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Chapter 4: The East Ayrshire Substance Misuse Family Support Project: Process and Outcome Evaluations

This chapter is in three parts. We begin with a description of the aims and the nature of the work undertaken by the East Ayrshire project before going on to present the results of the process and outcome evaluations.

Part 1: Project description

Project aims and objectives

The 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 by giving them the opportunity to have fun and to simply 'be children' away from their caring role. 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. Largely group-based activities are seen to enhance the development of confidence, self-esteem and social skills. The project is based within a general service for carers, including young carers. Whilst fully integrating clients with young carers as a whole, the project also seeks to address individually any worries and concerns which the young people might have. Personal substance misuse is not the focus of the project and is only addressed in awareness sessions offered to all young teenage carers, unless specific concerns emerge.

The project is based in the host agency's centres in Kilmarnock and Cumnock, with a broad catchment area across East Ayrshire. The funded post is a family support worker dedicated to supporting young people who are affected by parental drug or alcohol use. She is well integrated into the broader managerial structure of the host agency and shares many activities with the general young carer staff.

Client characteristics and recruitment

Young carers are eligible to engage with the project if they have any sort of caring role in relation to parental substance misuse, including alcohol. Some have a practical caring role which extends beyond looking after a parent and includes responsibility for much of the care of younger siblings. Caring is often interpreted as 'emotional caring' since young people may have a considerable emotional burden to carry, whether or not they have to undertake practical caring tasks. Ages range from eight years through to late teens.

Clients of this project are much more likely to be materially disadvantaged than other young carers and tend to need more practical and emotional support. They may have to face particularly challenging and traumatic events, such as eviction, moving school, or even parental imprisonment or death. A minority may be severely disturbed: for example self-harming, hearing voices or seriously withdrawn.

Referrals

Most referrals to the project come from social work and the voluntary sector. A relatively small proportion come from education or health. Self-referral is rare. In order to reach a greater number of these 'hidden' young people, considerable efforts are being made to widen the referral base.

Caseload and waiting times

The project had 78 registered clients with nearly 50 actively engaging in early 2005 (out of 400 registered general young carers). An initial visit is usually made within two weeks, with engagement soon after.

Nature of intervention

The project tries to avoid stigmatising young people whose caring role is related to drug and alcohol misuse by integrating them into the host project's activity groups. Thus, they participate on the same basis as other young carers but have discreet access to additional one-to-one support from the family support worker. All elements are free to the young person, including taxis to and from sessions, resulting in considerable demands on funds.

The intervention is delivered in a number of ways including group activities, respite breaks or holidays and one-to-one support. Individual advocacy is also available and, to a lesser extent, family involvement and support. 'Drop-in' support is offered, but in practice access tends to be limited to those living locally and to older clients who are better able to travel independently. The weekly group sessions are the main form of engagement for most of the young carers (divided into age groups; 8-9, 10-11, 12-14, 15-17 and 18+ years). The programmes are varied and include fun activities such as party nights, craft nights, ten-pin bowling, swimming and visits to restaurants. In addition, all sessions include a meal of some sort, as many young carers might not experience normal meal times and are often hungry. Some 'training' or 'information' sessions for the teenage groups cover issues such as drugs and alcohol and bullying in the context of a range of health issues.

All young carers are offered respite breaks. These range from long weekends to full weeks and include a wide variety of age-appropriate experiences and situations. As well as providing increased opportunities for fun and time away from caring responsibilities, these new group experiences are seen as promoting personal development and social skills.

Importantly, the project's emphasis on group activity participation does not exclude more focused interventions. Structured one-to-one programmes, usually short-term, may also be provided when required. In addition, young people can approach the family support worker or any other worker at any time to discuss a problem, or issues may emerge 'naturally' in conversation.

Care planning

Once the young person has had a chance to settle in, a personal development plan is completed, guided by an integral assessment tool measuring feelings across a range of key aspects. This identifies those parts of their life they would like to change and outlines how this might be achieved. Review dates are between one and six months depending on clients' situations.

Location

Most of the activities are undertaken in the East Ayrshire Carers Centres in Kilmarnock and Cumnock and a Carers Cottage near the headquarters. However, group outings and respite holidays form part of the programme. Individual work may incorporate activity-based outings and centre sessions. Home visits after initial registration are unusual. Clients are drawn from a widespread geographical area, including isolated and deprived communities with limited public transport links.

Case closure

Most clients who leave the service do so of their own volition, deciding that they no longer want or need to be involved. Often young carers remain with the project for many years.

Part 2: Process Evaluation

In the process evaluation we distinguish between those factors which appeared to facilitate the effective operation of the project and those that seemed to impede or limit its effectiveness.

Facilitating factors

An established host agency

The project benefits substantially from its location in an established host agency, the East Ayrshire Carers Centre. The organisation had considerable positive experience in relation to working with young carers prior to the establishment of the family support project and already had experience of recognising and addressing the needs of young carers affected by familial substance misuse in this context. In addition, the host agency had strong positive links with local services and expertise in making successful funding applications.

An enabling and supportive organisational structure

The host agency's organisational structures and management approach were positively experienced as enabling and supportive from the perspective of the project worker and more senior colleagues. Thus, whilst a single worker project, the project worker is fully involved in the regular weekly meetings for full agency staff and for young carers' workers. Informal support is also readily available from managers and other staff, aided by common working environments, and for much of the project this probably plays a larger role than more formal supervision.

"On a Monday morning we have a team meeting, and then we have a Young Carers meeting and that would be when any of the staff would get the chance to bring up something about a particular young carer … And also [Development Officer] and I being based down at the Cottage most of the time, I've seen us just sitting having a chat and I'll inform her about what's going on with different young people." (Project Worker)

Informal interaction among workers and management is reflected in general interchange of roles and expertise. Any level of staff in youth and adult sectors may have an input with any clients, especially those 'dropping in' to the centres, and there is considerable shared understanding of issues of relevance to all Centre clients.

"All of us, [Project Worker] included, are expected to deal with clients as they come in the door, so we do have to have a bit of awareness of what goes on in the adult care world. We respond to what is needed." (Manager)

One organisational benefit was that work with project young carers could continue during an early gap between post holders, supported by other workers. Conversely, however, when other general young carer posts were vacant, the project worker covered extra group activities to maintain staff-client ratios, which limited time for individualised work with project clients (see B1 below).

Experienced and committed staff

The project benefited from attracting a worker with relevant experience and strong commitment and retaining her for much of the study period. The recruitment strategy of prioritising experience of engaging with vulnerable young people living difficult lives over drugs familiarity proved successful. It was felt that knowledge of the effects of drugs on families could be acquired more easily.

"Someone who had experience of dealing with vulnerable people [was needed], who knew something about drug issues, but I felt that was something they could learn and find out about from people like the Bridge Project. You can get training and talk to the staff there. Somebody who is not judgmental and who would fit in and someone who the young people could talk to and like is very important." (Manager)

Active recruitment of participants

Inward referrals were crucial for project progress, although a small minority of cases emerged internally through young people's or parents' involvement in general carer services. The project was concerned that there were many 'hidden carers'; however the aspiration to recruit before families reached crisis point proved difficult. In order to reach this hidden population, the project made considerable efforts to develop recruitment through a range of routes. The project worker continued to build links with social work departments, the main referral source, through casework and attending area meetings and making contact with new post holders to raise awareness. Actively developing links with voluntary organisations related to substance misuse successfully yielded an increasing proportion of referrals. In parallel, a similar substance misuse post separately funded near the end of the study period recruited young carers specifically through General Practices and was proving fruitful.

"I think the most difficult to reach are the ones that aren't attached to [services] or GPs … because parents are keeping the drug problem or issue secret so nobody knows about it. Or the ones that are very, very bad - the parents won't allow the children to come to anything … because they are frightened they might get taken away …. There is the issue of the parents who don't recognise that their addiction is a problem. They have also got to see that it is affecting their children." (Project Worker)

Inadequate referral information has led to the project requesting completion of a standard referral form with details about the young carer, their caring role and reasons for referral. The first visit to the client is made with the referring worker to enable introductions.

An inclusive approach

The project, in line with the host agency, has a strong ethos of inclusiveness and a holistic approach which was felt to be a key benefit. This was apparent at many levels. Firstly, within the project, the family support clients participated in all activities, without being distinguished from other young carers. Unless they chose to reveal details of their home life, it was not made apparent to other young carers.

"We don't single them out. We have never done that. They are part of a group. And a lot of children don't know why other children are there 'cause we don't sit down and discuss it. If they wanted to talk about it individually then we would do that." (Manager)

The family support worker is recognised as the main contact but clients could also interact with other workers, enhancing ease of access to appropriate support, as well as sharing the workload for the project worker.

"I think probably there's a lot of blurred edges around what we do … The young people are not just stuck with me all the time; they get to work with different people. It also means I can work with more than one young person at a time." (Project Worker)

The non-stigmatising approach was felt to have many advantages for young people who are likely to feel socially excluded. Additionally, project experiences contributed to improving aspects of carers' lives which contribute to social exclusion: for example, difficulties in interacting with others were resolved through group and respite activities, and personal hygiene problems and poor personal appearance resulting from fending for themselves, can be discreetly addressed. The project also supported 'joining in' with local activities or accessing further education.

Finally, the inclusive approach meant that there was no routine focus on personal drug or alcohol misuse, apart from the awareness raising sessions aimed at all teenage young carers. However, alcohol and drug use could be addressed individually if it emerged as a personal issue. Workers perceived any drinking or drug use as being "mostly very rare" and "just like most teenagers", with very few exceptions. It is interesting, therefore, that responses in the outcome study (below) indicate that some young carers felt that their substance related behaviours were problematic and that the project had helped them with this.

Mix of group and individual work

The mix of approaches enabled more flexible responses to individual needs. Group activities were the core approach, but individual support was provided as needed, singly or in parallel to the groups, on an informal or structured basis. Participation in the groups is seen to have considerable strengths, ranging from enhanced self-esteem and social skills to fostering social inclusion, as well as 'having fun' and a piece of childhood. Thus, whilst not therapeutic group work, it was seen to bring many therapeutic benefits.

"I think it is the only two hours in the whole week where she can be a child again and she's getting to have fun and she's getting well fed." (Project Worker)

Importantly, group activities also facilitate individual interactions. Young people can initiate a discussion in these contexts about a 'secret' or worry or a more practical problem. This can be responded to immediately, or can be flagged up for more extensive discussion. Thus, concerns can emerge 'naturally' at the young person's pace.

"You will have time to sit next to someone when they are doing activities and just chat. That is when a lot of the worries - 'Oh I've had a bad day.' That kind of thing that leads to, 'Why have you have had a bad day?' 'Well…' Whereas normally you don't hear that." (Manager)

When a need was identified, the project also offered more structured one-to-one contact for in-depth work, usually short-term. Key times for such work could include: registration, the emergence of new issues, or difficulties in-group participation.

Engaging with new clients

A high priority was placed on positive and open engagement with the young carers. The initial registration process contributed to a good relationship, with careful explanation of project activities, a short introductory visit, and a sensitive review of ways in which the project could be of help. Confidentiality and child protection issues are also explained to the young carer and parents. Thus when discussing the personal development plan, the young person is reassured that neither their parent nor the social services would be told what they are saying, within the limits of child protection issues. The project worker and other staff developed considerable expertise in raising and addressing these issues, especially recognising any underlying fears that the child would be taken away. In addition, repeated contact with workers during weekly activities encouraged clients' confidence in them and greater openness.

"If there is something wrong you can normally tell straight away if there is something going on and maybe try and find out if there are any problems. … Often we get children … who will say, 'I've got a secret' and all this sort of thing. We would explain that … if we think that you are in any danger or maybe your family then we would have to pass that secret on." (Manager)

Multi-agency working

From the perspective of project and referring staff, the project has a good relationship with a range of statutory and voluntary agencies, in particular the social work department and local drugs projects. Whilst confidentiality was an important issue, active development of personal contacts is seen to improve information sharing, especially with more recent enhanced awareness of child protection issues. There is a relatively small number of statutory social service and health board localities across the catchment area. This is helpful in establishing and maintaining contacts with team members and links with the dedicated parental substance misuse social workers were particularly strong. The project worker also benefited from making contacts through networking meetings for those involved in family support, led by the social work department.

In addition to enhancing work with individual clients, establishing and maintaining contact with relevant agencies and workers is seen as an important vehicle for promoting the project and opening up new referral routes. Young carers' staff delivered workshop sessions in secondary schools with Year Two pupils and guidance teachers, and aimed to expand into primary schools. Whilst few referrals had come through schools, it was felt that raising awareness of young carer issues with both students and staff was important. Additional cross-agency interactions include inviting key services such as drugs education officers to deliver specialist inputs to young carers' groups.

Overall, the project is seen as unique in the area rather than overlapping with other services, and there is greater concern about gaps in service provision for young people in substance misusing families than competition between agencies.

"We tend to feel that children are the victims in all this. There is help there for the addicts, the families can be supported by groups like ourselves, but there is not a lot there for the children, that is why we developed ties with Young Carers and we have referred a good few." (Referring Worker)

Young people's involvement

The open informal engagement with young carers is felt to offer considerable opportunities for clients to comment on the service, although these are not formally collated. The agency as a whole has developed approaches to obtain internal feedback to contribute to future planning, such as a planning meeting at the start of each session. Internal evaluation forms are used after respite breaks and outings, and a comments box introduced later in the project is felt to enable identification of a range of issues. The agency has latterly encouraged young people's involvement in helping choose staff by including them in the interview process.

Limiting Factors

Dependence on a single worker

A project established on the basis of a single worker has many potential limitations and risks considerable vulnerability. Delivery of all the strands of the intended work within the context of increasing client numbers is likely to be more than one worker can offer. In a less supportive organisation this project would be difficult to replicate in a single worker format, although the observed support from other workers indicates that a new project could be successful with more staff.

The ethos of "we all muck in" meant that the project worker's involvement in group activities increased during vacancies in general posts, sometimes for several months. Whilst she would join groups used by project clients in any case, there was initially intended to be a more even balance between this and one-to-one work. In addition, flexibly offering structured one-to-one work to meet needs as they are identified, although part of the initial bid, was a challenge for much of the study period and in practice required support from other trained sessional activity workers. In contrast, provision of group activities is central to overall young carers' work and therefore consistently provided as a shared organisational priority. When the project was fully staffed, however, the worker found she had more time for one-to-one work.

"Because there were so many other workers here that could do things I had that extra time [for one-to-one contact]. So hopefully that will happen in the future and there will be more time for me to say, 'Can I have five minutes with you?' And we can go and sit somewhere else and find out how things are going." (Project Worker)

Another limitation that emerged was an increasing recognition of psychological disturbance among some of the young people, and at times the worker understandably felt "you're out of your depth", for example experience of self-harm and hearing voices. It was anticipated that a counsellor recruited at the end of the study period (see B2), would address these concerns. Staff also noted that a mix of gender role models might be beneficial which is an issue to be borne in mind since most staff were female.

Project costs and funding issues

Obtaining funding and keeping track of funding streams presented a continuing challenge. The Lloyds TSBPDI funding was reduced after three years, although the ADAT/Children's Change matched funding continued. Attracting additional funding for an on-going project was felt to be difficult, although latterly some separately funded initiatives in effect complemented the family support project, enabling employment of a counsellor and more activity workers.

Importantly, aspects of the project resulted in higher costs than anticipated. In particular, taxi fare bills averaging £2,400 a month across the two bases threatened continuing work. Taxis were necessary to enable group attendance because of factors such as: the rural geography and limited bus services, the young age group, financial hardship and often poor practical support for attending. In a few cases, individual social workers facilitated transport.

"Because of how dire the situation is financially, I think there would be a lot of kids who would benefit from the service who won't be able to access it because of that, unless something changes. I think that is just because of the area you are covering." (Referring Worker)

Organisational issues in external agencies

The project largely depends on inward referrals from other agencies as well as ongoing inter-agency working with individual cases and is therefore affected by external working environments. Social work services were the main referrers but many workers were felt to be still learning to recognise the needs of children in these situations. Additionally, frequent staff changes required continued awareness raising with new post-holders. Changes in non-statutory organisations also had an impact, and two substance misuse agencies closed during the study period, meaning a loss of referrals and expertise.

"You can see when a new person comes on board [in Social Work] how difficult it is for them to actually go from the focus on the adult, where the assessment is completely geared towards the adult. … I think in particular the [Young Carers] service has made people aware that there are kids out there …You are talking about social workers who are taking on board - 'Oh, this is actually quite necessary here'." (Referring Worker)

Monitoring and evaluation challenges

The structures within the project supported basic monitoring of individuals and activities attended and feedback on specific events but tended not to encompass broader evaluation of successes and gaps, individually or across the project. The varying individual goals and the varied nature of interactions with the project all contribute to making objective measures and evaluation more challenging.

A client database was maintained together with registers of group attendance. Files were kept for each young carer, but recording in individual contact sheets was limited, in part because of time pressures. Initially, the project incorporated a 'tick box' individual progress sheet intended to facilitate routine re-assessment of aspects such as behaviour and social interactions. However, this was not found to be particularly meaningful and was rarely updated. An internal personal development plan, introduced as the project progressed, is seen to be more young people friendly and to address more relevant issues in greater depth - such as feelings about their carer role, self-esteem and happiness. However, whilst this may help initial identification of key areas of concern, aided by a five-point 'smiley faces' scale, it is not used as a means to quantify or assess progress by repeat measures. Another potential assessment stage is the case review but recorded decisions reflect individual goals and comparison of progress across the project is difficult. In addition, the project has been unable to identify standardised assessment tools relevant to their intervention and clients which might contribute to measuring progress.

However, the worker and staff generally demonstrate considerable informal understanding of positive changes and challenges, enhanced by regular contact with clients. In addition, they seek and build on feedback from other agencies. Finally, staff see the high level of prolonged retention as a success in itself, as well as continuing success in reaching more 'hard-to-reach' young carers.

"They do come to the groups most weeks so you can keep a handle on them that way. You can't seem to get rid of them once they start coming. We must be doing too good a job." (Project Worker)

Challenges in engaging with wider family members

Family involvement was one of the early project objectives, reflected in the project title 'Family Support', but has been more difficult to achieve. At a basic level, parents have to sign agreement for the young person to join the service, and again for participation in individual activities, such as swimming and respite breaks. Whilst they are sent copies of the bi-monthly newsletter and invited to use any of the adult carer services, achieving more active participation would require substantial input. It is probable that lack of effective engagement reflects aspects of disorganised lifestyles rather than negative perceptions of the project. In a small minority of cases it was felt that parents took advantage of aspects of the service, for example, appropriating clothes bought for a respite visit.

Time limitations

There is a very limited time in which to work with young clients - after school but before they need to be at home. School holidays potentially offer a more flexible time, but the worker's time is largely taken up with respite breaks, although other staff can be contacted.

Worker safety

Home visits present a potential safety risk, reflecting chaotic lifestyles in some households. Initial visits are undertaken with the referring professional and follow-up visits undertaken alone are supported by a telephone check-in strategy.

Key findings from East Ayrshire process evaluation

• The project benefited from being based in a host agency with existing experience of this client group. Integration and support of the single worker within the host agency was valued and achieved through formal structures and informal interactions.
• The integrated work environment meant that this single worker project was also supported by generic young carer workers. This would need to be recognised by other projects seeking to replicate aspects of this project. Furthermore, as numbers increased and more complex needs emerged for some clients, one person could not have addressed all the intended strands. Latterly, separately funded initiatives, such as a counsellor and more sessional activity workers, in effect meant extra skills and support.
• Whilst the organisational approach minimised potentially negative isolation, integration and sharing of work roles meant a risk of imbalance for the single worker between project demands and needs of the overall young carer service, for example in periods of staff vacancies. Overall however, project worker support of general activities was balanced by agency staff support of the project.

• The mix of core group activities with informal or more structured one-to-one input was generally achieved. However, at times it was difficult to offer individual support when needs were identified because of resource or skills limitations.
• The inclusive approach of fully integrating project clients with overall young carers' groups was particularly important as they were more likely to live socially excluded lives, as well as having shared needs for fun and respite.

• Active networking with key referrers who work with substance misusing parents in statutory and voluntary agencies is important to identify 'hidden' young carers, but also among more generic workers in social work, primary care and education.
• Some costs were markedly higher than anticipated, reflecting a young and geographically widespread client group - in particular taxis were costly but crucial to inclusive participation in central group activities
• Monitoring and evaluation of project progress was made more difficult by flexible participation and varied needs. The project had not been able to identify a standardised tool to enable assessment of individual or project progress. Recording of client contacts was limited apart from attendance registers. A personal development planning tool was established, but not used on a regular basis to assess overall progress, although case reviews did explore personal goals.
• Whilst greater parental participation would have been beneficial to conducting more holistic work with families, the project did not have the resources to work on proactively increasing involvement. Although parents had an open invitation to make use of the Carer Centre, uptake was low.

Part 3: Outcome evaluation

In this section we present our findings on the impact of the project. This is in two parts: 1) an analysis of the clients' perceptions of the project and its impact upon their lives and 2) an analysis of the views of the collateral interviewees.

Impact of the intervention on clients' lives: client perceptions

The young clients' accounts of the benefits they derived from their participation in the project were extremely positive. Improvements were reported in their domestic situations, their emotional and psychological wellbeing, their social lives and their behaviour.

Respite and reassurance

One of the main things the young people appreciated was getting a break from the demands of their domestic environment and from the caring role they had been forced to assume. According to them, this helped to relieve their stress and enhance their ability to cope with the situation at home.

"Just when you come here and you get tae go tae yer groups and you can come away from everything that's going on at home. Just like…enjoy yourself and get some space and you don't need tae think aboot things that are worrying you an' that."

Several clients also said that they found it reassuring to meet other young people in a similar situation to themselves. This, they claimed, helped to counteract feelings of isolation and strangeness and made them feel better about themselves. For example: 'It's made me realise that ah'm no' the only person that stays in the hoose and helps her Mum.'

Increase in social contact and Activities

Several of the young people described how, prior to their involvement with the project, they had been more or less confined to the house. Attendance at the project enabled them not only to get out of the house for a time but also to associate with other young people, to make new friends and to expand their range of activities. Some of these activities were organised by the project and included various trips and outings; for example, they might go ten-pin bowling, engage in adventure activities such as abseiling, have a meal together or even go on holiday as a group. These activities were greatly appreciated by the young people. In particular, they liked trips and outings which took them out of their home town and introduced them to a different environment.

However, according to the young people whom we interviewed, in addition to these organised activities, their participation in the project had helped to make them more outgoing and more socially active generally.

"I do more now. Whereas before I used just sit in the hoose and no' do nothin', now I meet up wi' ma pals and go tae the pictures an' everything noo, and just like talk tae them. It's mostly friends who I've met through here."

Finally, some of the young people claimed that their participation in the project had also helped to improve their communication skills and their ability to interact with other people and to build relationships with them. For example: 'The activities are good 'cos yer learnin' tae go intae a group and communicate better and yer making friends.' 'They've helped me like talk….ah can talk tae other folk, ah used tae be no' able tae talk tae folk.'

Changes in behaviour

Several of the young people also reported that their involvement with the project had had an impact on how they spent their time and with whom they spent it. According to them, this was partly a product of the project's diversionary function and partly a result of advice and guidance which they received from project staff. Some of the clients claimed to have changed their friends, in some cases substituting them with young people from the project: 'Ah've dropped like a lot o' friends that ah used tae hing aboot wi'. Like the bad crowd that get intae bother.'

Others described how the project had 'kept them off the streets' and introduced them to new activities and how their behaviour had improved as a result.

"It's improved the way ah used tae be. Ah used tae run aboot wi awe the dafties that were intae awe the drugs and everythin'. Ah don't dae that anymare."

Some of the young people also claimed that the information and advice which they received at the project on the subject of the misuse of drugs and alcohol had resulted in a reduction in their consumption of these substances: 'Ah've cut down an awful lot. Ah don't take any drugs. Ah'm no drinkin as much. Ah used tae drink every day of the week. They helped me realise that it wis stupid tae dae it.' Four of the young people said that the project had persuaded them to drink less often and six claimed that it had helped them to drink more safely. Three clients reported that they had stopped taking illegal drugs entirely since their involvement with the project.

In three cases, the young people's school attendance had also apparently improved as a result of their involvement with the project with all three clients claiming that they were now ever present. Nine of the carers said that their participation in the project had improved their performance at school or in their job.

Improvements in home circumstances

All but one of the clients said that their attendance at the project had led to improvements in their home circumstances and, especially in relations between themselves and their substance-using parent. In the main, they attributed this to changes in their own behaviour and their ability to relate to their parents more constructively.

"I've been speaking to my Mum an' that more and that's been helping. We just get tae talk more now. Like before I didnae really talk and I was really cheeky and stuff like that. Now it's just…..different, because they've (project staff) been speaking to me, I've been able to talk to people."

The few young people who addressed the reasons for this change in behaviour attributed it either to the fact that they were feeling better in themselves as a result of their participation in the project or to specific guidance received from project staff on how to cope better with the situation at home. According to the young people, the latter frequently focused on encouraging the family to communicate better with each other.

Psychological benefits

Nine of the clients reported that the project had helped them to feel better about themselves. A number of them referred to the emotional and psychological support they had received from project staff as having been helpful, especially the opportunity to discuss, in confidence, things that might be troubling them. With only two exceptions, the interviewees said that their attendance at the project, and the support and counselling they had received from it, had enhanced their confidence and self-esteem.

"Ah think I've got more self-esteem and more self-confidence noo. They jist make me feel better aboot stuff and it's made me feel better aboot ma life and that."

As the following two extracts show, in some instances, the support they received from staff at the project might have been crucial to the young person's desire and ability to go on.

"The staff. They've been there for me when like wi' ma Mum and that, they've been helpin' oot when ah went and took ma overdose eh a couple a month ago, and they were really supportive and everythin' wi' ma Mum wis very supportive as well."

"I used to hate myself, I used to slit my wrists and everything just cause of life an' all that…. they make you realise that you're doing something that not a lot of people do."

Finally, it is important to note that all of the young people identified more than one significant change in their lives which they attributed to the family support project and most of them identified several. When asked what they had liked about attending the project, around half of the young people who were interviewed described liking 'it all' or 'everything'. One client summed up the project's effect on his life as meaning that he was now 'able to act like a normal teenager.'

Comparison of responses in the two interviews

While in general the clients' responses at interview 2 were consistent with those at interview 1, some young people reported progress in relation to their domestic circumstances, their behaviour or their confidence and self esteem between interviews 1 and 2. For example, in the second interview three clients reported having cut down on their consumption of drugs or alcohol while this had not been mentioned at interview 1. Conversely, some changes reported at interview 1 were not referred to at interview 2. These included positive changes in behaviour, including the reduced use of drugs or alcohol, and certain improvements in home and family life. In every case, however, the collateral interviewees confirmed that the improvements identified by clients at the time of the first interview had been maintained. One reason for these changes not being reported by clients at the second interview may have been because they were no longer fresh or new and had become consolidated into the individual's lifestyle and perceptions of themselves to such an extent that they were no longer considered notable.

Impact of the intervention on clients' lives: collateral interviews

Collateral interviews were conducted with 7 people who were, according to the clients, in a position to comment upon their progress consequent upon their participation in the project. The interviewees comprised 3 mothers, 2 grandmothers and 2 sisters.

By and large, the collateral interviewees confirmed the clients' accounts of the ways in which they had benefited from their participation in the project. There were few discrepancies as far as reported improvements in home life, the young people's social lives, their school attendance, their involvement in positive activities and their confidence and perceptions of themselves were concerned. Progress in all of these areas tended to be confirmed by the interviewees, with only a small number of exceptions. For example, one collateral interviewee did not confirm positive changes in a client's home life or friendships although both improvements had been reported by the client. There was less agreement between the clients and collateral interviewees as far as the young people's involvement in the consumption of drugs or alcohol and their participation in problem behaviours was concerned. Most of the collateral interviewees appeared to have little knowledge of the client's engagement in these activities, presumably because the latter tried to ensure that these particular behaviours remained hidden from significant others. On the other hand, one grandmother reported that a client had recently started to drink and to get involved in problem behaviours although the client herself had not reported this.

Improved home environment

Six of the interviewees said that they had noticed positive changes in the client's home life since their involvement with the project. Relations with other relatives, including the substance misusing parent, were said to have improved, people were reported as communicating with each other more effectively and the home environment was described as being 'less stressed' and 'more harmonious.' One problematic drinker described her daughter as being 'more settled' and added 'we're more able to get on and we talk a lot about stuff together now.' A sister remarked, 'Well she's been able tae cope wi' ma Mum a lot better, wi' ma Mum's demands…..she's jist been generally a lot happier and confident.' The project was credited with playing a major role in bringing about these improvements by giving the client an opportunity to discuss the situation at home and by offering advice and support.

Some of the interviewees also stated that an important aspect of the project's contribution to the young person's ability to cope with the situation at home was the fact that it provided respite from the stresses and demands of their domestic environment and enabled them to interact with people of their own age in an environment that was stimulating and fun. One of the grandmothers described this particular contribution succinctly as ' just allowing her (client) to be a child again.'

Psychological benefits

The collateral interviewees also confirmed the psychological benefits the clients claimed to have derived from the project. All but one of them said that they had noted improvements in the client's confidence and self-esteem. There were a number of ways in which they believed the project had helped to bring this about. Part of its influence was seen as deriving from the counselling and support it provided: 'Just being there. Being constant, someone always being there for her to phone up or go doon and talk to.' The reassurance that there were other young people in the same situation as themselves was also seen by some interviewees as contributing to the client's enhanced sense of self by affirming that their difficulties in the home resided in the circumstances that obtained there and not in themselves. Finally, the client's improved sense of self was seen by some interviewees as being partly a product of the opportunities and experiences that the project provided. In particular, meeting new people, making new friends and engaging in new, and sometimes challenging, activities were all regarded as having helped to promote a more positive sense of self.

The collateral interviewees also regarded the availability of a project worker to whom the young person could talk about any problems or difficulties they were having as being an important aspect of the service provided by the project. This was perceived as representing a form of support that was otherwise largely absent in the young person's life. In particular, it was seen as being valuable to have an outsider who could offer confidential and impartial advice.

Improved behaviour

As we indicated earlier, the collateral interviewees appeared to be largely unaware of clients' involvement in the consumption of drugs or alcohol or their participation in problem behaviours. In consequence, the interviewees provided little confirmation of progress in these spheres. An exception to this was the young people's school attendance. Four of the interviewees claimed that the client's attendance at school had improved since their involvement with the project. The interviewees were also convinced that it was the young people's participation in the project that had brought about this change.

Increased social contact and activities

Several of the interviewees confirmed that the young people's friendship circles and involvement in positive activities of various kinds had expanded since their participation in the project: 'She has more friends now, whereas before she didn't really have any. She didn't want to mix, but now she wants to mix.' While these positive developments were seen as being largely centred on the intervention itself, there was also evidence from the interviewees that some of the clients were developing relationships, interests and activities outwith the confines of the project. According to the interviewees, the confidence that was engendered in the context of the clients' participation in the project had helped to make them more outgoing and willing to engage with other people and activities.

Overall, then, the collateral interviewees believed that the project had made significant contributions to the young carers' wellbeing in a number of key areas and that, in many respects, their lives had been transformed by it.

Key findings from outcome evaluation

• The project provided the young people with valuable respite from the demands of the caring role.
• Attendance at the project increased clients contact with other young people and activities and reduced their sense of isolation.
• The young people reported positive changes in their behaviour, including their consumption of drugs and alcohol, as a consequence of their participation in the project.
• Some clients reported improved attendance and performance at school.
• The project led to improvements in home circumstances for nearly all of the clients, including their relationships with substance misusing parents.
• Clients valued the emotional support and counselling they received from the project.
• Attendance at the project enhanced clients' confidence and self esteem.
• Participation in group activities appeared to contribute significantly to the development of clients' social skills.

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