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Executive Summary
Background and aims
While there are a growing number of projects throughout the UK to assist young people who are vulnerable because of their own substance misuse or that of others, few of them have been subjected to any form of systematic evaluation. We therefore know very little about how effective they are and what works best and under what circumstances. The purpose of the present research was to contribute to that understanding by describing and evaluating a number of the projects within the Partnership Drug Initiative ( PDI), a Scottish-based funding programme that promotes voluntary sector work with children and young people affected by substance misuse.
The first stage of the research was completed in April 2004 with the publication of a report which profiled 17 of these projects and identified and discussed a number of important themes regarding their operation (McIntosh et al 2004). The present report presents the results of the second stage of the research: the case study evaluation of four of these projects. The four projects included in this part of the study were the Reiver Project, the Perth and Kinross Connect Project, the East Ayrshire Substance Misuse Family Support Project and the Aberlour Edinburgh Outreach Project.
The Reiver Project
The Reiver Project provides a brief intervention for 11-16 year olds whose substance use is beginning to get them into trouble. The intervention is conducted on an outreach basis with the young people being seen in school or other local authority premises or in their own homes. The aim of the project is to minimise harm in children and young people who are abusing alcohol or other substances. The project's approach to clients is holistic in nature and focuses not only on the young person's substance misuse but also on their wider behaviour and circumstances, seeking to encourage its clients to change their lifestyle in positive ways. In order to deal with the variety of needs among its target group, this project is highly flexible as far as the content of its interventions is concerned. The methods used in individual cases are determined by the client's needs and the project worker's skills, background and preferred style of working.
The Perth Connect Project
Perth Connect targets vulnerable young people aged 12 to 18 years who either already have problematic levels of substance use or who are at risk of developing them. An important part of the project's objectives is to seek to identify and respond to the factors responsible for their client's drug or alcohol use. A wide range of one-to-one intervention methods are employed, reflecting the project staff's diverse professional backgrounds and experiences. These include counselling, motivational interviewing and other freely adapted cognitive behavioural techniques.
The East Ayrshire Substance Misuse Family Support Project
The East Ayrshire Substance Misuse Family Support Project aims to provide support to young carers from families in which a parent is misusing drugs or alcohol. A major objective of the project is to provide respite for the young people. Other objectives include providing opportunities for the young people to socialise with others of their own age and to broaden their experiences by involving them in a range of activities and holiday breaks. The intervention is largely group based and this is seen as having additional therapeutic benefits, including the development of increased confidence and self-esteem and enhanced social skills. Individual advocacy is also available together with family involvement and support.
The Aberlour Edinburgh Outreach Project
The Aberlour Edinburgh Outreach Project is an Edinburgh-wide intervention that provides support and therapeutic services for families in which there is parental drug misuse. It is concerned exclusively with families with children under the age of 12. The aim of the project is to reduce the impact of parents' drug use upon their children. It seeks to achieve this by improving parenting skills, by promoting greater stability in relation to the parents' drug use and by helping children build resilience. The intervention with adults is conducted on an individual basis and is largely undertaken in the clients' own homes.
Methods
The research had two components. The first of these was a process evaluation which was designed to provide detailed information on the operation of the four projects. The methods used in this component included; in-depth interviews with project staff members and with workers in partner or referring organisations; the observation of selected aspects of the projects' work; and the analysis of relevant documentation. The second element of the research was an outcome evaluation. This was designed to measure clients' progress over time by means of repeat interviews with them and an analysis of their case records. Collateral interviews were also conducted with individuals who knew the clients well and were able to comment upon any progress they felt they had made as a result of their contact with the project.
Results of Outcome Evaluation
The young people's accounts of their experiences of Reiver and Perth Connect suggest that their participation in them had led to a number of positive changes in their lives.
The Reiver Project
For those attending the Reiver project the following were reported:
- reductions in drug and alcohol consumption
- reduced involvement in problem activities and behaviours
- improved relations with family members
- positive changes in attitudes towards school.
The Perth Connect Project
The clients of Perth Connect reported:
- substantially reduced use of drugs and alcohol
- a decline in anti social activities
- improved relations with other family members
- positive changes in friendship networks
- enhanced confidence and self-esteem.
A high proportion of the clients, in these two projects, also referred to the ways in which they believed they had benefited from the emotional and psychological support they received from project workers.
The East Ayrshire Family Support Project
According to the clients of East Ayrshire Family Support the project addressed a wide spectrum of needs and did so in ways that led to significant improvements in their lives. Benefits included:
- respite from the caring role
- improvements in home circumstances
- the opportunity to socialise with other young people
- contact with other young carers in a similar situation to themselves
- opportunities to engage in a range of activities they would otherwise not have had a chance to participate in
- positive changes in behaviour and company kept
- the receipt of emotional and psychological support
- enhanced confidence and self-esteem.
The Aberlour Edinburgh Outreach Project
The clients of the Aberlour Edinburgh Outreach Project also reported substantial benefits from their participation in the project. These included:
- improved parenting skills and capacities
- a reduction in their children's exposure to drug-related risks
- help to stabilise or reduce their drug use
- the receipt of valuable emotional and psychological support.
The improvements reported by clients in all four projects received independent endorsement from the collateral interviewees with the latter providing a comprehensive validation of their claims.
Lessons from the Outcome and Process Evaluations
The process and outcome evaluations identified a number of factors that had implications for the success of the projects:
Philosophy and approach
The philosophy and approach adopted by the projects was central to their success. There were two aspects to this. First, a non-directive and empowering approach on the part of the project staff enabled the client to feel valued and encouraged their participation in the project. Second, all four projects adopted and maintained a person-centred and holistic approach which meant that individual goals were tailored to the needs of the clients.
Confidentiality
The establishment of confidentiality and trust was essential to the development of a productive relationship between clients and project staff. Clients had to feel confident that, within the constraints of child protection concerns, information would not be repeated to other professionals or family members without consultation or permission.
Personal qualities of project workers
The personal qualities of project workers is an important factor in encouraging clients to engage with a project. For all three of the young people's projects, the ability of staff to establish a positive relationship with the young people was extremely important as far as the success of the projects was concerned. It greatly facilitated clients' engagement with a project if staff were regarded as being friendly and accessible.
Retention of experienced front line staff
The retention of experienced front line staff was important in providing continuity for clients. Given the importance of clients' relationships with project workers, continuity of staffing and the retention of experienced staff have major implications for the overall effectiveness of an intervention.
Projects for young people should be enjoyable
For the projects working with young people it was important for the latter's engagement with them that, as far as possible, they should be experienced as being fun and enjoyable.
Client engagement with the Aberlour project
For the Aberlour Outreach clients, it was important that they perceive the service as being relevant to their needs. While this perception might not have been in place when clients made their initial contact with the project, the subsequent development of this recognition helped to promote their constructive engagement with it.
Target Groups
It is important for projects to work at reaching their target groups. Very few self-referrals were generated by the projects. This meant that identifying and fostering appropriate referral routes capable of supplying the right kind of clients in appropriate numbers was critical to the projects' success.
Referrals
It is important for projects to work at ensuring that they receive referrals that are appropriate to them. Misunderstandings on the part of referring agencies regarding the work of the project could lead to clients being referred inappropriately. In consequence, projects not only had to continually clarify the work they undertook and the nature of their clientele, they also had to make clear the type of work they did not do and correct any misapprehensions.
Relationship with host agency
The nature of a project's relationship with its host agency was a significant factor in its success. Establishing a sense of ownership of the service by the parent organisation is essential to ensuring effective leadership, management and administrative support. Close integration with the host organisation was felt to offer considerable benefits such as accommodating management changes and covering staff absences or unfilled posts, as well as providing resources, mutual support and training opportunities.
Funding arrangements
Funding arrangements had significant implications for project planning and sustainability. While projects appreciated the renewal of financial support by the funding body, the reduced rate of this support could cause considerable difficulty. In addition funding uncertainties made planning difficult, particularly where staff had left and it was unclear if posts would continue beyond the first end-point.
Promoting client involvement
The projects need to continue to develop ways of promoting client involvement. Although the projects attached a high priority to promoting client involvement in project development, they experienced difficulties in establishing appropriate mechanisms for achieving this. This is an area where further development is required.
Assessment and monitoring procedures
The projects' assessment and monitoring procedures could be improved. The non-use of standard assessment tools within some projects, or the fact that they were not repeated following initial assessment, reduced projects' capacity to monitor client progress, assess client outcomes and measure the overall performance of the service.
Conclusion
The main conclusion of the evaluation is that each of the four programmes achieved a substantial measure of success in achieving their objectives. The need now is for the sorts of projects that are described in this report to receive mainstream support so that they can be made more widely available to those who require them.
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