This section contains useful information and resources for professionals and organisations. In the right hand column there are documents to download and links to further sources of information.

• Introduction to treatment tiers
• Substance Misuse Core Competencies
• VSA competencies

The four-tiered model of drug and alcohol interventions outlined in the Substance of young needs (HAS, 1996 and 2001) provides a framework for the service components of an integrated and comprehensive child-based service. The model should be viewed as a flexible approach to commissioning and service provision of substance misuse interventions for children and young people.

The following is a brief description of the four tiers.

Universal, generic and primary services providing drug education, information, identification and referral.

Services with some specific drug and alcohol knowledge, providing drug prevention and targeted education, advice and general counselling services.

Specialist drug services that work with complex cases (often multi-agency), usually offering a care plan.

Services providing very specialised and intensive forms of intervention for drug users with complex care needs.

Core Competencies

To work in the field of substance misuse, any individual should be able to demonstrate a number of core competencies.

For those working with adults the core competencies are:

• Communication skills
• Health and safety
• Continuing professional development
• Principles of care.

For those working with children and young people, the core competencies are:

• Child and young person development
• Safeguarding children and promoting welfare
• Effective communication and engagement
• Supporting transitions
• Multi-agency working
• Sharing information.

VSA Competencies

The competencies listed below are taken from the Home Office's publication 'Workforce Briefing - VSA' which can be downloaded on the right.

• Knowledge of the basic signs and symptoms of VSA
• Knowledge to refer individuals with VSA problems to the appropriate channels
• To have a basic understanding of the risks of VSA to the family and community
• Awareness of the correct emergency action to be taken in the event of a VSA-related incident
• To be able to identify VSA products and their methods of use.

• Ability to take a more detailed VSA history, identify risks and apply knowledge of VSA at a level appropriate to Tier 2 case work
• Knowledge of sudden death related to VSA
• The ability to distinguish and work with issues around harm minimisation and abstinence when dealing with VSA
• A more detailed understanding of the signs and symptoms of use and a good working knowledge of the VSA referral network at Tier 3, with the ability to make referrals to appropriate agencies
• Ability to apply knowledge and communication skills to limit experimentation and further misuse
• An understanding of the risks to family and community and when and how to act
• An understanding of the risk factors specific to particular client groups, such as school excludees
• An informed understanding of the varied individual reasons for VSA
• An understanding of the availability and trigger factors involved in persistent use and how this is related to legislation, e.g. the legality and ready availability of the substances used
• An understanding of the health and safety issues associated with working with volatile substance misusers and the ability to avoid dangerous situations.

• Ability to take a full VSA history and identify and act on risk factors
• Knowledge, skill and ability to perform a full VSA assessment
• Ability to apply the skills and knowledge necessary to work with VSA at Tier 3 in a one-to-one setting
• Excellent communication skills
• Ability to understand and deliver safe treatment within both a harm minimisation model and an abstinence model, and to understand the dangers of the harm minimisation model in relation to VSA
• A thorough understanding of the signs and symptoms of VSA to permit a distinction between chronic, acute and occasional VSA to be made
• Ability to understand, identify and diagnose the phases of VSA, including acute withdrawal
• Understanding of the symptomotology of chronic VSA and of the appropriate response to chronic VSA symptoms, including referral to professionals at Tiers 3 and 4, e.g. cardiology
• Ability to apply knowledge of VSA in order to limit experimentation and further misuse
• Knowledge and skill to respond to each referral as a crisis intervention
• Excellent communication skills to support Tiers 1 and 2 on a client-centred basis
• To have sufficient knowledge to deliver training to those at Tiers 1 and 2
• Advanced understanding of the complexity of triggers
• Advanced understanding of the risks to the family and community
• Skills to provide specialist family support on VSA
• Ability to perform an environmental diagnosis of risk, e.g. the petrol in machines used in prisons where volatile substances are assumed not to be available
• A thorough understanding of the long-term consequences of VSA on health, crime, family, etc.
• An advanced knowledge of VSA legislation and its application.

Specialist Tier 3 skills at Tier 1

Accident and Emergency services and paramedics must be aware of the role of adrenalin in VSA and its physiological implications.

Psychiatric liaison

By virtue of their expertise and role within the health service, psychiatric liaison staff should have VSA knowledge and skills as listed under Tier 2.