John Bellamy & Anita Cuca Research into Outcomes Among Users of an Integrated Family Support Service John Bellamy & Anita Cuca

Presentation Outline Introduction – evaluating outcomes Family Support Program/ Integrated Service Delivery described Research into outcomes while people are with the Family Support Program Research into outcomes after people have left the Family Support program Conclusions

Evaluating Outcomes Among Service Users Outcomes evaluation – a significant innovation Outcomes defined: what has changed or been maintained for people through participation in a community services program Why evaluate achievement of outcomes among community services programs? Demonstrate that the program makes a difference Better understand how it makes a difference Identify potential service improvements.

Identifying Service User Outcomes PLMs developed with staff Client focus groups and surveys Client Outcomes How to measure outcomes? Funding Bodies

Presentation Outline Introduction – evaluating outcomes Family Support Program/ Integrated Service Delivery described Research into outcomes while people are with the Family Support Program Research into outcomes after people have left the Family Support program Conclusions

Family Support Program Described Home visiting, case-management support for vulnerable and disadvantaged families with children aged 0-17 residing in the Liverpool region. Support is tailored to individual family needs with a focus on early intervention and crisis prevention. Service user presenting needs: child protection, relationship breakdown, domestic violence, housing, household budgeting and financial difficulties. Has a maximum of 85 service users at any one time. Staffed by 10 f.t. and p.t. Family Support Workers.

Integrated Service Approach Allows us to offer our service users easy access to all of our programs in order to meet their holistic needs.

Why Was the Integrated Approach Needed? Five programs working in silos but servicing the same client population Multiple intakes and assessments for the same client families Evidence that integrated or holistic service models are better equipped to help vulnerable families (Scott 2008) Preference in Anglicare for holistic service delivery. Scope for clients to receive more assistance beyond first presenting issue. Potential savings in staff time on assessment and service duplication which could be used in direct service. Sharing of administrative loads across teams. Potential increase in number of services and timeliness of service delivery for clients Potential increase in levels of trust and cooperation between teams.

Presenting Issues Among Service Users Household budgeting “Budgeting has been difficult since husband's hours have been reduced” Parenting, Child behavioural issues “I have learnt when I get stressed I take it out on my kids” Partner relationship “Stressed: having twins that are 3 years old, ex-partner whereabouts, vigilant all the time about seeing ex-partner”

Presenting Issues Among Service Users Legal, Health, Housing “I feel stressed due to my medical issues as my pain can't be controlled some days.” Under-employment or unemployment “I look for work but no luck.” Child Protection issues “I am involved with legal matters regarding getting my children restored into my care.” Social isolation “My self-esteem is low and I feel socially isolated”; “I find it hard to socialise with people because I don't trust them and I feel judged.”

Family Support & ISD - Video https://www.youtube.com/watch?v=uci2tc54W6g

What is the Program/ISD seeking to achieve with service users? Service Aims and Outcomes What is the Program/ISD seeking to achieve with service users? Short- term Medium-term Long-term Increased knowledge (eg. self-advocacy, tenancy) Improved parenting and household management Improved individual and family wellbeing Reduction in stress/anxiety Increased social inclusion and participation Resilience, efficacy and independence Speedy practical assistance and support Improved tenancy literacy/ sustainable accommodation Improved safety and family functioning Integrated service response Improved financial literacy

Presentation Outline Introduction – evaluating outcomes Family Support Program/ Integrated Service Delivery described Research into outcomes while people are with the Family Support Program Research into outcomes after people have left the Family Support program Conclusions

Evaluation of the ISD Approach The Integrated Service Delivery approach was formally evaluated in 2013/14. Some 50 clients and 12 staff were surveyed. Starting with this evaluation has led to two research exercises to measure client outcomes: Pre and post surveys of people currently in the Family Support Program Interviews among ex-service users who have experienced the integrated service delivery approach.

Pre and Post Surveys among current Family Support clients Measuring Service User Outcomes Pre and Post Surveys among current Family Support clients Use of scales, often developed in the psychology field. Scale completed on entry to the program (“Pre” survey), then again 3-9 months later, at time of case closure (“Post” survey) Three scales to cover three key outcomes: Financial Behaviour Scale (FBS) – Is there any measurable shift in self- reported budgeting and spending behaviour? Parenting Sense of Competence scale (PSOC) – Is there any measurable change in sense of parenting competence among service users? Resilience Scale for Adults (RSA) – Is there any measurable change in resilience?

Financial Behaviour Scale Improved Financial Behaviour Financial Behaviour Scale 5 items Self-Rating scale: ‘Poor’ to ‘Excellent’

Parenting Sense of Competence Scale (PSOC) Improved Parenting Parenting Sense of Competence Scale (PSOC) 16 items, Likert scales. Eg: “Being a parent is manageable, and any problems are easily solved” (Strongly agree to strongly disagree) “Sometimes I feel like I’m not getting anything done” 2 sub-scales: Sense of Efficacy as a parent Sense of Satisfaction as a parent

Resilience Scale for Adults (RSA) Improved Resilience Resilience Scale for Adults (RSA) 33 items Semantic differential scales, eg: I feel that my future looks: Very promising _ _ _ _ _ Uncertain 6 sub-scales: Perception of self Perception of the future Structured style Social competence Family cohesion Social resources

Do you agree or disagree with the following statements? Service User Satisfaction Do you agree or disagree with the following statements?

Presentation Outline Introduction – evaluating outcomes Family Support Program/ Integrated Service Delivery described Research into outcomes while people are with the Family Support Program Research into outcomes after people have left the Family Support program Conclusions

Interviews Among Previous Clients 45 clients were identified who had been part of 2013/14 ISD Evaluation 29 interviews were obtained. Of 16 who weren’t interviewed, only 4 were refusals Average length of time away from the program was 1 year and 10 months Interview schedule contained common questions as well as questions tailored to the individual’s previous casework goals In answer to the question, “Overall how have things been going for you since you left Anglicare?” – 14 were positive, 10 mixed and 5 negative.

Before, During and After Anglicare Comparison with Evaluation Study Results Before, During and After Anglicare

Do you continue to apply things learned at Anglicare? Continuing to Apply Lessons Learnt Do you continue to apply things learned at Anglicare?

Continuing to Meet Casework Goals

Common themes in interviews with ex-clients Long-term Outcomes for Service Users Common themes in interviews with ex-clients Improved confidence and self esteem Being supported Financial help Becoming better informed Improved parenting and family management “Being able to keep my children and look after them.” “Most of all I feel more confident and stronger.” “Emotional support to myself to keep up hope and ability to cope.”

Common themes in interviews with ex-clients Long-term Outcomes for Children Common themes in interviews with ex-clients Positive parenting/happier home life Referrals to services Support Stability/Safety Financial or material aid School and learning “Having a stable and safe accommodation.” “The kids are now regular at school.”

Presentation Outline Introduction – evaluating outcomes Family Support Program/ Integrated Service Delivery described Research into outcomes while people are with the Family Support Program Research into outcomes after people have left the Family Support program Conclusions

From interviews of previous service users: Conclusions – Challenges for the Program From interviews of previous service users: Building resilience to adverse life events Budgeting and long-term financial management Ongoing goal achievement

From the pre and post surveys among current clients: Conclusions – Outcomes Assessment From the pre and post surveys among current clients: Resilience, Parenting and Financial behaviour – preliminary results Use of assessment tools

From interviews of previous service users: Conclusions – Outcomes Assessment From interviews of previous service users: Improved confidence, self-efficacy and access to services Improved parenting and family life Improved stress management Value of interviews