Strasbourg, October 2003

P-PG / Prev (2003) 6 E

OUTREACH WORK WITH YOUNG PEOPLE, YOUNG DRUG USERS AND YOUNG PEOPLE AT RISK

Emphasis on secondary prevention

Njål Petter Svensson

Sheena Horner-Knight, Tommy Husebye,
Sabine Muerwald, Jürgen Schaffranek

Pompidou Group with the co-operation of the City of Oslo, Alcohol and Drug Addiction Service Competence Centre

 

NB: The opinions expressed in this work are the responsibility of the authors and do not reflect the official policy of the Council of Europe.

No part of this document may be translated, reproduced or transmitted, in any form or by any means, electronic (CD-Rom, Internet, etc.) or mechanical, including photocopying, recording or any information storage or retrieval system, without prior permission in writing from the Pompidou Group Secretariat.

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Preface

This manual was prepared in a co-operation of the Norwegian Ministry of Social Affairs, the Centre of Competence of the City of Oslo Drug and Alcohol Service and the Pompidou Group. As a publication aimed at decision makers, professionals and practitioners alike it is intended to reach a broad European audience and facilitate wider and effective implementation of outreach work with young people, young drug users and young people at risk.

Since the late 1960’s outreach work as an approach to drug prevention in the local community work has been a well-established practice in early intervention and related to drug prevention in most towns and cities throughout Norway. The encouraging results this approach has yielded led to the co-operation with the Pompidou Group with the idea of preparing a manual on outreach work for a European audience.

Over the years outreach work has proven useful in many countries. This publication includes examples of current practices in Austria, Germany, Sweden and the UK. This overview seeks to give a representative picture of the current state of the art across Europe.

The case for taking a broad and multidimensional approach to outreach work is based on two principal developments observed over the last years: (i) difficulties in dealing with increases and/or problematic drug use among young people, and (ii) experiences and successes achieved in different countries by implementing outreach work. Since the mid 1980’s outreach work as a preventive measure has increasingly narrowed its focus down to intravenous drug users and therefore became mainly a part of the toolbox for HIV-prevention. This is certainly useful but limits the potential of outreach work greatly. This publication aims at highlighting and reinforcing the tremendous potential of outreach work as a method in its own right in targeting young people at risk in their communities as a part of increased efforts in drug prevention. The manual hopes to raise awareness of the importance of outreach work as a professional approach to early intervention strategies in the field of drug prevention.

Lilleba Fauske Arne Schanche Andresen
Director General Head of Department

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Outreach work

Among other fields of work, the Pompidou Group elaborates targeted prevention initiatives in response to new trends in drug use and promotes greater access to information for those confronted with drug-related problems. Outreach work has been a continuous topic in the prevention activities of the Group since 1993. While in the early 90’s the outreach work approach was mainly reaching injecting drug users with a high level of dependency and associated problems, the outreach work approach presented in this handbook is focusing on young people outreach work as a tool for wide-reaching secondary prevention.
Young people outreach work has proven to be a successful tool in reaching a broad array of young people at risk of taking drugs. The handbook incorporates the experiences from various European countries and gives a comprehensive overview on the concrete forms and ways to implement outreach work. An additional benefit of young people outreach work is the excellent cost-benefit relationship. However, like with every sincere programme, outreach work projects require resources and financial commitment to make it a success. Looking at the experiences in several countries this investment can be a crucial contribution to more effective prevention work.

The Handbook
The handbook has been an initiative of the Norwegian government and was prepared with expertise from across Europe. A group of experts from Austria, Germany and the United Kingdom contributed substantial to the handbook, the editorial work, and advised the author. They have expressed a serious engagement in outreach work, and have contributed to sustaining the enthusiasm needed to continue picking up new approaches and perspectives within the field of secondary preventive work.
 

These experts are:
Tommy Husebye, City of Oslo – Competence Centre.
Jürgen Schaffranek, Gangway – Berlin – Repr. Bundesarbeitsgemeinschaft
Streetwork/Mobile Jugendarbeit, Germany
Sabine Muerwald, Save the Child – Streetwork Vienna, Austria
Sheena Horne Knight, The federation of detached youth work, England
Pete Hariss, The federation of detached youth work, England
Sophia Young, Turning Point Scotland.
 

The handbook is aimed at decision makers and professionals organising and implementing youth work and social services on regional and local level. It can also be used as a basis for initial and further training of practitioners on the specificities of outreach work.

Njål Petter Svensson
Senior Advisor

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Part one - Introduction

Outreach work is an important way of contacting and working with hard to reach groups. In Europe different outreach activities commenced after the Second World War. Outreach activities were introduced to contact young people in marginal situations, unattached young people or young people not participating in any organized activities. In the field of drug prevention the important target groups have been both the drug users and young people at risk of becoming drug users.

The HIV/AIDS epidemic reinforced the professionalisation, development and dissemination of outreach work. Due to the epidemic outreach work increased considerably and many new initiatives were established. At the same time focus shifted from young people at risk to harm reduction, prevention of HIV and sexual diseases and increased quality of life for intravenous drug users with a long history of misuse. (Tim Rhodes). Outreach activities are today widespread in Europe. Re. European Monitoring Centre for Drugs and Drug addiction (EMCDDA) – Outreach Work Among Drug Users in Europe. Increased focus on harm reduction has resulted in less priority and attention to outreach work with focus on early intervention, prevention and youth work. Even if the AIDS epidemic is the reason for many new outreach initiatives in Europe it is very important to evaluate and develop outreach work in a broader context. Outreach work represents an important preventive working approach. It does not only deal with harm reduction measures, but also acts as a working tool to build contact with young people at risk before or at the initial stages of drug use. Thus occurs the possibility for early intervention and perhaps an alteration of such destructive behaviour.

It should be mentioned here that one could find different meanings of the concept ”outreach work” in different countries in Europe. In England there is a significant difference between ”outreach work” and ”detached youth work” and in Germany one can find the same difference between ”street work” and “mobile jugend arbeit”.

Outreach work as we think of it in this book is a “Scandinavian mixture” which has its basics and principals in accordance to detached youth work and mobile jugend arbeit.

Outreach work also represents a possible contact and security net for people who have temporarily dropped out of treatment or rehabilitation programmes.

This book will focus upon outreach work directed towards young people, young adults and older children at risk and in marginal situations. The aim is to maintain and support outreach work connected with this.

The guidelines for evaluation of outreach work are thoroughly covered in a manual published by EMCDDA 2001.

Outreach work appears at many levels and in different connections. Generally speaking it appears in the arena between treatment programmes and more primary prevention measures. Metaphorically speaking: between the gutter and harm reduction activities on one hand and other youth activities in the local society on the other.
Outreach work provides direct, flexible and client responsive services, as well as education and preventive services. Outreach is an important approach for identifying hard to reach populations, and identifying their needs and perceptions of services. It has been found that outreach work with young people can alter behavioural influences and maintain such changes in the longer term.

Traditionally outreach work is separated into three categories; domiciliary, peripatetic and detached. Elements of outreach can be traced in domiciliary service delivery where the outreach workers take the service directly into people’s homes. Likewise elements can be found in community development where the outreach workers promote changes directly within the community.

Peripatetic outreach focuses more on organisations, where the outreach worker takes the service to the community agencies such as prisons, youth clubs, schools and health centres.

Detached outreach work is executed outside any agency setting where the outreach worker takes these services into the community. Good examples are the streets, in railway stations, galleries, clubs and squats. The aim is often risk reduction, attaching young people who lack any kind of belonging, or attracting young people to treatment or care services when necessary.

The balance between detached and peripatetic outreach work varies, from project to project, between and within countries. Outreach work towards young people has mostly been executed in the streets. During the last few years outreach has also been executed in connection with raves and house parties. This contact has also been executed on the Internet, and some outreach agencies have, for example, opened youth cafes to establish contact with the target groups.

Outreach is not a single activity. It can be described as a group of activities, which includes different models of establishing contact and intervention. In principle, outreach is a working method based within the target groups’ own environment and place of residence. There are a wide variety of outreach initiatives with different arrangements, and outreach may work in one or many ways.

In Europe the outreach activities have different descriptions and different organisations; Street work, Street Social work, Street Corner Work, Outreach Youth work, Outreach youth contact, Mobile youth work, Area work, Field youth work and Local network. It is based on voluntary efforts, peer groups or professionals, social workers, social pedagogic workers and health workers. The goals and target groups extend over a wide range, and the tasks are likewise connected to contact, Mobile youth work, area work, Field youth work and local networks. The goals and target groups extend over a wide range, and the tasks are likewise connected to individuals, groups, and efforts in the local environments, institutions and organisations. It ranges from more or less crisis intervention directed towards separate and specific situations (fire alarm), to more stable and long term work within the framework of community development and community planning.

In this book the target group is centred upon young people and, as mentioned, the term outreach work as it is used here is commonly known throughout Scandinavia and is corresponding with detached youth work in England and mobile jugend arbeit in Germany. Outreach work is adequate to survey groups of young people, and young people at risk or problem young people not reached by ordinary help and treatment offers. Using categories as detached and or peripatetic in this connection are not necessarily the most suitable, and they will probably be too schematic.

Outreach work towards young people appears different within the European arena. There are outreach institutions or groups of outreach workers focusing on preventive work with young people within their local environment. Further there are different models for combination of outreach work and social services such as economic support or unemployment exchanges (housing). There are models of outreach work combined with youth counselling such as pedagogic or psychosocial advice and crisis help. There are also outreach activities that are more or less integrated within the childcare system. Here outreach activities appear in an arena between control and care.
There are differences between and within countries. In practice, many of the same elements are used in identifying, approaching and communicating with the target groups. The nature of outreach work is to meet people on their own terms. The outreach work is generally based on voluntary, not compulsory methods, and the target groups are older children and young people at risk usually between the ages of 12 – 25.

The future challenges are to improve outreach work, knowledge and supervision connected to changes in youth culture, values, priorities and behaviour. Further, to follow changes in drug use (from old drugs to new and synthetic drugs) and abuse among young people and to supervise the development of subcultural activities and deviations from the norms.

Roots

Outreach work is often done by people on foot; on the streets or in parks, pubs, galleries, in shopping centres, railway stations or other areas where groups of marginalized youth or drug users are known to meet. As a systematic working approach it seems to have a short and loosely funded history. But in it’s nature this kind of approach can be traced back to the Salvation Army in the nineteenth century.

The founder of the Salvation Army, William Booth, was working in the slums of East London from the year of 1865. His early work was aimed at alcoholics, the destitute and the poverty stricken. The arena for his outreach work was the streets, the liquor stores and the pubs. The misery, alcoholic excesses, prostitution and criminality were enormous. Even small children became alcoholics.

The intention for William Booth and his brave Salvation Army soldiers in working for the poor was:


This depicts the Salvation Army during its early years, but can also serve as a metaphorical symbol for outreach work even today. Applied to us this could mean to reach out to meet people’s needs with love and solidarity as well as professional attitudes and standards.
- The warm feet will bring you to those who need help or need to be contacted.
- The clear mind represents the professional or working experience necessary to understand and evaluate problems and situations.
- The burning heart can serve as a symbol for our solidarity with the target group.
All three elements are important and are often necessary for success within the field of outreach work.

Professional tracks

Outreach work is not a new or a singular activity. The work of missionaries, health visitors, family doctors, priests and teachers are examples of this. In a broad sense outreach can therefore be described as a mixture of elements from different ideologies; professional, moral, romantic, religious and political, combined with a strong personal commitment.

Outreach work does not have it’s own distinct disciplinary base. It has several tracks of development and is routed within many different disciplines. It is often based on models from social work, counselling models and models for risk reduction. It ranges from work aimed at behaviour change among individuals and groups, as well as information and educational activities.

Elements of outreach can be observed within the history of:
- The Public Health Movement (immunization and eradication programmes)
- Medical models of service delivery towards marginalized groups (e.g. prostitutes with sexual diseases and tuberculosis patients who fall outside of regular treatment plans)
- Social change and community development
- Anti-psychiatry movement
- Community work, local social networks, social action and mobilisation of client groups and minorities - Anthropological theories, studies and experiences (Whyte: Street Corner Society; Chicago school of Anthropology).
 

In all of these disciplines we, to a strong degree, find elements of, and understanding of the importance of cultural knowledge. Understanding the subcultural standards and communication was the basis for establishing the necessary confidence. Similarly in outreach work today. These factors are especially important in outreach work with young people.

Development

Outreach work is often connected to drug abuse. Outreach, however, developed long before it was applied to drugs and drug abuse. Following the Second World War outreach work expanded and developed in the youth field, first in USA and afterwards in Europe.

Different outreach activities were developed in the light of the specific Youth Cultures.


Characteristically the aim of the outreach and youth workers were to find solutions to young people’s problems in their own environment, rather than deciding while sitting behind a desk what they considered best for the person concerned. The goal was to prevent further marginalization and encourage social integration.

New drugs and narcotics were responded to by new outreach initiatives. The focus for these outreach activities was to bring the activities in to effect as early as possible. The perspective on early intervention was important at that time as well.

The problem area most often connected to outreach work is principally drug abuse. Further it is people who experiment with, or abuse other types of intoxicants, including alcohol.

The development of outreach work in Europe must be seen in connection with the development of society with changes in family patterns and values. Likewise changes in commerce, habitual and educational structures. It was especially in the 1960’s that the young people’s social problems and commitment became focused on. In this connection we can look at the student riots in 1968 and the Vietnam War. This contributed to an explosion in involvement and critical processes of society within the fields of psychiatry, social sciences and social work. The hippie culture appeared as one of the critical voices, at the same time as narcotics such as cannabis, LSD and amphetamines were introduced. These are traits of the changing society often were perceived as a threat to tradition and values, and also as a risk to the health of the population.

It was young people as a group, and eventually young people in marginal situations that had the highest risk factors for abusing the new narcotics. A possible cause for this was thought to be social and family related problems, unemployment, education, spare time situations and various individual problems. Preventive work became prioritised to meet this development in a better way. The problems should be encountered in the connection they appeared; in school, work life and in the spare time. It is in this connection that outreach work became rooted with a strong focus on preventive work and early intervention. This was especially true in Scandinavia.

In the Nordic countries, Germany and UK, outreach work was developed and practiced towards different subcultural youth groups with a considerable anti-social behaviour, gang criminality and alcohol abuse. The most important target group being marginalized youth (youth work model).

Early outreach initiatives in this connection were for items such as outreach preaching abstinence from drugs and outreach linking to treatment, (catching client model). Different outreach activities were connected with youth counselling, crisis intervention and youth psychiatry.

The development pattern

 

Outreach in the 1960’s

Outreach in the 1980’s

Outreach in 2002

Youth culture

The hippies

Political conviction

Rock’n Roll

The fight for freedom

Revitalizing of the political consciousness

Punk-House occupations

demonstrations

Political unconsciousness

House and techno

Rootless ness

Big demands from society and a lack of close role models

Target group

Experimenting young people, hashish, LSD- Acid.

Youth environments in the city centres

Heavily established drug abusers, HIV, AIDS focus, + young, angry abusers

Focus on young people 13 – 18, spread focus, targeted towards “new” intoxicants, long-term relations

Method

On a team together with the youth against the society, outreach work

Outreach work and therapy-like forms, early intervention

Outreach work but also inviting base work. Establishing contact through the Internet, mobile phones, tempt them to seek us up

Degree of prevention

Secondary prevention

Secondary and tertiary

Primary, secondary and tertiary

Target

To establish contact, support

Harm-reduction, support,

Transfer to other parts of the help apparatus

Early intervention, shall catch many early on

Society’s attitudes

Abuse as an expression of immorality,

Condemnation

Stigmatisation

Abuse as an express-ion of immorality and destructive young people

Medical and socio-cultural explanation-models, liberalisation of now “soft drugs”

Political agenda

The society wanted a clear up

Focus on health by AIDS, soften the temper in the youth environments

Stop new drugs!

More weight on primary prevention

As seen in the table on the previous page, there have been changes in the youth cultures as well as in the society’s attitudes, political agendas and the outreach workers’ target groups and methods.

Knowledge

Knowledge and education will even today naturally differ strongly between the individual European countries. In some places it has been a target that outreach work is admitted as a part of for example educations in psychology, social work or social pedagogic. In other countries this is not so clear. It will also often be that the work form outreach work is based on that knowledge, experiences and methods are transferred from older to younger colleagues. No matter what approach one will be able to gain knowledge and theories within psychology, sociology and social anthropology.

Development psychology is important as a basis for the understanding of children and young people’s development and need.

Social anthropology can provide an understanding for environments, culture and belonging. The young people’s territories, networks, interests, languages, class backgrounds, norms and values etc.

Social learning theories give a basis for understanding of the interplay between the fieldworker and the young people. Social group work is a good presupposition to understand the dynamics in a youth group.

Communication theory is important for to improve in the outreach work. Outreach workers should be concerned about the relation between verbal and non-verbal communication, and of form and content within this communication.

Important knowledge for working with young people in their own environments would be the knowledge about:

    - Youth culture in general. Knowing and understanding changes and “new waves”
    - Youth biology (puberty – teens), and youth psychology
    - Group psychology, small groups and gangs
    - Norms and values
    - Communication patterns
    - Family relations and processes
    - Subcultural processes, activities and life style
    - Drugs, alcohol and drug abuse
    - Risk factors
    - Social medical conditions

Levels

The exercise of outreach activities towards marginalized young people, young drug abusers and others, can roughly be divided into three levels: individual, group and society. If we as our starting point take drug preventive work we mean universal initiatives that are aimed at the whole population, selective initiatives aimed at risk groups and special initiatives aimed at individuals that are already abusers.

The targets for outreach work are to work individually with young people at risk and with social problems, work with youth groups and at the same time to work for better conditions for growth. These targets can be reached through information activities and participation in local planning processes concerning preventative initiatives towards children and young people.

This presupposes detailed knowledge about different youth environments, youth cultures and development tendencies. By these means we can identify and prevent the growth of social problems among children and young people. This way we have the abilities and possibilities to help individual young people in crisis. We can sometimes help their families as well.

A much-used model is taken from preventive psychiatry (Caplan 1964). Here the different types of initiatives are separated by where in a problematic development course they begin. The model describes an axis that is divided in three and that divides between primary, secondary and tertiary preventive work.

Primary preventive work

Primary preventive work initiatives are directed at the whole of society. Primary preventive work implies to enter into initiatives before the problems have already appeared, and to hinder the appearance of problems. Examples of this can be police or customs activities aimed to limit the access to narcotics or campaigns aimed at educating or altering people’s attitudes about alcohol abuse as well as drug abuse. It could also be the establishing of drug free youth environments and initiatives to secure better environments for young people and children to grow up in.

There are examples of outreach activities taking part in general information campaigns aiming to hinder young people from destructive drug abuse, or that participate with their knowledge and experience in planning improved youth environments. In this connection the finger is often pointed at two approaches; they consist of initiatives for the reduction of risk factors and initiatives that protect against negative development. In these connections family relations, peer group relations, the school situations and the youth environment within the local environments are important.

The outreach workers can, through collaboration with other local activists, contribute with their knowledge in planning a better youth environment.

Efficient primary preventive work is obviously the preferred method because it prevents the problems from happening in the first place. At the same time it is difficult to gain success because the initiatives are often quite general, and thus it is often difficult to reach the ones that are the most at risk.

Secondary preventive work

Secondary preventive work is about hindering problems about to occur and to prevent already existing problems from developing further. It is normally about activities that are directed towards certain groups at risk. This is about identifying those who are at risk for the misuse of drugs, as well as goal orientated efforts both directed at individuals and group levels. Included in these groups are young people with risk behaviour, for example truants, criminals, and other young people who together constitute certain youth cultural groups that can be described as risk groups.

A circumstance that complicates secondary preventive work is that it can not be determined in advance which individuals or groups who during adolescence display deviant behaviour patterns, will end up as deviants such as criminals or intravenous drug users. It is therefore often difficult to decide who are at risk. Additionally, a too narrow focus on the groups at risk can stigmatise initiatives that were meant to be preventative, and will in this way contribute to consolidate and strengthen unfortunate conditions.

The division between secondary preventive work and normal social work is quite blurred when it comes to working with groups at risk. Successful secondary prevention often contains both young people at risk and more normal young people who are not strained with problems.

A considerable amount of outreach workers who work towards young people are, through their work, in contact with both of these groups. Outreach work itself originates from secondary preventive work.

Tertiary preventive work

Tertiary preventive work describes initiatives that are there to counteract already existing problems. This is normally the case for young people that are already heavily involved with drugs, and initiatives that are aimed mainly to minimise the damages from drug abuse. In this connection outreach work can be characterised by simple harm reduction, something we today see on the European arena when it comes to outreach work and drugs abuse. This applies to outreach work that, amongst other things, work with needle exchanges, substitute programs and Field-and Street care. In it’s extreme form outreach work can, under these circumstances, be described as moving hospitals and children and youth’s health clinics out on the streets. Quite often this has nothing to do with preventive work, early intervention and work with risk groups.

In 1999 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published the book: Outreach Work Among Drug Users in Europe. The book gives a broad overview over outreach work in Europe, and of different models and practices in the various countries. Very many of the outreach activities that are listed in this book can be described as tertiary preventive work.

Placing of the outreach work

Generally, outreach work can be seen to cover the whole of this scale. In connection with the more serious instances as for example heavy drug abuse, outreach work would normally be described as tertiary prevention. This, however, has often very little to do with preventive work, early intervention and work with groups at risk. In fact, many of the initiatives that are being described as outreach work has little more in common with outreach work than that the initiatives take place outdoors or outside treatment institutions.

Outreach work seen in connection with young people at risk and in marginal situations must primarily be defined as secondary prevention. Through contact with the exposed youth groups it is possible to receive important information that can be used as a foundation in more primary preventive planning work and other preventive activities. Continuous contact with the hardest hit environments, for example drug abusers, will on the other hand give the possibility to catch new recruits before they have established a heavy drug abuse pattern.

In this connection certain dilemmas will arise, and there will be obvious differences between and within the outreach work. On the one side there is individually orientated, crisis orientated and almost therapeutic outreach work. On the other side is the more resource orientated and preventive outreach work that are directed towards young people in their local environments.

The sooner in a problematic progress the preventive work is initiated, the more difficult it is to see who is in the danger zone and who the preventive work should be directed towards. On the other hand, the later in a problematic progress the preventive work is initiated, the harder it is to turn the development around.

We often find that initiatives are, on the one hand, directed towards the heaviest drug abusers, whilst on the other hand children and young people are receiving more primary preventive initiatives. This often means that we are not active enough when it comes to interfering with the recruiting process. It is not least in this connection that outreach youth work becomes important. Outreach work will therefore often overlap all levels of preventive work, and represent and unveil risk groups. This is especially important since it is often operated with a simplified dual model with primary prevention on one side, and treatment and harm reduction on the other.

Part two - Key elements and principles

Goals

To contribute to the improvement of children and youth’s living conditions through preventive children and youth work that, amongst other things aims to:

    - Early detection and prevention of social problems among children and young people as early as possible.
    - To preserve safe and healthy living environments
    in the cities
    - Make the young people’s own voice heard
    in youth policy making
    - To provide outreach services
    for individuals and groups of children, young people and younger adults in marginalized situations that need support and help and for whom existing outreach services and organisations are non-existent or insufficient.
    - To establish contact
    with these individuals and groups and their families as early as possible. Preferably before the drug abuse or deviant behaviour has become predominant. To work towards encouraging, motivating and informing about alternative occupations (such as schools, leisure-activities, work), and to a necessary extent motivate and inform about other care or treatment offers.
    - To provide necessary advice
    , information and counselling on both risk behaviour and the reduction of such behaviour. To provide relevant services and referrals to treatment and rehabilitation programmes for people using narcotics. Likewise medical, psychological and social services.
    - To teach young people to utilise the help apparatus
    offers and to contribute to the help apparatus having the optimal and most suitable offer for the young people.
    - To stimulate the development of work among children
    and young people. Either indirectly through initiatives that stimulate their environments, or directly via work with the child or youth environments.
    - To gather and provide information and knowledge
    about the living conditions for children and young people and the needs of marginalized young people and drug users. Thereby establishing a basic knowledge base vitally important for social planning initiatives and the taking of appropriate measures.
    - Based on knowledge and experience; take initiatives
    to improve children and young people’s living conditions. To systematically work towards making the administrative and political authorities take responsibility for the youth’s situations and needs.

This shows the importance of outreach work on different levels. From contact and work with individuals in need of treatment (medical, social or psychological help) on one hand, to the planning of local youth activities and the local environment (schools, youth clubs etc.) on the other.

There are comprehensive work tasks that are given to outreach work. Outreach youth workers shall reach groups of children and young people that are in need of support, guidance and help, and that, for some reason, fall outside of the established official or private offers, that being leisure, school, work, care or social services.

Here there are covered a wide spectrum of target groups. From, on the surface, a well functioning youth group in a neighbour/adult conflict caused by a lack of local places to hang out in their spare time, to young people who have been abusing drugs for several years and have a long history of experience with the help and treatment apparatus.

It is obvious that to arrange support, guidance and help to young people with heterogeneous needs require different approaches. This must be adjusted to what distinguishes the youth group in question, and after what aspirations there are for working with this group. Except from a clear separation of the heaviest drug abusers and outreach work harm reduction initiatives it is hard to make a clear separation between the different target groups. Here one also has to consider the local circumstances.

When establishing outreach work one will often encounter older young people or young adults who never before have been in contact with, or managed to utilise, any offers from the help apparatus. When these are connected to or take part in the same environment they cannot be rejected. They often struggle with youth typical establishing and emancipation problems, and should receive attention for their situation and their problems when they report the need for help.

However, when there are circumstances with different groups being in the same environments it is important for the outreach workers to maintain focus. The emphasis of the efforts should be directed towards the youngest age groups. At the street this can often be a difficult case as many groups are mixed age groups. In order to work effectively with the younger ones you need to establish a good relationship with elder members of the group, as these often are role models for the younger ones. However, the core of outreach work is prevention and therefore this focus enables early intervention and to slow down the recruitment process to the more heavily troubled groups.
In practise the outreach workers target groups will be:


Outreach workers must keep an active involvement in all of these target groups. With a special focus on prioritising the youth who already are in the danger zone, the outreach workers must through their work be orientated towards all the young people in the geographical area that they cover. This is necessary both to succeed with early detection, and to counteract stigmatisation of the individual children and youth groups. A more in depth description on target groups later in this part.

The work task can be summarized in that their tasks stretch from influencing the system and preventive work, like initiatives to improve the living environments for children and young people, to working with mediating with young people who need more extensive social, medical or psychological help and treatment. This way two partly different aspects appear: on the one hand outreach work becomes shaped as the treatment apparatus’ prolonged arm, with a work form that are based on individual explanation models. In circumstances like this a lot of work will be put into establishing contacts and arrange for individuals to be taken care of by the help and treatment apparatus. This approach especially aims to help the children and young people who have the most trouble, and the outreach work can therefore be considered as a part of the extended children welfare system.

On the other hand outreach work often functions as a general preventive initiative in the local arena. An orientation towards the local arena is deeply rooted in the recognition that it is not enough to help individual young people in crisis, if there are conditions in the local environment that repeatedly causes problems for young people. In this connection the outreach workers work together with children and young people and other adults to improve the well being in the local arena, and by this contribute to stop that the young drift into destructive environments. This type of outreach work is often heavily influenced by cultural orientation.

This shows a range in aims from individually orientated work to more society orientated preventive work. Most of the outreach youth workers will carry elements from all sides. What aims are prioritised will vary between the various countries, and within the different countries.

Work methods and theoretical frames

The outreach workers’ working methods have clear values of their own. Especially valuable is the method of working with children and young people in their own environments. This gives especially good opportunities for contact.

The outreach workers are not inhibited by heavy administrative routines and control functions. This enables flexibility when it comes to select a work approach.

With their closeness to children and youth environments the outreach workers are especially valid observation posts for the development in the environment and for the need of support and help activities.

A target would be that where there are other resources in the work towards children and young people there should be developed a variety of preventive and help initiatives for children and young people. In this connection it would be appropriate to consider placing, or actually placing the outreach workers as a link in a chain of various offers.

The difference between the outreach workers and other initiatives directed towards children and young people is the places and the situation that the work is being executed in. Outreach work on the street, in cafes on other places where children and young people meet in their spare time is the outreach workers most important and very special work approach. In this way the outreach worker’s work becomes different from other institutions, even though they have the same professional basis and in part the same target groups.

This condition can be illustrated by the fact that social workers in other institutions normally are heavily protected in their working places. They sit behind receptions, office doors and office desks. All this symbolises that they are the ones with authority. The outreach workers do not have such exterior signs or power symbols.

This is the peculiarity with the work, as well as its strength. It reduces the distance and increases the intimacy to the young people. The intimacy can also be very tough and challenging, and places big demands upon personal security. Where it is possible tuition and guidance must be organised. A main target for outreach work is to bring the help apparatus closer to children and young people who are in need for it, but otherwise would not benefit from it.

Methods and skills

Outreach work is jointly directed at both youth environments as individuals. Through having broad contact with and knowledge about the youth environments there is a possibility for discovering early problem developments and risk factors, both within the environments and connected to the individual youth at an early stage.

This demands skills such as:

Establishing contact as early as possible. Early detection becomes a central clue seen in connection with a risk situation and problem development. This must be based on a regular presence and good contact with the youth environments.


Different methods, techniques and skills that can prove useful are:

    - Techniques of conversation
    - Techniques of motivation
    - Family communication and intervention
    - Crisis intervention
    - Social and youth group work
    - Work with gangs
    - Social education
    - Activity education
    - Liberation education (FREIRE)

Further demands are the knowledge and skills of working in the homes of families. The approach to parents, family and relatives requires special concerns and tact. A possible situation here can be that the youth has run away from home or an institution, a family crisis or a locked family situation, truancy etc.

On the one hand the outreach worker must be careful so that he or she does not act in a way that worsens the situation or makes it more locked. On the other hand we know from experience that an experienced and safe outreach worker can use such situations to change and to soften habituation.

No matter the educational or qualifying possibilities in the individual country, by acquiring and practising the role as an outreach worker one should promote the skills practise and experience by doing outreach working in pairs, preferably in the form of the model senior (experienced) and junior.

Surveying/collecting information

Outreach workers are often society’s furthermost viewing post and point of contact in relation to the vulnerable and marginal youth groups. It is therefore important that they gather information systematically. This can be information on an individual, group and society level, and of the connection between these levels.

This registration serves the purpose of:

    - Promoting the systematic and methodical work
    - Bringing forward the content of and the result of the work
    - Documentation of the young people’s life situation
    - To visualize the youth’s life conditions, and unveil conditions in society that hinders the young people’s growth and development

This registration and surveying can be accomplished in different ways. Which methods that are chosen will often depend upon what is being surveyed and for what purpose. Valid methods can be observation (passive or participating), interviews (written or oral), questionnaires and other accessible data from public archives etc.

Even though all outreach workers are not trained in survey methods it is still of vital importance to develop a systematic survey and registration. This is both in order to better understand how outreach work functions, and as a basis for the development within the youth environments.

Characteristics

Outreach youth work divides from other outreach activities by not only focusing on drugs and drug addicts but has a more holistic approach and very often deals with problems from all spheres of life. The basis for the outreach work and intervention is a more holistic approach such as school, health, work, friends, and comrades and partners. Important instances in this picture can be various counselling offices, hospital clinics and youth clubs. Important activities and interests include music, sport, youth culture, and modern technology such as the Internet, sex and sexual life. An important consideration is to be knowledgeable about the young people’s local environment. This refers to both risk factors and resources that can work protectively, strengthen the young people’s will to master life and hinder maladjustment.

The outreach worker cooperates and works as a partner with, among others, teachers, other youth workers, nurses, social workers and other professionals in the local society. In this connection the outreach worker often acts as a coordinator or organiser. The difference with outreach workers working with heavy intravenous drug users, established prostitutes and the HIV/AIDS epidemic is that the outreach workers are for the most part more resource orientated than problem orientated.

Preventive work and cooperation

Outreach workers work with young people that are in the danger zone and at risk in many areas. An area that it definitely is necessary to prioritise is the schools. In many countries the schools are chosen as the national arena for drug preventive work. The education period normally gives 12 – 14 years of continuity in young people’s lives. It is especially during school time and most of all between the ages of 13 – 16 years that most drug careers begin, are established and developed. Outreach workers must have a special responsibility to expose the risk groups’ situations and perspectives in the drug preventive work within schools.

Even though outreach work should prioritise vulnerable groups and young people in the danger zone it should also be a goal to have the broadest possible field of contact. Most young people go to schools, which make schools an important arena. In this connection there can be several targets: To achieve contact with the broader youth environments and via this become as well known as possible. To gain the best possible view over development tendencies. It is also important to become visible in an arena that is not just connected to problems and problematic behaviour.

Through schools outreach workers can meet young people they otherwise would not have encountered, and establish contact with young people that have started to develop problems. Likewise they can enter situations where young people need aid to solve conflicts attached to school situations. Outreach workers can be a resource that schools can use when they identify young people with problems of the kind where it is unnatural for the schools staff themselves to enter into.

In cooperation with teachers and others who are connected to the schools such as counsellors, school health nurses and central norm shapers in the student groups, outreach workers can contribute to discover the growth of new developments within youth groups and new drugs and activities connected to them. Such cooperation can make it easier to develop and adjust initiatives directed at individual young people in the danger zone, and develop or work for solidarity together with well-adjusted young people.

Other important partners for cooperation in the local environment can be the child welfare office, the local unemployment office, cultural activities, social welfare offices etc.

The role of the outreach worker


Outreach work is traditionally executed in the public arena. In public spaces such as streets, parks, woods, shopping centres, railway stations, bus terminals, petrol stations, schoolyards etc. Likewise in more semi-public arenas as youth clubs, cafes, bars, pubs, games arcades or other meeting places for young people.

It is important to underline the broad aspect of this working approach. It often represents a working approach outside established agencies. The outreach worker has to abandon the traditional safe privileged and empowered position in agencies, and move out into the streets. Thus they move into areas with different and subcultural standards, where it is often extremely difficult to establish a structure of cooperation and the stable relationship experienced in traditional relationships between professional workers and their clients.

The outreach worker is thus not in his own territory. She/he finds themselves in everybody else’s territory, in the public room, underground stations, street corners, parks etc. These places are the young people’s own arenas. The outreach workers are not invited. Acknowledgment, acceptance, respect from and contact with the young people are often a presupposition to move around in this arena.

The whole time the rule holds that this is the young people’s own territory where the outreach workers are a type of intruders. The young people have not invited the outreach worker, and they decide whether they will admit them to the arena. In these circumstances trust and contact becomes decisive. These are conditions and challenges that become strengthened when the young people withdraw from public spaces and in to homes, private spheres and clubs, as we have seen the last years. Such a way of working also separates the outreach worker from more traditional youth work. The outreach worker is without exterior signs displaying that he or she is working although this may vary between European countries. Especially in England the outreach worker is often clearly identified. This as a result of several severe cases where adults has presented themselves to young people as social workers to gain trust and afterwards being violent and abusive.

Outreach youth workers are guests in the youth’s territory. The young people themselves decide to what degree they want contact. The young people can reject the outreach worker, but it is not in the outreach worker’s role to reject the young people. The terms of contact is defined by the young people. They decide whether the outreach worker is allowed into their arena or not. If the young people do not trust the outreach worker he or she will simply not obtain any contact (the young people ask the outreach worker to “go to hell”, they turn around from him/her, they leave etc.)

The outreach worker’s starting point is recognition from the young people and the outreach worker must relate to the young people’s situations and experiences. The young people do not need to qualify in any way to have contact with the outreach worker. It is the outreach worker who has to qualify to be with the young people. The outreach worker is on the street to meet young people and actively approaches them. In this way the outreach workers become intruders in the young people’s environment. The basis is that the young people do not ask the outreach worker to arrive.

An outreach worker, who has no respect for young people, dislikes or does not believe in them and who fails to bring forward his or her recognition of them, does not achieve a relationship, which is the supposition for the changing processes. The only “power” this outreach worker has is that he or she brings with her professional knowledge and experience that can prove useful to the young people. A supposition for the outreach worker to be able to present himself as and be experienced as a useful and important person is that the outreach workers manage to become accepted and obtain trust.

Common politeness is an important quality for the outreach worker, and that he or she can show some tact and sensibility. In outreach work they must appear as tactful listeners, but at the same time be confident enough to get heavily involved and provocative when this is necessary as a part of the contact work. It is important that the outreach worker appears with great personal integrity and shows respect for the young people’s own life stories and life situations. It is also important that they to the highest degree, and especially when it does not concern minors, show respect for the self-determination of their own lives.

In outreach work one has to be certain of one’s own role. One has to be an adult. One has to be a social worker. And thereby not put on an artificial youth role, but be concerned by and engaged by the young people. In their interests, values, ways of thinking and behaviour. At the same time one has to have a clarified attitude to drugs and crime, and be clear about who one is and what the outreach worker’s contribution to young people can be.

Outreach has shown that groups of young people, considered difficult to reach, are willing to communicate when the approach and communication are based on their lifestyle and are orientated towards their environment and to strengthen their own resources. In this connection it often takes time to be established and get recognition in the target group. This demands continuity and long term working.

This working approach demands vigour, warmth, imagination, integrity and respect. The outreach worker often has to be accepted not only as professional or helper, but also as a person and a fellow human being. It represents a difficult balance between elements of friendship, social worker, therapist, mediator, communicator and agent for influence. The outreach worker has to depend on her or himself and the partner, contacting and working with people in their own network, in their arena where their values and attitudes towards life are dominating. Crossing the barrier and establishing contact in this connection represents an important basis for work towards behaviour and social change, and a bridge to build new belongings.


The unique feature of the outreach worker is that the job is performed mainly on the streets or in the young people’s own environment.

The outreach worker has normally no exterior signs of his profession or job. When he or she moves around in the young people environments it is the young people who decide the terms for contact. The outreach worker moves himself into their territory. The outreach workers do this without distance to the young people, close and defenceless. That an adult can come and be together with the young people where they are, and experience some of their ordinary days with them, enables the young people to start trusting the outreach worker. The outreach worker becomes a person who knows how the young are.

Outreach workers often have no other tools but themselves. Rightly there are some differences between the various countries, but they have normally no economic sanctions such as Social Welfare or Social Security Officers. Neither have they other sanctions or means of control as for example the police or Child Welfare Officers have. This circumstance works against the traditional social worker – client role, or against the therapist role in line with the traditional sickness role. The outreach worker only has his own abilities to work with, his imagination, creativity, interests and knowledge.

The lack of any outward authority sign can lead to the outreach worker being heavily challenged on a professional basis. On the other hand it could also be judged as strength. Power symbols such as an office or a desk can reduce proximity and increase the distance to the young. The lack of office desks, filing cards, keyrings, etcetera are the opposite of traditional roles such as the social worker-client, that is a therapist role in line with the classic sickness model. Among young people the outreach worker can be known as one who separates himself from them by age and behaviour. At the same time the outreach worker is separated from other professionals by spending so much of his/hers working hours outdoors for long periods of time.

The outreach worker gains through this proximity to children and young people in their natural environment and contact and work within the local environment an insight and understanding of causes for social problems in the local environment.

Crisis

It is often in crisis situations that young people, as with other people, are the most motivated for help and change. Such crisis can, for example, consist of family affairs becoming critical or that the young people have been thrown out from their homes. Likewise expectations about housing, education and work that have not been redeemed, and depressive reactions and other psychological difficulties that experience shows can lead to suicides and other crisis for the young people. It is important for the outreach worker to have knowledge about, and practice with, and as well as possible master the work in crisis situations (crisis interventions).

Family

Children and young people cannot be seen in isolation from their remaining families. Contact with the family can therefore be of vital importance from time to time, especially connected to the youngest.

The condition for contact with and the following up of the entire family is that both the youth and the parents or the next of kin wish for it. When the outreach workers work related to families, together with the families to try to solve the problems they are experiencing, they might often have known the young people for a long time through outreach work. In many cases the outreach workers become stable contacts for a long period of time. Many of the young people have had far to little of such stable adult contacts. Therefore it is important to manage a positive balance between such long-term contacts and the transfer of young people and their families to the remaining help apparatus, when that is needed. Too soon a transfer might under this circumstance be experienced as rejection by the young people. Simultaneously, one has to be aware that an inadequate long-term follow-up can tie the youth exclusively to the outreach worker. There are no correct answers to this dilemma. It is a professional problem that must be individually appraised and adapted to the individual case, and which must continuously be discussed between the outreach workers and the collaborating institutions.

Local environments and networking

It varies how much the local environments means for the individual youth. The contacts here will be of great importance for those who stay in the local environments most of the day after school hours and for those who do not go to school or attend other activities. Many outreach works have therefore developed from individually orientated and client orientated work to (the young people’s social welfare office), to put more effort into work and projects attached to the local environments.

The approach to local environments and local networks builds on the realisation that it is not enough to help individual young people in crisis or social needs, if there are conditions in the local environments that repeatedly creates such problems for new young people. In such cases there will be important and expedient for the outreach worker to participate in work in the local environments. This can be local networking such as neighbourhood work, local committees that work for the interest of the local environments, or other activities in the living environment. The aim in this connection will be to develop self-carrying initiatives and processes that can be preventive and hinder a crooked development among children and young people. The outreach worker can actively engage in changing the problem creating factors and improve the conditions in the local environment.

Such work in the local environments therefore serves many tasks. Simultaneously with this kind of work one establishes or maintains more problem marked youth groups both to hinder increased problem behaviour and to hinder the further recruitment of young people to the more problem burdened youth environments.

There are several conditions within the local preventive work that creates possibilities for outreach work.

    - To work locally gives the opportunity to establish and develop near relations to the local population and the local authorities.
    - Fieldwork in the local environments give the opportunity to receive knowledge about the local environment and a better understanding of what causes the social problems in the local environment.
    - The role as an outreach worker implies proximity to children and young people in their natural environments.
    - The role as an outreach worker in the local environments often gives the greatest possibility to prioritise target-groups in relation to where the challenges are the greatest at every time.

In the local environment the work is aimed directly at the target-groups (children, young people, parents), or indirectly through other care and help workers such as teachers, local politicians and administrators. The most common levels are:

    - An individual level that includes procurement, conversation, adult contacts, following up and being available.
    - A group level that implies to relate to different youth groups and gangs, and to take initiative in-group activities.
    - Local environment work that can mean to work to find places for the young people can be in their spare-time, contact and collaboration with other help instances to identify the need for help and different initiatives. Environmental work, improving of the growing up conditions, organisation of the occupants. Collaboration with other youth workers and between voluntary and public organisations when that is suitable.

Social network

Both in the work with the individual young people, families and groups, the outreach workers should attempt to build up and strengthen the social networks in the local environments, by consciously activating as broad a selection of resources as possible, and stimulating to self carrying processes and structures.

Possible collaboration partners in such a work approach can be the leaders of the boards in housing co-operatives, sport clubs and other voluntary organisations. The goal must always be to increase the young people’s, the families and the local environments’ ability to manage on their own, and thereby also strengthen preventive work. It is important to hinder relationships that can make them into clients and thereby dependent upon the outreach workers, health workers, social workers and the remaining help apparatus.

Informal contacts within the help apparatus as a whole is often a key factor in outreach work as such contacts allows a high degree of flexibility and swift solutions on a variety of problems. Outreach work tends to be less bureaucratic and informal networks often saves time in problem solving.

Working with gangs/groups

The relationship to contemporaries becomes important in the young people years. For many young people groups with weak attachments to their families the environment of their friends or young people gangs become decisive when it comes to adaptation and further development. The circle of friends’ or the gangs are in many cases the only place where the young people experiences belonging.

To get out of a gang where drugs and criminality are a part of everyday life can be very difficult. The need for attention and acceptance in a community with other contemporaries will often be placed in front of other values and priorities such as education or being close to one’ s family. This especially holds true when breaking with the gang can lead to isolation and loneliness and to a life with expectations and demands the young people do not feel that they can live up to outside of the gang.

On the other hand the circle of friends can also have a positive influence on the young people’s development. The community and the friends can therefore be a resource to better the young people’s terms and developments. Not withstanding what approach and perspective is selected (problem orientated versus resource orientated), it will still be important to have knowledge and skills in working with gangs. For outreach workers it will, in all circumstances, be important to both have knowledge and skills about working with groups and gangs. Current target groups can be groups burdened with special problems or problematic behaviour. It can also be groups that show no visible signs of maladjustment, but who for various reasons are in opposition to their surroundings. These are often unorganised groups in local habitation environments.

Working with groups seen in connection with outreach work is most common with young people within their own living and local environments. This is amongst other things because the formation of gangs is more common and more visible in living areas. Environments in the city-centres, especially in big cities with drug abuse, are more marked by gatherings than by groups with their own norms and structure. To work with a group there must be a target, and a plan that must be built on a survey of the groups, structure, skills and resources.

A normal target for the work is to develop and inspire the young people group to influence their own life situations. Here the starting point must be the groups’ interests and resources. The group work must aim to strengthen the positive resources and suppress the negative norms and behaviour.

Traditional group work connected to outreach work can be boy groups, girl groups, and mixed groups.

Likewise, it can be defined groups with a particular feature such as parents, young people at risk, immigrant young people, young people attached to special subcultures and mixed young people groups.

One can also arrange groups upon the basis of for example alcohol, drugs, sex, racism, violence, self-esteem, limits, relations, friendship etc.

The activities in the groups can be arranged differently, but the target must be to create contact. Exercises in collaboration, communication and drama with for example spontaneous theatre are tools that often are used.

The basis for the group work must be accepting and respecting the young people cultural characteristic. From the outreach worker the work is based on care, personal interest and a non-judgemental attitude. The outreach worker shows independence and silence. The use of humour is important to create a warm and friendly atmosphere.

Information activities

Outreach work is, as described, directed towards young people in their own environments. Both because of this and because through this activity one gains contact with different groups of children and young people with tough upbringings, the outreach workers have access to very important information about the young people’s terms of adolescence and life situations.

Precisely because of this both broad and narrow approach, the contact with the young people’s environments and the knowledge this might give in relation to the shaping of special help initiatives as well as goal directed preventive initiatives, it is absolutely necessary to systematize the data and the experiences of the outreach workers.

The outreach workers experience and knowledge should be admitted in local planning of the shaping of housing and leisure environments, and the further development of support , help and treatment initiatives for vulnerable groups of children and young people.

Outreach workers should, based on their work approach and knowledge about the life situation of children and young people, pass their knowledge on to other health and social workers. Likewise they should, as a part of preventive work, participate in information work, lectures, collaboration with teachers and contribute to coverage in the media. The focus should be on preventive activities and the affairs in the local environment that have had a negative influence on the young people’s life situation and social conditions.

Premises

Outreach workers should have their own premises as the base for their work. The premises should be located centrally in the geographic area for the outreach work.

The premises should secure the social workers adequate possibilities (space) to follow up their cases. In addition to a more informal reception room with room for groups, it should have a room for conversations with individuals and with families. It should also be given room for office work such as writing and telephoning.

The premises of the outreach work should have set opening times where the young people themselves can visit the social workers. The young people should not be expected to always present well-defined problem cases. It takes time to get to know each other and to feel secure. Used in a proper way the premises can in itself become a working approach that contributes to break down the distance between the young people, the help apparatus and the rest of society.

It should also have set hours to be reached on telephone. The outreach workers should always aim at giving concrete offers and to follow them up as soon as possible after an inquiry from the young people.

In some outreach work centres emergency beds have been found to be suitable. This principally reflects the lack of other such help offers. The local conditions will in these circumstances be of importance. Normally the premises should not have emergency beds, since this will make it easier for some young people to keep away from and avoid their families and family conflicts.

In all circumstances the activities on the premises must not be of such an extent that the outreach work is limited. The premises should function as a supplement and support for the outreach work, which must be the most important element in the activity.

Principles

Among principles and approaches in outreach work we will find the following:

    - Distribution of services where youth, subcultural groups, young people at risk and young drug users are present in their own environment.
    - To design services based on the needs young people demonstrate and encourage their voluntary participation.
    - The outreach work is based on voluntary relations between the youth and the outreach worker. The relation is based on confidence, distinctness and continuity.
    - The outreach work is executed on the young people’s own terms.
    - Respect for the youth’s own values, their needs, their civil and human rights, their choice and their responsibility for their own lives.
    - Meet people with non-judgemental attitude, integrity, frankness and honesty.
    - Gender and ethnical background

One key element is always to take the young people’s own situation as a starting point. It is also a fundamental presupposition to develop a broad contact network and to come across as somebody who can assist with offers and contact. It follows from this that one must have respect for the young people’s own values. Judgemental attitudes do not belong in the relationship with the young people. At the same time the work must be carried out patiently and not contain unrealistic expectations that in themselves limit the possibility for contact. An impatient and bothersome attitude will often be experienced as rejection. This could lead to many young people perceiving the outreach work in a similar way to other initiatives they feel have rejected them.

The outreach worker should attempt a holistic approach to the youth and his/hers life situation also when the outreach work takes place in a drug abuse environment. The drug abuse must not be seen in isolation, but in light of the youth environment it appears in. It must also be connected with the problems it expresses or results from. Young people with drug problems are a fragmented group. As with all other young people their choices and actions must be understood as coming from a combination of biological, sociological and psychological factors.

Very many of the established and heavy drug abusers have had problems from an early age. These could be family problems, school problems and other adaptation problems. The intoxication will for them often be an escape to avoid the feeling of being superfluous beings, a failure, useless and lonely.

Another key element is that outreach work should be carried out both during daytime and during nighttime. During the days the environments are often less marked by drug abuse, and it is therefore easier to have more goal orientated contact with the young people, make arrangements, and follow up the work in a proper fashion. During daytime the other help apparatus also are available, and can, if necessary, be involved in problem solving work. The target groups at daytimes are often children and young people who play truant or who are not involved within an educational system or with the labour market. In the evenings and at nights the situation is often more marked by drug abuse, among other things, and by that all kinds of young people gather in the town centres or at other attractive meeting places. Outreach work in the evenings is important to catch the recruits to this environment. Likewise, it is important to maintain contact and to be at hand in emergency situations.

The number of outreach days and the balance between day and night must be shaped after the resources, tasks and the number of persons who work in every outreach activity. No matter the number of days and evenings it is important to be stable and continuous.


Trust

In these circumstances trust becomes a necessary provision for collaboration. If the young people experience that the outreach worker is not trustworthy, the whole basis for doing outreach work falls apart.

To build a relation to young people where trust constitutes a central element both becomes a goal on it’s own term and a method for further work.

Outreach work means that dialogue and the capability to commence a dialogue become the most important work tools. Tact and discretion is important in this connection. Tact we understand to be the delicacy in human interaction, and that which is appropriate and suitable. This is connected to caring and sensitivity. An outreach worker should be able to understand the youth’s “inner life” and be able to interpret what lies behind the behaviour and expressions.

The outreach worker’s approach to gain trust is deeply rooted in some basic work principles and methods. These are continuity, flexibility, voluntary decision and professional confidentiality.

Continuity

Continuous contact with the young people is vital in order to get to know, create alliances and arrive in a position to be able to intervene. Regular presence in youth environments over an extended period of time makes the fieldworkers predictable and thus approachable to the young people. Long term, patient attachment to and work within the youth environments are presuppositions to succeed in this kind of work. Only adult professionals or experienced co-workers who are out in the youth environments over an extended period, have the opportunities to reach ahead with work that can influence and change.

Even in periods when the young people have little interest in, or completely rejects contact, it is important to appear regularly. Hereby the outreach worker signals that he or she cares with, and cares about, the young people.

There can be special crisis situations where a type of “fire-extinguishing” would be needed. (Aggressive youth behaviour in gangs etc.) This is normally not sufficient as a model, or foundation for, establishing outreach work. Even though gaining contact with the young people can be easy, it often takes a long time to gain their trust. Trust is often a presupposition for security and a foundation for stable relationships.

Flexibility

To continuously visit and to be patient as an outreach worker, without at the same time being flexible, hampers the possibilities for contact. The outreach workers must be able to relate to changing situations and different places, and also be able to act fast, safely and appropriately in difficult situations.

A young people group can change their meeting places and hangouts and meet at new times. The inrush to a young people environment can increase so that the environment becomes insurmountable. Ways of meeting and patterns of communication can change. There can also be changes in types of drugs abuse, a-sociality and negative behaviour. The constitutions of groups, norms and leaderships within these groups can change.

If the outreach worker does not manage to meet these challenges through altering his work hours, approach methods and ways of reacting to the young people, he will soon have discarded his role as a trustworthy adult. The young people’s interests, ways of being together and behaviour are marked by quick changes. If the outreach workers are insufficiently flexible in relation to these changes, they will easily fail to meet the young people’s standards, and so will not be able to gain any trust.

Accessibility

Continuity and flexibility makes the outreach workers easily accessible. It is important to be easy to reach and gain contact with if one wants to catch and prevent problems in the youth groups. On the one hand young people live for the moment, they are not very good in planning for the future. On the other hand they are often sceptical to the help apparatus and to adults.

Appointments and written inquires do not work well if one wants to get in touch with young people with problems. That the outreach workers frequently visit the young people over a certain time period, that they are flexible and preferably have some kind of premises where the young people can visit without appointments, makes the fieldworkers easily accessible. Thereby an important presupposition for the young people to trust the outreach worker is fulfilled.

The outreach worker has to show that he or she is easily approachable, a trusting situation has to be achieved and a relationship established. After this the outreach worker can start working towards change and towards making the young people feel responsible for their own actions.

Accountability

A target for good professional contact, support and help work towards young people aims to stimulate the youth’s learning and maturing processes. This way they can reduce negative behaviour and develop positive behaviour. An important element in this process is to teach children and young people about their rights, demands and obligations, and how they shall proceed to use these in constructive attempts to change or strengthen their own functioning. In these circumstances it is important not to work in such a way that responsibility is not removed, but instead systematically work for making the help apparatus and administrative and political authorities responsible in relation to the youth’s situation and needs.

It is of considerable significance that the before mentioned principles distinguishes the outreach workers working methods.

Voluntary decision

The starting point for contact and work with young individuals and groups of young people must always be that they want, or get to want, contact and to be followed up. The young people choose whether they want contact with the outreach workers or not. Young people are involved with suggesting and planning initiatives that are directed towards the individual young people or young people group. They know that the outreach workers won’t act “over their heads”. This type of voluntary decision is decisive for gaining trust and admission in the youth environments.

To have the opportunity, over an extended period of time, to see and learn to trust an adult social worker in his or her own environment, often initiates motivation processes and a wish for support and help to begin change.

Many children and young people with problems are suspicious and sometimes hostile towards authoritative adults. This can cause the work to fail unless the outreach worker does not show that he or she is trustworthy, does not gossip and basically are on the “side of” the young ones. This does not prevent the social worker in established contact relationships from continuously setting limits, but in an open and honest way that excludes that he or she in any way tricks the young people.

Professional confidentiality

Protecting the person and professional confidentiality is a presupposition for trust. When professional confidentiality keeps being emphasized as an important work principle, it is due to the fact that young people can be very sceptical to adults and have very little trust in them. They can have experienced that teachers, parents or police have talked about them without the young people being informed of this.

If a youth cannot trust that what he or she tells a outreach worker doesn’t come any further, there is little foundation to gain trust.

Professional confidentiality implies that the young people can bring up topics they find hard talking to others about. This is important and necessary to create alliances and relations between the young people and the outreach worker. All of the outreach workers should therefore have to keep professional confidentiality about what information they receive about the children and young people that they meet. Since outreach work has to be done in the youth’s own environment it is an important supposition for establishing contact that the young people are convinced about the trustworthiness of the outreach workers. Some of the young people hang around or are attached to criminal environments and hard and at times brutal drug abuse environments. Professional silence will in these circumstances also be a necessary protection for the outreach workers themselves.

It is especially towards parents, police and child welfare authorities that this professional confidentiality can create conflicts. The question about the duty of information and professional confidentiality, both duty bound and the right to confidentiality, will vary. The laws will differ from the various countries, and professional confidentiality will reflect this. It is, however, important to note that if the young people don’t feel reasonably safe on this, it is highly possible that they won’t have any contact with the outreach worker. Thereby the foundation for the outreach work is undermined. When it comes to information concerning individual persons and police affairs one will have to be especially attentive.

Experience shows however, that professional confidentiality is not a problem when the collaborative instances work well together and get to learn about the special work forms that distinguish outreach work. When planning and establishing outreach work it is therefore important that there is time to inform about the special circumstances and discuss collaboration routines with co-working instances.

Having said all this, and keeping in mind that professional confidentiality is a key factor in outreach work, there is situations where secrecy must be put aside. From time to time outreach workers get knowledge about severe crime, violence and abusive actions or plans in such a direction where professional confidentiality must leave the room and information delivered to the right authority. It’s important that the outreach work service has a high degree of transparency so that the work done can be appreciated and evaluated by other cooperative services.

Methodological approach

Different working methods can be applied in outreach work.

    - Individual work with children or young people with special problems, destructive drug abuse or asocial behaviour.
    - Work with groups that have special problems.
    - Work with groups that have no visible signs of a faulty development or maladjustment, but who, by different causes, are in opposition to the surroundings.
    - Different types of networking. For example there are Neighbourhood work, club activities, housing co-operations and other initiatives in the local area that will have a preventive effect in relation to adjustment problems, marginalization and drug abuse amongst children and young people.

Thus outreach work can and must be described as being on different levels. Levels aside, outreach work has, however, important traits in common with other types of youth work. Their choice of methods and target groups complements each other, and reflects at what level the work is being done.

Outreach work should preferably be executed in pairs. It can be difficult and sometimes dangerous to be alone when working on the streets. Both the work situation as well as the youth environments can be difficult to follow. Situations can change, and events occur rapidly. Therefore it is an advantage to be two, so that one can complement each other. This is both to supplement each other when it comes to gaining an overall impression of situations, group patterns and activities, and to locate, and use, different approaches in the relationships with young people. If possible both sexes should be represented and often outreach workers with different ethnic origin is a pre requisite.

It is also necessary to work through, analyse and discuss what one experiences in the youth environments. This is important, both in order to learn about, and to understand the youth’s situations and tendencies within the youth groups. Simultaneously a response to one’s own behaviour is to be desired, about how one could handle certain situations better and with thoughts of later action. In circumstances like these it is an obvious advantage to be two.

Outreach work can be described both as direct and indirect. Direct outreach work is defined by having direct contact with the target groups. Indirect outreach work can consist of establishing and maintaining contact with certain persons in the target group and the followers, partly by informing the authorities about the youth’s social situations. Such information will have as its purpose to create attention about unfortunate conditions and will aim to change these.

Establishing contact is essential in outreach work. Direct outreach work demand both creativity and imagination when it comes to choose approaches for this. Here are a few examples of approaches.

    - Contact with known young people within the current group. This is both to follow up individual persons in the special environment, and to make oneself known/get to know the youth environment. It is important to be seen and recognised in the youth environments. This demands that one stays in the environment regularly, in set places over an extended time period.
    - Contact with unknown young people through contact with, and after requests from known contacts, or from direct contact with unknown persons.

Indirect contact work towards young people can take place through spare time activities. This can for example take place through so-called adrenalin sports, motor-cross, garage activities and drug free cafes and contact offers.

Sometimes contact with young people is established through someone else’s initiative. Normally the one making the initiative would be parents, siblings or friends. Initiatives can also be made by schools or by child welfare authorities. Young people that no other instance can help, or young people who withdraw from that kind of help, can often be transferred to outreach workers. In these cases the outreach workers have many possible ways of contact available. They can arrange meetings through other instances or attempt telephone conversations, letters or goal orientated outreach work to seek particular young people after their given locations and descriptions.

Even though outreach work shall be both pro-active and active, it shall also be a voluntary offer, which is not to be imposed on the young people. Neither have the young people any obligations to make contact. A great challenge will often be that the young people themselves do not perceive that they are in any need of help from or contact with the outreach workers. In these instances questions concerning continuity and trust become decisive.

It is also important to distinguish the outreach work from socio-political or other conflicts of interest that may exist between alternative environments and the surrounding society. This can be between especially vocal youth groups, local societies and the police. Or it can be between prostitutes and drug abusers on one side and the police on the other. The outreach workers must be very certain of their own roles and of how they are perceived by the young people, without vouching for or looking through their fingers upon various asocial activities.

Conflicts of interest and disagreements may also arise between outreach workers and the surrounding world, such as politicians, the police and the remaining care- and help apparatus. Politicians might expect that youth problems shall be identified and controlled. The police have interests in their own tasks and goals. The collaborating care instances might have unrealistic expectations about the young people’s withdrawal from their negative environments.

In outreach work it is important that the young people in the environment gain knowledge about the tasks of the outreach work and the fieldworkers. Outreach work has to be made visible and known in the environments, and be open about its intentions.

Target groups and risk factors

Target groups and areas of effort will vary between small districts to big cities, from local societies and Districts to the heavy burdened environments in the city centres. Some places it might be advantageous to work “indirectly” with potentially exposed or vulnerable groups, or simply towards broad youth groups in order to create an environment where the young people can experience well being, achievements and feel included. This can contribute to counteract against an early drug debut and experimentation with illegal drugs. At other places it is the more heavily burdened young people and young adults that are the target group. It can be described as preventive work towards young people in the danger zone, and corrective work directed towards individual young people with obvious and defined problems.

The principal target group for outreach work is young people who are on their path into worrying or already established drug abuse environments. The most worn out and heaviest abusers are in this connection not the main target group. On the other side this must be considered in relation to recruitment. To help the most worn abusers may have preventive effects. As long as there is an established drug abuse environment in a city, District or local environment, it can seem attractive to young people adrift and with weak attachments. To contribute or reduce the established drug environments as much as possible must be of importance. Also to make these established environments as unattractive as possible, especially in the eyes’ of the youngest, can reduce the recruitment to such environments. On the other hand it is important to be aware of the environments the young people seeks will, in this connection, be experienced as a “free place” that can simultaneously be both open and shut. They can be shut in relation to the surroundings, and have made their own lives and environments with their own norms and values. At the same time they can be open to new young people and in this way represent a recruiting field. This is especially in relation to the weakest, those without a strong attachment or other sense of belongings.

No matter what it is important to attach preventive work to young people who find themselves in a marginal situation and who are in danger of developing various kind of problems. These are often described at risk groups. This is connected to that many young people show sign of needing help, without them needing any special treatment. It is especially here that outreach work has major tasks, that as mentioned earlier seems to have been reduced in favour of harm reduction and outreach work directed towards the heaviest drug abusers.

Marginal groups, exposed groups or risk groups are relative and not unambiguous terms. It is not an easy task to identify the ones that are thought to be in a risk situation. There will not be any obvious limits between those who are not at risk and the current target group. Traditionally the term “risk” is connected to exposed children and youth groups who shows signs of different forms of reality escapes or aggressive or destructive tendencies. This can be manifested in experimentation with drugs, truancy, bullying, crime, rituals in groups, etc.

There are risk groups within every age group and social class in a population. Studies of young people’s drug abuse patterns show, however, that it is not accidental who become drug abusers.

In general it can be pointed at the close connection between different types of attachment problems in childhood, difficult conditions while growing up, early adaptation problems in relation with schools, early debut as a criminal and flawed family situations and previous adolescence and drug problems later in life. There is a socially vulnerable risk group where we find different deviant behaviours connected to background variables and the way the young people were brought up. These can be low social class, ethnic origin, poor school careers, drug-abusing parents, group pressure, drug related crime, etc. Similarly one can often find that clients of child welfare, juvenile delinquents and others with equivalent backgrounds are over represented among heavy drug users. Groups that grow up in homes where the parents are drug abusers and have poor connections with working life plainly constitute risk groups. When it concerns the abuse and mistreatment of children there is a connection between being hit as a child and hitting one’s own children.

It can be pointed to that there is a close connection between different types of adjustment problems in childhood and early adolescence, difficult terms for growing up, early adaptation problems concerning schools, early criminal debut and burdened family affairs can be closely connected to drug problems later in life. This is a socially vulnerable risk group where we find various types of deviant behaviour attached to background variables and conditions while growing up.

It could for example be a low social class, ethnic origin, bad schooling, abusive parents etc. Thus one will also find that clients of the child welfare system, previously convicted and others with corresponding backgrounds are relatively over represented in heavy abuser environments. Groups that grow up in homes where the parents are drug abusers and who have a weak connection to the labour market, clearly constitutes a risk group. When it comes to abused children there are a strong connection between having been beaten as a child and beating one’s own children. It is often such risk factors and characteristics that appear in relation with crime.

Immigrant groups can be especially exposed due to isolation, departures, change of cultures, racism, language problems etc.

Unemployment can lead to low self-esteem, weak attachment to society and a lack of the experience of belonging somewhere. It can, in general, be pointed at problem factors such as a very high alcohol consumption, criminality, psychological problems and bad mental health, a weak attachment to school, the labour market and society.

In 1995 The Danish Directorate of Health (Sundhedstyrelsen) put together a list of characteristics of young people that are especially exposed to abuse and can be called high risk factors:


Risk groups are found in every age group and social class within the population. Therefore it is important not to limit the understanding of drug abuse, crime or other maladjustment to previous social problems. Youth researchers often describe this as a recruitment path to abuse through a career as a deviant. Youth researchers also operate with a youth cultural recruitment path. It is drug cultures and abuse that changes in time with youth cultural expressions and changes. Examples of this are the hippie movement in the 1960’s and 1970’s and the raves and house cultures in the 1990’s and after.

Drug abuse as a youth cultural phenomena has been changing with time. The career as a deviant has on the other hand always been strongly present. We have in this connection witnessed large youth cultures that both accept the use of illegal drugs and who initiate and introduce these narcotics. This often happens among young people with many resources. Most of these young people have proved to eventually stop using illegal intoxicants. It is the socially vulnerable who take over more and more. And who add the use of illegal drugs on top of other problems such as a high alcohol consumption, crime, charged family relations and weak attachments to schools and organised activities. Many of these young people have previously had contact with child welfare. Of these many of their parents have themselves been clients of the child welfare system. The element of so-called social heritance is in this way often considerable. It is therefore not accidental who become heavy drug abusers. The problems do not strike at random.

Outreach work should concentrate its efforts on older children and young people that are about to be involved with the drug-taking environment or about to be involved with drug abuse or asocial activities. These will often be marginalized young people, gangs, subcultural groups, asocial groups, young people at risk and young people at the beginning of a drug-using career.

Ages without distinct borders 13 – 21 (12 – 25) (including the parents of these groups.)

Important target groups not traditionally linked with or seen as a part of the drug scene are:

    - Traditional groups such as young people that have run away from home or institutions.
    - Street children or homeless. Children who are vagrants. Children who drop out of school. Children who exhibit psychological signs of falling out of the educational system.
    - Young prostitutes.
    - Youth groups known for their violence and criminality.
    - Hooligans and skinheads.
    - Asylum seekers, especially younger asylum seekers that are without a network, without language skills, traditions or an understanding of their host’s culture.
    - Ethnic minorities. Migrant groups.

    This also goes for new groups or old groups in new guises within the new waves of youth culture, expressions and phenomena. Examples of this during the past 10 – 15 years have been the house music culture, ravers and hip hoppers.

As a simplifying manoeuvre we can divide the age groups (13 – 25) into three groups with distinctive characteristics. We call them group A, B and C where group A and B are the key target groups of outreach work.

A 13 – 18 years

These young people are distinguished by often drifting away from school and friends. They run away from schools and they often have conflicts with adults, they dabble in crime, they get drunk in the weekends, they flirt with intoxicants. Many have experienced care deficiencies, sporadically contact with school psychologists, counsellors and the child welfare office.

B 19 – 25 years

Young people that are in a vague life situation without knowing what it leads to. They have an escalating consumption of intoxicants. Compound psychiatric problems. Interrupted schooling and work relationships. Not much contact with their families.

C 25 years and over

This group is not the primary target group for outreach work, but it exists and it will at times imprint the environments where young people are gathered. It is therefore valuable to have contact with this group, to watch the developments within the environment. This group belongs to the heavy user groups. They are very often long time criminals. They have interrupted social relations. They have little or no contact with their families. Interrupted schooling. Continuous use of strong narcotics. Bad mental and physical health. They are often reliant upon the help apparatus.

The groups A and B must be the primary target groups, with the main age group being between 14 – 22 years. Additionally many outreach workers have in their work established activities of a more primary preventive character. This is directed towards groups with a special consideration or groups that do not necessarily carry any sign of big mental or social strains. This is in order to get in early before a deviant career becomes consolidated and when the potential for change is at it’s greatest.

Part three - Present and future challenges

The last years have brought new narcotic trends to Europe. Some environments use several different kinds of narcotics when there is a party in the weekends.

The concept “recreational drugs” is often used, and indicates that this is drug used for recreational purposes.

Statistics shows that during the 1990’s the youth’s use of illegal drugs has increased considerably, and the amount of young people who have tried and tested illegal intoxicants is increasing. This is especially true for cannabis, but amphetamines and ecstasy are also drugs on the rise.

Several researchers have also launched the concept of “normality thesis”, which implies that drugs are used outside of the subculture they were introduced, and then spread to youth groups in general. During this process they become “normal”.

Many drug workers tell about the current conditions in the broad layer of youth groups to be similar to the spread process that cannabis and marihuana went through in the late 1960’s and thereafter. Social scientists assert that this is happening as an interplay with bigger processes in society, whereby different forms of liberalization, resistance against limitations of the freedom of the individual, the hunt for pleasure and the personal “kick” and the demand for, to a bigger degree, creating one’s own identity must be seen as essential components of the social-psychological climate where the use of these new drugs take place.

House and rave cultures were first introduced in the European arena late in the 1980’s. The first major parties had almost an explosive spread. These arrangements were dance parties to very hard techno music. They were arranged in factories, warehouses etc.

Those who were involved with the house culture at an early stage experienced the culture as much more than just a dance form. It also had it’s own philosophy: It followed the hippie-like ideology in the sense that it revolved around having fun. It was anti-racist; house should be tolerant and accepting. It was anti-sexist; the culture distanced itself from traditional gender roles. It was new thinking; technology is fun and dance. Movements to music have always been a central element within the house culture.

During the 1990’s the new electronic culture constantly gained young followers, and the culture became more and more commercialised. Simultaneously new drugs as ecstasy, ghb, poppers, 2cb and Ketamin became introduced. Together with amphetamines, cocaine and LSD these new drugs got named under the collective term: Party-drugs.

Eventually both the recruitment and the atmospheres of the Parties increased. Succeeding the initial years there are no longer not only young people that experiences with illegal intoxicants, but many of them also exhibits a range of other traditional risk factors.

After a while outreach workers therefore found it important to make initiatives towards these house environments. (Stop the drugs not the dancing/Future, Stop dopet ikke dansinga/Future/Crew 2000). The following targets can be found for outreach work within house environments:

    - To create good norms for a drug free house culture
    - To prevent young people from beginning to use intoxicants
    - To promote engagement of young people
    - To prevent and reduce the harmful effects of narcotics
    - To arrange for parents and professionals to achieve knowledge about drugs
    - To make an alternative for those who choose to become intoxicated
    - To obtain an overview of new trends and developments in the house environments
    - To let the young people practise their social skills
    - Harm reduction. This effort is however heavily disputed, since the method often focuses on “safe use” of drugs. (chill-out zones, water and fruit distribution). The goal is not “no drugs”, but a more safe use of drugs.

Outreach workers composed information material adjusted to the new target groups. This included preventive and health promoting information that were distributed at raves and house parties. This kind of work and ways of approaching spread to several European countries. Inspiration, experience and knowledge were imported from amongst others various English organisations.

In many places working out on the parties represented a new methodological approach. Voluntary young people who knew the environments better than the outreach workers were included and given important tasks. From this a new model was developed, where the outreach workers worked side by side with the volunteers, who in their way also represented the users.

Eventually the hip-hop environment also became included as a target group. Other current youth phenomena of relevance to outreach work are straightedge and skate boarding cultures and various ethnic youth groups and other subcultural groups.

Philosophical aspects and principles in this work are, amongst others:

    - Youth to youth communication
    - Co-operation (with the users)
    - Resource orientation
    - The young people are the experts in their own lives
    - To make the young people conscious and active. Remove them form the role as clients
    - Role model – thinking
    - To strongly emphasise working in groups. Young people influence each other.

This work can lead to results as:

    - Admission to subcultures
    - Trustworthiness as a provider of information to young people
    - Young people themselves require help and advice in relation to drug orientated questions
    - A stable youth group with suitable young people who work on contracts for the projects
    - Voluntary co-workers who increasingly lead others in contact with outreach work
    - Increasing number of inquiries from e-mails from young people who wants information or contact
    - Demands and attention from other professionals
    - Increased focus and attention on the problems

Future challenges

Traditionally, the methods in outreach work have been, in fact, us. Though the ‘methods’ handbook cannot replace the actual work outreach workers conduct on foot while seeking out and contacting youth at risk, there is a need to think differently.

In striving for objectivity and documentation as outreach workers, ‘walking the streets’ is no longer satisfactory. We must develop new methods in light of the technological and socio-cultural changes we encounter on foot on a daily basis.

In recent years, the majority of adolescents encountered in outreach work had distinct geographical boundaries and symbols linking them to particular areas and subcultures clearly visible to the outreach worker. However, this visibility has disappeared due to mobility and new information technology within this group, making it easier for them to move from one place to another, crossing the traditional boundaries we have become used to and comfortable with. This tradition involves the workers in physically present, face-to-face relationships with the youth, as opposed to the new technology that has the capacity to transcend physical and national boundaries.

The new technological advances in cell phone and the Internet have driven this developmental trend among adolescents. These advances have created different forms for contact, so it is no longer necessary for youth to meet face-to-face in public places. For instance, new friendships and acquaintances have developed, cutting across national boundaries, regions, counties and ethnic groups. This has made it more difficult for the outreach worker to find them in the open spaces where they used to meet because they are more dispersed.

This development makes it necessary for the worker to adjust to the public places where the youth actually meet. Extensive use of the cell phone by youth, sending text messages and pictures and making the usual calls and contacts, have become the norm in most countries. Along with the traditional methods mentioned in outreach work, the cell phone has also been adopted by the worker as an additional means for establishing contact with the youth.

Internet is used in a similar way by outreach workers in many European countries, as a new means of communication with youth. Outreach centres have created websites, giving youth the opportunity to contact them anonymously, if they wish, and ask questions about ‘all or nothing’, and in this way they learn about the services the outreach centre provides before having direct contact with a worker. Many outreach workers have said that the youth they meet on the streets have learned about the outreach centres on the Internet and in chat rooms.

Youth culture has always been characterised by innovation and change, and these changes occur rapidly and with determination. If outreach work should maintain its place in the field of prevention and drug prevention, it is crucial that we have command over information technology. New technologies are here to stay and we must keep up with these rapid and innovative changes.

Other changes connected to the general development of western society, particularly affecting youth culture and important for outreach work is:

    - High unemployment among youth
    - Increased demand for high performance in school
    - Increased economic pressure on the family, both parents working and little time for the family
    - Formation of racist groups
    - Liberalisation of drug policies
    - Larger range of drugs to choose from
    - Increased contact with teenage girls suffering from eating disorders, suicidal tendencies and emotional problems
    - Indiscriminate use of prescription drugs
    - Media focus on the body and sex aimed at young girls, focus on ‘bimbo’ culture in music videos

As media and information technologies diversify, there is no reason to believe that the difficulties and challenges youth face while growing up will decline in the future. This indicates that challenges in the field of drug prevention and early intervention will continue to be major issues for politicians, planners and professionals. Prevention in the local community has proven more cost effective than extensive treatment, rehabilitation and care programs.

Yet another obvious point is that outreach work must maintain its exclusive status in the field of drug prevention thus taking the temperature in the streets to find out what is going. This unique position involves making new contacts and collecting information about the trends in youth culture and other subcultures that arise over time. If we are to have a command over the situation we must be physically present in the environment where they are. While outreach work must include street work, it must also involve the new technologies developing in cyberspace. Many outreach centres have put into use this new technology with good results, especially concerning contact with adolescents on Internet.

For now there is no sign that we are faced with a new ‘wave’ of youth culture that we must rapidly respond to with new approaches. Though youth culture may have a great capacity for change and to adopt new trends, the development is still occurring at a similar rate as before. However, it does not have the same impact as ‘House Culture’ had yet this does not mean that the ‘party culture’ has faded. Many have suggested that the extensive use of drugs that grew out of the ‘House Culture’, or perhaps better said caused it, has been absorbed by the general youth population who go clubbing or to cafes. As a response to this, many centres have formed ‘party patrols’, offering services and information on dangerous drug use, handling crises and overdose, and at the same time the ‘party patrol’ establishes contacts and monitors new trends in drug use.

Experimentation, recreational use and diversity

Many workers in this field have reported a relatively liberal use of drugs among the youth and a willingness to experiment with different drugs. Moreover, they are experimenting with drugs that were used only by drug users with a long career of misuse. In Europe, amphetamine is widely used by young people at clubs and parties. Ecstasy and rohypnol are commonly used drugs. In Scandinavia, it appears that there is a high consumption of prescription drugs used among young people. Both pharmaceutical companies and medical doctors have been sharply criticised for their liberal views and advertising campaigns concerning the use of prescription drugs as ‘happy pills’, giving the implicit message that this is a way of solving problems. We have suggested that such practices lead to increase misuse of drugs among young people.

Because of the general tendency toward experimentation with different types of drugs, understanding the behavioural changes and the dependency that occurs with long-term use is taken lightly. Drug use is seen by youth as socially acceptable behaviour and part of a recreational life-style. Drug use seems to include certain segments of the youth culture where consumption is seen as less stigmatising. It is still considered a recreational activity as opposed to a destructive life style. Pills, ecstasy and GHB are taken indiscriminately while the more experienced smoke heroin without making a fuss about it.

The growing interest in drug experimentation among youth is important to communicate to politicians and decision-makers, making documentation and continuous monitoring of the situation critical for outreach workers. There is a positive development in that we still encounter many young people in clubs and cafes at the experimental stage, since they have not yet developed a drug problem, and we must still continue to work with this group toward open dialogue and change.

Yet there is cause for concern for teenage girls (14 - 16 years old) whom we communicate with on Internet. It appears that there are an increasing number of girls who suffer from eating disorders, depression and problematic relationships with family and friends. Self-inflicted injuries are not uncommon in this group, but rarely with fatal outcomes.

Today, the users of outreach centres in Europe are a diversified group, made up of drug users and non-users, some with a criminal background and others without and some with emotional and/or social problems. Diversity presents a challenge not only to the outreach worker but to the youth as well. There are no easy answers and no ‘happy pill’. This process requires active engagement and co-operation with other partners in the field of preventive work such as the school system, social and health services, employment agencies, employers and the police. When do young people switch from experimentation to misuse then to abuse? Some will grow out of it while others will continue. The categories can be blurred for the outreach worker doing prevention work, and these problems require discussion as well as various services that can adjust to the user’s needs.

Outreach work in Europe has been criticised as being too broad and without any methods. We hope that we have made clear in this handbook our principles and values concerning our work, outlining the challenges the worker faces and offering practical advice. Outreach work has developed the ability to adjust their services to the needs of the individual and, most importantly, we have developed flexibility within the discipline of secondary preventive work.

Along with flexibility, new methods, competency and knowledge will be picked up within this field and applied to outreach work. There are more and more centres in Europe that are contributing to the competence and knowledge but we still have a long way to go as time goes on. We should therefore be able to exchange our experiences with other countries in Europe. The fact is that our target group is becoming more mobile and travelling is affordable. Studies abroad are becoming more common. Internet, international music festivals and international youth organisations contribute to fast exchanges of human and cultural relations across borders with positive as well as negative aspects. Are outreach workers being left behind?

In order to keep up with the rapid changes and hence to foresee developments and new trends, early interventions will depend on extensive knowledge and understanding of the changing trends of youth culture. Therefore, in this situation where youth all over Europe experience few limitations in communication and are developing a common way of expressing themselves through fashion, music etc., it is utterly important that outreach workers throughout Europe find opportunities to exchange experiences and knowledge. It is our hope that this publication is a small contribution to this end.

Cultural competency in outreach work

A multicultural society is marked with ethnic, linguistic and religious components.

Since the impact of globalisation and the introduction of the market economy are evident in nearly all societies, cultural competency becomes more important for professionals working in the field of drug abuse and prevention. This impact has created a pattern of migration centring on working-class migrants involved mostly in industrial or service occupations. From this perspective, outreach work as related to secondary prevention cannot be successful without developing cultural competency that illuminates the contrast between the global and the local patterns of migration.

The following elements are important and can be used as a guideline for developing cultural competency among outreach workers. It is a competence that implies a specific social component that enhances cultural aspects in multiethnic societies and is related to:

    - Individual attributes of the outreach worker
    - Social environment and social conditions

Developing cultural competency is an open-ended process and aimed at considering the social needs of all ethnic groups in an immigrant society, including the need to assess and evaluate the quality of social services aimed at ‘sharing’ and the social policies aimed at achieving that sharing.

Important Elements

Cultural competency can be viewed as the means the individual has:

    - to recognise cultural differences
    - to be aware of one’s own attitudes and values
    - to act according to different cultural contexts
    - to initiate and to support a cultural learning processes in the field of outreach work.

Developing a cultural competency

In order to achieve cultural competency, the emphasis is on four main abilities:

    · Empathy is the willingness to understand young people from different cultural and social backgrounds and the ability to put yourself in their situation.

      It also includes the ability and readiness to sympathise with young people subjected to prejudice, social exclusion and stigmatisation. Respect, open-mindedness and commitment are necessary elements in outreach work relevant to cultural competency. It concerns the renunciation of clichés that stereotype people who belong to different cultures. There is no typical “Turkish, Arab or Russian” etc.

    · Developing a professional attitude and a detached role in relation to outreach work should be the result of a critical process of self-reflection.

    · Tolerance of uncertainty: means that the clash of different cultures can cause misunderstandings, ambivalence and alienation. Managing this situation requires tolerance, concern and continuity.

    · Ability to communicate: communication with young people from different cultural backgrounds requires a broader approach focused on trying to understand several things about migrants at one time such as their networks, activities and lifestyles. This also involves non-verbal communication and the meaning of the gestures; signs, symbols and rules that govern particular cultural scenes are important elements to interpret in order to develop better cultural communication.

Practice

While working with migrant groups and youth from different cultural backgrounds, it is important to understand that drug use is different in each group. Drug abuse among certain groups is taboo while in others it is not, and in some cases it can lead to ostracising or rejecting the drug user from the family. Reasons for this are that:

    - Drug use is often sanctioned harshly in families of migrant people.
    - Drug use can result in exclusion of the adolescent from the family.
    - Drug use is interpreted as a moral “weakness” of the individual as opposed to the group or family, which often results in harsher treatment on the adolescent.

By developing cultural competency, a worker can respond to different situations and problems that arise. Secondary preventive work cannot reach the target groups without developing a cultural sensitivity.

Principles and approaches in outreach work



 

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Important reasons as fundament for establishing outreach work

Appendix I - Training seminars in Germany

Seminars and training programs that focus on outreach work is still rare throughout Europe, but some examples can be found. In Berlin, Germany several universities have one semester programme which offers a theory-based and practice-oriented education.

The programme highlights the following subjects:

1. Introduction to the Seminar.

Lectures, discourses, information on outreach work in Germany, introduction to outreach projects in Berlin. Organisational structure covers goals, content and methods of the seminar. Statement on outreach, referring to standards.

2. General Introduction to Outreach Work.

History of outreach work and its development in Berlin. Outreach work as a matter of course.

3/4. Nature of Outreach.

Social problems, the streets as public arena. Goals of Outreach / Street work.

The situation in Berlin. Survey of outreach projects in Berlin. Important gender and ethnic references and relations.

5. Legal Basis for Outreach/ Street work.

Legal questions in connection with outreach work as a particular method and the worker’s rights and duties.

6/7. Particular Methods and Diversity of Outreach and Street work.

Analysis, establishing contact, group work, project work, leisure activities, counselling, confidentiality, ethics, prevention of violence and conflict management etc.

8. Co-operation

Working together and practical measures of co-operation with other important local institutions. Youth policy on street level. Interference and lobbying.

9. Relationship to Police and the Authorities Responsible for Keeping Order.

Order and security strategy versus outreach work.

10. Outreach Work.

Social work in practice: nearness and distance

11. Frame Structure and Evaluation of Outreach Work.

12. Development of Outreach in Future.

New trends in youth situation, social and youth policy in Berlin.

Summary, retrospection and feedback.

Similar programs are being established in Norway and England. Initial discussions have also taken place in order to establish one European training program for outreach workers. This could be an important opportunity to secure a basic set of standards and disciplines for outreach work.

Appendix II - Two examples of outreach work from Austria

1) A skinhead invites some friends to his home for a party.

After a short time all of them are inebriated. One of them stands on the balcony and starts provoking students on the neighbouring balcony who were also having a party. They begin insulting the skinhead. Suddenly, the skinhead takes a crossbow, aims it at them ready to shoot. One of the students calls the police.

Twenty minutes later ten people from the ‘armed forces’ (WEGA) storm the flat with bulletproof vests, helmets and automatic weapons. The people ransack the flat and apprehend the skinhead. The usual procedure begins with the interrogation at the police station and detoxification in the cell. The next morning he appears before juvenile court. He receives 18 months conditional release from jail. Friends of the skinhead call the outreach workers (street workers) on their mobile phones telling them that the skinhead refuses to get a lawyer and will only talk to the outreach workers.

On his first day in jail when the adolescent sees the outreach worker, he smiles bravely, but he tells them that the first days in jail were hard without contact with the outside world. He tells his version of the incident, saying it was ‘something really stupid. I was drunk. I’m so sorry.’

The appointment at the juvenile court is in a month. Twice a week, the outreach workers visit him in jail. During that time the workers develop a close relationship with him and in small increments are working with him on his terms. The juvenile has written a letter to the students he has threatened with the crossbow and tells them that he’s sorry and regrets what he has done. Together with the social worker responsible for conditional released youth, the outreach workers are working with the juvenile.

The youth is sentenced to 4 months in jail and 18 months conditional release from jail.

After his release the outreach workers met with him. He seems to have changed. The social worker has managed to obtain a flat for the juvenile, and he wants the outreach workers to assist him in looking for work.

Background information of the juvenile:

18 years old. We don’t know anything about his mother, his father lives, whom he has little contact with and has cancer, lives part-time in Austria as well as in other countries. When the juvenile was 8 years old he saw his elder brother hang.

We work on the distinction between aggression, on the one hand, and violence on the other. We talk about the interaction between the state of euphoria as produced by alcohol and violence. We look at violent acts and what violence costs and what purpose does it serve and, of course, we explore other ways and strategies to get rid or reduce of his aggressions.

The continuous relationship we have had with him has contributed to a stable basis for good conversation in relation to violence (e.g. power, fear, respect, analysing his emotions etc.)

We are motivating him take his education while he is in jail as well as to continue with this goal when he is released. He has joined one of our working projects and wants to start therapy to deal with his aggressive and violent behaviour.

2) 16 year old Renee moved out of her parent’s home when she was 15.

She used to live with some friends who were squatters, ‘hidden homeless’, and has since earned her own living. In the beginning she was working illegally. Then she joined two projects for jobless youth, but she quit both of them because she didn’t have the discipline to complete.

Her main problem is that she has many debts such as mobile phone, transportation and compensation to another person whom she caused physical injury to during a fight. She also gives her boyfriend, who is in jail, money. When she gets drunk she becomes aggressive and is often involved in fights, which can be described as habitual behaviour.

Now, she is in job training to become a waitress and her debts are being paid off through an arrangement we have made together with her creditors. We have arranged payments with telecom and an agreement with a lawyer for the compensation, and we supported her when she was looking for a job. She has joined two work-training projects. She has also tried to form a girl band called ‘Renee Band.’

We accompany her to the police, to the court and other appointments, and have a solid, working relationship with her. We try to motivate her to take a genuine interest in what she is doing and to follow through with her goals such as job training and, most importantly, paying her debts. We encourage her not to give up her training. We talk about her personal problems, e.g. relationship to the boyfriend, birth control, violence and aggression, and other methods of getting rid of aggressive behaviour due to her high alcohol consumption.

Appendix III - Outreach work in the city of Gothenburg, Sweden

The outreach group (Feltgruppen) consists of 5 outreach workers employed by the city of Gothenburg. The main activity is outreach work in the city areas. The target group is youth at risk, ages 13 – 20 years old, and outreach work is conducted in the afternoons, evenings and most weekends.

Method

By establishing contact the worker’s intention is to change their social environment and activities that contribute to high-risk and antisocial behaviours. The client-related work consists of motivation, mediation, counselling, support, individual treatment and follow-up.

The primary focus of outreach work is on prevention and early intervention. Outreach work is based on respect, trust, integrity and ‘voluntary decision’. At the same time it is important that the outreach worker is visible in his or her role as an adult and a representative of the authorities. An important characteristic of the work is flexibility. This implies that some essential elements of outreach work can be changed according to the needs of the young people and the variability of risk factors in their surroundings.

During the summer, separate activities are organised for a chosen group of teenagers the outreach workers are regularly in contact with girls and boys ages 14 – 19. Such activities include working activities, group discussions and gatherings. Discussion themes involve topics such as love, sex, friendship, alternative lifestyle changes and their dreams.

The group also does outreach work with young people in prison, ages 15 – 20. They offer contact through conversation and encourage them to establish or re-establish contact with the treatment or social service system. The outreach group is also contacted when a teenager is missing.

Co-operation

While working individually with teenagers, the outreach group co-operates with several institutions such as i.e. social security, child welfare, schools and treatment institutions.

On the structural level, the outreach workers co-ordinate the city’s activities in connection with large, youth arrangements. The aim is to gather information and knowledge relevant to the target group’s situation while working with them individually and within groups to reduce social marginalisation and deviant behaviour. From a social perspective, the aim is to prevent anti-social lifestyles and to promote better conditions for them in their social environment that enhances a healthy development and personal growth.

On organisational level the outreach group also works closely with local youth organisations. For issues connected to general policies concerning youth in general, there is also some co-operation with the local police.

The outreach group also has it’s own newsletter with information about the activities and the youth situation in the city-centre.

Appendix IV - Theory into practice

The Federation For Detached Youth Work in England has recently produced the first ever, national guidelines for detached youth workers:

1. Planning and negotiation

The guidelines suggest that:

    - Planning and preparation are essential to the success of any initiatives.
    - Workers need to fully understand why a project is being initiated.
    - When working in partnership there must be clearly defined roles and responsibilities.
    - The aims of Detached Youth Work should be promoted and not compromised.
    - A needs-led service, existing for the benefit of young people should be allowed to predominate.

2. Understanding the ‘environment’ and building initial relationships

The guidelines suggest that:

    - Relationships should be carefully negotiated at a pace and level relevant to the young people.
    - Workers must identify themselves and their purpose but remember that young people have the control, and choose whether or not to respond.
    - Workers must not attempt to buy relationship, friendship or trust from young people by offering resources or ‘activities’ immediately.
    - Once initial contact has been made workers must make a commitment to regular contact.
    - Workers must provide a service that ensures resources, information and opportunities are relevant to the needs of young people on their terms.

3. Producing

The guidelines suggest that:

    - Workers should make their engagements with young people part of a learning process.
    - Needs and interests should be identified before strategies for action are introduced.
    - Workers should adopt strategies that enable young people to explore their own ideas.
    - Recordings and evaluation should be carried out after each session and the relevant lessons adopted.

4. Evaluating the outcome and process

The guidelines suggest that:

    - Evaluation should be used to highlight and promote the achievements of young people.
    - Workers should deliver a clear exit strategy, demonstrating that contact is not ending, merely changing in frequency, intensity and purpose.
    - The process of evaluation will be more successful if it takes account of young people’s ideas, opinions and thoughts.
    - The process of evaluation ensures that workers remain accountable and that the role of detached workers is valued.

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References:

Council of Europe (1994) Outreach. Proceedings. Symposium organised by the Council of Europe and the World Health Organization (Council of Europe Press)

Egedal, M (1998) Det flyvende korps. (Hornbæk: Konsulentkompagniet. Danish edition)

European Monitoring Centre for Drugs and Drug Addiction (2001), Guidelines for the evaluation of outreach work. A manual for outreach practitioners. (Lisbon: EMCDDA)

Garsjø, O (1987) Folk i mellom. (Oslo: Tano forlag. Norwegian edition).

Gref, K. /Menzke, D. (eds.) (1994) Grenzgänger. Strassensozialarbeit und offene jugendarbeit (Nürnberg: emwe-Verlag)

Gref, K. and Menzke, D. (eds.) (1997) Grenzgänger II. Strassensozialarbeit und offene jugendarbeit. (Nürnberg: emwe-Verlag)

Grimsheim, C. (2000) Elektronisk Ekstase. Housekultur, partydop og nye trender

(Oslo: Oslo kommune Rusmiddeletaten. Norwegian edition)

Hjort, H. (1988) Det oppsøkende arbeidets osykologi (Oslo: Universitetsforlaget. Norwegian edition)

Hollie, E. (ed.) (1989) Fyrtårn og Redningsbøye (Oslo: Uteseksjonen i Oslo. Norwegian edition)

Kammerer, B. (ed.) (1998) Offene Jugendarbeit und Strassensozialarbeit (Nürnberg: emve Verlag)

Kammerer, B. (ed.) (1999) Jugend sucht Hilfe. Sekundärprävention in der Jugendhilfe (Nürnberg: emve Verlag)

Klose, A. and Steffan, W. (eds) (1997) Streetwork und Mobile Jugendarbeit in Europa (Münster: Votum Verlag )

Klyve, A. and Storbækken, S., (1998) Å arbeide i utekontakt

(Oslo: Rusmiddeldirektoratet. Norwegian edition)

Klyve, A. and Tvinnerheim, R, (eds) (2002) Mellom barken og verden (Bergen: Pedcom forlag. Norewegian edition)

Konzept 2002 – Streetwork. Rettet Das Kind (2002) (Wien)

Korf, D., Riper, H., Freeman, M., Lewis, R., Grant, I., Jacob, E., Mougin, C. and Nilson, M. (eds) (1999) Outreach work among drug users in Europe: Concepts, practice and terminology Insights.Series Number 2 ( Lisbon: EMCDDA)

Lie, G. (1981) Gatelangs. (Oslo: Universitetsforlaget. Norwegian edition)

Nielsen. J. (1998) Det rullende værested (Hornbæk: Konsulentkopagniet. Danish edition)

NOU 1980: 37 Oppsøkende barne og ungdomsarbeid. (Oslo. Norwegian edition)

Rhodes, T. (1996) Outreach work with drug users: Principles and practice, Council of Europe Publishing

Sosialt fältarbete-en definition. (1997 Riksförbundet för fältarbetare.Swedish edition )

Stel, J v.d., Voordewind, D. (eds.) (1998) Handbook Prevention. Alcohol, Drugs and Tobacco (Council of Europe and Jellinek Consultancy)

Streetwork Wien. Jahresbericht 2001. (Rettet Das Kind 2002 Wien)

Svensson, B. Svensson, J. and Tops, D. (1998) Att komma för sent så tidligt som möjligt (Helsingfors: Nordiska nämden för alkohol og drogforskning. Swedish edition)

The Federation for Detached Youth Work (2001) Vision Statement (London)

Universities of Luton, Durham and Lincoln: Outreach and Detached Work. Interim report (University of Luton)

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The Author

Njaal Petter Svensson, born in 1943, is currently working as a senior advisor in the Alcohol and Drug Addiction Service, City of Oslo, Norway. By profession he is a social worker with additional advanced studies in social policy, social administration and social anthropology. He has more than 30 years professional experience and has held different positions as a social worker and outreach worker as well as within leadership and administration, development of organisations and social policy, national, municipal and professional planning, supervision and teaching in Norway. His field of specialisation is treatment, rehabilitation, prevention and child welfare.

Summary

Since the late 1960s, outreach work as an approach to drug prevention in the local community work has been a well-established practice in early intervention and related to drug prevention in most towns and cities throughout Norway. The encouraging results this approach has yielded led to the co-operation with the Pompidou Group with the idea of preparing a manual on outreach work for a European audience.

The manual hopes to raise awareness of the importance of outreach work as a professional approach to early intervention strategies in the field of drug prevention. It presents examples of current practices in Austria, Germany, Sweden and the UK. An additional benefit of young people outreach work is the excellent cost-benefit relationship. Looking at the experiences in several countries this investment can be a crucial contribution to more effective prevention work.

The Pompidou Group

The Council of Europe's involvement in the fight against drug misuse and drug trafficking is carried out through the work of a multidisciplinary co-operation group known as the Pompidou Group. It was set up in 1971 as an intergovernmental body at the suggestion of the late French President Georges Pompidou and was incorporated into the Council of Europe in 1980. It provides a forum for European ministers, officials, specialists and other professionals to co-operate and exchange information.

The Group currently has 34 member states: Austria, Azerbaijan, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Iceland, Italy, Lithuania, Liechtenstein, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Russian Federation, San Marino, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Turkey, and the United Kingdom. The European Commission is also a member. Since 1991, technical co-operation has been extended to countries of Central and Eastern Europe which are not members of the Pompidou Group, including: Albania, Romania and Ukraine. Some countries which are not Council of Europe members participate in the Group's activities on an ad hoc basis, for example the United States of America, Canada and the Holy See.



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