Information and Instructions

• Cumulative harm and AOD use
• Volatile Substance Use (VSU)
• VSU working groups
• Assessing a young person at immediate ‘high-risk’
• Alcohol and other drug use and young people not in the CEO’s care
• Alcohol and other drug use and young people in the CEO’s care
• Safety planning
• Alcohol and other drug use and leaving care

Cumulative harm and AOD use

 

If the young person is engaging in high-risk behaviours and/or harmful AOD use, and the young person comes to the attention of the Department, a CSI must be considered, and the Interaction Tool completed.   These behaviours often indicate abuse, including neglect, in older children and adolescents. They are also more likely to present in young people who have been exposed to caregivers who engage in AOD use and where it is easily available in the home.

'Cumulative harm' occurs when a young person is exposed to repeated incidences and/or chronic abuse, including neglect and family and domestic violence (FDV). The accumulation of the physical, emotional and physiological responses to trauma can have profound impacts on a child, including damage to the developing brain, developmental delay, flashbacks, sleep problems, emotional dysregulation, mental health issues, difficulties in developing and managing safe relationships and conduct issues.

It should not be surprising that children and young people who have experienced cumulative harm, have much higher rates of harmful AOD use. Making decisions to engage in harmful use of AOD may appear destructive and can place a young person at further risk of abuse and harm, but it  may allow a young person to feel they have agency, to mask and soothe the symptoms of trauma and to manage circumstances outside of their control, such as poverty and racism.

Assessment and intervention for a young person engaging in harmful AOD use, should be based on harm-minimisation principles, professional collaboration and relationship-based engagement.  

Racism, stigma, environmental adversity and social disadvantage constitute ongoing stressors for Aboriginal and Torres Strait Islander youth. Intergenerational trauma and loss experienced within broader kinship networks continue to impact on young people, and their physical and mental health outcomes continue to be poorer than their non-Aboriginal peers. Family and country is central to Aboriginal culture and connectedness to family and being on country are key to healing processes. Responses should consider family history of coping with ongoing stressors, culturally appropriate supports and how to integrate family healing and recognition of familial strength into any broader intervention.

 

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Volatile Substance Use (VSU)

​Experimental and episodic Volatile Substance Use (VSU) is present among young people from urban, rural and remote areas, and across all socioeconomic groups. High levels of widespread and chronic use are most prevalent amongst Aboriginal and Torres Strait Islander communities in rural and remote areas. Young people experiencing homelessness are also at higher risk of chronic VSU, as it is an accessible and cheap mind-altering substance. Most young people will stop engaging in VSU as they get older, with a very small number continuing, usually as part of polysubstance use patterns, into adulthood.

Volatile Substance Use (VSU) involves "sniffing" aerosol cans such as deodorant or insect spray, petrol, felt tip pens, glue or other volatile substances which provide a similar effect. The substance might be "sniffed" straight from a can or container, or if using spray paint, it might be sprayed into a bag and sniffed from there. This latter form of VSU is called "chroming" and an indication of use can be specks of spray paint on the face or in the hair of the young person.  Other signs of VSU include:

• a strong smell of solvents on the young person's body, breath or clothing
• a brief period of euphoria, followed by drowsiness and lethargy
• slurred speech and communication difficulties
• bloodshot eyes and blurred vision
• runny nose and excessive salivation or drooling
• poor coordination and muscle weakness
• fast onset of confusion, impaired memory and ability to focus or concentrate
• nausea, vomiting, diarrhoea and/or non-specific physical pain
• hallucinations, delusions and/or delirium; and
• depressed breathing and heartrate, convulsions, and/or loss of consciousness

 

If a young person displays physical and cognitive signs of VSU and you believe they have been using, you must ensure that young person has access to medical advice and/or treatment.   Given the extremely high risks associated with VSU the default decision should be to seek medical advice where VSU use is known to, or suspected to, have occurred.

Young people engaging in (VSU) do not usually understand the risks. Inform them that if they are "sniffing" and experience a sudden increased heart rate, like when they are exercising, extra pressure is being put on the heart which can cause it to stop. This is sometimes called "Sudden sniffing death". It is important not to scare a young person, but they need to be aware of the specific dangers associated with VSU.

Being mindful of the risk of "sudden sniffing death" and avoid situations  that may cause fear or stress, or where the young person is inclined to run. in a young person you know has been engaging in VSU. Refer to the Australian Indigenous Health Infonet: Alcohol and Other Drugs Knowledge Centre for further information.

Other long-term effects of VSU include:

• neurodevelopmental development delay
• brain damage
• chronic nausea
• damage to heart, kidneys and lungs
• serious mental health issues such as depression, and
• chronic muscle weakness.

Where a young person in the CEO's care is known to engage in, or has engaged in past VSU, ensure the carer or staff at the care arrangement are aware of the risks associated with this. The young person should have a clear safety plan in place for when they are substance affected. The plan should include regular checks on the young person, even when they are sleeping, to monitor if medical treatment is required. It should also note the importance of all carers and workers remaining calm and limiting the young person's access to substances wherever possible. 

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VSU working groups

Given the significant and long-term negative impact on children and young people, their families, and the community, VSU is addressed in Western Australia at a local, regional, and state-wide level. Responsibility for managing the issues related to VSU sit across a broad range of government sectors, including child protection, health, law enforcement, criminal justice, recreation, and education. For details on reporting VSU, see VSU Working Groups by Location (related resources) and the Mental Health Commission website.

For information or support to develop a local VSU Working Group to address VSU issues in your region, contact the Volatile Substance Program at the Mental Health Commission.

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Assessing a young person at immediate ‘high-risk’

 

Where a young person presents at immediate risk due to AOD use, either due to a medical and/or mental health crisis, you must ensure that young person receives appropriate medical and/or psychological assessment. This response is required regardless of the young person's care status.

The response you provide to a young person who is severely substance affected and/or in crisis, should be directed by the needs of the young person. Where you have immediate concerns for a young person, you should consider the following:

For a young person not in the care of the CEO:

• Does the young person's level of intoxication and/or their current presentation indicate that they can make safe and appropriate choices, or are they likely to be at imminent risk of harm and/or vulnerability?

• Does the young person have a safe and supportive parent or other safe adult willing and able to engage in safety planning to ensure their immediate safety?

• Are there other indications that the young person is at risk apart from  those associated with their immediate AOD use?

• Is the young person likely to be a risk to others? Do they have a history of violence towards others, including family or healthcare staff?

• Is the young person likely to be a risk to themselves? Has the young person made any disclosures of harm or suicidal ideation/intent to self-harm?

• If an ambulance is called, who and how will follow-up with the young person occur?

• Once the young person's immediate safety has been secured, either by calling an ambulance or by ensuring the young person will be cared for by a safe adult known to the young person, consider what additional information you may need: Is this a young person who regularly engages in high-risk behaviours? Or is this an isolated crisis? 

• If this is an isolated crisis, can you make an appropriate referral for the young person and/or their family to limit a recurrence of this crisis?

• If the young person is at high-risk due to homelessness, mental illness, trauma, chronic engagement with the juvenile justice system and/or exploitation, who is responsible for monitoring and planning to manage the risk for this young person? Is the family able to manage and engage with services after referrals are made? If not, who is responsible for managing the support and safety for this young person?

Who will speak to the young person in the moment and then when appropriate, ask them their views and wishes in relation to making a referral to an AOD service? Are there any specific considerations to be made during this conversation in relation to this child? Does the young person need an interpreter or other communication supports?

The young person is in the care of the CEO:

• Is there a safety plan in place already? Is everyone aware of this plan and following it? If so, is this safety plan still meeting the needs of the young person?

• Is the current care arrangement meeting the complex care needs for this young person? If the young person is struggling in their care arrangement, what additional supports can be put in place to support/educate the carers and/or staff to meet this young person's needs?

• If an ambulance is required, who will attend the hospital with the young person? Who will liaise with the hospital to manage the medical and/or psychological needs of the young person? If management of the situation is required afterhours, consider submitting an Afterhours Action Request to Statewide Referral and Response Service – Crisis Care Unit (SRRS-CCU).

Once the young person's immediate safety has been secured, consider the following:

• Who will speak to the young person and ask them their views and wishes in relation to making a referral to an AOD service? Are there any specific considerations to be made during this conversation in relation to this child?

• How will this situation be described and reflected on their Assist file? Discuss with the young person how they think the situation should be reflected in their file.

 

When a young person is in physical or mental health crisis due to AOD use, consult with the team leader (TL) to develop a response. Managing worker safety should be considered alongside the needs of the young person. Stay with the young person and organise for another safe adult to remain with the young person if you must leave them to manage referrals, transport or consultation. If you must leave the young person alone, keep the time they are alone to a minimum and check the area to make sure it is safe prior to leaving.

 

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Alcohol and other drug use and young people not in the CEO’s care

​There are circumstances where a young person with AOD difficulties may come to the attention of, or is already having contact with the Department, but is not in the CEO's care. See below for the most common situations where this will arise:

• Youth at Risk Strategy (YARS), including Youthbeat, in Northbridge.

• Where the family is already open for other concerns. The case may be focused on the safety of younger siblings.

• Self-presenting at a district office or via a phone call.

• Reports of concern sent by concerned adults, e.g. schoolteacher, or via a Mandatory Report (MR).

• Hospital Emergency Department (ED) where a young person has presented following a crisis.

• Family and Domestic Violence Incident Reports (FDVIR's) where the young person is using violence in the home or present when another person in the home uses violence.

Given the prevalence of co-occurring harmful AOD use and child protection issues in young people, you should actively screen for child protection concerns. For example, ask the young person or the referrer if they have any other concerns apart from the AOD use and if the young person has safe, supportive family members. If the young person or referrer raises additional child protection concerns, apply the Interaction Tool and consider if an Intake is required. See chapter 2.2 Processing referrals and interactions for more information.

When engaging with young people known to be regular substance users, be mindful that the young person's mental health may be fragile. If there are signs the young person is engaging in self-harm or is feeling suicidal, discuss this with them consider their risk for suicide. See Chapter 1.4 Suicide and self-harm for further information and consider the above information on how to manage AOD crisis presentations.

Where there are no obvious child protection concerns but the risks for the young person due to their AOD use are very high, consider what services can be put in place immediately and longer term to support that young person. You should call an ambulance, an emergency mental health team, or recommend an appropriate adult take the child to hospital, particularly if the young person is highly intoxicated and/or may be at risk of suicide. Where a young person is referred to an acute service, you should provide the service with a thorough handover of how the young person came to the attention of the Department, all relevant information about their AOD use and why you are concerned for their safety in relation to their AOD use.

It is important to leave the responsible adult caring for the young person with contact details for services for future support. Examples of appropriate services may include, but are not limited to:

• Local youth accommodation services
• Next Step Community Alcohol and Drug Services Referral
• SHIFT Youth AOD Outreach Service
• Youthbeat Case Management Service
• Centercare's Counselling for Adolescent and Parent Service
• Centercare's Youth Support Service
• Wungening Aboriginal Corporation

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Alcohol and other drug use and young people in the CEO’s care

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When developing a longer-term AOD safety plan, you should gradually transition power and decision-making responsibility to the young person as they demonstrate capacity to manage this responsibility safely. Managing their own safety and learning how to make safe choices is an important developmental milestone for the young person as they move towards independence.

Alcohol and other drug use (AOD) is common among the majority of young people in the CEO's care. Before making any plans with the young person to respond to the AOD use, it is important to explore what their AOD use looks like and what impact it is having on them. For examples or what questions to ask a young person to understand their AOD use, see AOD use in young people: prompt questions (in related resources).

A young person's harmful AOD use, conversations with the young person about their use and any decisions made should be documented. In addition to using case notes to document incidental conversations and consultation, the young person's Care Plan should include any planning around the young person's harmful AOD use. Planning in this area may cross several dimensions of care but should primarily sit within health care planning.

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Safety planning

Safety plans should be driven by the needs and wishes of the young person. Where a young person has said they do not want to stop using because it helps their mood and connects them with friends and family, a harm-minimisation approach will be most helpful. A harm minimisation approach may include a referral to an AOD service, with agreement from the young person, even where they have expressed that they do not want to cease use. Before making a referral, ensure the service also adheres to harm minimisation principles.  Where a young person has identified that they want to reduce or stop using, you should make appropriate referrals, so the young person has appropriate and adequate support to help them make changes. 

All safety plans should:

• be developed with the young person and their care team

• take a harm-minimisation approach, avoiding responses where the young person feels judged or penalised

• be reviewed and updated regularly

• identify clear roles and responsibilities for the care team

• be shared with the young person, the carer and other appropriate significant people, with consent of the young person

• be placed on the young person's file to be accessed as necessary

• identify triggers for use and how to reduce these triggers

• focus on the young person developing skills to manage these triggers where they cannot be avoided

• identify the biggest risks for the young person, recognising that this will be different for everyone

• include strategies to mitigate these risks

• identify the strengths of the young person and how they have kept themselves safe in the past

• include names and contact details for safe people that can be called anytime, day or night. If appropriate, this should include SRRS-CCU; and

Sometimes the necessity to focus on keeping the young person safe due to their AOD use can detract from a more holistic approach to supporting the young person in other areas of their lives. Once a safety plan has been developed and appropriate referrals have been made, work collaboratively with the AOD professionals, but try not to focus too heavily on this one area of the young person's life. See AOD Issues - Referral Tip Sheet (in related resources) for further information.

When a young person is involved in Drug Court or Youth Substance Treatment Intervention Regime (YSTIR) programs, you should:

• assist the Court or Drug Court assessment teams
• participate in the Drug Court pre-court discussions, and
• provide support to the young person while they undertake Drug Court or YSTIR programs. 

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Alcohol and other drug use and leaving care

Young people leaving care often feel ambivalent about turning 18 years. They may feel excited to experience the freedom of adulthood and the withdrawal of Departmental involvement in their lives, in addition to anxiety around losing the support of the Department. Because of these complicated feelings, leaving care is a risky transition for young people with harmful AOD use.

Where a young person is known to engage in harmful AOD use, this should form part of their leaving care plan. Consider and explore what supports are available if they need it, where the young person is known to engage in experimental, occasional, or non-harmful AOD use. Where a young person is not engaged in AOD use, their leaving care plan should consider where and how they can receive support in the future if they develop worries about AOD use.

See chapter 3.4 Leaving the CEO's care for more information.

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