Effective Interventions Unit
Working with young people: A profile of projects funded by the Partnership Drugs Initiative
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This report provides interim findings from an evaluation of projects funded by the Partnership Drugs Initiative (PDI) to work with young people. The research was funded as part of the Scottish Executive's Drug Misuse Research programme. The report describes the work of 17 projects funded in 2001. The final report in 2005 will present results from a process and outcome evaluation of a selection of these projects.
The PDI (involving Lloyds TSB Foundation for Scotland, Atlantic Philanthropies - a U.S. based charitable trust - and the Scottish Executive) began issuing grants in Scotland in April 2001 to support voluntary sector work targeted at three groups:
children and young people in families where parents are misusing drugs
preteen children who are at high risk of developing patterns of problem substance misuse and
young people who have already developed a pattern of problem drug use.
By the end of 2003, the PDI had funded 52 projects across Scotland.
The research builds upon and extends a series of reports from the EIU which assemble evidence of effective working in relation to young people and substance misuse. These reports include: Integrated Care for Drug Users: Principles and Practice (EIU 2002); Drug Treatment for Young People: A Research Review (EIU 2002); and, Services for Young People with Problematic Drug Misuse: A Guide to Principles and Practice (EIU 2002). Collectively these reviews have identified the importance of developing services that are appropriate for young people and which avoid a narrow focus on illegal drugs.
The first stage of the research has involved:
reviewing projects' original applications for funding
reviewing projects' routine monitoring information
records of contacts between projects and the funding body
information on their current and past client lists
76 semi-structured interviews with staff in the profiled agencies.
3. Project Profiling
The PDI has led to the rapid development of a wide range of projects across Scotland focussed on the three key target groups. Most of the projects have succeeded in contacting and working with their chosen client group over a sustained period of time. Predominantly, projects attracted their referrals from social work with fewer than expected from education and health agencies. There were also relatively few self-referrals into PDI projects.
The level of client contact varied. The main difference was between projects which were easily accessible or which worked with clients in a low intensity way and those which were less accessible or which were working in a more intensive manner. The former tended to have recruited a larger number of clients.
4. Philosophy and Focus
Despite some diversity in the way they operate, all projects placed great importance on working holistically with clients: drug related problems could not be treated in isolation from other aspects of young peoples' lives. They also emphasised the importance of developing a client centred approach: emphasising the empowerment of the client. All the projects emphasised the importance of working alongside clients, giving them a voice and enabling them to participate in decisions about how the intervention should proceed.
The importance of having a clear focus in their work with clients was emphasised by staff across projects. However it was evident that, in some projects, the breadth of the work with clients and the importance of flexibility in working with them could have an adverse effect upon the clarity of a project's focus. The holistic philosophy underpinning projects could also, on occasion, make it difficult for staff to draw boundaries around their work with clients.
The principal way projects recruited clients was through referrals from other agencies. There were three aspects of these referrals which could limit the effectiveness of projects in their work with clients:
The main method agencies sought to solve the problem of low referrals was through intensive networking, local advertising and easing the process through which referrals could be made by, for example, enabling referrals to be made by telephone. In some projects staff had needed to devote considerable time and effort to drumming up referrals from surrounding agencies.
However, simply attracting referrals was not sufficient; the referrals also needed to be appropriate. To ensure this, staff sometimes needed to clarify with surrounding agencies the sorts of clients whom they were able to work with. Finally, in relation to late referrals some staff felt that, whilst they saw themselves as part of an early intervention project, in some cases clients were being referred to them at a stage at which their problems were already fairly well advanced.
All projects assessed clients' needs on initial contact and subsequently set goals for their interventions. Assessment and planning were regarded as vital in individual cases to maintain focus and promote progress towards closure. Most projects sought to involve clients in this process: stressing the importance of meaningful and substantial client involvement towards the achievement of agreed goals.
Across projects, staff were using a variety of assessment tools depending on the client group and the nature of project work. The time taken to conduct the assessment varied enormously. Some assessments took less than an hour to complete while others could involve 4-6 hours of face-to-face work. The range of assessment tools used by projects was quite wide and included the EuroADAD, the POSIT (Positive Screening Instrument for Teenagers), the SCODA assessment instrument, the Parent Hassle Scale, the Department of Health Assessment Framework and the Thomas Kilmann Conflict Mode Instrument.
7. Case Closure
Project staff were reasonably comfortable with the process of assessment and goal setting, but the issue of case closure was more problematic. There were three problems associated with case closure which staff in some of the projects had to deal with.
First, case closure could be slow because of the intensive and protracted nature of some of the work. Staff in some projects highlighted that successful outcomes and enduring changes for clients could take a long time to bring about and that the very nature of a project's work with clients militated against the rapid onward movement of cases.
Secondly, case closure could be impeded by difficulties in referring clients on to other services. This could result in projects acquiring backlogs of cases.
Thirdly some projects experienced difficulties in identifying clear criteria by which cases could be defined as satisfactorily concluded.
Confidentiality was an important issue for all of the projects. Staff were acutely aware that any breaches of confidentiality could be highly damaging to clients and to the wider project. Whilst clients were reassured that information on them would not be divulged without their permission, it was also recognised that, in circumstances where there were concerns over child safety, staff would be required to breach confidentiality. Similarly, it was also recognised that client confidentiality could be particularly difficult in rural areas where individuals' movements were more visible and where there was a greater likelihood of clients and staff members being known to each other.
9. Relationships with Host Agencies
Each PDI project was located within a larger 'host' agency which provided an appropriate administrative and professional context for the project and its work. The extent to which a project was integrated with its host agency played a significant part in its ability to function effectively, according to many project staff. There were three main elements of integration that bore upon project working:
First, a complementary relationship with the host agency increased the perceived value of the project in the eyes of staff in the wider organisation and facilitated cross referral and joint working.
A second important element of integration concerned the extent to which the members of the host agency understood the nature of the PDI project's work and objectives. In two of the profiled projects this understanding was lacking and staff had to devote time to developing it.
Finally integration could be facilitated or impeded by the way in which the projects and their host agencies were organised. There was greater potential for integration where project and host agency staff were based in the same building and attended joint meetings. The majority of projects seemed to have established good relations with their host agencies. In a small number of cases it was evident that the relationship was rather more strained.
10. Relationships with External Agencies
Developing and maintaining constructive relationships with a range of external agencies was regarded as crucial to the work of the projects. This was especially important for referrals. External agencies could be important to a project in other ways. For instance, they could deliver specialist inputs, supply important information or assist a project in its activities. Most projects had worked hard at networking with related services and agencies and mostly reported having developed constructive relationships with them. It appeared that positive working relationships were easier to establish in rural communities where there seemed to be an enhanced culture of partnership working. This may be a consequence of the relatively small number of agencies and services working in these areas.
Relationships with other agencies could be adversely affected by perceived overlaps in their work or by boundary disputes. This could give rise to serious tensions. Sometimes boundary problems occurred because the nature and purpose of the project had not been communicated to outside agencies with sufficient clarity.
It was helpful for projects to be able to claim that they were providing a service which addressed a clearly identified gap in provision. In this respect, the more a project was able to present itself as offering a unique service the better. This not only avoided problematic overlaps with other services, but also enhanced the project's perceived utility and made it more clearly identifiable as a potential referral outlet. A final danger for projects in their relationships with other agencies was that their very usefulness could rebound on them in the sense that they could find themselves being used to supplement, or substitute for, statutory provision where resources were short.
11. Relations with Funders
Several projects altered their aims or approach from the original proposal to accommodate changed circumstances or priorities. In every case this was only undertaken with the approval of the PDI sponsors. The latter were universally praised for responding flexibly and supportively to proposals for changes to the original specifications. This flexibility was greatly valued by the projects concerned and was regarded as having made a significant contribution to the appropriate and successful development of their initiatives. The PDI's willingness to allow projects to innovate and take risks was especially appreciated by some of the projects.
Many projects felt that 3 year funding might have an adverse impact in the future if continuing funding could not be secured. Several workers and managers claimed that the typical three year funding period imposed restrictions on their project's strategic activities and could have an adverse impact upon the career decisions of staff members. It was feared that anxieties over the continuation of funding might encourage workers to leave, especially when a project entered the final stages of its funding. Staff also expressed concern at the difficulty of replacing staff at that stage and that a project might close just when it was beginning to establish itself.
12. Management, Teamwork and Safety
Most projects seemed to be well managed with clear lines of authority and accountability. Regular supervision appeared to be a feature of all of the projects and many staff reported feeling well supported by their managers. Frequent team meetings were a feature of all of the projects and these appeared to be important to their success. The culture of informal support between staff was highlighted as equally important to formal meetings.
The safety of staff was an important issue for a number of projects. This applied particularly to those working on an outreach basis or undertaking home visits. All such projects had developed policies and procedures for minimising the risks to staff. This included ensuring that a worker was never alone in a project's premises, holding client meetings on neutral territory such as schools and health centres and requiring lone workers to phone into the project/host agency before and after a home visit.
13. Staffing and Recruitment
Staffing and recruitment was a problem for some projects. The progress of one project had been so seriously delayed by recruitment difficulties that project staff had still to make direct contact with young people eight months after its inception. High staff turnover was also a feature which had a negative impact on some projects. Staffing problems could lead to the overloading of staff, the disruption of relationships with clients and to some services not being delivered at all.
The small scale of the projects also meant that staff absences, due to leave or sickness for example, could create significant difficulties. The impression from the site visits was that some projects only survived staffing difficulties because of the professionalism, dedication and sheer hard work of those who worked on them.
More positively, all project managers identified the calibre of project staff as one of the most significant factors in their success. Many had qualifications in social work, youth work, community education or nursing while some also had specialist qualifications in relation to drugs and alcohol. There was a fairly widespread view among managers and co-ordinators that formal qualifications could be less important than the ability to engage effectively with clients.
Appropriate premises was vital to all of the projects. Despite its importance however, several of the projects reported difficulties in acquiring accommodation which they considered suitable. Some premises were regarded as being too small, others as being inadequately equipped. A number of projects reported having difficulties in securing suitable accommodation for outreach work. Some were struggling to find premises that were accessible to their clients.
The overall impression gained from the interviews with project staff was that projects were generally well organised and well managed. Many of the projects also appeared to be making significant contributions, often in areas in which service provision had previously been deficient. Many of them were breaking new ground by targeting formerly neglected groups or by employing innovative techniques and methods of working.
A range of factors appeared to contribute to the success of projects:
a flexible and holistic approach by staff that could deal with the complex needs of clients
emphasis on client-centred approach- involving clients in decisions about the form that intervention might take in their case.
a clear model of care and support with well-defined boundaries. If the focus was too broad or too vague workers could feel confused and become swamped by the diversity of demands.
In the main, projects were well integrated with their host agency or agencies. This produced many benefits including, for example:
the capacity to share resources
opportunity to take advantage of in-house expertise and training opportunities and
on occasion, staff to be re-deployed within the host organisation.
The form of integration exhibited by most projects allowed the organisation as a whole to adopt a more co-ordinated and strategic approach. Achieving successful integration required careful planning and preparation, satisfactory staff induction, a clear idea on the part of host agencies of the nature of the project and its articulation with existing services and a management approach which was characterised by inclusiveness and clarity of purpose.
Many of the projects were experiencing difficulties in satisfying the demand for their services. In a significant number of cases this was compounded by staffing problems. Projects' small-scale rendered them particularly vulnerable to problems in recruitment and retention of staff and to staff absences. Although this had had a profound impact on the work of some of the projects, it is difficult to see how this problem might be avoided.
Finally, one area which many of the projects need to address in the future is the question of how to define criteria for the closure of cases. There is a danger that cases will simply drift on and, in the process, block the recruitment of new clients. A number of the projects had recognised that this was something which they were going to have to deal with and some were already actively engaged in the task. The fact that some projects had been able to address this issue successfully demonstrates that it can be done.