Since the publication of "The substance of young needs" by the Health Advisory Service in 2001, young people’s substance misuse services have been commissioned in line with a four tier structure.

Through closely monitoring the services they commission, commissioners can determine the number of young substance misusers accessing services. This gives an indication of the met need for each of the four tiers. However, this does not tell commissioners about the number of young people with substance misuse needs who are not in contact with these services or, in other words, the extent of unmet need. Furthermore, traditional approaches to needs assessments are static and do not enable commissioners to predict future needs as populations change.

These problems are solved by this health needs analysis tool.

Measuring unmet need

There is a strong evidence base that young people in vulnerable groups are more likely to require support for substance misuse needs. These groups include:

• young offenders;
• young people in contact with social services;
• truants and school excludes; and
• homeless young people.

The health needs analysis tool uses data routinely collected by services in contact with these young people to determine the number of vulnerable young people in an area. It then uses robust national and local research to estimate the number of young people with each tier-level of need.

The most vulnerable young people will appear in more than one of these groups. The tool incorporates primary analysis on a large cohort of vulnerable young people to account for this. The analysis explores in detail the proportions of young people in contact with different combinations of services.

Determining the number of young people requiring different treatment tiers

The Home Office study Drug use among vulnerable groups of young people: findings from the 2003 Crime and Justice Survey (2005), amongst other research, provides robust estimates of the patterns of substance misuse amongst young people. For example, it outlines the percentage of young people in contact with social services who use drugs frequently.

The tool uses this research to make informed judgements regarding how patterns of substance use amongst young people translate into the need for treatment services. For example, the assumption that "all young people in contact with social services who use drugs frequently will need either tier 2 or tier 3 treatment" can be incorporated into the tool.

The Home Office study provides the "default" assumptions for determining the need for the different treatment tiers. It is possible for commissioners to override these assumptions based on their local insights. For example, social services practitioners may report that 50 per cent of the young people they are in contact with require either tier 2 or 3 support. This new assumption can be incorporated. The assumptions page enables the assumptions to be adjusted.

The outputs

There are a range of outputs produced by the tool. These include:

• an overall summary report giving the size of the vulnerable population and the numbers requiring tier 2 and 3 services;
• numbers of young people in each vulnerable group;
• breakdowns of the population of vulnerable young people and those requiring tier 2 and 3 services by gender, ethnicity and ward; and
• high and low level estimates for each population.

It is also possible to use the tool as a modelling instrument. All the assumptions underpinning the tool can be manipulated and it is possible to uplift or reduce populations based on local knowledge of population trends.