Chapter 3: Reiver and Perth Connect Projects: Process and Outcome Evaluations
This chapter focuses on the two interventions - Perth Connect and the Reiver Project - that are designed to assist young people who are experiencing problems with the misuse of drugs or alcohol. The chapter is in five parts. Parts 1 and 2 present individual descriptions of the aims, organisation and content of the two projects. This is followed in parts 3 and 4 by separate process evaluations of the interventions with an analysis of the factors which supported or hindered the projects in achieving their care goals. Part 5 presents a combined account of the results of the outcome evaluations for the two projects. The outcome findings are presented in a combined form because the number of clients and collateral interviewees who participated in the evaluation of Perth Connect were too small to sustain a separate analysis.
Part 1: Description of the Reiver Project
Project overview, aims and objectives
This project supports young people, aged 11-16 years, who are experiencing problems through substance misuse. They also offer support to other family members. The aim of the project is to minimise harm among this client group. The project's approach to clients is holistic and focuses not only on the young person's substance misuse but also on their wider behaviour and circumstances, encouraging positive lifestyle changes.
The project is based within the offices of its parent organisation in Galashiels and covers the entire Scottish Borders region. Interventions are conducted through outreach, and young people are seen at a location close to their home. For most of the study period the project team comprised a project manager, a project worker and an administrator.
Client characteristics and recruitment
The project's clients are young people who are experiencing problems through substance misuse which may be leading to them getting into trouble. Negative consequences of their substance misuse include truanting, offending, deteriorating schoolwork and disruptive behaviour.
Referrals
The majority of clients are referred for alcohol related problems with cannabis use being the next most common reason for referral. The main sources of referral to the project are the local secondary schools and Borders General Hospital. Hospital referrals are generally young people who have been hospitalised as a result of excessive alcohol consumption and are referred from Accident and Emergency or the children's ward which accepts people up to the age of 17. Clients who are identified as having severe psychological problems are referred to other agencies for specialist support. In these instances responsibility for the client is passed to the relevant agency and the project has an important role in helping the young person to engage with the new service.
Recently, an increasing number of referrals have been received from the police, mainly as a result of young people being apprehended during operations targeting street drinking and anti-social behaviour. School referrals can either involve substance misusing individuals or groups of pupils referred due to a specific drug or alcohol incident within a school. The project also expanded the service for a period to include school drop-in sessions to encourage self-referrals.
Caseload and waiting times
The original intention of the project was that each worker should have a caseload of around 10-12 clients. The actual caseload of the project peaked at 30 clients between the two case working staff. The project has not operated a waiting list, although an increased caseload has affected the frequency with which sessions are delivered. In most instances, contact with the client is established within two days of referral.
Nature of interventions
In order to deal with the variety of needs among its target group, this project is highly flexible as far as the content of its interventions is concerned. Interventions include one-to-one counselling, youth work methods, addressing risks through education, and acting as an intermediary with schools or parents. The methods used in each instance are dependant upon both client need and the workers' skills and preferred style of working.
Most sessions are conducted one-to-one using cognitive behavioural methods. Workers cover a variety of drug and alcohol related themes in these sessions including the risks associated with drug taking, legal aspects of drug taking, how to calculate units of alcohol and the role of peer pressure. A variety of resources and materials are used to support the sessions, including videos, booklets, quizzes and games.
The number of sessions can vary from one or two to as many as 12 where more support is required. Sessions are usually delivered weekly and generally last about an hour.
Assessment and care planning
For each client an initial assessment is made using one of two assessment tools; the Rickter Scale or POSIT (Problem Oriented Screening Instrument for Teenagers). The Rickter Scale may be re-administered in later sessions as a device to review the client's progress. Both tools form an integral part of the intervention providing 1) a means of generating dialogue with the young person, 2) a mechanism for examining factors linked to their alcohol and drug use and, 3) a method for identifying and setting personal goals. These goals subsequently form part of an action plan which is agreed with the client.
Location
Appointments with the client can take place at the young person's home if appropriate. In such cases a parent or guardian would always be in attendance. Otherwise, clients are seen in schools, health centres, youth centres or other locations.
Parental involvement
Where possible, workers encourage the participation of parents and joint meetings with the young person and a parent or guardian is a common feature of the work, particularly in the early stages of the intervention.
Case closure
Case closure is decided in consultation with the young person, though where possible staff also consult with parents to assess the appropriateness of disengagement. Towards the end of the study period, the project introduced a follow-up procedure whereby clients are contacted by telephone three to four months after closure to provide feedback on the service, to review their situation and to provide an opportunity to meet with their project worker. Uptake of these appointments is reported to be good.
Part 2: Description of Perth Connect
Project overview, aims and objectives
The aims of the service were described as reducing harm caused by substance misuse among vulnerable young people. Members of the original project team also identified abstention as the ultimate goal of the project. The project seeks to identify and respond to the factors responsible for their client's drug and alcohol use, and takes a holistic approach to its clients and their problems.
The project is based in the centre of Perth and is managed by its parent organisation based in Dundee. The project started in April 2002 and aims to cover Perth and four of its target satellite communities. It has a staff of five when at full capacity, a project leader and four project workers (two PDI funded workers and two seconded posts). The project has experienced considerable staffing upheaval over the period of study operating at one stage with one project worker in post supervised from the parent organisation. Towards the end of the study period both seconded posts were withdrawn
Client characteristics and recruitment
The project targets young people aged 12-18 who are engaging in the problematic use of substances (most commonly cannabis and alcohol). Service users typically demonstrate a variety of related problem behaviours such as truanting, offending and self-harming. Many also have challenging backgrounds and difficult family circumstances, including exposure to drug dealing, prostitution and violence. Recreational and occasional users with no significant underlying or related problems are normally excluded from the project.
Referrals
Most referrals to the project are from the social work department and local secondary schools. There are also fairly large numbers of self-referrals; these are often relapsed clients whose cases had previously been closed, or clients who have been prompted to make an enquiry by a concerned parent. In all cases the individual's consent is required prior to the project engaging with the client, although in some cases the referrer can compel the young person to attend for assessment (this was particularly the case with instances of drug use in schools).
Caseload and waiting times
The number of clients with the project at any one time has fluctuated according to staff levels - from seven cases carried by one worker, to 24 cases carried by 3.5 FTE1 workers. Project workers normally try to establish contact with the client as soon as possible, typically within 48 hours of initial referral.
Nature of interventions
Most of the sessions with the young person are carried out on a one-to-one basis, using a wide range of intervention methods which have been brought to the project by its staff. These include counselling, motivational interviewing and other freely adapted cognitive behavioural techniques, person-centred planning and goal-setting, visualisation, life mapping, cycle of change, befriending, enabling and life skills development, confidence building and diversionary work. The precise interventions that are delivered are left to the discretion of individual workers based on the skills and experience of the worker and the needs of the young person. Group work, although originally envisaged as part of the project, has not been found to be practical.
Contact with the client varies from once a week to almost daily depending upon client need. Sessions with the client typically last about two hours, although this can vary according to the workers' preferred style of working.
Assessment and care planning
Following initial assessment (using Euro ADAD), a care plan is devised to fit the young person's needs. Typically this will be organised around one-to-one counselling sessions, but may also include mediation with a school or parents, support in gaining work experience or buddying by a volunteer.
Location
Outreach work is the main mode of operation with workers meeting with clients in a variety of settings including social work premises, local cafés and the client's own home. Some workers prefer to meet with the young person on the project premises where this is feasible. The project also has an open-door policy at its base in Perth.
Case closure
Clients can be seen for an indefinite period with case reviews taking place every three months. Closure is decided in agreement with the young person. Unless the client decides to leave under his or her own volition then the decision to close is left with the project worker. Most workers attempt to taper the amount of contact with the client as they approach closure.
Part 3: Process Evaluation: The Reiver Project
In the process evaluation we distinguish between those factors which appeared to facilitate the effective operation of the project and those that seemed to limit its effectiveness.
Facilitating factors
Local knowledge
The local DAAT had a critical role to play in setting up the project, for example, establishing the initial gap in service provision, identifying an appropriate parent organisation and establishing links with referring agencies (described further at A3). This role was not without its challenges, however, and highlighted difficulties of having to work closely with the parent organisation to ensure it had in place the necessary management structure and range of skills to support the project, whilst at the same time encouraging it to assume full responsibility for project management.
Staff continuity and commitment
Despite limited job security and career development opportunities (due to short term, fixed term contracts), there has been a relatively high level of staff continuity. This has been critical to the project's success in developing the service and ensuring consistent relationships with clients. Staff also demonstrated an ability to adapt and to innovate the service when necessary; for example, by transforming the service to meet client needs and by broadening the referral base to improve client access (described further in A3).
An important factor contributing to the solidarity evident among the project team has been the mutual support mechanisms they have established. Staff maintained regular contact and met weekly as a team at the project base. These meetings were considered to be particularly important to maintaining team cohesion as the need to cover a wide geographic area meant that staff frequently worked away from the base and had limited face-to-face contact.
Professional engagement
The strategies employed by project staff to engage referring agencies were an important feature of the project's success. Initially the project relied upon a single agency to supply referrals - however this resulted in low numbers of referrals and placed pressure on staff to accept referrals that were inconsistent with the project's target group (see 'B: Limiting Factors'). In response to this, they renegotiated the referral protocol with the original referring agency and sought to identify new referring agencies and build relationships with specific staff responsible for making referring decisions.
This process was facilitated by the local DAAT, who provided a forum to discuss service provision issues and to map out potential referral pathways. From the links made through the DAAT, the project could more easily identify and engage with key personnel within target institutions.
These strategies proved successful in boosting numbers of referrals and establishing appropriate referral pathways. The project has fostered strong links with the region's schools, police and the local hospital. Another factor in the project's new approach has been to 'add value' to referring agencies' existing services. They have contributed to schools' drug policies, supported the police youth offending and crime prevention strategy and helped to relieve the pressure on an over-stretched child-psychiatric service. However this approach - establishing links through contributing to the work of the referring agency - does not seem to have been as successful with other agencies (see 'B: Limiting Factors').
Efforts to establish ties with referring agencies have also created opportunities for partnership working. For example, project staff have given talks as part of the secondary schools' social education programme. Concerns have been raised by senior staff as to the appropriateness of this type of work, given the project's mandate; whilst classroom talks address need at tier one, the project's remit is to target need at tier two and higher 2. However, project staff have sought to defend these actions on strategic grounds. It is argued that these activities raise awareness of the service, encouraging self-referrals, and help to build stronger links with the school guidance staff responsible for making pupil referrals. The evidence for these initiatives encouraging self-referrals is mixed; direct self-referrals to the project increased over the period when class talks were taking place, but uptake of the school drop-in service (the most likely point of contact with the service) remained low and was later abandoned. The evidence for this kind of work helping to strengthen relations with school staff is stronger, and is reflected in feedback received from teaching staff through internal evaluation, and in project staff's own observations:
"When we first started, the schools didn't want us in there. So getting all these wonderful reports from them now - it's like we don't have a problem … The guidance teachers are delighted. They are seeing these young people and they are able to refer them on." (Project Staff)
Availability of suitable venues
Building good relations with other young people's services has also been important to establishing suitable venues for outreach work; in order to minimise the risk of young people coming into contact with other, older client groups very few meetings were conducted in the parent organisation's premises (as this was used as a venue for adult services). The project has experimented with a variety of local authority venues.
The geographic distances involved in providing outreach to a rural area placed a strain on staff resources and were cited as a constant consideration in planning work schedules (see 'Limiting Factors'). Provision of daytime meeting venues in local schools was of great assistance in overcoming some of these difficulties. This reduced the pressures on project workers created by evening visits (a significant factor given the travel time often involved) and offered additional opportunities to undertake group work. This also led to fewer broken appointments - if clients broke their appointments they could be summoned out of class.
However, schools also have certain drawbacks; meetings are normally restricted to a single teaching period, typically less than an hour, and finding a private space in which to work has proven problematic with interruptions a common feature.
"(Name of school) ….. we often get to use the guidance room and you'll get staff walking in and out in the middle of things, although we put a notice up on the door - 'interview in progress'. We sometimes get the medical room but there is a first-aider on this side. That is fine, but then she has to get into the fridge. She has to come in to get into the water supply. So it's not ideal." (Project Staff)
Perhaps the most significant drawback of the school setting is its value to those clients who have been excluded from mainstream education or who choose not to attend school. For this group the project relies on alternative local authority venues such as community centres and health centres, and in some instances the client's own home. The greatest challenge has been when dealing with clients who self-refer and who wish to maintain their anonymity. Maintaining contact and liaising with this type of client has proven problematic and project staff expressed particular concern about working with this group without parental consent, and often seek to encourage the involvement of parents. The project relied upon a range of informal venues such as cafés and youth centres to meet with these clients.
Parental involvement
Involving parents in the intervention has been found by project staff to enhance the project's ability to respond to the needs of the young person. Consequently, where possible, project workers have sought to encourage the participation of parents, or a responsible adult in joint meetings, normally in the early stages of intervention. Their involvement has a number of advantages, enabling workers to: build a more comprehensive picture of the circumstances surrounding the young person's substance use; identify other services already providing support to the young person; mobilise the parents' support; and to provide advice and information to the parent.
"The young person could be telling me anything. It is usually mum who comes along to the first meeting … You are getting a more rounded picture. Also if it is mum - say the young person has ended up in hospital - mum's got all these issues going round. She's in shock. She doesn't know, 'Is it my fault?' You know all the sort of stuff that goes around, 'What is going on and what has happened?' I can also offer mum some support." (Project Staff)
Enlisting the parents' support was a particularly common feature of the work. In some instances this could involve challenging the parents' own behaviour, particularly when dealing with instances of heavy alcohol use. It was not uncommon for project workers to find themselves working with a young person living in circumstances where it was relatively easy to obtain alcohol, and where there was acceptance of hard drinking from an early age - including by parents.
"With one person I was working with, the parents bought the 13 year old a crate of beer. It is very much the family culture. And of course they come out with, 'Well it's okay if they are doing it in the house'. This particular young person was in a lot of trouble - mainly fuelled by alcohol. So I did a lot of units work with the family, bringing in a message about how young people are still developing. They shouldn't be able to drink as much as adults. And just about what is sensible drinking." (Project Staff)
Project workers also provided parents with copies of information materials and consulted them towards the end of intervention to assess the appropriateness of closing the case.
Whilst involving parents was seen by project staff as enhancing the value of the intervention, it was also apparent that this policy was in part influenced by the concerns of referrers and project workers themselves, some of who expressed anxiety about seeing clients without parents' knowledge, particularly younger clients.
Client involvement
The project invested resources and time involving young people in the development of the service - for example, by surveying the views of key stakeholders, including young people on the value of the service. These findings led to various service developments, for example the investment in a project web site and review of text messaging as a possible means of communicating with the client group. The project manager also sat on the DAAT Young Person's Sub-group which had input from young people and was reported to act as a useful source of advice and ideas for the project. Efforts were also made to establish a group constituting young people who had engaged with the project, although attendance was poor and the initiative was abandoned.
Limiting factors
Service models
It was a widely held perception that the project, in its early development phase, was unable to meet the needs of the new client group and to secure an appropriate level of referrals. The main reasons cited for this were a reliance upon a single referring agency and a lack of fit between the proposed service model and local service needs. The original approach of the project had been an attempt to import the service model used by the parent organisation - an adult alcohol service using group-based interventions - that proved inappropriate for use with young people. However, it was eventually agreed to abandon the parent organisation's intervention model and replace it with a more flexible one-to-one approach, whilst a revised strategy was set in place for establishing links with a range of referring agencies (see 'A:Facilitating Factors', above).
Difficulties in staff recruitment
Recruiting staff with an appropriate mix of skills also emerged as a limiting factor, and was responsible for restricting the project's early development. Difficulties in recruiting workers with experience in both substance misuse and youth work hindered the project; the staff responsible for client caseloads had no prior experience of working with the target age group.
Importantly, this issue was acknowledged and a member of staff with youth work experience was employed (albeit for a short period). It was reported that as the project progressed and staff confidence and experience of working with the target group grew, the issue became less significant to project functioning.
Quality of referrals3
Whilst project staff undertook extensive measures to boost referrals to the project (see Facilitating Factors), the quality of referrals was variable.
The target group were described as 11-16 year olds developing a clear pattern of problematic behaviour linked to substance misuse, as distinct from young people showing signs of dependency or simply experimenting with substances:
"It was set up for people not who got caught doing something once, but people who were getting into more of a pattern where things were going wrong for them, they were getting into trouble with the police or they were truanting or they kept getting ill and ending up getting their stomach pumped or something like that - so you weren't looking at dependency - it was one of a range of problems they were experiencing." (Senior Staff)
There was some ambiguity regarding the fit between the service and client's level of need; while some clients clearly demonstrated a variety of related problem behaviours, others were at an earlier experimental stage with few, if any, associated problems. To deal with this variation the project adapted the service to level of client need, in some instances offering relatively brief intervention. Referring agencies tended to assume a perfunctory role, passing on client details rather than actively screening clients according to need.
Actual uptake of the service was extremely variable, with motivation to engage partly determined by referral source. For example, low levels of engagement were especially apparent among young people referred by the police. All parents of children referred by this route are automatically contacted by the service if they do not instruct the police to withhold their details. In most instances, low uptake was explained by low perceived need apparent in this population. In some cases project staff speculated that there had been a real need to intervene but the parent was reluctant to engage.
"I think probably one of the main reasons that we don't get as big an uptake (with police referrals) is because a lot of the youngsters, and maybe as much as 50% of them, haven't actually been drinking, they've just been there and had their details taken. Many parents come back to us and say, 'We don't think there is a problem, we will deal with it ourselves', and that's fine. Some of the families we don't get any response from, and they tend to be the ones we know of. They have a very chaotic lifestyle, maybe mum and dad are not really that fussed whether their child gets support or not." (Project Staff)
The lack of opportunity to establish a dialogue with the parent and parents' general wariness of the police would appear to explain why those clients with the level of need targeted by the service chose not to engage. This contrasted with level of engagement in schools and the local hospital where staff at these institutions actively facilitated access by arranging times and providing a space in which to meet and encouraging the young person to attend.
Professional boundaries
Whilst the project has formed strong partnerships with some referring agencies it has been less successful with others, most notably social work, where, it was reported there was a "tension" between the agencies, with a perceived failure by social work to recognise the contribution made by the project. One practitioner suggested that there was a lack of communication and co-ordination, with agencies "treading on each others toes."
The main source of these difficulties has been differences in opinion on the project's holistic intervention approach. For those directly involved in the project it is regarded as key to the project's success in engaging and establishing productive working relationships with the client group.
"It's no good us banging away about drugs and alcohol if their dad is kicking the hell out of them, for instance. We need to try and address that first then look at the drug and alcohol stuff. 'Cos it has to encompass all these things. It has to be holistic. If it isn't we are wasting our time." (Project Staff)
However, one senior practitioner whilst acknowledging there was a need for a specialist drug and alcohol service, believed there was also a need to establish a more specific role for the Project working as part of a support team, "to ensure the young person gets the right support from the right person for the right thing".
Both positions would appear to have their merits and clearly there is potential value in establishing a partner relationship. Resolving these different positions would appear to be a managerial matter. There is a need to find a mechanism for bringing the agencies together to address the underlying relationship issues and to focus on the needs of the client group.
Geographic reach
For most of the study period, the project caseload was carried by two members of the project team. The heavy reliance placed on these staff was responsible for creating some difficulties meeting the needs of clients, particularly in outlying rural areas. To minimise the amount of time project workers spent travelling between meetings, efforts were made to allocate caseloads on a geographic basis - however, this was not always practical. Towards the end of the study period the project also joint funded an outreach worker in a voluntary organisation in the southern edge of the target area. This arrangement was set in place to help overcome the problems that the project had in reaching their clients. It was too early to evaluate the success of the initiative.
Key findings from Reiver process evaluation
- Recruiting project workers with experience and training in working with young people and substance use is important to project development and functioning.
- Parental involvement has been seen as a beneficial feature of the service. However, it is important to respect the wishes of the young person where anonymity is requested, and to recognise that lack of family support can be a factor responsible for the young persons problems.
- Covering a broad target area from a single site and with a small staff presented considerable logistical problems in delivering the service. Dividing the service up into geographical areas and working closely with schools to provide daytime meeting venues helped to address these problems.
- Finding suitable venues in which to meet and maintaining contact have proven difficult when working with young people outside of mainstream education or who wish to retain their anonymity. Agreeing communication channels from an early stage and a reliance on more informal meeting venues have proven useful when working with this group.
- Working in a rural locality can result in caseworkers operating in relative isolation from each other and the parent organisation. Having regular meetings where workers can discuss their cases and share ideas has been important to maintaining team cohesion and overcoming some of the pressures of working alone.
- Working in close partnership with referring agencies and building strong links with individuals responsible for making referral decisions has been important to securing sufficient numbers of referrals. However, care is needed to ensure that these relationship-building activities are consistent with the overall aims of the service and that agencies are clearly briefed on the type of clients for which the service is designed.
- Adopting a flexible intervention approach has been important to ensuring the service addresses individual client need. With a relatively open-ended approach close collaboration is needed with other agencies working with the same client group to ensure clarity of purpose and effective use of local resources.
- Finding ways of involving young people in the development of the service whilst desirable has proven particularly challenging. Former users have been reluctant to engage in group activities, although school surveys carried out with the wider target population have been helpful in providing ideas for how the service might be promoted.
- Harnessing the local knowledge of the DAAT has been important to the development of the service, particularly in contacting local service networks and forming links with referring agencies.
Part 4: Process Evaluation: Perth Connect
As with the Reiver project, we distinguish between those factors which appeared to facilitate the effective operation of Perth Connect and those that seemed to reduce its effectiveness.
Facilitating factors
Links with professional networks
The local knowledge and expertise of the project leader was critical to the project, particularly in the early stages. The leader's reputation and links with the local service network enabled the project to build a steady stream of referrals and meant that project workers " hit the ground running" when they came into post. These links helped to secure the local social work department as the project's principal referrer, although efforts to establish new links, most notably with local GP practices, proved less successful.
Links with the local social work department were consolidated at a grassroots level by the project workers. Informal feedback from the clients and evidence of client engagement with project workers were used to corroborate referrers' personal assessments of the project and its competency in working with the client group. Through this process the project has developed a reputation for relating well to the needs of the client group and for challenging difficult problem behaviours.
Quality of referrals
The referrers' relationship with the young person impacted on both the appropriateness of referrals and the young person's willingness to engage with the project. Social work consistently made referrals at tier two and three in line with the project's intended client profile. This consistency was explained by the amount of contact they had with clients and the quality of the assessments they were able to make. In contrast, police referrals and some school referrals were less consistent in this respect, and were attributed to a limited understanding of the client's personal circumstances and needs.
Social work also helped the young person to engage with the project by providing relevant insights into their personal history and circumstances and by hosting joint meetings to introduce the young person to the project worker. Other agencies (most significantly the police) lacked the necessary knowledge and expertise to facilitate engagement.
"The route that works very well is social work, because they will invite you to meet the young person first. They will talk to the young person about what is involved. So there is a lot of pre-discussions going on already. With the police it is more difficult. The social worker has already had that discussion in a casework context. So when we come in to meet the young person there is a degree of understanding as to what it is about. Also we can establish before we come in that that is the proper level of referral - level two or level three. We can then engage the young person and we can negotiate that and work it back in again into the care plan." (Project Staff)
The majority of referrals to the project were at the upper end of the target age range (mainly 15-18 year-olds) and were resident in Perth. The low numbers of referrals from rural localities is explained by resource limitations and inability to establish bases in outlying areas (see 'D: Limiting Factors'), whilst the age profile of the client group was attributed to local social workers' tendency to retain their younger clients and to engage in partnership working once they reach 15.
Team spirit
In the early stages of the study project staff demonstrated a strong camaraderie and commitment to the project which was credited to the enthusiasm of the project leader. Regular contact with other project staff at the project base was an important source of support to project workers and provided an opportunity to share problems and to exchange ideas on ways of working with clients. Staff saw each other on an almost daily basis and attended a weekly team meeting.
"Personally, it's a great team, supportive-wise everybody's really brilliant, everybody supports each other, and it's great for suggestions, great for ideas. And there's such a wealth of different experience, different backgrounds that you get a brilliant view, you get somebody else's view and it's completely different and it makes you think, which is quite good." (Project Staff)
Varied intervention methods
Project staff had a diverse range of skills and experience from their backgrounds in childcare, children's rights, youth work and work with the homeless. This brought a degree of flexibility to the way in which the project could respond to client need and encouraged the exchange of ideas and learning between project staff.
A wide range of one-to-one intervention methods and approaches have been employed by project staff, with choice of technique dictated by the project worker's experience and the needs of the young person.
"You've got a clear idea of a sort of constructive network to build round this young person to get them to where they want, or at least further down the road towards it. So I find person-centred planning techniques can have an effect with certain young people. With certain other young people, I won't use them. You've just got to pick and choose really." (Project Staff)
Whilst the diverse backgrounds of project staff and free exchange of ideas has created an environment conducive to innovation and new learning, it has also led to some concerns regarding the consistency and efficacy of intervention with the methods applied left to the discretion of the project worker. Plans were made to catalogue the range of techniques as a resource for fellow and future workers, but high staff turnover resulted in much of this potential learning being lost.
Person-centred approach
Project workers took their cue from the young person. Consequently, intervention methods were selected in response to the client's specific and sometimes evolving needs. In this respect, the extent to which intervention could be planned was dependent upon client stability and circumstances at time of intervention. For example, workers were more likely to work through pre-planned exercises with the client during those periods when their life was relatively stable and they were less prone to stress. A more chaotic episode could prompt more intensive problem solving and advocacy work aimed at stabilising the client's behaviour.
"I would certainly have a plan in my head before I went in and we would work through it that way. That would be okay if they were on a relatively stable period but if it was a chaotic period, then you tend to be reacting to whatever is going on and it would be problem solving." (Project Staff)
This level of variability also dictated the amount of time that workers spent with the client. For more structured activities workers normally met with their clients once a week, usually at the same time to encourage routine, while during periods of relative instability intervention work could be more intensive, in some instances resulting in the worker meeting with the client daily until the immediate problem was resolved.
Partnership working
Working in close partnership with referring agencies has been a positive feature of the project, particularly with the principal referring agency, social work. However, integrating project work with social work care plans and ensuring that work boundaries and areas of responsibility are respected has presented some challenges. Most significantly, some concerns were raised by referrers about the extent to which the project focuses on drugs and alcohol work, with project staff sometimes seen as performing a general resource worker role rather than focussing exclusively on substance use issues. Significantly, project workers themselves describe the work they do as resource work in so far as they seek to identify and respond to the factors responsible for their clients' substance use. This was seen to be consistent with the project's holistic, person-centred approach which involves responding to both immediate and underlying need in order to make a positive impact on client substance use.
"You get involved at all levels. You don't focus purely on the alcohol. You would look at all the issues behind it and address them. You wouldn't have it off and say that is someone else's problem … it's taking a holistic approach towards the young person." (Project Staff)
The project's response to these concerns has been to ensure the needs of the client remain the partnership's primary focus. Consequently the project's role has been negotiated on a case-by-case basis. Feedback from referring agencies who have worked closely with the project have responded well to this aspect of the project and to workers' commitment to the young person.
"Sometimes you can spend ages just chasing people. But it hasn't really been an issue with (project worker). I feel it's good because there is that sense of autonomy - we'll get in touch with them, they'll get in touch with us. We both feel that we're working in partnership. What we'll try and do is complement each other in the message that we're saying. We did a joint visit to [client name] yesterday and that was really good because it was allowing him to see that I was supporting her and continuing to try and meet with him and it was really important for him to see that (project worker) was reinforcing my relationship with him." (Referrer)
The project's independence and specialist credentials were seen by social work as important factors in helping to gain the trust and confidence of the young person.
"Getting CONNECT involved was an opportunity for us to try to sell it to the young person [going into residential care] and say, 'Look, this is sort of a specialist for you. Somebody that'll come and meet with you and spend time with you and help you try to face up to some difficult issues', because this person just wasn't engaging. They hadn't built up a good relationship with their previous social worker… It seemed like a really pertinent move to provide them with someone separate from social work who they could maybe talk to." (Referrer)
These beliefs were supported by the project workers' own observations and by the clients themselves who valued the degree of confidentiality afforded by project workers.
"Their strengths are confidentiality. You can tell her anything. And you know it's not going to be put forward unless it has to." ( YPAG Member)
Limiting factors
Managerial issues
The project has a relatively complex partnership arrangement: as well as two PDI funded posts contracted to the parent organisation, the project also hosted two seconded posts from the local social work department. There were no discernable differences between the service provided by the PDI funded workers and the rest of the project, with all workers operating primarily on an outreach basis and all line managed by the project leader. The project leader carried out these management duties on behalf of the three main project partners, the DAT, the parent organisation and the local social work department, through a project advisory group.
Initially the project ran relatively smoothly attracting a steady stream of referrals and establishing a strong team spirit. Tensions then emerged within the advisory group over the project's status and strategic direction. Although the specific details remain unclear, a failure at the outset to establish a formal partnership agreement detailing the project's management structure and accountability was identified as a critical oversight, and its absence was regarded as a contributory factor to project partners' inability to agree a way forward for the project. This loss of impetus had important ramifications for project functioning, affecting the project's professional reputation and staff morale and supervision, and resulting in job insecurity and restrictions on project development. Despite these problems, new project staff are committed to the project. They have made strenuous efforts to re-establish the service and its client base and continue to manage heavy caseloads to meet prevailing demand.
Administrative support
It had originally been intended that the parent organisation would provide administrative support from its base in Dundee. However, the physical distance between the two organisations made this impractical. This was partially resolved by relying on volunteer support workers and issuing project workers with personal laptops to assist record keeping, but led to additional problems with concerns emerging over client confidentiality, inconsistent record keeping and inadequate procedures for collating and analysing client information. Improvements were made following a review of operational practice instigated by the new team leader, and the move to new premises which provided secure office space and resources for a part-time administrator.
Difficulties in becoming established in rural communities
A feature of the original project proposal was to establish the service in four rural communities surrounding Perth. However, the majority of referrals have been from child care services within the city. The project has found it difficult to establish bases in the outlying towns serving these rural communities where it was reported local residents are reluctant to acknowledge the need for a local drug and alcohol service, and where it was difficult to maintain client anonymity.
The project was able to establish a physical presence in one town through joint partnership arrangements with other local agencies providing services to young people and their families living in the area. This work may provide a model for delivering this type of service in other rural communities. However, it is likely to have significant resource implications.
Problems with premises
As well as providing an outreach service, the project also operated an open-door policy at its base in Perth, where clients were encouraged to drop in for a chat or to discuss issues of concern at their own discretion. This created staff safety issues in the project's original premises which had no reception or secure work areas for staff and only one point of entry and exit from the building. These concerns were heightened by the project's system of working which meant that members of staff were sometimes left in the building on their own or with untrained volunteers.
"If you are in the end room and someone is kicking off you cannae get out 'cos there is only one exit and it is at the end of a narrow corridor…… I had a student there at one point and one of my young people kicked off and he felt very vulnerable." (Project Staff)
The physical layout of the building was also responsible for raising client security issues with concerns that shared office space could result in client confidentiality being compromised. Most of these concerns were addressed by the move to new, larger premises which offered a wider range of facilities, including a visitor reception, private meeting rooms and secure office space. These new premises also offer scope to expand the service. However, the project has been unable to realise this potential owing to prevailing staff shortages.
Difficulties in introducing group work
Group based intervention work, though envisaged as part of the service, has not been found to be practical. Attempts have been made to set up young people's groups but these have not been well attended. Finding appropriate venues and co-ordinating client availability has proven a major challenge, particularly in more rural areas where clients are physically dispersed.
"We found that our biggest problem is that our kids come from everywhere. Now to get them together in a group is difficult. To get them together and compatible is more difficult. Because you've got boundary issues, rural versus city issues all that sort of stuff." (Project Staff)
In the earlier stages the project also attempted to set up a parent's group at the project base, but low attendance resulted in this being abandoned. The move to new, larger premises means the facilities for running groups is greatly improved. However, staff shortages have led to plans to restart group work being placed on hold.
Some success has been achieved in recruiting pre-existing groups of young people brought together following a school-related drug incident, though much of this work has been relatively short-term and not all clients identified in this way fit the project's target group profile in terms of level of need. In some instances these group sessions have been used to screen for clients for more intensive one-to-one work.
Lack of client involvement
As well as group-based intervention work the project also attempted to involve young people in project development issues by setting up a young people's advisory group. Clients who had received more intensive support were invited to participate in the group, and whilst this had some initial success, most notably in assisting with the refurbishment of the premises, only two continued to participate on a regular basis. This apparent lack of support was put down to a desire amongst former clients to move on in their lives.
"You need to have young people who have come through the process and want to stay around. It is difficult to get young people who want to stay around when it is not seen as a positive part of their life. They are there because they have got lots of negative things going on. When you fix the negative things you don't want to stay." (Project Staff)
Consideration has also been given to establishing a new group, but has been placed on hold because links with suitable candidates have been lost following staff departures.
Assessment and monitoring
The project adopted Euro ADAD as its standard assessment tool. It was found to be a useful tool for identifying factors responsible for substance use and for agreeing goals with the client, although it proved impractical to use with dysfunctional clients or clients who were going through a chaotic period in their lives.
In some cases workers have adapted the tool to make it easier to use and more engaging for clients. Sometimes this has simply involved making minor adjustments to language or altering the way that questions are asked. In other instances additional measures have been incorporated to provide information on topics such as homelessness and dependency.
"If you look at it, it doesn't look like the kind of instrument a young person would be interested in. But it's how you pitch it. It's how the questions are asked. You've got to rub the corners off it. You've got to reframe questions, you've got to make it actually entertaining in some way." (Project Staff)
"I think where it falls short is with the drugs and alcohol project and it doesn't address the drug and alcohol need. There's a page on drugs and alcohol but it doesn't look at how they would rate their dependency, it doesn't look at how ready they are to change that use and if they're substance users, which ones they're prepared to stop and which ones they're not, so you have to kind of do a different assessment on top of that." (Project Staff)
Repeated efforts by project staff to adapt and amend the tool appear to have undermined its value as an objective assessment method. Attempts were made to devise a standard version of the tool for use within the project but resulted in the instrument becoming unwieldy and difficult to maintain the client's attention.
Euro ADAD has not been used to assess progress towards goals. Instead project workers have generally relied upon anecdotal indicators of change such as school attendance, making an important appointment, staying alcohol-free and attendance at meetings with the project worker.
"To me, how I would gauge the effectiveness is that young people are actually still working with me after this time. And also if I'd offset how their drug use was and how that was impacting on other areas of their lives." (Project Staff)
This form of assessment was consistent with the project's unsystematic approach to monitoring and record keeping. Whilst various recording documents, such as referral and screening forms, plan for change protocols and records of contact had been drawn up, these were not always consistently applied and case notes and records were sometimes incomplete.
The reason for these shortcomings in client monitoring are complex, but a number of contributory factors were evident. These included: limited commitment to measurement of client outcomes; lack of support for measurement tools; inadequate administrative support; and concern over the security of client case files held at the project base.
Key findings from Perth Connect process evaluation
- Pre-established links with the principal referring agency, social work, have been critical to the project's early success in securing client referrals.
- The level of knowledge that social work have about their clients has been important to ensuring that referrals match the intended target group and to encouraging clients to engage with the project worker.
- Bringing together a project team from diverse backgrounds can help to create a stimulating working environment, encourage the free exchange of ideas and enable the project to respond flexibly to client need.
- The capacity to identify, agree and respond to the factors responsible for the young person's substance use is important to gaining the client's support and involvement in the project.
- The project workers' independence and specialist credentials can be an important asset when attempting to secure the young person's trust and confidence.
- One-to-one intervention methods appear to provide the most effective means of responding to individual need and are preferred to group methods by the client group.
- Close collaboration with partner agencies and a joint recognition that intervention is an evolving and relatively fluid process is essential to ensuring effective partnerships with other care workers.
- When more than one employer is providing staff to work as part of a project team, there is a need for senior managers to agree a management structure and responsibilities from the outset.
- Adequate administrative support and secure premises are preconditions for implementing effective client monitoring systems, as is developing an assessment tool which can be used with the full spectrum of clients seen by the service. Assessment tools also need to be used to measure the progress of clients.
- Retaining a degree of staff continuity is essential to project viability. Failure to do so can have major long lasting ramifications, for example, loss of commitment from referring agencies and undermining its ability to attract qualified staff.
Part 5: Outcome Evaluation for Perth Connect and Reiver
This section examines the impact that the projects had on the young people's lives from the perspective of the young people themselves and that of others who knew them well. The findings derived from the clients' own responses are presented in the first section. This is largely presented as a qualitative analysis, although it also includes some quantitative data. The second section reports on the collateral interviewees' assessments of the clients' progress.
Impact of the intervention on clients' lives: client perceptions
The great majority of the Reiver and Perth Connect clients were positive in their assessments of the benefits they had derived from the projects. As we will see, a high proportion of the clients reported changes in their lives or behaviour which corresponded with the projects' main objectives.
Reduced consumption of drugs and alcohol
All but one of the Reiver clients reported that their attendance at the Project had led to changes in their substance-related behaviour and activities. The main change was in relation to their consumption of alcohol. A few said that they had stopped drinking alcohol altogether but most of them reported having moderated their consumption, either by drinking less or by switching to less intoxicating drinks. Several of the young people said they had reduced their consumption of other drugs as well as a result of their attendance at the Project.
"I don't drink as much as I used to cos they've gave me lots of information on what alcohol can do to you and it kind of scared me." (Reiver client)
"Ah dinnae smoke as much hash anymore. ah drink less and ah dinnae really drink the same stuff as ah used tae." (Reiver client)
The young clients of Perth Connect also reported that their use of various substances had altered substantially since becoming involved with the programme. As one of the young people put it; 'Wi' them talkin' tae me, they made me realise just what kinda trouble ah was makin' for myself.' Reductions in their consumption of drugs and alcohol were reported as having increased over the period of the study. While none of the young people had stopped drinking alcohol completely by the end of the study, all of them claimed that their intake was greatly reduced. They also said that their use of drugs had been modified considerably. The following accounts were typical.
"Well, drugs…ah'm not takin' anythin' other than cannabis. Em, alcohol, ah now only drink about once a week, at the week-ends but ah just have a few drinks, ah don't now go out jist tae get drunk and ah used tae get drunk all the time." (Perth Connect Client)
"I can say 'no' to like smack, speed, I can say 'no' to all that. Cos, just like here we have talks, like talking about what the stuff actually does tae you, the side effects and things like that. We've had videos and everything that I've looked at with people on it, and it was like a reality check, like "Is that what people see me like?" I never want to go down there again." (Perth Connect Client)
For both of these projects, analysis of the young people's responses at the time of the two interviews confirmed that the reported modifications in their use of drugs or alcohol were sustained for the duration of the study.
Changes in behaviour and social networks
In addition to changes in their consumption of alcohol and other drugs, most of the Reiver clients also reported changes in other aspects of their behaviour, some of which they attributed to the influence of the project. In particular, they claimed reduced involvement in anti-social activities such as vandalism, fighting and graffiti writing. Nine of them said that they were also less likely to get into trouble with the police. Several of the young people qualified their comments by making it clear that, while their behaviour had improved, it had not necessarily been completely transformed. As one client said, 'There's still some things I dae that I used tae dae but no' as much, so they've helped me cut oot the major stuff.' Several of the young people at Reiver also claimed that their attitude to school had altered and that, whereas in the past they had been frequent truants, partly as a consequence of their drug or alcohol use, they would in future be attending regularly.
In part, the young people attributed the changes in their behaviour to a reduction in their consumption of alcohol: 'Because I've calmed down on the drinking I've no' been picking up charges and stuff like that.' However, several of the young people indicated that their changed behaviour was a result of them acquiring a greater measure of self-control as a result of guidance received from the project workers.
"It's made me feel better 'cause they've given me confidence so that when I think about doing something that I ken is wrong then I can stop myself from doing it now." (Reiver client)
Reiver's efforts to divert the young people on to more positive activities would also, according to their clients, appear to have had some measure of success.
"They've encouraged us tae get in tae the youth centre, and I'm going away on trips wi' them, so I'm no' hangin' aroond the streets an' stuff." (Reiver client)
However, some of the Reiver clients attributed positive changes in their behaviour either to the fact that they had simply moved on in their lives or to the intervention of other agencies. One had taken up study at college, two had become employed and another had got involved in outdoor pursuits through the intervention of social work.
All of the Perth Connect clients reported positive changes in their behaviour which they attributed to their involvement with the project. They were, they claimed, now creating and getting into much less trouble. As with Reiver, there were a number of ways in which the project was said to have influenced their behaviour. Partly, the latter had changed as consequence of their reduced use of drugs or alcohol: 'Well ah've stopped getting intae trouble now 'cos ah'm off the drugs now.' In part, too, the Perth Connect clients attributed the fact that they were no longer getting into trouble to the fact that they were now spending much of their time at the Project engaging in its various activities. This acted to divert them from negative activities and to both encourage the development of more constructive pursuits and the formation of alternative friendship networks.
"They gave me somewhere tae go instead of walking round the streets and that helped tae put ma mind on other things. Instead o' getting drunk at nights we had things organised for us in Connect, there was always somethin' going on, even if it was just sitting chatting." (Perth Connect Client)
"I'm actually doing things instead of going about breaking into places, I'm actually doing things like bowling and swimming and stuff. I go to the gym every Wednesday so I'm doing things more…..I'm doing more constructive things with my life now, more activities and stuff instead of…..like I said, instead of going around getting into trouble." (Perth Connect Client)
All of the Perth Connect clients reported that they had made changes in the company they kept and had either stopped seeing former associates altogether or had reduced the amount of time they spent with them. They attributed this, very largely, to the influence of the project; 'They stopped me hangin' aboot wi' like all the folk that ah wis getting intae trouble wi'.' These changes were sustained or, in some cases, enhanced in the course of the study.
In contrast to the clients at Perth Connect, at the time of the first interview only one of the Reiver clients said they had changed who they spent their time with since being involved with the project, 10 said they had not. Two of the young people had kept the same friends but, acting upon advice received from the project workers, claimed to spend less time in their company. By the time of the second interview, two more Reiver clients had changed their friends, but in neither case did they attribute this to their involvement with the project. One boy came to regard his former friends as 'immature fannies' while another decided to 'keep better company' where there was 'no trouble.'
Improved relationships with family members
Several of the young people at both of the projects claimed that their relationships with other members of their family, especially their parents, had improved as a result of their participation in the programmes. Some of this improvement was attributed to changes in their consumption of drugs or alcohol: 'Comin' here ah came off drink and that and ah stopped being so aggressive tae ma family and we get on a bit better.' Some of the improvement was portrayed as being a result of changes in their behaviour in the home and in the way in which they related to significant others. This, in turn, was very largely attributed by the young people to the intervention of the project.
"Well, like, ma keyworker would always give me advice if ah discussed something with her about ma family then ah'd take that advice back and see if it worked and if it didn't work then ah'd go back and tell her but most of the time it did and that was good….so she helped me through a lot of family stuff, she gave me good advice. She made me understand ma family more, she made me understand how they were feelin' sort of thing." (Perth Connect Client)
Psychological and social benefits
In addition to the changes reported above, a number of other important benefits were reported by the clients of the two projects. These related to their general sense of wellbeing and their ability to engage effectively with the wider world. For some of the young people, simply having somebody to talk to, not just about alcohol or drugs but about anything that was concerning them, was highly valued. Many of the young people appeared not to have anyone else with whom they could discuss, in total confidence, things that were worrying them and seven of the Reiver clients and all five of the Perth Connect clients identified having somebody trustworthy in whom they could confide as being one of the more valuable aspects of their involvement with the projects: 'Being able to talk to (project workers) about how I'm feeling, what's going on in my life has been good. You can trust them.'
While it was more commonly reported by clients of Perth Connect than those at Reiver, young people in both of the projects also said that they had appreciated the counselling and emotional support which they had received from the project staff. This, they said, had helped them to address problems in their lives and had made them feel happier.
"They've given me a purpose and yeah I feel a lot better about myself because ah thought ah was gonnae be a bum. Everything they've done for me here has helped one way or another." (Perth Connect Client)
The five Perth Connect interviewees all spontaneously identified an enhancement of their confidence and/or their self-esteem as being a major benefit of their participation in the project.
"Ah don't know exactly what they've actively done but whatever it is they dae, ah feel much better aboot maself…ah can talk tae the worker and that so that makes me feel better 'cos like that helps me no' tae feel bad aboot maself. And the confidence ….ah don't know how they've done it but they helped, ah'm a lot more chilled." (Perth Connect Client)
In addition to being beneficial in their own right, these psychological improvements were also credited with assisting the individual in dealing with any substance misuse problems they might have and in becoming more outgoing and making new friends.
The majority of the Reiver clients also claimed that their contact with the project had enhanced their confidence or made them feel more positive about themselves: 'They made me more confident about maself. Ah used tae be all shy and that but no' so much now….now ah feel good aboot maself.' In part they attributed this to counselling which they received from the project staff. Comments such as, 'It wis speaking tae somebody that did it;' or 'Showing me no tae care what folk think of me and ah can get on wi' what ah want tae dae' were typical expressions of this point of view. However, they also attributed their more positive feelings to the fact that their behaviour, including their drug and alcohol consumption, had changed for the better. According to these young people, their changed behaviour made them feel good about themselves.
"It's changed ma opinion about maself and everything else around me. Before when takin' all the drugs …ah jist thought nothin' about maself, ah wasnae interested in doing anythin' and ah wasnae interested in anybody. That's all changed thank God." (Perth Connect Client)
It also meant that they got into trouble with the police and other authorities less often and this appeared to contribute further to their enhanced sense of wellbeing.
Comparison of responses in the two interviews
There was a high degree of consistency in the responses which the Reiver clients gave in the two interviews. Positive changes in behaviour and family relationships tended to be already present at the time of the first interview and, perhaps more importantly, to endure until the second interview 8 months later. A small number of the clients indicated that they had made positive changes to their activities or friendship networks between the two interviews. Apart from one boy who reported that his relationship with his mother had deteriorated by interview 2 and another who claimed to have increased his consumption of drugs and alcohol in the 6 months preceding the second interview, none of the changes reported between the two interviews were in a negative direction.
All of the Perth Connect clients claimed to have made additional progress in various areas of their lives between the two interviews. Two of the young people had further reduced their consumption of drugs or alcohol, two reported having more or less severed all contact with former substance-misusing friends and two said that relations with other family members had improved. One of the clients claimed enhanced confidence and self-esteem. None of the Perth Connect clients reported having regressed in any way between the two interviews.
Impact of the intervention on clients' lives: collateral interviews
Collateral interviews were conducted for 9 of the Reiver clients (8 mothers and 1 social worker) and 1 of the Perth Connect clients. In each case, the interviewees had been identified by the young people themselves as being in a position to comment upon their progress subsequent to their participation in the project.
The fact that we were only able to obtain a single collateral interview for Perth Connect means that it is of limited utility as a means of corroborating the clients' accounts. However, this interview - with the girlfriend of one of the clients - produced a wide-ranging endorsement of the client's own claims that his behaviour and emotional state had improved substantially since his involvement with the intervention. She confirmed that; ' before he was at Perth Connect he was doing like every drug there is, mixing them, but since he's went to Perth Connect they've helped him come off the drugs'; that his involvement in anti-social activities had ceased; that he had changed the company he kept; and that he was 'a more settled, quieter person.' According to his girlfriend, apart from the advice and guidance they offered, the project staff had also helped by providing the client with an opportunity to discuss in confidence things that were troubling him: 'They were there for him tae speak to about how he felt about things 'cos he didnae like tae speak tae anybody about what was goin' on so they were the first people that he started speakin' tae about his problems.'
The collateral interviewees for the 9 Reiver clients appeared to have a fairly extensive and detailed knowledge of the young person and his or her activities. Their ability to comment upon the client's progress was almost certainly assisted by the fact that in 8 of the 9 cases the collateral interviewee was the young person's mother. The other interviewee was the client's key worker from another project. The mothers were, of course, especially well placed to observe changes in the client's behaviour and attitudes in the home. Other changes tended to be inferred indirectly; for example, the young person's consumption of alcohol might be assessed in terms of visible signs of inebriation while the frequency with which they got into trouble with the authorities might be taken to indicate the extent of their involvement in problem behaviours.
The collateral interviewees provided an almost total endorsement of the clients' accounts of the progress they had made as a consequence of their participation in the project. They were able to confirm positive changes in their substance-related and other behaviours, in the company they kept and in their confidence and self esteem. Only one mother gave a negative assessment of a client's progress and of the perceived effectiveness of the project. In doing so, she confirmed and reinforced the views that had been expressed by her son. In this case, both mother and son agreed that his behaviour had deteriorated following his involvement with the project. The mother attributed this to the fact that her son was simply not receptive to the intervention.
While there were some minor discrepancies between the accounts provided by the clients and the collateral interviewees, these took the form of omissions on the part of the latter, not contradictions. For example, a parent might not be fully aware of the company their son or daughter kept, or the specific nature of their leisure activities or the fact that, although their alcohol consumption had been greatly reduced, they continued to smoke cannabis. There were no instances of a parent contradicting a claim made by a client. As we will see, the parents were also able to usefully elaborate on some of the improvements in the young people's lives from their own perspective or to place their progress within a broader context. For example, they were able to describe the impact of the client's behaviour upon other members of the household, to relate improvements in the client to their growing 'maturity', and to speculate on whether the progress the young person had made would be sustained.
The interviewees also felt able to comment on the part they felt the project had played in the client's progress, despite the fact that they usually had had no contact with the project themselves. Their assessments were largely based on what the client told them about the nature of the project, combined with their own observations of changes in the young person which appeared to coincide with their participation in it. Basically, where changes in behaviour or self-image followed the individual's participation in the project, there was a tendency for the interviewee to attribute at least part of that change to the latter. The mothers were also well aware of the interdependent nature of the various outcomes that could be attributed to the project. For example, a reduction in the young person's involvement in anti-social activities was seen as being directly associated with a moderation of their consumption of alcohol or other substances.
Our interviewees were less able to comment on the strengths and weaknesses of the approach and methods adopted by the project. Their knowledge of the content and philosophy of the intervention was constrained by the fact that they were dependent upon what their son or daughter chose to tell them about it. They had no first hand knowledge of the project themselves. The mothers' comments on the methods adopted by the project and the possible reasons for its effectiveness were therefore limited in number and in scope. Nevertheless, a small number of the parents endorsed the young people's views that the non-directive and confidential nature of the intervention were both central to its success.
"She likes her privacy. Knowing that they widnae pass anything on tae anybody else was very important tae her."
"Ah think the guy, the way he was with him, he dinnae lecture him or anything like that, he really had a nice way wi' him and they'd have relaxing chats….. they had a laugh and things which wis good 'cos ah think if he had been all….ye know, asking questions and stern and stuff it widnae have worked at all. Ah think (the project) is a great idea, ah really do. He wis really taken wi' the guy."
We now consider the various impacts which the interviewees believed the project had had upon the young people's behaviour and self image.
Reduced consumption of drugs and alcohol
The interviewees appeared to have a fairly detailed knowledge of the young person's pattern of drug or alcohol consumption and how that had changed since their involvement with the project. While acknowledging that the client was still drinking or taking drugs, all but one maintained that this had changed for the better since their referral and that they were either consuming less and/or doing so more responsibly.
"Ah think he is more aware, he's definitely more aware of the dangers. He's still drinkin' but no' mixing as much, ah think he's drinking more safely. For a while he wis jist drinkin' anythin' and everythin', it was jist all mixed up but now he'll stick tae one or the other."
The interviewees attributed these changes largely, though not exclusively, to the intervention of project and the information and counselling it provided on the effects and dangers of alcohol.
"They've certainly made him more aware 'cos he wouldnae listen tae me but he would certainly listen tae them. Aye he did take it on board, ye know everythin' they said. And he did learn a lot."
However, some parents also recognised that the focus of the intervention extended beyond substance misuse and that part of the service's effectiveness lay in its ability to address other underlying issues and problems; things that were troubling the child.
"Ah think they also made her see that there's other ways of dealing wi' problems apart fae jist getting drunk and tryin' tae forget them….ye only get rid of the problem for as long as yer drunk, it disnae last long unfortunately."
While recognising the role of the project in altering the young person's behaviour, some of the parents suggested that their changed behaviour was a product, at least in part, of a developing maturity.
Reduced involvement in problem behaviours
Most of the interviewees also reported fairly dramatic improvements in the young people's involvement in problem behaviours. For the parents, a significant indicator of that improvement was the fact that their son or daughter's involvement with the police had been greatly reduced or, as in most cases, eliminated entirely. In the parents' view these behavioural changes were a direct result of the young person's participation in the project.
One way in which the interviewees saw a clear link between the intervention and the young people's behaviour was in its influence upon their consumption of drugs or alcohol. For the mothers there was a strong connection between the young people's substance misuse and their involvement in problem behaviours. A reduction in their consumption of drugs or alcohol was therefore perceived as having a major influence upon the young person's behaviour.
Increased participation in positive activities
The majority of the interviewees reported that, not only had the young person's involvement in problem behaviours declined but, conversely, they had also increased substantially their participation in a range of positive activities. This included a variety of things such as taking part in sports, spending time with younger siblings or other relatives, helping in the house, listening to music or getting a part time job.
Some of the mothers credited the project with having helped their son or daughter to make more positive life choices by encouraging in them a new self image and sense of purpose.
"They gave him the confidence to do what he's doin' now. She gave him something else tae look at as he was obviously going doon the wrong path and he's seeing now there's more tae life and it's a better life."
Once again, the parents saw a clear link between a reduction in the consumption of drugs or alcohol and their participation in what they described as more 'normal' activities.
Changes in friendships
Alongside changes in their behaviour and activities, the young people were also frequently reported as having changed the company they kept. In particular, according a majority of the mothers, they no longer spent time with former friends who drank heavily and got into trouble: 'Some of the right bad laddies that he wis goin' aboot wi', the ones that get intae all sorts a' trouble, he has nothin' tae do wi' them now.'
These changes in their friendships did not mean that the young people now kept the company of the completely abstemious. Their parents acknowledged that most of them still used alcohol or other substances in the company of other young people. The difference was that, with their new friends, they tended to be used more responsibly and to not be associated with getting into trouble. The influence of the project in bringing about this change was again acknowledged by the parents: 'Ah think they played quite a big role actually because (project worker) talked tae him quite a bit aboot that and he did see some of them (former friends) for what they were.'
Improved behaviour in the home
According to the parents, positive changes in the client's behaviour and attitudes was also reflected in their behaviour in the home and in their relations with other family members. Nearly all of the mothers reported that their son or daughter was less aggressive, more communicative and got on better with others in the household. The young people were variously described as being 'calmer', 'more pleasant', 'less argumentative', 'less nasty', 'more helpful', 'easier to talk to' and, in one case, 'like a different person'.
Once again, the project was regarded by the parents as having played a decisive role in bringing about these changes. In part, this was seen as being a product of their reduced consumption of alcohol.
"They're (the project) the reason he's now a lot better, no' spendin' half his day constantly being crabby and moody and………..and he's much better in the mornin' even although he's had a late night, he can still get up 'cos he used tae be terrible in the mornin' but now he's much better. He's a changed boy."
However, some of the parents were also aware that the project worker had worked with the young person in trying to improve the dynamics in the home. In particular, the project worker's suggestion that the client and their family should talk through any contentious issues was regarded as having been especially constructive and productive.
Growth in confidence and self-esteem
Most of the parents claimed that their son or daughter had grown in confidence and self-esteem as a result of their participation in the project. According to them, the change in the young person's sense of self was often quite pronounced.
"Oh she's a lot better now…..ah mean ah never realised she thought so little of herself but now…..ye can jist see that she's happier… She's a lot more self-confident."
"He dinnae really like himself for a while, he jist thought he wis stupid, he wis this, that and the other but he's got that bit of confidence now, he's not knocking himself down as much. One of the other changes is that he seems happier, happier in himself."
Those parents had no doubt that the project workers had played a significant part in improving the young person's confidence and self image.
Improved school attendance
According to the parents' accounts, improved school attendance appeared to be another benefit of the client's participation in the project. Several mothers reported that their son or daughter was either now attending school more regularly and/or was more committed to it. Once again, the project was seen as having played a part in the improvement, principally by encouraging the young person to review his or her current behaviour and future prospects and by helping to improve their confidence and self-esteem: 'They played a big role, they've given him the confidence tae realise he's got goals and he can achieve his goals instead a' lookin' at somethin' and thinking 'naw'.'
Key findings from outcome evaluation of Reiver and Perth Connect
- Substantial reductions were achieved in the young people's use of drugs and alcohol.
- Clients in both projects had reduced their involvement in problem behaviours and increased their participation in positive activities.
- Many of the young people reported enhanced confidence and self-esteem.
- Participation in the project had led to improved relations with other members of the household.
- There was evidence that the Reiver clients' attendance at school had improved.
- Clients in both projects reported benefiting from the counselling they received from project workers.