Background, aims and methods
1. This report examines the establishment, operation and impacts of intensive family intervention projects operating in Scotland. The research was initiated mainly to evaluate the three 'Breaking the Cycle' (BtC) schemes funded by the Scottish Government as a two-year pilot programme running from 2006/07-2008/09. In addition to the BtC projects (in Falkirk, Perth & Kinross and South Lanarkshire) the research also encompassed the Dundee Families Project (set up in 1996) and the Aberdeen Families Project (established in 2005). These longer-established schemes were included in the study mainly to enhance the scope for analysing Project support impacts - particularly in terms of the longer-term sustainability of any improvements in families lifestyles and behaviour achieved with Project help.
2. Drawing on the ground-breaking Dundee model, the BtC schemes were seen by the Scottish Government as 'demonstration projects' aimed at illustrating the benefits of DFP techniques as well as testing the effectiveness of these techniques delivered through a purely 'outreach support' model rather than incorporating core residential accommodation for the families concerned.
3. The evaluation was undertaken within the context of a growing recognition that anti-social behaviour can be symptomatic of deep-rooted problems within families and that such problems can be transmitted from one generation to the next. Partly evoked by the Dundee Families Project experience, the past few years has seen a groundswell of opinion that, albeit expensive, properly targeted intensive support has the potential to generate long term public expenditure savings (through preventing the need for eviction and/or family breakup). A growing body of evaluation evidence - particularly in relation to intensive family support projects in England - suggests that such potential gains can, indeed, be realised.
4. This research analysed the characteristics, histories and support needs of the families helped by the Projects. It was charged with cataloguing the methods used by Project staff in helping families to overcome their problems. It also had to assess the effectiveness of Project support and the financial costs and benefits involved. In addressing these objectives diverse methods were employed. These included in-depth interviews with service provider agencies, with other local stakeholders and with current and former Project service users. Statistical databases on families referred to the Projects and exiting from Project support were also built up and analysed.
Project origins and organisational arrangements
5. All five projects were established through initiatives involving the housing and social work departments of the relevant local authorities. While one authority - South Lanarkshire - ran its scheme as an in-house service, the other four Projects were operated by voluntary agencies under contract. The Dundee, Aberdeen and Perth projects were run by Action for Children Scotland (formerly known as NCH) and the Falkirk project was run by the Aberlour Childcare Trust.
6. The model used in Aberdeen and Dundee differed from that used in the other authorities in that it included a 'core block' residential facility as well as outreach support.
7. As well as seeking to help service users avoid homelessness and family break-up, for example through children being looked after and accommodated, the projects aimed to promote broader social inclusion for family members as well as safer, more cohesive communities. Referrals for Project support were triggered by anti-social behaviour and many of the families had long been considered problematic by the agencies working with them. However, there was no rigid requirement that a referred family needed to have been subject to legal action.
8. Most of the recently-established Projects experienced substantial difficulties in recruiting and/or retaining staff. These problems were partly attributed to the short term nature of Project funding, but also related to the highly demanding nature of the work and the modest salaries on offer. While the staffing complements of the five Projects were fairly similar (7-10 FTEs) caseloads varied to a greater extent, apparently implying variation in the intensity of support from Project to Project.
9. About 55% of referrals to the Projects had been made by housing department officers, with those originating from social workers accounting for most of the remainder. Projects rejected only a very small proportion of families formally referred and assessed. However, informal discussions between referral agencies and Project staff at an earlier stage appear to act as an initial sift to minimise 'inappropriate referrals'.
10. All five Projects were partly accountable to oversight groups bringing together key stakeholders from the provider agency (where relevant), as well as from relevant council departments (e.g. housing, social work, community safety). Such groups were found to be invaluable as a means of furthering constructive joint working around referral processes as well as service delivery to families accepted for Project support. Nevertheless, some of the Projects faced considerable challenges in bridging cultural divides separating them from key stakeholders and, thereby, establishing their credibility as effective operators.
Referrals to the Projects
11. In keeping with the nature of reported antisocial behaviour, more widely, family misconduct triggering referral for Project support usually involved excess noise (in 73% of all cases). Well over half of referrals (62%) were also triggered by 'youth nuisance'; in almost two thirds (65%) of cases children were implicated in ASB, with only 35% of cases where such misconduct was believed to be perpetrated only by adult family members. The seriousness of ASB prompting referrals is indicated by the 44% of cases where there was police involvement at the point of referral and by the fact that three quarters (74%) had been warned or charged by the police in the preceding three years (usually in relation to ASB rather than (or as well as) other offences).
12. Although ASB complaints about referred families had been ongoing for more than a year in most cases (60%), the typical duration of such problems varied considerably across the five Projects. In particular, the profile for Dundee was quite different from the norm, with more than two thirds (68%) of Dundee's cases involving ASB complaints dating back less than 12 months. This appears consistent with the suggestion that, being far more long-established than the other Projects, DFP is more able to encourage and accept referrals at an earlier stage in a family's offending behaviour, a key issue for the other Projects.
13. Some 42% of all referred families were secure tenants in social housing under threat of eviction. A similar proportion (43%) were considered by Project workers to be at 'high risk' of family breakdown at the point of referral, usually on account of the possibility that children would be taken into local authority care.
14. Most referrals (62%) involved single parent families. Family size tended to be larger than the national norm, at 4.3 persons; almost a fifth of families contained five or more children. At the same time, however, almost half (48%) of referrals involved families containing two children or fewer.
15. In almost every referred family (92%) at least one family member was disabled or suffering from ill-health of one kind or another. Well over half (58%) contained one or more family members subject to depression. Frequent school absence was an issue in well over a third (39%) of families.
16. An analysis of a sample of individual family Support Plans submitted by each of the projects found that the plans reflected the overall aims of the Breaking the Cycle programme; usually focusing on improving family dynamics and parenting, enhancing household management skills, reducing antisocial behaviour and increasing children's engagement with nurseries and schools. Half of the Support Plans included measures aimed at reducing alcohol or substance misuse. The initial assessments on which the Support Plans were based typically identified key family strengths as their positive engagement with the projects, their desire to change their circumstances and the loving relations between family members.
17. The actual delivery of Support Plans and provision of supportive interventions evolved considerably as the Projects developed. Project workers faced new challenges in responding to the size of families, the intensity of the support required and the need to holistically address a wide range of family problems. The size of caseloads and the model of dedicated worker teams for each family were effective. However, the typically formidable challenges facing families, the frequently protracted nature of assessments, and the sometimes sporadic pattern of subsequent engagement all tended to increase the duration of support programmes by comparison with what had originally been expected. While Projects attempted to avoid families becoming dependent on caseworker contact, this had in some cases proved difficult to achieve and consequently some families whose cases had been formally closed continued to access guidance and advice from Project staff.
18. The supportive interventions delivered mirrored Support Plan priorities, focusing particularly on addressing underlying causal factors such as low self-esteem, depression or substance abuse. Most interventions were delivered directly by Project workers, although these frequently included helping adult family members to access other services, both mainstream and specialist. Key themes in support provision also typically included help with parenting, emotional support, benefits advice, domestic management and children's school attendance. Promoting healthy social networks was another common component of Project support - both in terms of reducing isolation and detaching family members from harmful circles.
19. Through their 'core block' services the Aberdeen and Dundee Projects were able to offer particularly intensive support and supervision. This was seen as highly beneficial for certain families. However, because of the degree of scrutiny involved, core block placements could also bring to light problems previously unknown to Project staff (or social workers). Such 'emerging problems' sometimes included child protection issues, and this not infrequently led to children of 'core block families' needing to be looked after and accommodated.
Working with the Projects: service user perspectives
20. Based on the 78 in-depth interviews undertaken with members of 51 families supported by the Projects (a small proportion of which were follow-up interviews with the same people), it is clear that families tended to be socially isolated and, in the absence of local support networks, were particularly vulnerable to stresses and pressures which in other circumstances they might have been able to weather. Violence within the home was not uncommon. While respondents rarely mentioned intimate partner violence - a finding probably related to the fact that most of the adults interviewed were lone parent women - intergenerational violence by teenage children towards their parent(s) was more frequently acknowledged.
21. Confirming inward referral monitoring data, service user interviews emphasised the wide range of health problems experienced by family members, many of which had not been adequately addressed prior to referral. Drug abuse problems were, in some cases, longstanding.
22. In some families ASB complaints were largely or entirely triggered by children's conduct. This could be exacerbated by non-attendance at school, leaving children unsupervised and liable to get into trouble. In some instances, a poor attendance record was partly due to bullying by peers or attributable to ADHD which could make it difficult for teachers to tolerate a child's classroom behaviour as well as impacting on their capacity for learning. ADHD also caused considerable problems for some parents in the home environment.
23. Asked to describe behaviour which could be considered 'antisocial', family interviewees tended to refer to their own conduct. While this suggests families had accepted their behaviour as problematic, it may also reflect the extent to which the household had been labelled - and accepted the label - 'antisocial'. Such views were balanced by the frequent contention that complaints about family behaviour had been somewhat exaggerated, with conflicts between families and neighbours being two-sided, and the resulting sense of unfair victimisation.
24. Project staff emphasized that families were not formally compelled to accept referral for Project support - nor could such an approach be practicable. Many families recognised that their choice on whether to engage with Project support was constrained, since refusal would place them at severe risk of homelessness and/or family break-up. Others, however, viewed referral more positively, seeing this as presenting an opportunity to 'turn their life around'.
25. Almost universally, service user interviewees spoke positively about their experience of working with the Project and strongly praised Project workers. Progress in tackling family problems was frequently seen as a direct result of Project support. Such views were testament to the commitment and dedication of Project workers. In comparison with other professionals, they tended to be seen as more trustworthy, more sympathetic and less judgemental.
Project support outcomes
26. Evidence mainly from Aberdeen and Dundee suggests that families accepted for Project assistance were typically in receipt of such help for about 9-11 months. It is not possible to derive comparable figures for the three more recently established Projects. Across all five Projects 70% of families whose cases were closed during the evaluation period successfully completed their agreed support programme. Even among those who had withdrawn or otherwise had their support programme terminated early, most had at least partially engaged with Project help.
27. Project staff assessed 81% of families as being at reduced risk of homelessness/eviction by the time their cases were closed. Although measurement and interpretation is complex, it would appear that complaints of antisocial behaviour had, at this point, been reduced in 94% of cases (Project records here closely matched those of the agencies from which referrals had originated). In seeking to prevent family breakup Projects faced a more challenging goal. Nevertheless, in exactly half of all cases the assessed risk of family breakup had been reduced by the point of case closure, with this figure rising to almost two thirds (63%) among those who had completed support programmes.
28. Across each of a range of health and wellbeing indicators, the overall balance of change during Project support was assessed as positive. For example, in 62% of cases where depression was an issue at the time of the original referral, the situation was improved at the point of case closure; in only 14% of cases had the situation deteriorated in this respect. Likewise, alcohol abuse had improved in 43% of cases while deteriorating in only 10%. Children's educational progress and prospects were recorded to have improved in 66% of cases and worsened in only five%. The aspect of family problems apparently least susceptible to Project assistance was mental ill health.
29. All the Projects were acutely aware of the need to engender lasting improvements in self-esteem, lifestyles and relationships rather than focusing narrowly on the immediate suppression of antisocial behaviour. Crucially, staff member interviews in all the Projects demonstrated a concern to avoid fostering service user dependency and to plan exit strategies for deployment at case closure. A critical factor placing the sustainment of improved lifestyles and behaviour at risk was a reversion to drug abuse. However, although evidence is limited, it would appear that only a small minority of former service users fail to sustain progress at least during the first few months following case closure. By and large, former service users interviewed by the researchers reported maintaining the gains achieved in the course of Project support and complimented Project staff on helping them 'turn their lives around'.
Project-related costs and cost consequences
30. In assessing the economics of intensive family support projects, the evaluation adopts a form of 'cost consequences' approach. This follows from our assessment that it is not possible to undertake a full cost-benefit analysis of the Projects within the scope of the brief. Whilst the cost consequences approach identifies and tabulates relevant costs and benefits, it does not attempt to quantify or monetarise the value of those outcomes to society.
31. The analysis in this chapter is based on activity and cost data to the end of June 2008. Although the three Breaking the Cycle Projects were well-established by this date, they had not been operating for long enough to have fully achieved 'steady state'. The data for the Aberdeen and Dundee Families Projects provide a useful indication of steady state costs and also show the importance of working with a sufficiently large caseload (e.g. of about 20 families) to achieve important economies of scale.
32. Two unit costs have been calculated for each Project - the average cost per family month and the average cost per closed case. Recent activity and cost data show that the average cost per family month was about £1,300 - £1,900, with values falling considerably after the set-up period. Given that some of the Projects had closed very few cases during the evaluation period, the average costs per closed case achieved to date should be interpreted with some caution. However, the analysis shows that such costs will range from about £15,500 - £23,000 if the average duration of contact is 12 months. Some families, however, work with the Projects for considerably longer, which could have a detrimental impact on their unit costs.
33. The benefits (e.g. cost savings) associated with the Projects can be quantitative and qualitative and can arise in the short-term and/or the longer-term. Although many of the cost savings will be experienced by statutory services, some benefits will be enjoyed by the families themselves and by their neighbours and communities. Having considered the outcomes achieved to date and the costs of key services that might have otherwise been required (e.g. those relating to homelessness; looked after children and young people), the overall conclusion is that the Projects may be cost-effective in the short run. The extent of their overall cost-effectiveness, however, depends on the extent to which benefits are realised and the timescale under consideration. Potential longer-term benefits for individuals and for society associated with improved school attendance are indicated, although it may be years or decades before it is clear whether these have been generated by the Projects. Improving family functioning could also have important short-term and longer-term benefits. However, overall, it may not require many positive outcomes for the Projects' benefits to outweigh their costs.
34. It has not been possible to determine the cost-effectiveness of the core units, as separate information on their costs and outcomes is not available. However, the core units will allow Projects to work very intensively with families whose problems and needs may be too complex for them to be managed as effectively through an outreach service, where a longer contract period would be required. It is also likely to be important that core units have sufficient capacity that is used with enough intensity to spread the associated overhead costs across several families over a year.
35. The wider roll-out of the Dundee Families Project model to a new generation of intensive family support schemes has proved a successful venture. As in Dundee, the new Projects have been able to engage with numerous families experiencing complex problems and in many cases facing a significant risk of eviction and/or family breakup. While 'core block' provision may well be a desirable component of an IFSP it is clear that Projects set up without such facilities can be effective in helping to resolve family problems.
36. Because of the relatively short duration of the Breaking the Cycle pilot it is too early to be certain of the exact 'success rates' of the new Projects. It would appear that there have been considerable short term gains, but the longer run impacts and prospects for families are less certain. However, based on the evidence of the longer-established Aberdeen and Dundee projects as detailed in this report, it would appear that there is a good prospect of positive outcomes from schemes set up on this model.