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Evaluation of Intensive Family Support Projects in Scotland

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Annex 1 - Service User Experiences of Project Support: Additional Material 24

A1.1 Views of the referral process

Family members' views varied on the extent to which they had a choice about being referred for Project support. Some felt they had no real choice since refusal to engage would place them at severe risk of homelessness an/or family break up as the following comments illustrate.

"We had no choice, or we would nae have had a house".

"It wasn't until they started coming up to ... speak to us and see us about it and that…I was determined I was nae coming [to work with the project] but then I got told, if you don't go, you're getting your kids taken off you for supervision. So I thought, right, I'm going. That's it".

As noted in Chapter 5, however, some interviewees portrayed these issues in more positive terms.

Most of the families believed that Project aims and objectives were fully explained to them at the point of referral. However, as the Projects work with the families on a wide range of issues, interviewees understandably felt that there had been a lot of information to take in. Only one mother felt that the Project's role had not been fully explained. This related to the vulnerability of the mother at the point of referral and her inability to be confident enough to ask questions: " No, really. Because I did nae get all the details. I was nae asking a lot of questions".

It should be emphasized that this view was exceptional across the interviews. All the Projects appeared to have taken very seriously the provision of information about their work, and indeed, engaged with the families over several weeks before accepting them for longer-term Project support.

While Project aims and objectives were explained comprehensively, some families had remained reluctant to work with the IFSP, worried about letting their "guard" down. One young man who had grown up in care was particularly reluctant about working with the project: (although he had gone on to do so)

"I just felt, back to this again, I dinnae need all this. I've been through it all before. I hate having to sit and explain all my business and this and that and telling this. And getting other people telling me, oh you've got to do this and do that. I know how to do it, I know how to run a house. I dinne need anybody to tell me what to do".

Another interviewee was reluctant about becoming involved with the IFSP as they did not believe that the project could offer the type of support which would benefit his family:

"I'll be honest. I was sceptical about the project. They said this that and the next thing. But I thought what can you give me? Do I really need you? I didn't want anyone to psycho-analyse me. Then Ruth came round with another worker. He went right through it, he told us all about it and that if we had any objections we could stop it at any time".

Some families did experience feelings of shame about being referred to an IFSP. Parents expressed concerns that by accepting support that they had somehow let their children down:

"I try not to tell them as much as possible because I don't think we should be in this situation for a start. You know, its never got as far as this where we're needing to have help".

Linked to this, some families were also nervous about precisely what being involved with an IFSP would actually mean:

"At first I thought, oh yeah, I felt kind of, you know, not ashamed, just worried about coming here, you know. Different things, you've got people 24/7, you know. And I thought, do I need all this? But it's been helping".

Although accepting that the Project's role had been fully explained, one family explained how the amount of effort involved in working with Project staff was a 'shock':

"I think they explained it well enough. I got a bit of a shock when I came in, about what I was expecting and what was actually happening since I moved in here".

A1.2 Understanding of the role of Support Plans

The five Projects all adopted a similar approach to planning out their work with families. During the initial assessment phase, Project staff worked together with families to develop an individual support plan. With the exception of two very recent referrals, all the families in the interview sample had a support plan in place.

None of the interviewees felt that the support plan had been imposed on them. Instead, support plans were generally developed after a number of sessions between the family and their project worker. The support plans can be thought of as a written summary of these sessions, with a list of key issues and the actions needed to address them. With Project workers' help, service users contributed to the development of their support plans based on their own perceptions of the support needed:

"I think I had the full say, ken. It was like Jill was talking, do we think this is the best way to go? And things like that. And it was like, up to me, which way I was going to go for it …With this, its for me to pick out what we are going to work on".

As testament to this process, families typically had a high level of ownership of their support plan. A number of interviewees mentioned that working to achieve the goals set in the support plan was hard work - one mother spoke of going home to do her 'homework'. However, plans were also seen as exemplifying a 'partnership', based not just on what the families would do but also what Project staff would do for them:

We had a plan written up where we had, yeah, we had to meet certain targets but it wasn't given as a kind of, it wasn't sold to us as a kind of, ultimatum. It was like, this is what we're going to achieve together and this is what we're going to do for you. Rather than this is what you must achieve. And that's important as well. I mean, again, its totally getting away from the, from the enforcement side of things".

A1.3 Working with the Projects

An important aspect of the support provided by the IFSPs was the way in which the work was structured. Project workers clearly understood that the families working with them were able to address only a limited range of issues at the same time. Initially, Project workers focused their attention on measures directly addressing the behaviour that had prompted the referral and the need to stabilise living conditions for the family. More 'aspirational' goals, such as training or employment, were considered at a later stage in the plan.

Although there were commonalities across the households in terms of vulnerability, unemployment, housing instability the 'story' for every family was unique. In response the Projects designed unique, family-centred solutions. Below the main forms of support provided by the project are discussed in turn.

Housing support

As seen by Project staff, an important part of the service was help to create a stable living environment for families. In some instances this was seen as requiring re-housing, while in others it meant helping families to resolve outstanding repairs, rent arrears. A significant amount of work by Project staff involved negotiating with social landlords to help resolve neighbour disputes and addressing complaints about behaviour. Project workers often worked jointly with housing staff to run workshops for Project service users on tenancy rights and responsibilities.

An important aim of the Projects was engendering confidence among service users that Project staff were "on their side". Thus, staff often helped families handle ASB complaints in a more positive way. This proved beneficial, especially where complaints were thought to be unfounded:

"They stepped in as, like a middle man, and sort of, explained to the council our side of the story [regarding ASB complaints"]

"Er, yeah, they've been good because when we first moved up here there was complaints … against us, but they were unfounded. And it was because of the Project workers, I think, because they were pushing it so much that they … got investigated and they were unfounded and stuff. I think, if it wasn't for them, I don't think it would have happened so quick".

Liaison with other agencies

Another key IFSP function delivered was brokering and co-ordinating help from other agencies. The review of case files undertaken alongside the service user interviews revealed that at the point of referral it was not uncommon for numerous agencies - sometimes dozens - to be working with families. One parent had noted during a review meeting: "I don't want too many chiefs telling me what to do". Prior to referral, families had sometimes found such activity uncoordinated and confusing.

Thus Project workers often spoke of adopting a case management role; where necessary, streamlining input by other agencies. In some cases involvement with other services was ended, thus allowing families to build trust with a more manageable number of agencies. In the following quotations interviewees refer to the case management style role offered by the Projects:

"It's like, the Families Project are like a hub and they've got different arms reaching out to all different agencies working alongside. But they're the hub of everything, with us, to help us, every step right from beginning to end".

"And very close as well with social work. But if issues come up, they actually work with Jane [social work]. If Jane calls a meeting there's always somebody from [the Project]"

The Projects also worked with families to develop the skills to negotiate with other agencies. A number of interviewees acknowledged having previously failed to face up to their problems, for example, by ignoring warning letters and " throwing them in the back of the cupboard". One spoke of the help provided by the Project in terms of working with her existing social worker:

"when I spoke to her, she seemed to be opening the doors for me …. So she went there [to meeting with social workers], guiding me like, and to the conferences and first screenings…[previously] If I was to say something to social workers or that, it kept getting turned round the wrong way. Because like I say, she's given me confidence".

Where children's attendance at school was problematic, parents often described difficulties negotiating with education departments. Where this was an issue, Project workers were often reported as helping parents to liaise with schools - e.g. in agreeing alternative support services for children on part-time timetables:

"He was home, I think he was home for nearly a whole year just about. So they helped me to contact other agencies and that for me. And then they assessed the boys to see what areas was more important to start off with and then work through"

Practical support

Many families stated that help with practical issues had proved to be the most beneficial aspect of the Project support (so far). This included help with decorating, gardening, accessing funding for new household items and managing mail. One family was supported to get new carpeting, which in turn helped to reduce noise levels from the flat:

"Cos that makes a big difference because see when you're walking in your house and you ken you've no got carpet on your stairs, it makes you feel like you're just a pure failure like. And carpets are really expensive and I'll admit, I'm no good at saving up".

"Debbie also got us a package off the homeless, like I got a new freezer and cooker. It's getting carpets and blinds fitted as well. That's been really good money wise, cause it would have been a struggle without it. Karen will also come with me to appointments".

Another parent was assisted with removing old furniture from her house and accessing funding to purchase new household items. In this case the parent had by her own admission " let things get out of hand". Helping the family get the house 'tidy and organised' allowed them to move onto address more fundamental issues, such as parenting and routines.

One parent commented that practical support in keeping appointments had been invaluable, and together with parenting skills and routines setting had helped the family enormously:

"They have been helpful with me, like if I need to go to something, they tell me when it is. They are involved, and so are the social work and the Council. Its helpful cause I'm no good with it, like I miss appointments".

Finally, the Project workers assisted families to access support or help from other agencies, such as education, training, benefits advice and help accessing nursery placements. This latter service proved to be invaluable for many parents, especially those with no support from extended family.

Finances and budgeting

For many families with older children, budgeting and help with finances was not a priority. However, it was a fairly common concern for younger families, particularly young single mothers. Help with budgeting was often closely linked to practical support, such as shopping, cleaning and tenancy related support. One young mother said that she had no 'home skills' and described how the project assisted her in this area:

"She helped us budget my money so we'd go shopping and just get that shopping that we needed for the whole week. And then she would help us cook and show us how to cook and clean and stuff like that".

One single mother who had recently separated from her husband commented she had ignored financial issues as problems with ASB had worsened. Support with handling rent issues was of great importance:

"[the help with rent and budgeting was] very helpful because sometimes you don't know, you don't know who to go to…. And especially, I'm responsible for the kids, I'm responsible for everything. I'm responsible for the income coming in the house, the paying the rent and things like that. Especially cos as I say, things have been getting on my, things have just become a bit overboard recently".

Another mother described the support provided to assist her with her rent arrears:

"Aye it's been good aye. Cos … I don't like phoning up and saying about repairs about the house because I get all stuttering and all that. Aye, cos …I've gone into arrears and Geoff's sorted it oot into a plan what I've to pay a week".

Help with parenting skills

One of the problems most frequently cited by parents was the lack of control they had over their children's behaviour. Thus, parenting skills was a focal point for many support plans, to be addressed through workshops and one-to-one sessions. Project staff would often visit a family at key points during the day and assist with routine setting. One project was connected to a dedicated parenting project (located in the same building) and referrals could be made directly to this service.

Work in all five Projects was similar, with a focus on helping parents establish a setting of routines and boundaries. This included setting morning routines (getting children clean, dressed and fed), evening (getting children be home before dinner, have dinner, to do their homework) and bedtimes. Work also focused on how to manage aggressive or controlling behaviour. One mother was described as treating her children as "friends" and as such was unable manage her children's poor behaviour.

Parents generally responded well to these routines, although some found the frequent visits by Project staff initially difficult to handle. Two parents below described their positive experiences:

"They help with Emma [daughter, 3] getting her into routines. I feel like I have support and help with her now. Like she had problem with eating. She wouldn't eat anything. And sleeping, getting her to bed".

"It was mainly to do with Jessica and Joe. Like rows breaking out and me shouting. Basically it was to do with the weans. Like I've got a temper anyway, and then when they don't sleep there is a fight getting them to bed, then you are tired the next morning. I've had parenting classes and filling in the charts".

Work with children

Many cases involved Project workers engaging directly with younger family members, as well as with parents. In some cases, children's behaviour had prompted the referral thus work often focused on the reasons for the behaviour and individual support needs. In other cases, the children were affected by the behaviour of the adult members of the households. For example, children were being affected by loud music and parties within the home, family violence or substance misuse.

One-to-one sessions with children were used to focus on a range of different issues, for example, confidence, self-esteem or attitudes bullying. Depending on a child's age Project workers used different approaches to address these issues. Activities described included drawing or painting, using 'concept cards', taking children out for activities such as snooker or rock climbing. Project workers also helped children to access out of school activities or other educational services if they had fallen out of mainstream schooling.

It was noted by some adults that parenting skills, while useful for younger children, could not be applied to older children. Project workers adopted different approaches to working with older children, for example, by trying to engage them in training programmes, education or outdoor skills course (like the Princes Trust). One parent described how successful this focused one-to-one attention had been for her 14 year old son:

"The day before, he started on us, oh, I was just so not well that I just could nae handle it, do you know what I mean? The Project worker came and she took Graham out. Had a word with him. And yesterday as well, she had him out. And last night, … I took the 2 wee ones out, we went to Strathclyde Park. And we came back and it was that way, the atmosphere in the house. So I just took the 2 boys up the stair, because he'd been bullying the 2 wee ones, do you know what I mean? So I took them up and it was about half an hour later, Graham actually came up and he's apologised to us. Which is a thing that he's never, ever done. He's never apologised, do you know what I mean? He can accept he's done wrong, but he's never come out and says Mum, I'm sorry for what I've done… And I think with the project worker taking him out and explaining the situation and that".

However, success engaging with older children was mixed. As described by one single mother where older children were unwilling to engage, this mean that Project workers had to concentrate on helping parents:

"They are no working with him. Because any time that the Project workers comes up, he just sat there and laughed at her. He was not taking an interest. I says to him in front of the Project worker one day, aye [they are here] because of your behaviour. And he just sat there and laughed. So all the work has been with me".

In some cases were the 'offending behaviour' of older children had been so serious that Project staff had seen no alternative to their removal from the family setting. This happened in two cases, where the relationship between an older child and other family members had completely deteriorated. Indeed, for both the families concerned, the removal of the older child automatically ended the ASB. The children removed were, in both cases, referred to dedicated youth support projects. A third parent was looking at this option in the hope that it would change her son's behaviour:

"she's got something sorted for him. A kind of, its no a hostel, it's a, it's like a unit and you get a key worker and that with you. So she's going to organise that for him, do you know what I mean. We're hoping that he's just going to come back with his tail between his legs, do you know what I mean?".

Emotional support

Project workers were frequently cited as just spending time with families, chatting about everyday life and talking through family members' personal problems. All the interviews found this type of emotional support to be important, helping them to address problems with control, stress, self confidence and self esteem.

Linked to helping family members feel more in control of their lives many service users were encouraged to use 'anger management' techniques. One couple had realised that their aggressive behaviour as a couple was affecting their child and worked with the project to address their anger. Learning to handle conflict had not only had a positive effect on their relationship and their child, but had also helped the couple develop tools for handling conflicts with their neighbours:

Female: "Now we ken what way to deal with things. Like, if one of us is upset or whatever, we just go outside …I'm glad that we ken the tools that we ken now. But I wish I kent it then, but I ken it now. Like for instance, if anybody, neighbours or anybody was complaining or shouting, I would nae react, I would just be nice and I would just go [walk away].

Partner: If we are arguing, I just go up the stairs and I'm up the stairs for about 10 minutes. She'll go Sandy, go and come down the stair, its crap sitting here on my own".

Health issues

Many families were assisted by Project staff to address health problems that most people would regard as mundane, e.g. visiting the optician or the dentist. In a number of cases, mothers suffered from very poor dental health which impacted on confidence and self esteem. Helping to ensure that such problems were dealt with was seen as a high priority by Project staff.

In seeking help to tackle more fundamental health issues (such as substance abuse or depression) family members were generally referred to external agencies, although Project workers took the time to discuss such issues with family members during one-to-one sessions:

"They know the situation as far as, me having to have my tablets changed because, and they said that they had access to people, they could pass me onto, you know, people that could counsel me. Sort of like, acting as a middle man, not offering me a direct service from them, but telling me about other services".

Creative solutions

Project staff were credited for adopting creative approaches to working with families. While social work services were often described as "just talking at you", project workers often devised innovative and interactive ways of working with families. These included:

  • Relaxation and aromatherapy classes
  • Parenting classes (with other families)
  • Worry books (to help children get their emotions out)
  • Creative drawing (to look at issues such as self confidence, image and bullying)
  • Accessing driving lessons
  • Star charts
  • Outdoor activities such as rock climbing

A1.4 Views on Project support outcomes

As well as rating the Project worker, interviewees were also asked to rate Projects overall. All ratings were six or above, and most awarded a score of nine or ten.[Note that this was not a 'scientific' scoring exercise, simply a crude way of gauging interviewee opinions about Project staff and their effectiveness).

Families were also asked to state what aspects of the service they would like to change. Responses here reflect the high overall ratings for Projects. Most stated that there was no aspect of the project that they would like to change. However, four families felt that the Projects could work more actively with younger family members. This perhaps reflects the difficulties that Project staff had when engaging with older children.

One interviewee felt that it had been difficult to adapt to the intensive support after years of doing what she wanted. However, this change was seen in a positive light:

"But I struggled with it. I used to call this prison sentence, I was like, this is a friggin prison. I used to take fits all the times, going mad and everything. All the time, totally, all the time. But its just totally changed my life [for the better]. Totally has".

Another parent, whose child was eventually diagnosed with ADHD had hoped that the intervention could have taken less time. Again, however, there was a recognition that the project was unable to make things go faster:

"that's just our expectations of hoping things have a quick fix when there isn't really a quick fix for it … And I think its important that anybody that gets involved with the project digs in. but no, I don't think there is anything that I could really call back on and say, it could have been done better".

For most families the support provided was seen as invaluable in changing their lives for the better. Consequently, it was difficult to say precisely what had helped them the most:

"Its kind of hard to explain. I think, the easiest way I could put it is, the Families project has given us the tools and the know how, to help ourselves. That's the easiest way I can explain it. Its not one thing, its all collective. I couldn't really point to one single thing and say, you know, that is the one thing that's turned our family around. It's a collective thing. It's also the other agencies they put us in touch with".

'No, no. I couldn't identify just one thing because there's been so many different things that, I had to get told about. Like, parenting things like one-on-ones with Elaine, for like my emotions. And things for my kids and protecting my kids and things like that. There is a lot of different things that they've helped us with. You know what I mean?".

The majority of service users interviewed stated that working with the IFSP had made a lasting improvement to their quality of life. Many stated that since being involved with the Project ASB complaints had substantially reduced or ceased entirely. Service users also spoke positively about the way Project staff had helped them mediate with other agencies (especially housing and ASB teams) to prevent further enforcement action:

"I managed to keep the property. And we went to court to keep my eviction as well. The closure order got stopped and the ASBO got sorted out".

This was connected to families having developed a "different outlook" on both their behaviour and what they wanted out of life. Many felt that their relationship with their children and extended family had improved. One parent felt that she was now able to talk to her family and her neighbours to address her problems, something she would previously have been unable to do. One service user had been encouraged by her project worker to start seeing a psychiatrist on a regular basis. Compounding work on parenting skills she had started to see a real improvement in the relationship she had with her children.

Stress, tension and aggressive behaviour were common themes amongst many of the families referred to Projects. Many felt that the project intervention had had a "calming" effect and had helped them address anger and negative emotions. Linked to this was the feeling of being "in control again", especially amongst single mothers. The ability to start coping with daily life had an enormous impact:

"I've started speaking to my father. I'm now speaking to my mother. I've got myself a job. I've got my kids in a routine and they are now behaving themselves more better. I've got a better relationship with my kids. I'm starting to get to see my oldest kid. There's just loads".

Concerns were expressed that in some cases improvements may be difficult to sustain without the on-going support of the project. Earlier interventions, particularly with regard to children, so that problems could be addressed before they became too entrenched, were seen as one means of ensuring greater sustainability. An increase in Core Block accommodation was seen as another. One service user interviewee believed that families were more likely to be able to sustain improved outcomes if they had received the particularly intensive support provided by the core block. Another professional expressed the opinion that what really mattered was not the way the support was delivered, but what was delivered in terms of developing key skills and attributes (parenting, self-esteem, confidence building etc) that were sustainable in the long-term. Despite the excellent work of the project staff, it is important to recognise the long-term and intra-generational nature of the families' problems, which necessarily constrains the support that can be given, even within the confines of the Core Block.

In the final analysis, the sustainability of improvements will be dependent on the political will and concomitant resource allocations, as well as the multi-agency and intensive ways of working that have been successfully piloted thus far.