services

For more information, see Improving access to drug and alcohol services for young Londoners.

Question 4

2. Interventions and delivery models

Accepted Answer

Local councils should commission evidence-based universal and targeted interventions for children and young people in a variety of settings, while also making a range of specialist interventions available.

For clinical guidelines on specialist interventions, see ‘Clinical guidelines for alcohol treatment’ and ‘Drug misuse and dependence: UK guidelines on clinical management’.

Universal prevention

Universal prevention interventions are for all children and young people.

Information and education

Alcohol and drug services play an important role in supporting their local communities. They provide accurate, relevant and timely information about the health harms of alcohol and drugs to every child and young person. This should include helping local education providers with their:

alcohol and drugs policies
lesson plans

The PSHE Association has developed lesson plans on drugs education.

Reducing risk and strengthening protective factors

The United Nations Office on Drugs and Crime and the World Health Organization’s International standards on drug use prevention suggest that universal prevention approaches for children and young people focus on reducing risk and strengthening protective factors. These approaches are more effective than topic-specific programmes and interventions. A wider prevention strategy should include a focus on:

school attendance
positive relationships
meaningful activities

Approaches that are least effective include:

knowledge-only approaches
scare tactics and images
using people with lived experience of dependence or the police as drug educators where their input is not part of a wider prevention programme

Targeted prevention

Targeted prevention is targeted towards children and young people at increased risk of alcohol or drug-related harm. It aims to reduce their risk of harm and strengthen their protective factors.

Harm reduction

Targeted prevention interventions should include age and context appropriate harm reduction for all children and young people, including advice and information on:

the spread of blood-borne viruses
sexual and reproductive health, including local chlamydia screening, condom provision, early pregnancy testing and unbiased pregnancy options advice
overdose risk and prevention, including naloxone supply where appropriate, in line with the guidance Supplying take home naloxone without a prescription
health harms and reducing risky behaviour

Care pathways should be in place for children and young people to access age-appropriate sexual health services and testing and treatment for blood-borne viruses.

Needle and syringe programmes, such as those provided in pharmacies, should operate in line with National Institute for Health and Care Excellence (NICE) public health guideline Needle and syringe programmes. They should also work to policies that have been agreed with the Families First Partnership programme and local safeguarding children’s partnerships.

Delivering targeted prevention interventions

Targeted interventions can also be delivered to children and young people with alcohol or drug problems who may not feel ready to engage with services. Where children and young people meet the threshold for a specialist intervention, specialist alcohol and drug services and partner agencies may offer:

screening or triage sessions
joint assessments

Targeted prevention interventions should be delivered by skilled staff who children and young people believe are knowledgeable and credible. They should be available in a variety of settings, including:

schools
youth hubs
primary care settings

For 16 to 24 year olds, services should consider appropriate place-based settings, such as:

further and higher education providers
festivals
night-time economy venues, such as pubs and bars
local community hotspots, such as youth clubs, community centres and Best Start Family Hubs

Working with children and young people at risk

Targeted prevention interventions should be delivered in partnership with services working with ‘at-risk’ groups. These groups include children and young people:

in care and care leavers
who have been exploited, abused or neglected
who are not in mainstream education or are NEET
who are experiencing mental health problems
with special educational needs and disabilities

Supporting children affected by parental alcohol or drug use

Some children and young people’s alcohol and drug services, and some children and family services, provide targeted interventions for children and young people whose parents or carers have alcohol or drug problems. These services provide this type of child-centred family support work whether or not the children themselves are using substances or the parent or carer is receiving treatment for their alcohol or drug problem. Child-centred family support work helps:

safeguard children
promote their health and emotional wellbeing
prevent future substance problems

Children should be guided by a professional to explore and understand their feelings and experiences of parental alcohol or drug use. Family members should also be supported individually and collectively to reduce the risk of harm and strengthen their protective factors.

Comprehensive capabilities for the drug and alcohol family support workforce are outlined in NHS England’s Capability framework for the drug and alcohol treatment and recovery workforce.

Specialist drug and alcohol interventions

Specialist drug and alcohol interventions refer to packages of care-planned support delivered in the community. They are tailored to children and young people who are experiencing harm related to their alcohol or drug use. Interventions are primarily psychosocial but can also be pharmacological and should include harm reduction advice.

Specialist interventions should be in line with:

‘Drug misuse and dependence: UK guidelines on clinical management’ - section 7.10 ‘Young people’
‘Clinical guidelines for alcohol treatment’ - chapter 23 ‘Specialist alcohol interventions and support for children and young people’

Since alcohol and drug problems have multiple causes, specialist interventions should typically involve a range of local partners and a child or young person’s parents or carers. Local partners may include:

schools
child social workers
mental health teams
youth offending teams

High-intensity support for the most vulnerable children and young people with severe complex care needs should be available in every local council area. Drug and alcohol complex care includes multi-agency care packages, developed with a child social worker. These packages include alcohol and drug specialist interventions, along with accommodation if appropriate, for example through an emergency foster care placement, and access to education. Psychiatric intensive care within CAMHS or an inpatient paediatric admission may also be clinically appropriate. See section 7 for more information.

Universal, targeted and specialist interventions in a variety of settings

Assertive outreach allows targeted alcohol and drug interventions to be delivered to children and young people who are not in contact with specialist services. It meets children and young people in places where they already are, including on the street or in public places. Assertive outreach requires workers to be proactive in contacting children and young people, to build a relationship with them and help them engage with further support.

Similarly, targeted and specialist interventions can also be delivered in settings a child or young person is comfortable and familiar with. Interventions are typically delivered in local partner agency settings, such as:

schools
youth offending services
complex safeguarding services
CAMHS
alternative mental health support services

Service-based models should offer interventions in a dedicated building or space within a building. Such dedicated spaces are designed to deliver alcohol and drug interventions in an environment that is accessible, welcoming and safe for children and young people. See section 4 for more information.

Specialist treatment service in Southend-on-Sea: case study

Southend-on-Sea City Council commissions an all-age alcohol and drugs specialist treatment service, with dedicated teams for children and young adults to address their distinct needs. These teams operate primarily offsite, engaging with children and young people in environments they are comfortable in, such as schools, youth centres and homes.

The service includes specialist roles, such as a:

criminal justice worker for young people
hidden harm worker supporting children affected by parental alcohol or drug use

As well as structured one-to-one interventions, the service employs a schools and education link worker to:

build relationships with educational institutions
support the early identification of students at risk of problem alcohol or drug use
provide targeted alcohol and drugs education

The service has recently formed a young people’s advisory council. Young people who have completed targeted sessions are helping to improve the service’s social media presence, especially on TikTok. Their involvement helps to create and co-produce harm reduction content and promotional posts, to raise awareness and encourage more children and young people to confidently access support.

Question 5

3. Strategic commissioning and partnership working

Accepted Answer

Commissioning approach

Commissioning quality standards for alcohol and drug treatment and recovery services provide a framework to enable effective commissioning in partnership. The standards aim to increase the transparency and accountability of commissioning, including between local partners, and enable local areas to assess their commissioning practices.

Alcohol and drug service commissioners should work collaboratively with strategic partners to understand local need, plan services and oversee service delivery. Strategic partners should include:

children and young people’s specialist alcohol and drug services and adult drug and alcohol treatment services
education providers including schools, further education, higher education and pupil referral units
children and family services, including children’s social care
mental health teams and commissioners
youth offending teams and the police
young people with lived and living experience
local council community safety and licensing teams

Local groups and forums

The local combating drugs partnership, or a specific children and young people subgroup, should be used as a forum that brings together the above partners. This includes working together to:

prevent under-age sales and proxy alcohol sales
support education providers with their alcohol and drug policies

For more information on combating drugs partnerships, see Home Office guidance ‘Drugs strategy guidance for local delivery partners’.

Commissioning a full range of interventions

Commissioners should ensure that service providers offer universal, targeted, specialist and complex care interventions and services. These should be relevant to the different patterns of children and young people’s alcohol and drug use and the types of harm they can experience. See section 2 for more information.

Referral pathways

Referral pathways into alcohol and drug targeted prevention and specialist interventions should be made clear to everyone working with children and young people in the local area.

There should be enhanced, supported referral pathways in place for priority groups, in line with local needs assessments. This should include all at-risk groups covered in ‘Working with children and young people at risk’ in section 2.

For example, for children and young people who are not in mainstream education, are NEET, or at risk of becoming NEET, enhanced referral pathways could include referrals through pupil referral units, youth centres and assertive outreach. This should be supported by workforce training to help staff understand the barriers to engagement faced by this group. This will help earlier identification and referral.

Children and young people’s specialist drug and alcohol services should also know how and when to refer to other agencies.

Working with education providers

Children and young people’s specialist alcohol and drug services should work with schools and pupil referral units in their area to develop good referral pathways, prioritising the children and young people with the greatest need. They should deliver targeted prevention interventions in educational settings.

Similar pathways should also be established with universities and colleges for young people aged 18 to 24.

Work with education providers should include supporting them to develop their drug and alcohol policies that incorporate:

evidence-based education
early intervention
support pathways

This approach can help develop:

referral pathways
harm reduction opportunities
targeted intervention opportunities
collaborative partnerships

See section 2 for more information on universal interventions with education providers.

Care pathways in hospitals

Care pathways should be in place between alcohol and drug treatment services and hospitals for children and young people presenting to emergency departments with alcohol or drug-related problems. Depending on where the services are and existing links to hospitals, these pathways may need to be established on a regional or sub-regional basis.

Continuity of care

There should be arrangements in place to support continuity of care for children and young people with alcohol or drug problems, particularly during transition between services or settings.

Services should give particular attention to children and young people:

entering, transferring within or leaving the secure estate
receiving complex care interventions

For these groups, the risk of disengagement from support, gaps in care or poor co-ordination between services may be greater.

Bringing together local partners to improve health and wellbeing in Leicestershire and Rutland: case study

The Leicestershire and Rutland substance use and young people working group brings together a range of local partners to improve health and wellbeing outcomes for children and young people affected by alcohol and drug use. The group is part of the combating drugs and alcohol partnership and develops an annual action plan informed by recommendations from joint strategic needs assessments. It focuses on prevention, early intervention and co-ordinated responses to emerging trends.

Main activities include:

co-ordinating a training and education package for professionals, parents and children and young people
maintaining a data mapping tool to capture and analyse local trends in alcohol and drug use

This intelligence supports evidence-based decision making, targeted interventions and shared priorities across agencies. The group encourages collaboration, strengthens capacity in frontline services and ensures a joined-up approach to reducing harm, building resilience and improving outcomes for children and young people across the county.

Question 6

4. Accessible, safe and personalised services

Accepted Answer

You’re Welcome: guidance for establishing youth-friendly health and care services sets out standards for accessible and personalised services.

Alcohol and drug services for children and young people should comply with the standards set out in ‘You’re Welcome’ and the principles in this framework. Commissioners and services should also use the ‘You’re Welcome’ self-assessment tool to ensure they comply with the standards.

Children and young people with lived and living experience and personalised care

Personalised care and care planning

The voice of children and young people should be central to their care and to the development of services.

Care plans should be personalised. They should consider ways to reduce risk of harm and strengthen protective factors for every individual child or young person accessing alcohol and drug services. Plans should recognise strengths as well as needs.

Children and young people should be involved in their care and care planning. Children and young people with alcohol or drug problems, or at risk of developing them, should have enough information and opportunity to make choices about the kind of support they receive.

Alcohol and drug assessments and care plans should be carried out by a trained professional using a sensitive and non-judgemental approach.

Involving parents and carers

When it is safe and appropriate, parents or carers should be actively included in discussions and decisions about their child’s care.

Services should offer parents or carers sufficient support to enhance their understanding of alcohol and drug use and help their children. This may include access to:

drop-in sessions and facilitated peer support, where parents or carers can seek advice and share concerns
relevant information and resources, including how to recognise signs of problematic substance use, have supportive conversations and access treatment and wider family support, enabling them to make informed decisions and offer meaningful support at home

With the child or young person’s consent, services should consider assertive outreach to reach parents or carers who are not engaging with their children’s care.

Reviewing and updating care plans

Changes in risk of harm and protective factors should be regularly monitored and care plans should be reviewed and amended accordingly. This should be done in collaboration with children and young people and their parents or carers where possible.

As children and young people with alcohol or drug problems often have multiple support needs, care plans should include input from other relevant services. In many cases, a multi-agency response will be necessary.

Improving service delivery

The experiences and opinions of children and young people with living and lived experience should be sought and acted on to understand and improve delivery of alcohol and drug services. This includes governance arrangements, service design and development.

Commissioners can adopt models of participation that include methods that enable children and young people to influence decision making. See ‘Models of participation’ in section 1 for more information.

The views of children and young people should be specifically considered, especially at-risk groups as set out in ‘Working with children and young people at risk’ in section 2.

Children and young people should be made aware of their right to confidentiality. They should understand when confidentiality may be overridden, for example where there is a risk of significant harm.

Staff should be trained in assessing the capacity of a child aged 15 years and under to consent to treatment. This is known as Gillick competency. For more information, see the NSPCC learning resource Gillick competency and Fraser guidelines. For young people aged 16 years and over, staff should apply the Mental Capacity Act 2005.

Work in partnership with parents and carers

All services should work in partnership with parents and carers as far as possible.

Children and young people should be made aware of how information about them may be shared with other agencies. This includes sharing it for research and official statistics purposes, such as data records held in NDTMS. For more information, see the NDTMS website.

Services should recognise that the support needs, maturity, capacity to consent and competency of children and young people can change over time. They should be reminded of how their data and information is being used, as appropriate.

Accessible services

Accessibility and service delivery

Children and young people’s alcohol and drug services should be accessible and welcoming to children and young people. Support should be provided in safe areas and separate from adult services.

Local councils should consider having distinct identity and branding between adult and children and young people’s services, particularly where providers deliver both. For example, services could have dedicated and distinct:

workers for children and young people, and for young adults
service leadership
service specifications for the children and young people’s services and adult services

Services working with children and young people should understand that there are not only differences between adults and children, but also between children of different ages.

Available written material should reflect the age, culture, gender and ethnicity of the children and young people using the service, and these materials should be accessible.

Services should be flexible, creative and accessible to children and young people. They should adapt opening times, locations and how services are publicised, to meet the needs of children and young people with complex support needs.

Face-to-face care

Specialist alcohol and drug services should offer face-to-face care in both specialist service settings and in local partner agency settings. In these settings, specialist alcohol and drug interventions should be clearly defined and embedded within the service delivery model. Also, support in partner agencies should be delivered by children and young people’s alcohol and drugs service workers. This should happen in a variety of settings such as:

the child or young person’s home
schools
youth offending services
CAMHS

This can be offered on a routine or needs led basis.

Where there is support in partner agencies, services should ensure children and young people are met in a safe, quiet and confidential setting. In this setting, they should be free to speak openly about their alcohol and drug use and other sensitive issues.

All services should consider the appropriateness of the settings they use. They should consider how comfortable every child or young person feels in different settings, recognising that this may vary between individuals. They should also consider the potential for stigmatisation. For example, there might be more risk of stigma receiving treatment at school rather than at home.

Digital and online access

Services should use technology to help children and young people access the service, for example sending text message appointment reminders and having an online appointment booking system.

Many children and young people respond well to digital approaches and online interventions. However, services should consider individual circumstances. For example, digital poverty, including limited access to devices or the internet, can create barriers to accessing online support for some children and young people, especially those without smartphones or unsupervised internet use. Some children may also lack a private space at home where they can engage openly.

Alcohol and drug services should ensure that children and young people understand how they can self-refer into alcohol and drug services. This includes a communications plan that uses social media and targets children and young people, as well as important stakeholders and referrers.

What young people think a good service looks like: case study

The ‘Lived experience voices’ initiative run by Revolving Doors gathered the views of young people with lived experience and young ambassadors, with the help of service providers. Young people were asked what a good service for children and young people would look like.

They told us that services should:

have dedicated hubs that combine treatment, prevention and creative activities, providing a safe, accessible space within communities
use inviting, homely spaces - with both informal and private spaces - in multipurpose buildings
offer activities that are fun, therapeutic and available in both indoor and outdoor spaces
consistently involve young people in developing and implementing strategies and policies
offer peer support, especially from those with lived experience
have a strong social media presence managed by young people
provide an app for young people, parents and professionals
do outreach at events like raves and festivals
provide education and support for parents, including drop-in sessions and resources to help them understand and support their children
make transitions to adult services smooth, removing barriers to access them and ensure they are young person-centred
start universal education early, using age-appropriate content that focuses on harm reduction and realistic portrayals of the consequences of drug use
improve joint working and develop good relationships with other agencies
be empathetic, non-judgmental and focused on understanding the reasons behind young people’s actions

Question 7

5. A skilled workforce

Accepted Answer

Children and young people’s feelings about the quality of their relationships with adults and peer mentors contribute significantly to their wellbeing and positive outcomes.

So, the therapeutic relationship children and young people have with their keyworkers is vital.

Capability framework and training curriculum

Delivering high-quality and effective interventions depend on a skilled workforce. In 2025, NHS England published the ‘Capability framework for the drug and alcohol treatment and recovery workforce’. This capability framework supports commissioners and service providers to develop a multidisciplinary workforce that can consistently deliver high-quality services. It identifies core capabilities for children and young people’s alcohol and drug workers, as well as 10 other core roles, including family support workers.

Children and young people’s drug and alcohol service commissioners, employers and service managers should use the capability framework and the new curriculum to ensure their workforce has the required skills, knowledge and behaviours.

They should also meet the following principles.

Training and development

Training and development for commissioners should be in place to ensure they are competent to commission safe and effective services for children and young people.

Service specifications should clearly indicate the level of professional competence required to deliver safe and effective services for children and young people.

Service providers should consider the specific training and continuous professional development needs of their workers, including:

the specific age and development needs of children and young people and the ways they differ from those of adults
age-appropriate evidence-based psychosocial and pharmacological interventions for children and young people

Supervision and workforce plans

Service providers must ensure that their workers receive mandatory safeguarding supervision. There should be a good model of supervision that supports caseload management but also reflective practice to identify worker development needs and wellbeing.

Treatment providers should have workforce plans that describe how specialist staff are trained and supported to make sure they are competent and supervised to deliver specialist interventions for children and young people.

Professionals in the workforce

A range of medical and health and social care professionals should be a part of the workforce, who provide clinical and system leadership and support. This includes:

doctors
nurses
consultant and practitioner psychologists
social workers

Services should also have good links to, and partnerships with:

sexual health workers
youth offending workers
mental health workers

Reciprocal training

Reciprocal training between alcohol and drug teams and other local practitioners working with vulnerable children and young people should be delivered. This will help to ensure that:

children and young people’s alcohol and drug workers have a comprehensive and up-to-date understanding of multiple support needs, referral pathways and legislative responsibilities
partner agencies understand alcohol and drug related stigma, behaviour and related problems, and screening and referral skills

Reciprocal training should include the following services:

children’s social care
mental health
youth offending
education providers

Online learning in North Yorkshire: case study

North Yorkshire Horizons drug and alcohol service has developed an online learning platform called the Drink Drug Hub. Launched in March 2022, any professional from across the county can access resources, including free drug and alcohol awareness training. The training is evidence-based and developed in collaboration with partner agencies and experts.

There are currently 8 modules, including one on having conversations with children and young people about drugs, launched in July 2025. Bespoke courses are also available on request.

Over 1,300 people have been trained, with a strong uptake from:

children’s social workers
mental health workers
youth workers
early help practitioners
housing officers
foster carers
parents and carers

Over 250 people have completed the children and young people’s module. The training has been provided to trainee social workers and to newly qualified social workers one year into practice. Around two-thirds of these trainees intend to move into children’s social work practice.

The latest session was run in collaboration with the local lived experience recovery organisation (LERO). This brought the voices of people with lived experience into the session, including people who began taking substances as young people, as well as current parents and carers. These sessions will run annually with each new intake of social workers.

Drink Drug Hub forms part of North Yorkshire’s strategic ambition to ensure consistent training and non-stigmatised practice across the county’s workforce.

Question 8

6. Safeguarding

Accepted Answer

Promoting and safeguarding child welfare

Promoting and safeguarding child welfare refers to:

preventing harm to children’s health or development
providing timely interventions to prevent problems escalating
protecting children from exploitation, abuse and neglect

Alcohol and drug services working with children have a critical role to play in promoting and safeguarding child welfare.

It is also important to note that some vulnerable young people aged 18 to 24, such as care leavers or those on an education, health and care (EHC) plan, may still receive social care support. For more information on EHC plans, see Children with special educational needs and disabilities.

What services should do about safeguarding

Children and young people’s alcohol and drug services should:

A multi-agency and co-located model for services in East Sussex: case study

East Sussex has a well-established, multi-agency substance misuse service for young people aged 25 and under delivered by children’s services. The team is made up of a range of professionals. These include social workers, nurses and CAMHS workers, alongside children and young people’s drug and alcohol workers.

Staff work within an integrated management protocol and to a detailed service specification, which outlines delivery to identified vulnerable groups. Many staff are co-located in services, for example youth justice, care leavers and the child criminal exploitation team. The service also provides specific screening and service access pathways for children who have been excluded from school and those accessing emergency departments.

Any worker with sufficient alcohol and drugs training may act as lead professional, regardless of their specialism.

For all children 17 and under and care leavers up to the age of 25, co-located workers use a shared case record system. This allows alcohol and drug assessment and interventions to be included seamlessly within statutory planning processes.

The engagement and retention of children and young people in treatment is high in East Sussex, as is the children’s workforce confidence in working with alcohol and drug use issues. The multi-agency and co-located model is a significant factor in the service’s effectiveness.

Question 9

7. Multi-agency complex care arrangements

Accepted Answer

Community-based treatment

Community-based treatments are usually more appropriate and effective for children and young people than interventions that temporarily remove them from their family and support network.

Differences in emotional and cognitive development, problem awareness and readiness for change, as well as consent and safeguarding issues, all require a different approach. This means that residential rehabilitation designed for adults does not easily translate to children’s services. Professionals working with children and young people should always consider local solutions before looking for residential placements.

Complex care

Complex care comprises intensive, multi-agency care packages for extremely vulnerable children and young people. A child or young person may need complex care when they:

are experiencing significant harm, and need substantial additional support, related to their alcohol or drug use
have had a comprehensive and holistic assessment that recommends residential care or community or inpatient detoxification as part of their multi-agency care package

Commissioner and provider responsibilities for complex care interventions

Commissioners and providers should have clear processes in place for situations where there is a clinical need for:

removing a child or young person from their home
detoxification provision
a Deprivation of Liberty order, where clinicians deem a child exceptionally high risk of harm to themselves, from others or occasionally towards others

Multi-agency arrangements and assessment

Every local council area should have multi-agency complex care arrangements in place.

As well as alcohol and drug use, comprehensive and holistic assessments should include as a minimum:

physical and sexual health needs
mental health and neurodiversity needs
developmental maturity
parental status
safeguarding considerations
family and wider support networks
readiness and goals for treatment
the capability and suitability of the service being considered

Safeguarding and parental or carer involvement

Child social workers must always be involved in assessing and reviewing safeguarding risks before, during and after a child is placed in a multi-agency complex care arrangement.

Where it is still safe and appropriate, parents or carers must be involved in assessments, care planning and reviews of safeguarding risk. When children and young people are removed from their home as part of their care, safe ongoing contact with parents or carers must be supported and prioritised.

Special consideration should be given to whether a complex care intervention is appropriate for young people aged 18 to 24. This may require the involvement of:

Where a child or young person has co-occurring mental health or neurodiverse support needs, a lead professional or care co-ordinator should be involved in their care. This is to make sure that both alcohol or drug and mental health or neurodiversity needs are fully considered in risk assessments and risk management.

Risk assessments and management should be an ongoing process, involving child social workers, and, where appropriate, other professionals and parents or carers. This is particularly important in the event of a change of placement or circumstance, for example a discharge from a hospital to a placement with parent or carer.

Care packages and residential placements

Support offered to children should be a multi-agency care package. This should include:

alcohol and drug specialist interventions
continued access to education
an appropriate and safe residential setting, for example an emergency foster care placement, CAMHS inpatient ward or secure children’s home

Where residential care for children is deemed necessary, children should be placed in residential services that are registered with both the Care Quality Commission and Ofsted. Local councils will secure Ofsted permissions for unregistered placements, where required. All children should have an allocated social worker to oversee care planning and ensure looked-after children statutory processes are followed. For more information, see the statutory guidance Children Act 1989: care planning, placement and case review.

Detoxification

Detoxification in a specialist alcohol and drug, CAMHS or paediatrics inpatient unit is generally only clinically advised when someone is physically dependent on alcohol, other GABA agents or opioids. Inpatient assessment and stabilisation may be clinically appropriate for other drug use where physical needs are complex and severe, such as in cases of prolonged ketamine use.

Where a child aged 10 to 17 requires alcohol detoxification, practitioners should follow NICE clinical guideline Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence.

Where a child aged 16 and over is assessed as requiring detoxification for opioids, practitioners should follow NICE clinical guideline Drug misuse in over 16s: opioid detoxification.

It is essential to maintain links with children and young people’s positive social networks and local sources of support, including family, schools and mental health services.

Supporting young people with complex needs in St Helens: case study

In St Helens, every young person aged 17 and under with complex needs is placed on a child in need or child protection plan. Cases are reviewed regularly at multi-agency child exploitation meetings.

Child social workers work in partnership with drug, alcohol and other local services to make sure comprehensive health and safeguarding measures are in place. Every young person with complex needs receives a thorough health assessment to identify any unmet physical, mental or sexual health needs. Co-ordination is maintained with their GPs and, where needed, referrals are made to specialist consultants, dietitians and urologists.

The local alcohol and drug service for children and young people is further supported by a specialist nurse from the adult service.

Children and young people admitted for inpatient treatment receive intensive pre-admission support and a detailed post-discharge care plan. This covers education, positive activities and support from age-appropriate mutual aid and LERO groups.

Parents and carers have access to:

a fortnightly open session
naloxone training
support with detox admissions and discharges

The council is working with the local children’s hospital to expand treatment options for young people aged 16 and under, with the aim of broadening available care pathways.

Question 10

8. Support for young people (aged 18 to 24)

Accepted Answer

Emerging adulthood (aged 18 to 24) is a distinct developmental phase. It can involve:

greater independence
less parental control
self-exploration
changing social networks

These changes can increase the risk of alcohol and drug use as young people adjust to their new role as an adult.

Alcohol and drug services for children and young people and their commissioners should consider the following principles.

Developmentally appropriate support

Support for young people aged 18 to 24 should be developmentally appropriate. For a definition of developmentally appropriate, see NICE guideline Transition from children’s to adults’ services for young people using health or social care services (NG43). Service providers should consider a young person’s:

maturity
cognitive abilities
psychological status
physical and mental health support needs
social and personal circumstances

Support can be provided in an adult service or in a children and young people’s service, as part of a transitional arrangement to prepare young people to receive support in an adult service. Some areas have dedicated alcohol and drug workers supporting people aged 18 to 24, either in adult or children and young people’s services, or in a dedicated young adult service. Irrespective of the local arrangements, the following principles apply.

Where treatment and recovery support for young people aged 18 to 24 is not part of a transitional arrangement, it should be funded by the adult treatment budget, regardless of which service is providing it.

Welcoming environments and tailored services

All services should be welcoming to young people aged 18 to 24 and ensure that this group feels that their distinct needs are recognised. This could include:

specific publicity material
a named or differently branded young person’s service
visible information about young people’s health needs and patterns of drug use and harm

All services should make sure they have tailored interventions for young people aged 18 to 24, including dedicated clinics or drop-in times.

Children should not be put off accessing specialist interventions because of a large presence of over-18s in a children and young people’s service. Also, young people aged 18 to 24 should not avoid accessing an adult service because they do not feel safe, welcome or that it does not meet their needs.

Where a children and young people’s specialist service has a high proportion of people aged 18 or over in their care, commissioners and service managers should consider whether this:

reflects local need for improved transitional arrangements
means the children and young people’s specialist service has sufficient capacity and resource to fully meet these needs
suggests adult services are not equipped to meet the needs of young people aged 18 to 24
indicates that a dedicated young adult service should be commissioned

Staff from children and young people’s alcohol and drug treatment services can help to upskill local adult services to work with young people aged 18 to 24 and adults with developmental delays.

The views of young people aged 18 to 24 with living and lived experience of alcohol and drug use should be a part of local needs assessments and service evaluations. This should help to ensure that their needs are being met by local services.

Transitional arrangements

Transitional arrangements support young people approaching adulthood and 18 to 24 year olds with ongoing alcohol and drug problems to continue their care in adult services. NICE guideline NG43 notes that guidance outlining the principles of effective transitional care is not often fully implemented in day-to-day practice. Without effective transitional support, young people may disengage from services.

NICE guideline NG43 and quality standard Transition from children’s to adults’ services should apply to all young people aged 24 and under who are transitioning from children’s to adult health or social care services. For those not covered by health, social care or education legislation, alcohol and drug workers should begin planning for adulthood from year 9 (age 13 or 14). However, this approach may not be suitable for all children in alcohol and drug treatment, as treatment is usually brief. Where support is likely to continue into adulthood, transition planning should begin as early as possible.

For young people aged 18 or over who enter treatment in a children’s or young people’s service, transition planning should begin right away. A thorough assessment of their needs and readiness should be carried out, involving the young person and, when appropriate and safe, a parent or carer. If this assessment shows it would be better for them to remain in the service until age 25, they can do so. In these cases, there should still be transition arrangements in place ahead of time, so the move to adult services at 25 is seamless and effective.

Lead practitioners, who may be a child social worker or a worker from another partner agency, should make sure that a transition plan is co-ordinated across all relevant services. The plan should involve the young person, as well as their parents or carers where appropriate.

Different services, such as youth offending teams, CAMHS and statutory children’s services, transition young people at different ages or developmental stages. These different arrangements should be detailed in the transitional care plan, so that everyone knows which agencies are involved, what support they are providing and when it is due to end.

Young people with care experience and those with EHC plans have legal entitlements to receive support for education, health, housing and life skills up to age 25. This can include remaining in a children and young people’s alcohol and drug service.

Children and young people’s alcohol and drug services are responsible for making sure that young people in their care are prepared for the transition to an adult alcohol and drug service. Where it is safe and appropriate, parents or carers should also be prepared for the transition.

Both children and young people’s and adult alcohol and drug services are responsible for making sure young adults receive continuous support. As a minimum, each service and the young person should review and update the final care plan before transition. Where possible, parents or carers should be involved in transition planning.

Supporting young people not in education, employment or training

Children and young people who are NEET, or who are at risk of becoming NEET, should receive co-ordinated support.

As part of their assessment and care planning, services should understand a young person’s education, employment and training status and any barriers to participating in them.

Where appropriate, services should establish pathways to education, employment and skills support, including individual placement and support (IPS) services. IPS is an evidence-based approach that helps people find and stay in work alongside treatment and recovery support.

A recent report on the outcomes of IPS found that 62% of people aged 24 and under who accessed IPS moved into employment, and around three-quarters of those who found work stayed in it for more than 13 weeks.

As well as supporting people into work, IPS can help young people start or return to education, training and apprenticeships. Participating in education, training and employment can support recovery and a successful transition to adulthood.

Employment support in South Tyneside and Gateshead: case study

Emerging adults aged 16 to 24 with alcohol or drug problems can face unique challenges when entering employment. These include:

uncertainty about career goals
balancing education and work
managing personal barriers, such as trauma, neurodiversity and mental health problems

South Tyneside and Gateshead councils have a dedicated IPS employment specialist for young people aged 16 and over. This ensures individually tailored support that enables young people to thrive in the workplace.

The employment specialist sits within the young person’s treatment team and works closely with recovery workers. They also work with a range of other partners as required, including:

social care and safeguarding teams
the young person’s education provider
training and apprenticeship providers
the young person’s family

The standard IPS model is adapted to recognise that young people:

often need more time and flexibility
may simultaneously need support to stay in or return to education
may want to explore work opportunities that include educational elements
may benefit from family involvement, where appropriate

This approach allows the employment specialist to support young people into sustainable employment by addressing their specific challenges.

Increasing engagement with alcohol and drug treatment services in Derbyshire: case study

Derbyshire County Council has developed a dedicated service for emerging adults called 1625 Outreach, delivered by Change Grow Live. It is a multi-component, community-based model designed to increase access and engagement from 16 to 25 year olds who would not typically use alcohol and drug treatment services.

The service relies heavily on integrated partnership working to operate from a range of age-appropriate, place-based settings, including:

night-time economy venues, such as pubs and bars
festivals and other large, organised events
further and higher education settings
community hotspots like youth centres

The service provides targeted, responsive support through a range of innovative engagement methods, including pop-up stalls, education workshops and a mobile unit. Digital outreach is also an important feature, using a range of social media platforms to promote age-appropriate harm reduction content.

These targeted, early interventions aim to reduce illicit substance use and related risk-taking behaviours among 16 to 24 year olds that are at increased risk of experiencing alcohol or drug-related harm. The service also acts as an accessible first point of contact for those who may need more structured treatment, with direct referral pathways into both young people’s and adult alcohol and drug services in Derbyshire.

In 2025, the service engaged 6,312 young people aged 16 to 24 across these place-based settings. Of these:

44% had used cocaine
43% had used ketamine
36% had used nitrous oxide

A total of 76 referrals were made into treatment services for continued, care-planned interventions.

A feasibility study to evaluate the 1625 Outreach service has been published on the ‘Our research’ page of the Change Grow Live website. Aspects of the model have since been adopted in Sheffield, Derby, Nottingham and Liverpool.

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