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Chapter 6: Clients' Perceptions and Experiences of the Four Projects
In this chapter we examine two related themes based on the outcome evaluation. First, using a combination of the quantitative and qualitative data, we report on the clients' satisfaction with the four projects. Second, we explore those factors which, according to the clients, encouraged their participation in the projects and promoted their positive engagement with them.
Clients' satisfaction with the projects
Clients in all four projects expressed a high degree of satisfaction with the service they had received. In both of the interviews clients were asked to describe any aspects of the projects they attended that they had not liked or that they would like to see changed. This elicited very little in the way of negative comment or suggested changes.
The overwhelming majority of the responses from the clients of the Reiver and Perth Connect projects indicated that there was 'nothing' that they had disliked or would want to change. In addition, fourteen of the fifteen young people attending these two projects rated their project as good or very good and the same number said they would recommend it to a friend. Only 3 of the Reiver clients expressed any negative sentiments about the project. One boy said that he felt that there had been too much emphasis on alcohol at the expense of drugs and one of the girls said that she found the counselling sessions awkward because she had difficulty in expressing herself. Another boy objected to the compulsory nature of his referral and claimed that he had derived no benefit from it. The main complaint raised by the Perth Connect clients related to the departure of a highly valued worker in circumstances which, although unspecified, the young people clearly did not regard as being justified.
For the clients of the East Ayrshire project only one negative comment was recorded, and, even then, it was a criticism which reflected the value the young person attached to the project. The client wanted the meetings to last longer. The rest of the East Ayrshire clients reported that there was nothing about the project that they had not liked. Nine of the ten East Ayrshire clients assessed the project as being good (3) or very good (6) and the same number said that they would recommend it to a friend.
These accounts of the young people's experiences would suggest that their participation in the projects had been an unequivocal success. However, when the clients of the 3 young people's projects were asked if they agreed or disagreed with a series of statements about the interventions ( Appendix 6), the Reiver and Perth Connect clients expressed concerns about certain aspects of the projects. Of the 15 young people who were interviewed for these two projects, only 10 said that they trusted the project staff completely, only 9 said that a member of staff was always available when they wanted to talk and only 9 said that they had agreed with staff about what the project should do for them. A significant source of dissatisfaction appeared to be a tendency for staff to enquire about matters which the individual would rather keep private with 6 of the young people saying this had been a problem for them.
The overwhelming majority of the Aberlour Outreach clients indicated that there was 'nothing' that they had disliked or would want to change about the project. In addition, 10 out of the 12 respondents at interview 2 assessed the service they received as either good (3) or very good (7). All 12 clients said that they would recommend Aberlour Outreach to a friend. There were only two exceptions to these overwhelmingly positive comments. One woman, while acknowledging certain benefits of her involvement with the project, expressed bitterness at the amount of time she had to wait for a place in a rehabilitation centre and was scathing about the project's contribution in comparison to what she felt she needed. Another parent thought that the project worker should take the client out for a break or a trip on a monthly basis as a form of respite. She also felt it would be helpful if the project worker had the facility to exchange needles on an outreach basis.
Once again, however, the Aberlour clients' responses to a series of statements about their experience of the project ( Appendix 6) revealed some additional dissatisfaction. Specifically, 4 parents reported disagreements over objectives while the same number felt they had been asked about things they would rather have kept to themselves.
As a further endorsement of the clients' positive experiences of the four projects, very few of them had left a project on their own initiative.
- All 5 of the Perth Connect clients were still participating in the project at the time of the second interview.
- None of the Reiver clients were attending the project by that stage. However, only one had left the project unilaterally. The rest of the former Reiver clients all reported that they had stopped attending because the project staff considered their intervention with them to have been completed.
- All but one of the East Ayrshire clients was still participating in the project at interview 2. The girl who had ceased attending said it was because the project had stopped sending transport to collect her.
- Only 3 parents discontinued their involvement with Aberlour Outreach during the period of the study and, according to them, in all 3 cases they did so with the agreement and approval of their project worker.
Factors which promoted clients' engagement with the projects
In each of the interviews, we explored with clients the things that they had found positive about the projects they attended and the things that they felt had encouraged, or discouraged, their participation in them. Several common themes were identified in their responses.
Factor 1: Feeling valued and empowered
One of the key elements in the clients' engagement with a project was the adoption by the workers of an approach that was perceived as valuing and empowering the client. The two main elements in this were, first, that the project staff should be seen as being non-judgemental and, second, that they should offer advice in a non-directive way. The Reiver and Perth Connect clients claimed that the staff on both projects did not appear to judge them and did not seek to direct or control their behaviour. The emphasis was upon enabling them to make informed choices rather than telling them what to do and how to behave. This experience was contrary to what many of the young people had expected when they first came into contact with the projects.
"Ah thought ye would get in trouble, like they'd tell you to like stop doing stuff and that but they jist like tell you ….like explain how stuff is and that." (Reiver client)
The young people claimed that they greatly appreciated not being 'instructed' or 'lectured to' and instead being given information on which they themselves could make informed judgements about their use of drugs and alcohol. This does not mean that project staff did not offer guidance and direction to the young people. However, this was accomplished in a manner that did not involve telling the young person what to do but, instead, involved discussing with them various options concerning their current and future life styles and the likely consequences of different choices. It was an approach that the young people appeared to respond to positively.
"She's (project worker) a great person. She disnae jist try and get tae know yer business, she gets tae know you before yer business. (She) gave me time tae get tae know her, let me open up tae her in ma own time, when ah was ready. She never put pressure on. She made ye see how things really were, not how you wanted them tae be through drink or drugs. She made you see what your family were going through and why they were reacting the way they were. She did all that without bullyin' ye intae anything and she wisnae soft either. She was firm as well." (Perth Connect Client)
An aspect of the Perth Connect project that was experienced as being empowering was the clients' participation in decisions about the activities pursued at the project. According to the young people who attended this project, it was common for them to be included in a range of decisions about the sorts of things they should do and about aspects of the running and organisation of the intervention.
The Aberlour clients were equally appreciative of the empowering approach adopted by their workers. According to them, their project workers were non judgemental, were respectful of their wishes and preferences, and did not seek to direct or control their behaviour. Their approach was to offer advice and support in a context of self-determination. This does not mean that the project workers did not speak their mind. They did and, according to the parents, they often did so with considerable frankness. However, the message was conveyed with sensitivity and respect and in such a way that the client's self esteem and independence were preserved. The consequence of this was that the clients felt valued, respected and in control.
"The workers backed me up by making me feel confident and comfortable with the decisions I was making. I never, ever felt pressured in anything, they made me feel in control of the situation. Same with the kids and anything to do with the kids, I was always in control of everything that happened. I didn't ever feel like anyone was prying or trying to take control ……I was always in control. So it was really good because a lot of mothers have issues where they feel that people are coming in and taking control of their children cause they cannae cope or they're no' able. It was never a scenario like that. I always felt in control of the situation." (Aberlour Outreach Client)
The Aberlour Outreach clients were clear that an approach that was empowering and which respected them as individuals was much more likely to secure their continued participation in the project and to promote a meaningful and open dialogue with project workers than one which did not.
Factor 2: A sense of trust and confidentiality
It was clear from the accounts provided by the clients in all four projects that trust and the assurance of confidentiality were central to their ability to engage with the interventions effectively. It was their ability to trust their worker that made the clients feel able to open up to them and talk frankly about issues. This is illustrated by the following account by one of the Aberlour clients of how the establishment of trust determined the pace and extent to which she felt able to disclose to her project worker.
"For the first few months I wisnae totally honest with her. I never lied to her, I just didnae tell her everything, because a lot of things I was really embarrassed about and didnae want tae talk about. Then after that, after really getting to know her, I realised that I could talk to her."
The clients from the three young peoples' projects appeared to be entirely secure in the knowledge that they could confide almost anything to their workers and it would be treated completely confidentially: 'They keep things that ah tell them to themselves, they don't tell anybody a word.' 'Ye can jist talk tae them aboot anythin' and they'll no' tell naebody and ye can jist tell them the truth.' The Aberlour clients also expressed confidence that they could trust their project workers. A particular issue for them was the assurance that their project worker would discuss an issue with them, and advise them of any action they proposed taking, before raising it with a third party. The parents indicated that they would much prefer to learn of potential actions regarding their family from the project worker herself, even if those actions were unwelcome, rather than decisions being taken in secret with their worker's clandestine complicity.
"Somebody that's no judging you, that's no judgemental, you ken? It's safe, you feel safe, ken whit I mean like? She'll say, ' It's just staying between me and you', know whit I mean? 'What you've said. Don't want what we said tae go tae the social work'. It would just stay between me an' her, I liked that. Unless it was something that was putting the bairns at risk. Then she'd have tae tell them. But she would tell me that. I understand that and I'm fine wi' that." ( Aberlour Outreach Client)
Finally, a relationship of trust between worker and client did not develop immediately but instead was forged on the basis of the client's experience of the relationship over time. For this reason, continuity in the staff with whom the clients were in contact was an important element in sustaining trust and confidence across all four projects.
"I've always had the same person every single time I've seen them. So I trust her. She's more like a friend than an actual person that's trying tae help, so I like that. They've no' chopped and changed." (Aberlour Outreach Client)
Factor 3: Friendliness and approachability of staff
It was clear from our interviewees' descriptions of their experiences that the personal qualities of staff members and their ability to present a friendly and accessible face to clients was of great importance in facilitating the establishment of effective relationships between clients and workers. A personal liking for the staff and the way in which they related to them came through strongly in the interviews with the young people. Comments such as, 'I liked the staff', 'ma counsellor wis class,' ' she was brilliant' and, 'the staff are good to you' were common. The majority of the Aberlour Outreach clients also referred to the friendliness of their project worker as having been a significant feature of their experience. For some of the clients their project worker almost assumed the status of a friend.
"The person ah work wi', ah feel she isnae sort of a worker she's more of a friend, eh,there wis a friendship there rather than lookin' at her as a worker, d'ye ken what ah mean, she wis really easy tae talk tae. She's no' like any other workers ah've had or doctors either, she's been a lot better. Aye, she's really good tae speak tae, she's more like a pal than a worker. She's really good at her job and that, she's really professional but she's good tae talk tae. Ah've got a good relationship wi' her." (Aberlour Outreach client)
"Ah really really did get on wi' ma keyworker. Ah loved her, she was brilliant. She helped me get off the drugs, she was there for me whenever ah needed her. She was just brilliant. All the good things ah've been able tae dae ah put down tae (project worker). She was like that wi' us all, she wasnae just yer keyworker, she was yer friend." (Perth Connect Client)
According to the clients, this close relationship enabled them to feel at ease in their worker's company and helped them to feel comfortable about discussing personal or sensitive issues: 'Ah jist really like her. Ah can talk tae her. Ah can tell her the truth.'
A further important aspect of the project worker being seen as friendly was that it enhanced his or her perceived approachability. The fact that the project workers were regarded as being approachable was important to clients in all four projects since it contributed to their sense of having a resource whom they could contact at any time on almost any subject.
Factor 4: Making attendance at the young people's projects enjoyable
An important aspect of the three young people's projects was that they were regarded by clients as being enjoyable. For the East Ayrshire Carers and Perth Connect projects, making attendance at the intervention enjoyable was an essential ingredient in the provision of effective respite from a range of difficult circumstances. However, the staff in all three projects were also well aware that the young people had to want to attend the intervention and to enjoy being there for it to be possible for them to work effectively with them on other things. This was something that the staff in all three projects sought to achieve and it appeared from the young people's accounts that they largely succeeded in this. In the interviews, clients in all three projects frequently referred to the enjoyable aspect of their participation in a programme and how this had often tended to confound their expectations.
"(I liked) the sense a' humour wi' (project worker) 'cos he's funny so ……that wis mare interesting instead of boring." (Reiver client)
"Ah thought it wis we were tae go and fill in questions an' all that but when ah got there it wis tae have fun". (East Ayrshire Client)
Indeed, because they found it enjoyable, some of the young clients found themselves engaging with a project and its staff almost in spite of themselves. This was especially evident as far as Reiver was concerned where the young people reported considerable initial resistance to becoming involved with the intervention. While all of the young people attending Reiver expected to receive advice on moderating their drinking and changing other aspects of their behaviour, there was a degree of scepticism regarding what this might achieve. Most of the young people expected the intervention would involve being lectured to on the dangers of the excessive use of alcohol and being instructed on how to behave appropriately. It was clear from their accounts of their expectations at the time of their referral that the majority were resistant to a process they anticipated would be 'boring' and unpleasant: 'I didn't think they'd help much at first. I just thought they'd tell me that I couldnae do this and I couldnae do that.' This attitude is perhaps not surprising given that all of the young people had been referred involuntarily to the project by another agency. None of them had referred themselves on the basis of a self-identified problem. However, in the majority of cases, the young people's expectations appear to have been confounded by their experience of the project.
Factor 5: Aberlour clients' acceptance of their need for assistance
The Aberlour Outreach project staff were well aware that a precondition for clients' effective engagement with their programme was an acceptance by the latter that they had problems with parenting. While parents may have had some awareness of their shortcomings at the time of their introduction to the intervention, the project staff saw one of their main initial tasks as being to develop this awareness as a preliminary to working on parenting weaknesses with their clients. It appeared that the staff enjoyed considerable success in achieving this since, by the time of our first interview with the clients, all of them indicated that they recognised and accepted that they had difficulties with parenting and regarded the intervention of Aberlour Outreach as being legitimate and worthwhile.
The positive attitude which the clients expressed towards advice and support on parenting was reinforced by the fact that a number of them had had children removed into care because of their drug use. Others had experienced the threat of having their children taken away. As a consequence, those parents saw the intervention in a positive way, if for no other reason than it would assist them in retaining custody of their children.
Key findings
- The clients in all four projects expressed a high degree of satisfaction with the service they received.
- The biggest source of dissatisfaction across the four projects was with staff who were seen as enquiring about matters which the individual would rather have kept private.
- A sense of empowerment, the establishment of trust and a perception of the staff as being friendly and approachable were all important in facilitating clients' constructive engagement with a project.
- For the three young peoples' projects it was important for client engagement that attendance at the programme be experienced as enjoyable.
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