Best Practices -- Early Intervention, Outreach and Community Linkages for Youth with Substance Use Problems

1. Introduction

The purpose of this project was to develop guidelines for best practices related to outreach, early intervention and community linkages for youth with substance use problems, to provide health and community professionals with updated information around the specific challenges in these areas, and to encourage further best practice research.

Health Canada initiated this project as part of the research agenda developed by the Alcohol and Drug Treatment and Rehabilitation Federal/Provincial/Territorial Working Group (ADTR Working Group). Part of the mandate of the working group is to oversee the development and implementation of research studies that contribute to effective and innovative substance abuse treatment and rehabilitation programs by identifying best practices, evaluating model treatment and rehabilitation programs, identifying emerging issues and disseminating the knowledge across the country.

This project builds on a series of best practice publications, including Best Practices -- Substance Abuse Treatment and Rehabilitation (Health Canada, 1999); Best Practices -- Concurrent Mental Health and Substance Use Disorders (Health Canada, 2001a); Best Practices -- Fetal Alcohol Syndrome/Fetal Alcohol Effects and the Effects of Other Substance Use During Pregnancy (Health Canada, 2001b); Best Practices -- Treatment and Rehabilitation for Women with Substance Use Problems (Health Canada, 2001c); Best Practices -- Treatment and Rehabilitation for Youth with Substance Use Problems (Health Canada, 2001d); Best Practices -- Methadone Maintenance Treatment (Health Canada, 2002a); Best Practices -- Treatment and Rehabilitation for Seniors with Substance Use Problems (Health Canada, 2002b); Best Practices -- Treatment and Rehabilitation for Driving While Impaired Offenders (Health Canada, 2004); and Best Practices -- Early Intervention, Outreach and Community Linkages for Women with Substance Use Problems (Health Canada, 2006a).

The goal is to make best practice guidelines available to service providers, program planners and policy makers who are involved in delivering substance abuse programs or services to youth. As well, this publication will be a resource to clients of these services, their families and communities. The best practice guidelines were identified by reviewing recent literature, interviewing key informants on current and recommended practice, and interviewing youth who have had or are now having problems with substance use.

This report is organized into five main sections:

• Project background and description: A summary of the methodology and research activities.
• Literature review: A critical analysis of relevant research.
• Interviews with key experts: A summary of key insights from experts across Canadian provincial and territorial jurisdictions representing academia, managers and clinical professionals.
• Focus groups with youth: The perspectives of youth who are or have been in need of early intervention, outreach or community linkage services to address problem substance use.
• Best practice statements: Guidelines related to early intervention, outreach and community linkages for youth with substance use problems. The sections of the document that support each best practice statement are cited in Appendix B.

Literature Review

The literature review provided a critical analysis of the key issues related to early intervention, outreach and community linkages for youth with substance use problems. Documents were drawn from Canadian and international sources of published information and articles in recognized publications, as well as from recent unpublished reviews by key experts. The scope of this search was limited to relevant documents published or written between 2000 and 2006, including:

• professionally reviewed or expert-juried research documents;
• summary and literature review articles;
• comparison studies of different approaches or methods;
• controlled trials or quasi-experimental investigations;
• program evaluation reports;
• theoretical literature related to best practice research;
• pre-2000 publications where warranted by unique research.

The following databases were consulted:

• Medline (medical studies);
• CINAHL (nursing and allied health literature);
• Canadian Centre on Substance Abuse (CCSA) Addictions Databases;
• EBM Reviews -- Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews;
• ETOH (National Institute on Alcohol Abuse and Alcoholism);
• SAMHSA (Substance Abuse and Mental Health Services Administration -- U.S. Department of Health and Human Services);
• PsycInfo (psychological studies).

1.1 Methodology

Key Experts

In consultation with members of the ADTR Working Group, key experts working in early intervention and outreach services or facilitating community linkages for youth with substance use problems were identified throughout Canada (see Table 4). The 18 key experts who participated held various roles and had diverse backgrounds (Tables 5 and 6). All respondents were given time and opportunity to provide detailed information for each question. Interviews were conducted over the phone in either English or French, given the preference of the interviewee.

Focus Groups

Eight focus group sessions were conducted across four Canadian regions. Initial contact with participants was done in collaboration with local and regional youth service agencies. Forty-six youth participated in the sessions (see Table 7).

Definition of Best Practice

The concept of "best" or "better" practices related to program delivery in the health and community sectors has been approached with varying degrees of rigour (Association of Ontario Health Centres [AOHC], 1999; Health Canada, 2002b). Recent approaches have emphasized the importance of systematically analyzing the convergence of published literature and lessons learned from practitioners, policy makers and recipients of services. The outcomes are subsequently used to formulate statements that serve as guidelines for program managers and practitioners involved in developing community-based service delivery systems (AOHC, 1999; Murnaghan, 2006).

For this project, best practices are emerging guidelines, gleaned from client and key expert perspectives and the literature. Consistent with other Health Canada documents, the best practice guidelines outlined in this report should be regularly reviewed as research in this area continues.

1.2 Scope and Limitations

The focus of this report is on early intervention, outreach and community linkages for youth with substance use problems. Youth were defined as adolescents and young adults between the ages of 12 and 24. Research related to adults or to children under age 12 was considered to be beyond the scope of this project. The term "substance" is used to describe alcohol, solvents, prescription medication and illicit drugs.

Efforts were made throughout each phase of the project to investigate gender-based differences among youth. Where specific differences are indicated, descriptions of those are noted. As well, risk and protective factors are addressed throughout the document.