Effective Interventions Unit
Evaluation Guide 13: Supporting families and carers of drug users
This document is also available in pdf format (77k)
Evaluating interventions supporting families and carers should follow the same basic principles of any evaluation. The Effective Interventions Unit has produced a series of short evaluation guides that cover a range of topics from definitions and planning through to reporting and dissemination. These are available at: http://www.drugmisuse.isdscotland.org/eiu/eiu.htm
WHAT IS FAMILY SUPPORT?
'Family support' covers a range of interventions aimed at assisting family members who are affected by a relative's drug use. What families seek support for, and where they seek it, can vary greatly. It can range from informal support from relatives and friends, to seeking support from others who are in a similar situation, and to more formal support from agencies and professionals. Very often family members seek support for their substance-using relative rather than for themselves (expecting treatment for their drug-using relative to help reduce their own stress), and interventions involving family members often focus on treating the drug user. As a result, outcome measures and evaluations have focused on the impact of change to the drug user rather than on the needs of, and benefits to, the family. Although the family's health, social and financial circumstances can improve as a result of treatment for their drug-using relative, it is entirely dependent on that relative's willingness to undertake treatment and whether stabilisation or abstinence is achieved. This can be a long-term process. Evidence presented in the EIU review 'Supporting Families and Carers of Drug Users' (EIU 2002) suggests that, to be effective in helping families, services should have clear aims and objectives specific to that client group.
WHAT DOES FAMILY SUPPORT AIM TO ACHIEVE?
Methods of supporting families and carers of drug users
To assist family members gain a level of knowledge that improves how they understand and deal with their circumstances
To work with the whole family (including the drug user) to improve its overall functioning and help the drug user reduce their use of drugs
To help family members come to terms with their circumstances, to allow individuals to explore their concerns and identify ways of dealing with and responding to these concerns
To improve trust and communication between family members
To improve the emotional and mental health of family members and help them support each other
To give families and carers the opportunity to get a break away from their everyday situation and to maintain some form of social activity
To assist people by giving them confidence to ask questions and obtain the care and services they are entitled to
To increase social opportunities and contacts for family members, and help them maintain their self-esteem and confidence
Family support groups
To collectively support each family member through the difficulties they may be facing
To provide support and advice out of hours and direct family members to other relevant services
WHY EVALUATE FAMILY SUPPORT SERVICES?
The main aim of evaluating family support services is to establish whether they achieve their aims and objectives (i.e. whether and to what extent the harm caused to family members as a result of their relative's substance use is reduced). An evaluation can also help determine what difference an intervention has achieved, and help establish what is best practice in supporting families and carers. For example, an evaluation of a service providing information, counselling and advocacy can help to establish whether there has been a reduction in the personal stress experienced by family members, or whether family members feel they are no longer left alone to cope with situations where they may have little knowledge and understanding (for general information on evaluation go to EIU Evaluation Guides 1 and 2, for a definition go to Guide 12. All available on: http://www.drugmisuse.isdscotland.org/eiu).
OUTCOMES AND PERFORMANCE INDICATORS
In order for an evaluation to determine if aims and objectives have been achieved, you will need to describe what successful outcomes would look like and develop mechanisms to establish and measure whether these outcomes have been achieved.
Outcomes are the impacts and benefits that an intervention has on family members. Typically, they represent a change in behaviour, knowledge, attitudes, life condition, skills and status that occurs as a result of interventions.
Outcomes are measured by identifying conditions or characteristics that indicate whether change took place. These conditions are the performance indicators.
There are different types of performance indicators. For example, indicators can measure the number of clients that successfully achieved a specific outcome, including:
the number of 'harder to engage' family members (e.g. fathers or siblings) the service works with
the number of family members taking less time off work
the number of family members accessing other relevant services.
In addition, performance indicators can measure the distance travelled or progress made by individual clients towards the agreed outcomes. These indicators do not provide absolute measures but rather measure the degree of improvements reported by clients. They provide indications of achievements on the progress made towards outcomes. These indicators can be more difficult to measure (for more details see EIU Evaluation Guides 1 and 9) and include:
improvements in family relationships and dynamics
reduction in levels of anxiety, helplessness and isolation experienced by family members
increases in the level of self-esteem and confidence felt by family members
changes in the attitudes of family members, and improvements in their ability to deal with the situation and get on with their lives
Examples of core outcomes and indicators for family support interventions
Types of core outcomes
Examples of indicators
Families and carers are better informed
Increased knowledge of other available services
Increased access to relevant services
Increased recognition and understanding of their own needs and how to seek help
Better understanding of the effects of drugs and the nature of dependency
Better understanding of how family members can help with the recovery of a drug using relative
Better informed about health risks (e.g. the process of addiction, Hep. C)
Improvement to physical and psychological health
Reduction in experiencing anxiety, fear, worry and confusion
Reduction in physical symptoms such as heart and stomach problems
Ability to deal with the situation rather than resort to denial or self-blame
Improved family relationship
Improved communication within the family
Reduction in tension and conflict within the family
Rebuilding of trust amongst family members
Consistent response from family members to drug-using relative
Improved relationship with drug-using relative
Improvement to finance and employment
Taking less time off work and being able to concentrate on work
Being able to attend work without feeling stigmatised
Being able to access welfare benefits
Improved ability to manage finances
Improvement in the overall financial situation
Improvement to social life
Reduction in isolation and increased access to new social contacts
Increase in the pool of support and networks available for family members
Experiencing less shame and stigma
Engaging with the whole family
Reaching 'harder to engage' family members (e.g. fathers, siblings and wider kin)
Engagement with the individual needs of family members
In order to measure the 'distance travelled' by family members you will need to establish a starting point or a 'baseline' from which to measure progress. Baseline measures aim to establish the clients' situation before the intervention starts and without them it is virtually impossible to establish whether any change has occurred. The initial assessment phase can provide an opportunity to gather a range of baseline information. This includes: relationships within the family; measures of levels of anxiety; helplessness or feelings of isolation; the ability of family members to deal with their situation; and levels of self-esteem and confidence. Depending on your resources, you could gather the same information at various stages during the intervention, or just at the end of it. This will enable you to have a better picture of the progress made by individual service-users. It could also help service provision be tailored to the needs of individuals. For more information about using assessment data for evaluation see EIU Evaluation Guide 7.
It is often not sufficient to evaluate the outcomes of a project. Process evaluation is also important. It seeks to find out how an intervention works, why it worked well and under what conditions an intervention works or fails. The definition of 'process evaluation' and techniques commonly used for evaluating these aspects are discussed in EIU Evaluation Guides 1 and 2. This part of project evaluation should cover aspects such as:
publicity, promotion, client recruitment and accessibility (e.g. did we get the right clients? Are we working with the range of family members we were hoping to work with?)
project activities and methods of support, including client-centred action plans (e.g. how and why were we successful in assisting family members gain knowledge and skills relevant to improving family function? How and why were we successful in helping family members access the services they are entitled to?)
project management and resources (e.g. did the project have sufficient and appropriate financial and human resources and systems?).
EVALUATING FAMILY SUPPORT GROUPS
A family support group is a group of individuals experiencing difficulties in their lives that are common to other members of the group. Support groups exist for a wide range of health and substance misuse issues, and influence the development of services. In relation to drug use, support groups are made up of family members who are affected by a relative's drug-use. The aims of these groups include:
Is there a need to evaluate family support groups?
As is the case with any other form of support to families, family support groups could benefit from evaluation. Generally, an evaluation would help the group assess whether its aims and objectives have been met. More specifically, evaluating could bring a range of benefits, including:
assisting group members recognise the achievements the group is making
helping the group identify areas where they need to improve and what factors prevent improvement
helping the group to be more accountable to funders, group members and the wider community
Increasingly family support groups seek funding from a range of bodies. Given that funders expect to know that their money is being used appropriately and has been spent as intended, groups are often required to be more accountable and transparent. Greater accountability would also provide helpful information for funding applications. To help them be more accountable, group members will need to be clear about:
to whom they need to be accountable
what information stakeholders need and want (e.g. some may want financial reports only, others may also want details of outcomes)
what information group members need (this may be different information from funders need)
Do all family support groups need to evaluate?
Whether or not family support groups need to evaluate their own work depends on the type of activities they engage in. For example, groups that meet on a regular basis to provide informal non-judgemental support to one another and an opportunity to share experiences may not need to conduct a formal evaluation of their activities. However, groups who organise formal counselling sessions for their members (either on an individual or a group basis) should evaluate this aspect of their activities. The evaluation guidance included within this guide and other EIU guides could be helpful.
EIU is currently working in partnership with Scottish Drugs Forum on a separate 'user-friendly' guide focusing on evaluation of family support groups and aimed specifically at local community-based groups.