The Vision Project

Social policy and the substance misuse field in
general has been slow to understand and respond
to the implications of this research. A recent
large scale meta-analysis of 453 Randomised
Control Trials involving 31,933 participants
that spans 53 years found the effectiveness of
youth interventions remained stagnant during
this time. Specifically, treatment effectiveness
increased non-significantly for Anxiety. Treatment
effectiveness has decreased non-significantly for
ADHD whilst the effectiveness of treatment for
Depression and Conduct problems has worsened
over the last 50 years.
So whilst the number of young people presenting
for help has decreased, the complexity levels of
those who do present has increased. Those in
the field of youth work must recognise that we
are now operating in a realm of need beyond
social education and befriending but one of
more acute mental health needs in a grossly
underfunded sector. There is reticence in the field
to identify young people’s needs specifically for
fear of “labelling” young people. However, there
is no evidence that diagnosis worsens young
people’s conditions. Failure to better calibrate
young people’s needs, and tailor their treatment
accordingly, may be contributing to worsening
outcomes for the most vulnerable young people.
The improvement of treatment outcomes for
young people demands better understanding
of their pathways and profiles. Interventions
must begin to take better account of the specific
drivers and profiles of use within each pathway.
The inability to control impulsive behaviours is
a different therapeutic challenge to Depression.
Treatment intensity must also better reflect the
underlying social functioning levels of young
people that have become curtailed through
substance involvement.
This should be combined with new approaches
to interventions. For example, real time feedback
processes to track and inform young people’s
progress in treatment. Technology offers new
a new world of opportunity in adapting and
developing specific interventions matched to
neural systems implicit in young people’s clinical
profiles. This is not treatment as usual that is
simply delivered online via the internet. Computer
games like Go-Stop Tasks have improved impulse
control in young people, Erickson’s Flanker Test
improves concentration, Working Memory tests
reduce cravings, Emotional Recognition Challenges
improve depression and virtual reality holds
promise to reduce anxiety. These games ‘work’
brain systems that improve their functioning and
reduce presenting symptoms with practice. These
approaches are often more attractive to screensavvy
youth. The introduction of such procedures
has helped double to triple young people’s
expected outcome in projects across Wales and
Cornwall.
All too often young people are regarded by adults
as a blank screen to project what they feel is
wrong with the world or what they feel should
be right in the world. At worse this has led to the
politicisation of youth work whilst at its best we
have simply drawn down adult models for the
not yet adult. The history of effectiveness of
young people’s services does not support either
position. Instead we need to draw upon the
increasing weight of research that illuminates
what it is to be young and translate this into
more developmentally informed approaches. This
requires the profound acceptance of one central
fact: we cannot make young people us but we can
help young people become themselves.
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THE VISION PROJECT