Problem addressed
According to 2023 Eurostat data, 12,4% of young people in Europe aged between 15-34 were NEET, “Not in Employment, Education or Training”, with the figure rising when considering Italy (18%). While the Portugal figure is slightly lower (9,3%), specific pockets with higher rates within the country are still present.
Considering the “hard to reach” nature of similar situations, which are often worsened in the case of marginalised groups (such as Young People with disabilities, migrants, low education, on low-income families, from isolated areas, and women) a collaborative model ensuring adequate services the possibility to reach, engage and subsequently build a path for the social inclusion of NEETs was deemed fundamental.
Innovative solution
C.O.P.E. aimed to foster social inclusion for hard-to-reach young people through an innovative approach that combined Social Prescribing—a well-established methodology adapted for a new target group—with a relational proximity community network, a novel concept that exceeded initial expectations.
To achieve its goals, partners adopted innovative strategies at multiple levels. These included building partnerships among organizations from the public, private, and third sectors, and establishing a network of 83 Link Workers from diverse professional backgrounds and 34 entities across all sectors. Training was a key component, with 72 professionals trained as Link Workers in Social Prescribing methodology (48 hours of core training plus 55 additional hours) and another 85 professionals receiving Social Prescribing training. Link Workers were supported through over 180 hours of supervision.
Creative methods were used to disseminate information to young people and the broader community. These included 900 meetings and events, camper tours, peer-to-peer activities, radio and TV broadcasts, social media posts, articles in local newspapers, and the distribution of 30,000 info cards. Local hubs were established across the territory, offering drop-in services and appointments to enhance accessibility for young people and their families. The project also resulted in 82 new shared agreements with community resources and the development of two digital platforms: one funded by a partner to facilitate opportunity identification and the co-creation of individual plans, and another privately funded to support young people in their explorations.
The initiative introduced a four-stage engagement process for hard-to-reach individuals, consisting of exploration, pre-engagement, initial engagement, and full engagement. It also identified personalized pathways focused on employment, training, education, re-socialization, prevention, and health and wellbeing.
C.O.P.E. supported young people through Individual Action Plans that addressed their needs, preferences, and motivations using a co-creation approach. Families played a crucial role in the process, participating actively with the young person’s consent and always in cases involving minors. The coordinator assigned a Link Worker based on geographic location, availability, and professional or personal expertise. The Link Worker acted as a bridge between young people and the community.
The success of the project relied on the contributions of all stakeholders, including entities, professionals, and citizens. A proximity community provided accessibility, a person-centred approach, and both physical and virtual spaces for connection. Access to the program was made available through referrals by services, families, or self-referrals.
Key results and benefits
The realist evaluation showed: a statistically significant improvement in mental wellbeing, a reduction in psychological distress, particularly for those YP who had relatively worse mental health at baseline. At baseline (n=427), 47% of Italian responders reported a mental health condition versus 11% of the Portuguese, who experienced emotional distress at baseline instead. LWs offered emotional support, support for employment or training or other, in 54.4% more than one form of support, in 9% no support.
The Intervention Programme Theories showed: YP benefited from C.O.P.E. with increased self-esteem, social skills, physical activity, agency in determining what they wanted to do, and mental wellbeing, with reduction in psychological distress.
The Social Return on Investment showed between €4.27 and €5.36 for each euro invested, although healthcare resource savings remained stable overall.
The project results show the importance of maintaining a satisfactory balance between clinical/health aspects and social aspects, to offer YP holistic support, as was the aim of the project. This aspect was widely considered by the LWs during the interviews, indicating a shift in their approach to intervening with YP. In terms of intervention, the LWs emphasised the flexibility of the project, and each young person co-created their IAP.
The main innovations concerned the partnership among organisations, community and professional levels that supported the implementation of SP with specialised interventions with YP, ensuring increased social cohesion, reduced social isolation and increased employability.
According to LWs and YP, the person-centred and relational proximity approach adopted, which is respectful of each individual's experience, was crucial to achieving the results presented.
Potential for mainstreaming
The innovative application of social prescribing (SP) as a methodology to promote social and labour inclusion, as well as the well-being of young people in NEET situations, holds significant potential for mainstream adoption. C.O.P.E. has provided a solid foundation for this transformation, demonstrating the impact of integrating health, social, and cultural care in a person-centred approach. Building on these learnings, several key strategies have been identified to ensure the continued implementation and expansion of social prescribing models.
During the final event of the C.O.P.E. project, essential components for the future design of SP services were highlighted:
Establishing an independent department on SP within national Employment Agencies.
To ensure a systematic and coordinated approach, an independent SP department should be embedded within national employment agencies. This department should operate at a territorial level, adopting a multi-agency and flexible approach that integrates diverse social sectors and tailors solutions to regional characteristics.
Periodic mapping of specific solutions for rural and urban areas.
A periodic mapping exercise should be conducted to identify and document specific solutions that cater to the unique challenges faced by young people in both rural and urban areas. This would enable the continuous improvement and adaptation of SP services based on evolving needs and regional contexts.
Co-design and co-evaluation with Young People.
Young people should be actively involved in the planning, implementation, and evaluation of SP services. Co-designing activities with target beneficiaries ensures that interventions are relevant, effective, and aligned with their aspirations and needs.
The role of a LW coordinator.
A dedicated LW coordinator should be appointed to foster collaboration between professionals from different fields. By developing strong interprofessional relationships, the LW coordinator can enhance the effectiveness and reach of SP interventions.
Holistic training on multi-dimensional needs.
Providing holistic training on multi-dimensional needs, such as mental health and social well-being, is essential for professionals working within SP frameworks. This ensures that practitioners can deliver comprehensive and empathetic support to young people facing complex challenges.
The C.O.P.E. intervention model has been presented to provincial policymakers in Trentino to explore opportunities for sustaining and expanding its impact. From March to April 2024, the Autonomous Province of Trento (PAT), the Provincial Health Services Trust (APSS), and the Trentino Federation of Cooperation (FTC) collaboratively developed a technical document outlining the adaptation of C.O.P.E.’s model to the regional context. A high-level technical meeting with the Health Councillor for Health and Social Policies of the Province of Trento was organized to present the model and advocate for the continuation of the initiative beyond its initial implementation phase.
The C.O.P.E. project has already had a significant influence on the expansion of SP services in Portugal. Since its implementation, the integration of social prescription into health and social care services has grown, facilitating the connection between service users and community-based resources. These efforts have led to enhanced well-being, reduced social isolation, and improved employment opportunities for young people.
Even after C.O.P.E. officially concluded in June 2024, its methodologies and resources continue to shape practice. The communities of practice established during the project remain active and serve as critical platforms for interprofessional collaboration. These networks have also fostered new national partnerships focused on social inclusion and employability, ensuring the sustainability and evolution of C.O.P.E.’s initiatives.
One notable example of this expansion is the municipality of Cascais, which launched its Social Prescription initiative in October 2024. As one of the first municipalities in Portugal to adopt this approach, Cascais aims to address key social determinants of health, including loneliness and social isolation, through an informal support network that complements traditional healthcare services. Inspired by this success, similar projects are now being developed in municipalities across northern Portugal.
The mainstreaming of social prescribing for the social and labour inclusion and well-being of young people in NEET situations is a promising avenue for social innovation. By institutionalizing key components, fostering regional adaptations, and expanding proven methodologies, SP can become a fundamental tool for improving well-being and employability. The C.O.P.E. project has set the groundwork for this transformation, and its ongoing influence demonstrates the feasibility and necessity of integrating social prescription into national and regional policies. With continued collaboration and investment, the potential for mainstreaming this innovative practice remains substantial, paving the way for a more inclusive and supportive social framework for young people across Europe.
