Scottish Government

Background

Thrive is a counselling and support service based at the Sandyford Initiative in Glasgow, focused on male survivors of childhood sexual abuse. FMR Research was commissioned to conduct an evaluation of the Thrive service by NHS Greater Glasgow, as part of the Small Research Projects Initiative.

Objectives

The objectives of the evaluation were:

1. to identify the contribution that counselling provided by Thrive can make to reduce suicidal intention amongst male survivors of childhood sexual abuse
2. to indicate how Thrive counselling can help reduce stigma and discrimination through supporting personal change and confronting the impact and effects of stigma and discrimination experienced by this group
3. to evaluate the Thrive service's ability to raise awareness and promote positive mental health and wellbeing amongst male survivors of childhood sexual abuse
4. to assess how effectively the Thrive service promotes and supports recovery from mental illhealth experienced by male survivors who are experiencing suicidal ideation and emotional and mental distress.

Methods

There were three main components to the evaluation:

• review of secondary data, in particular Thrive's CORE (Clinical Outcomes in Routine Evaluation)
• interviews with 10 Thrive clients
• interviews and focus group with the Thrive team.

Main findings

The research data suggest Thrive has an important and distinctive role in NHS Greater Glasgow's service provision portfolio and, within the methodological bounds of this study, appears to be achieving the essence of its service related aims.

Objective 1

Thrive appears to have made a strong contribution to the reduction of suicidal ideation amongst male survivors of sexual abuse.

• To the best of the project's knowledge, none of Thrive's clients has completed suicide. This information needs to be viewed in the context that Thrive places high importance on clients' wishes for privacy and anonymity. This limits the project's ability to be proactive with client contact - Thrive can only communicate with any of its clients if that client wishes.
• The CORE data show a reduction in the dimensions of propensity for suicide and the propensity for selfharm. Whilst encouraging, this needs to be considered in the knowledge that the application of CORE by Thrive is underdeveloped, with the project exhibiting administrative and conceptual difficulties in applying the tool. There is also a tension in the data between the CORE output and the views of Thrive clients with respect to suicidal ideation - the CORE data suggesting clients have a lower propensity for suicide at the start of the process than the views of the clients themselves seem to suggest. Thrive clients and the Thrive counsellors intimated that CORE may underrepresent the condition of Thrive patients at the start of the process due to patients' reticence to be fully disclosive so early.
• The Thrive clients interviewed gave unprompted opinions that Thrive had significantly helped with the reduction of suicidal ideation. Whilst this perspective was strong in the qualitative data, we were only able to talk to a small percentage of those who had reached a point in the Thrive process where they were 'eligible' for interview.

Objective 2

The focus of this objective was well supported by the views of the Thrive counsellors and the opinions of Thrive clients. The main dimension to the stigma and discrimination relates to "self stigmatisation", the ability of Thrive to give its clients a safe opportunity for disclosure, and the resultant capability of male survivors of childhood sexual abuse to take pressure off themselves.

Despite the care and sensitivity that the Thrive service applies to its work, there are some aspects which need to be improved from the point of view of stigmatisation. These relate to the environment at the Sandyford Initiative in which clients find themselves immediately prior to counselling sessions. Some clients felt particularly uncomfortable with the present arrangements. Whilst recognising Thrive is a pilot project, we hope this evaluation helps Thrive secure greater permanence and the ability to integrate more seamlessly with its context.

Objective 3

The evidence of Thrive's ability to raise awareness and promote positive mental health and wellbeing amongst male survivors of childhood sexual abuse is strong. The Thrive clients, team opinions, and the CORE data to which we had access, were able to point to improvements in perceived mental health and wellbeing.

The one area Thrive needs to strengthen in this regard is its linkage with other specialist help services, given that many male survivors of childhood sexual abuse have other conditions and issues that would also benefit from appropriate intervention.

Objective 4

The evaluation demonstrates Thrive's capability in relation to this objective, and the service appears to be working well to promote and support recovery from mental illhealth.

Thrive also recognised areas in which it could develop to be even more effective in this regard.

These include the management of the waiting list through risk analysis and the introduction of telephone counselling to reach more clients - these are now in place. Thrive is also considering the introduction of group sessions for its clients.

Thrive's effectiveness will be further enhanced if it clarifies why CORE is being used, and improves the ways in which CORE data are collected and utilised.

Suggestions for service development

It is suggested that:

• Thrive becomes clearer on its aspirations for CORE (therapeutic help and/or evaluative tool) and integrates the tool more closely with the Thrive operation as appropriate
• Thrive becomes substantially more efficient and diligent in the administration of CORE data and substantially increases its ability to analyse and interpret CORE outputs
• Thrive increases its ability to obtain and provide the necessary management information for the project, in particular appointments provided, cancellations and waiting list data
• the project ensures all people who are part of its service are trained/competent to the required level (with particular reference to the incoming call handling/risk assessment dimensions of the service)
• Thrive improves its reception to clients, seeking to avoid the anxiety and stress that people waiting for appointments are prone to feeling prior to meeting their counsellor
• the project pilots a groupbased approach with some of its clients.

Further details from:

simon@researching.co.uk