An evaluation of the NSPCC face to Face service. Prakash Fernandes and Louise Bazalgette

1. Using a brief solution focussed
approach with children in care: An
evaluation of the NSPCC Face to
Face service
Prakash Fernandes and Louise Bazalgette

2. • 45% of children in care have a mental disorder (Meltzer et al, 2003); a rate that
is four times higher than children in the general population (Ford et al, 2007)
• The mental health needs of children in care are frequently unmet due to:
o A lack of routine assessment
o Ineligibility for support (e.g. not meeting diagnostic criteria/ child is not in
a stable placement)
o Waiting lists for CAMHS and inaccessible services.
• NSPCC research conducted by The Who Cares? Trust with children in care
found they wanted:
o Face to face support in a venue that was “not like an office”
o An accessible location
o Support from a person who would “understand and not judge”
o A confidential service that was “not a big heavy thing” and would make
them “feel happier”
2
Why a new service for LAC

3. The Face to Face model
• Aimed at young people aged 5-18 (in care or on the edge of care)
• Solution Focused Brief Therapy as the method of intervention
• Supporting the child/young person to identify their skills and strengths
• Child/ young person-led approach (their issue)
• A timely and responsive service – aim to respond within 24 hours
• Brief intervention – up to 8 sessions.
• Flexibility: the child or young person decides frequency and location of sessions
Referral pathways:
• Referral by a professional or self-referral
Access and reach:
• The service has been offered in 18 locations in England, Wales and N. Ireland
• 1,543 young people accessed the service between September 2011 and
February 2015.
3
Service Development

4. Evaluation

5. • The Outcome Rating Scale to measure change for young people
• To measure ‘quality of life’ changes not change in just ‘symptoms’
• To give young people control in defining the changes experienced
• Follow up data after 3 months using the ORS and a questionnaire
• Questionnaires at the first and last session
• Interviews with children and foster carers at the end of the service
• Focus groups with practitioners
• Interviews with referrers
5
Evaluation Design

6. 6* ( a change of 5 points or more is defined by the authors of the scale as reliable change)
ORS data at first and last session
(n=603)
0
5
10
15
20
25
30
35
40
6 to 12
years
(n=277)
13 to 17
years
(n=301)
18 years
(n=25)
First session
last session
Increase in children and young
people’s well-being at the end of
the work
The average change in scores for
young people across the service
was 7.1 points, indicating the
average change is reliable
change*
64% of young people achieved a
reliable change*
58% of young people started the
work with clinical levels of distress
and at the end of the work only
14.5% sill had clinical levels of
distress- a decrease of 43.5
percentage points

7. 3 month follow up with children
(n=91)
7
31.1
27.5
19.5
0
5
10
15
20
25
30
35
40
6 to 12 years
(n=41)
13 to 17 years
(n=45)
18 years (n=5)
First session
Last session
3 month followup
• The average Time 3 score is
higher than the average score at
the First session for all age groups
but lower than the average score
at the last session
• The average ORS scores move
from below the cut off point at the
first session to being above the cut
off point at Time 3.
• The average ORS score increase
is 5 or more points for all age
groups from Session 1 to the 3
month follow –up indicating a
clinically significant change as
defined by the authors of the scale

8. Helped
a lot
(%)
Helped to
some extent
(%)
No
difference
(%)
Did not help
(%)
Solving my immediate concern 73 22 5 0
Helping me feel more in
control
70 26 4 0
Increasing my confidence to
get help
81 14 5 0
Making me more hopeful 75 18 5 2
8
Feedback at the end of the service
Outcomes for young people in relation to the face to face service (n=353)
Source: Questionnaire data completed at the end of the service.

9. How young people after 3 months since the face to face ended?
9
Time 3 questionnaire data
Have things changed for you? n=95
Things improved 66%
Things stayed better 29%
Problem still affects me 5%
Other new services received by young people during the period
Approximately half (51%) of the young people in the sample were not
accessing any support from services. The other half ( 48%) identified
support they were receiving from CAMHS, children services, other
counselling services or programmes and 1% were waiting for support
from other agencies.

10. Interviews
with
children

11. • Increased confidence
• Managing anger
• Better relationships
( with family and peers)
• Better Learning at school
• More positive outlook to life
• Greater confidence to seek help
11
Types of changes for young
people
Just I feel a better person just now I
can talk more to people. If I had
something bothering me I an go
and talk to them because before I
couldn’t have done that because I
would have felt nobody’s
listening, who cares? But now I
know there's people out there that
do care and do want to help me.
So I feel a better person for
managing to talk.

12. • Making them feel good about themselves
• Focussed on a key issue
• Rehearsing different ways of doing things
• Helping young people look ahead and ‘let
the past go’
• Scaling questions to sustain change
• Relationship : made me laugh,
persistence, just gets it, face to face
• Being in control
12
How Face to Face helped them
achieve change
Because if someone else has
said, you know, “Right go and
do this. Go and talk to this
person.” Then you'll feel
pressurised and you don’t want
to, you’re scared, whereas if
you’re thinking and you’re
thinking to yourself, ‘I could do it
myself,’ then you find you make
it easier for yourself.

13. How face to face is different from
other services
• Focused on strengths
• Practical
• Independent
• Helps ‘prevent, problems
13
Like sometimes we just do like
he’ll become the social worker
and I’ll try to talk to him and we
do it like that. My feelings are
never really changed but I think
slowly – he gives me ways to talk
to them, which makes me kind of
get somewhere without getting
angry . Before when I got angry, I
would swear and just lose my
temper but he’s given me like
techniques to talk to them ( social
workers) in like the appropriate
way that makes them listen.

14. • Too much talking: would have liked more activities, drawing things
• More involvement from fostercarers /family would have been helpful for
some sessions
• More information about the service at the beginning of the work
• Length of sessions could have been longer
• Meeting in different venues such as the park or café may help some
children
14
Barriers to achieving change

15. Facilitators
and
Barriers:
Practitioners
and Referrer
perspectives

16. • Child centred approach
• Child/young person defining the problem, separating the professional
goals
• Listening- to use language of child
• Children in control
• ‘Time limited nature of the approach
• Beginning work with a clear outcome
• Lends itself to more focussed inter agency working
• Solution focussed approach
• Focus on the positives and their interests
• Techniques of best day, preferred future and scaling – powerful tools to
think about change
16
Key aspects of the model that
facilitated change

17. • Building rapport with the child to gain trust seems rushed to finish in
eight session
• Younger children or children with learning difficulties struggle with
some aspects of the model- scaling and preferred future
• Young people having ‘unachievable’ goals
• Unstable placements at time could limit engagement of the young
person in the work
17
Barriers to helping children
achieve change

18. • 64% of young people had experienced a reliable change of 5 points or
more on the ORS
• Only 14.5% of young people were still experiencing clinical levels of
distress by the end of the work
• 3 months after the work had ended, 95% of young people said things
had continued to improve or had stayed better
• Young people and practitioners were able to articulate clear benefits of
this way of working
18
Summary

19. Knowledge transfer strategy: Making Face to Face more widely available
• Final evaluation report will be published (June 2015)
• Practice toolkit and implementation pack for commissioners, to be made freely
available (June 2015)
• Supporting the scale-up of this service with other providers (including statutory
and voluntary sector)
For more information please contact:
Louise Bazalgette
Development Manager
020 3772 9030
louise.bazalgette@nspcc.org.uk
19
Next steps

20. Fernandes, P. (April 2014), ‘Face to Face Service Impact and Evidence
briefing: Interim Findings’, London: NSPCC
http://www.nspcc.org.uk/globalassets/documents/evaluation-of-
services/face-to-face-interim-report.pdf
Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric
disorder among British children looked after by local authorities:
Comparison with children living in private households. British Journal of
Psychiatry, 190, 319-325.
Meltzer, H., Gatward, R., Corbin, T., Goodman, R., Ford, T. (2003) ‘The
mental health of young people looked after by local authorities in England’,
The Office for National Statistics, London: The Stationary Office.
20
References

21. 21
Summaries of all our evaluation plans
Each summary includes:
• Details of the evaluation methods we are using for the service
• Details of any challenges faced and how we overcame them
• A list of the measurement tools we are using
• Contact information of the staff member involved in the evaluation
Tools for measuring outcomes for children and Families
We've outlined our experiences of using each tool, along
with details of what it measures and how easy it is to
use.
Each measure includes:
• An explanation of the measure
• Details of who to use it with
• The time it takes to administer
• Any training or expertise required
• It’s validity and reliability
• Cost
• Our experience of using it
And much, much more….
Our Impact and Evidence Hub can be found at
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