Women's Health Advice Centre evaluation 2011 by Helen Fussell

Evaluation of the Womenâ&#x20AC;&#x2122;s Health Advice Centre 2011

Funded by:

Comments about Women’s Health Advice Centre

“It keeps you away from the doctors”. Service user

“They are the kind of organisation that Public Health England should be investing in”. Senior manager from the Northumberland Care Trust

“I think they’re excellent, unique … a jewel in Northumberland’s crown”. Safer Northumberland Coordinator

“It was something that was just mine. I could just be me, away from

the world, it was a lovely, simple gentle quiet, peaceful place. Just what I needed, my counsellor was lovely”. Counselling client

“I would like to thank the staff for the excellent service you provide. You were my strength at a time when I felt desperate and alienated”. Counselling client

“I practice [Tai Chi] at home in the mornings and it sets me up for the day … I do more things now which I wouldn’t have attempted before”. Service user

About Women's Health Advice Centre Women's Health Advice Centre or WHAC provides a non medical service to women, which aims to improve their physical, mental, social health and well being. This is achieved by offering: • • • • • • • •

Brokering support so women can access other organisations and services Counselling Family law and debt advice (in conjunction with DAWN Advice) One-to-one lifestyle sessions Personal development courses Support groups Support to survivors of domestic abuse and sexual violence Volunteering opportunities

More information: www.whac-online.co.uk

About the authors Barefoot Research and Evaluation is a not for profit social research organisation based in Newcastle upon Tyne. It has particular expertise in work with vulnerable and at-risk groups and on projects and strategies to support them. Barefoot Research and Evaluation has carried out work for both public and voluntary sector organisations on project and policy research and development. Dr. Christopher Hartworth, who set up Barefoot, has 20 years’ experience of research and evaluation, beginning in developing countries in poverty alleviation programmes and continuing in the North East of England in work with disadvantaged communities. More information: www.barefootresearch.org.uk

Executive summary Womenʼs Health Advice Centre (WHAC) has been delivering services to women in Northumberland for over 25 years. WHAC supports women with often complex problems, commonly related to their health or employability. They also help women who face many barriers to access other services in the community. WHAC is a key organisation in the network of provision for women in Northumberland, with a small core staff and a large team of volunteers. This is an evaluation of the Womenʼs Health Advice Centre (WHAC) and its activities between 2008 and 2011. WHAC provides a range of services to women in Northumberland aged from 14 years upwards including:

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Counselling (funded by the Big Lottery and Northumberland Care Trust): this is delivered by a team of well trained professionals on a voluntary basis, free at the point of access. Support and Advice Service (funded by the Big Lottery and Working Neighbourhoods Fund - WNF): WHAC provides women with support and direction to access a range of services, including family law, debt advice, information on healthy eating, further education, back to work and personal development courses. One-to-one support (funded by the Big Lottery and WNF): this is delivered by volunteers who meet with clients who do not need formal counselling but do need the support of a ‘friend’ or mentor. Training and education (funded by Big Lottery and WNF): WHAC delivers a number of education and training courses both provided from WHAC’s premises and via outreach. Health promotion activities (funded by Fair Share): these are provided in collaboration with four community organisations in Seaton Valley. Volunteering opportunities: WHAC provides the opportunity to volunteer in a variety of ways, including as a counsellor, an organisational support volunteer, a volunteer mentor or as a trustee.

Between 2008 and 2011, WHAC’s key outputs have been:

• • • • •

366 clients receiving over 2000 hours of counselling 48 education and training courses with 2077 attendances 1060 clients accessing the Support and Advice Service 405 people receiving one-to-one support and over 12000 receiving telephone support 33 volunteers helping deliver services and supporting WHAC, giving 4422 hours of time.

Referrals into WHAC come from a wide variety of services, with most people being referred either by a GP or referring themselves. GPs and other public 1

health and employability agencies refer women to WHAC for counselling and therapeutic support. Since 2008, WHAC has raised £658,000 from the Big Lottery, Northumberland Care Trust, Northumberland County Council, Ministry of Justice and invested this in supporting and improving the lives of women in South East Northumberland.

Evaluation findings The evaluation produced a series of findings, which have been divided into general findings, findings from service users and findings from partner agencies. We make the following general findings.

• • • • • • • • • • •

WHAC has achieved or is on target to achieve its agreed outputs: WHAC has fulfilled its funding obligations and in many cases have exceeded them. WHAC supports women who experience a range of complex problems: with poor mental health including stress, depression and anxiety being the most common issues, followed by relationship problems, self esteem, bereavement and domestic violence. WHAC is a highly professional organisation with comprehensive staff and volunteer support systems: this is evident on a number of levels, from the trust and respect afforded WHAC by other organisations, to the systems and processes in place. WHAC operates in a similar way to a one-stop-shop: it does this through offering a series of other services that address health and other needs. WHAC is able to respond effectively to client and service user needs: WHAC has the flexibility to respond in a reactive manner to the needs of clients and service users. WHAC delivers a variety of well attended courses: during 2010/2011 WHAC has run 15 courses including new courses in arts and crafts, life coaching and managing stress as well as the popular courses in self development, confidence building, relaxation, creative writing and others. WHAC has provided women with support they needed to stay in employment: there was evidence to indicate that WHAC kept some women in employment. Without WHAC’s intervention, a number of women would have left work due to mental health problems. WHAC’s services are provided to and accessed by all: it was reported by one senior manager interviewed that “WHAC transcends social boundaries”. WHAC’s counselling services are being accessed by increasing numbers of young people: in 2009/2010 a total of 15 percent of all counselling clients were aged under 25 and in 2010/2011, the percentage rose to 26 percent. The Fair Share project achieved its objectives and has had wide ranging health impacts: the project has expanded and increased access to exercise and improved diet in local communities. The Fair Share project resulted in the increased use of community resources for health-related activities: one community venue said that the

•

• •

project had resulted in between 20 and 30 additional community centre users each week. WHAC assisted the County Council and Northumberland Employability and Work Service achieve its strategic employability objectives: WHAC engaged with economically inactive claimants and provided support to tackle both mental and physical health and employability barriers in the most deprived parts of the county. The Working Neighbourhoods Fund has contributed to the sustainability of WHAC and levered in additional funds: in early 2008 WHAC came very near to closing due to insufficient funds, redundancy notices were issued and new clients were no longer accepted. WNF then invested in WHAC, ensured their survival and allowed them to access different funding streams. WHAC was able to effectively adapt its services to provide a focus on employability: WHAC’s core service is women’s health but as ill health and worklessness are closely associated with each other, WHAC was able to incorporate both when working with clients. WHAC has effectively used the Hanlon System for recording: WHAC started using the Hanlon System in 2008. It was a condition of WNF funding and WHAC are increasingly using it to examine outputs.

The evaluation made the following client and service user findings:

• • • • •

The services of WHAC are highly regarded by clients and service users: this appreciation is reported both from WHAC’s base in Ashington and of its outreach work. WHAC’s interventions encourage people to progress into employment, volunteering or further education: the responses in the training and education evaluation forms demonstrate that the courses encouraged people to progress onto other productive activities. The health promotion activities and the health-related courses improved people’s health: there were many reports from people that they felt in better health as a result of participating in the health-related activities. The counselling is reported by WHAC’s clients to improve their mental health and allows them to recover: this has a series of positive impacts on women and their families. WHAC’s long term presence was particularly appreciated by clients: many women who use WHAC’s services reported a major benefit to them was feeling secure in the knowledge that they could go back to WHAC for support in times of need.

The evaluation made the following findings from research with partner agencies.

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• • • • • • •

WHAC is unique in Northumberland: it was unanimously reported that WHAC is unique in the services it provides. WHAC offers a highly professional service: this is one of the important reasons for the high level of trust awarded WHAC by other organisations. WHAC actively contributes to policy development and partnership working across Northumberland: WHAC provides representation on a number of steering groups and local initiatives. WHAC has increased local partnership working: WHAC is proactive at developing partnership working arrangements and this includes organising a number of local partnership information and advice days. There has been an increase in the number of people accessing family law and debt advice: as a result of the partnership working between DAWN Advice and WHAC, people have accessed legal advice who would not normally have accessed it. The Northumberland Care Trust and WHAC have a mutually strong relationship: the Trust has cooperated in project delivery, e.g. in the location of the Health Trainer at WHAC and supporting WHAC clients with their Condition Management Programme, and as a commissioner of services. WHAC is important for a number of other organisations and helps them to achieve their objectives: this occurs on a number of levels, for example, by providing a free counselling service, WHAC assists Community Psychiatric Nurses, GPs and other mental health services in the work they do with their clients.

Outcomes Based on the findings, we can make a series of judgements about the outcomes achieved by WHAC.

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WHAC connects hard to engage people with universal services: one agency reported “WHAC is the missing link … it is the bridge between formal services and people that wouldn’t normally walk through the door”. It does this because it is an accessible and trustworthy local community service which brings people in. Once involved with WHAC, clients can then access a range of other services such as debt advice, family law advice, further education and health information. In addition to these services, WHAC provides women with support to access other community services. This is not simply a signposting function, in that clients are given contact details, moreover it is a support service and women will be accompanied to where they need to go on the first occasion, if required.

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WHAC plays a major public health role by improving the health of its clients: and this happens on a number of levels. A Northumberland Care Trust representative reported that women’s health issues were constantly changing and WHAC were in a good position to respond to new health challenges. Clearly, WHAC’s most significant health impact is in improving the mental health of women through counselling. However, either at the 4

same time as the counselling period or afterwards, WHAC engages women which then provides the opportunity to discuss female specific issues such as binge drinking, smoking, obesity (diet and exercise) and diabetes. It was also reported by a series of agencies that the clients of WHAC are unlikely to present themselves at routine medical services as in need of mental health treatment. As such WHAC intervenes at an important point in women’s lives; with no intervention many of their clients would have presented at critical services (e.g. A&E, Police). This has obvious cost saving implications to local and national services. WHAC’s public health role also extends past the counselling service and also includes its education and training and individual support services.

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WHAC’s intervention commonly results in client progression: service users and clients have demonstrated progression on a number of levels such as from counselling services to courses and group work, from isolation to voluntary work and from volunteering to employment. Many of WHAC’s users demonstrate this progression which indicates that WHAC is effective at both the engagement and pre-engagement stages (see figure 1.1) and at moving people into more productive roles.

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WHAC ensures positive social reproduction and builds social capital: these sociological terms refer to the ability of a group of people to successfully maintain their status as a cohesive group and continue to function in that way and social capital refers to connections within and between social networks which helps make communities more resilient. By impacting positively on women who are often either mothers or heads of household, WHAC is ensuring the family’s survival and growth and by implication assisting the local community by providing strong constituents. Similarly, assisting people remain in existing work or find new employment has additional positive impacts on social reproduction.

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organisations are diverse and range from social enterprises (who report that they have expanded their services and geographical reach because of WHAC) to public health bodies and employment agencies with associated targets, which WHAC helps them achieve. We conclude the evaluation with the observation that WHAC is in an excellent position to provide key public health and employability services both in South East Northumberland and county-wide (the latter through ongoing expansion via outreach and with a mixed gender service). Indeed, not only are WHAC key to engaging with targeted populations, but they also have a proven track record in good partnership working and delivering commissioned public health and employability services.

Table of contents i

Executive summary

1.0 1.1 1.1.1 1.1.2 1.1.3 1.1.4 1.1.5 1.2

Introduction The funding streams The Big Lottery The Working Neighbourhoods Fund Northumberland Care Trust Fair Share Ministry of Justice The evaluation

8 8 9 9 11 11 12 12

2.0 2.1 2.2 2.3

Context and background The services of WHAC Staffing and administration Referrals

13 16 19 19

3.0 3.1 3.2 3.3 3.4 3.5 3.6

Outputs Total outputs Big Lottery outputs Working Neighbourhoods Fund outputs Northumberland Care Trust outputs Fair Share outputs Support for Women Around Northumberland outputs

20 20 22 22 24 24 24

4.0 4.1 4.1.1 4.1.2 4.2 4.3 4.4

Evaluation findings General findings Fair Share specific findings Working Neighbourhoods Fund specific findings Findings from clients and service users Findings from partner agencies Outcomes

26 26 29 31 35 38 43

5.0 5.1 5.2

Conclusion and recommendations Conclusion Recommendations

46 46 47

Appendix one Appendix two

Flower power assessment tool Examples of publicity for bespoke packages

50 51

1.0 Introduction This is an evaluation of the Women’s Health Advice Centre (WHAC) and its activities between 2008 and 2011. There are five distinct funding streams which have contributed to WHAC during this period. These are:

• • • • •

The Big Lottery The Working Neighbourhoods Fund (WNF) Fair Share (a Big Lottery fund administered by the Community Foundation) Northumberland Care Trust Ministry of Justice (Diverting Women from Custody Programme)

The first three funders required an external evaluation as a funding condition. It was decided by WHAC and agreed by the funders that these evaluations could be combined. The SWAN project receives Ministry of Justice funding and is delivered by a partnership of voluntary sector organisations led by Escape Family Support with WHAC being a delivery partner. SWAN was the subject of a full and separate evaluation1 in early 2011. This report presents the services of WHAC and its outputs since 2008. The evaluation then makes a series of findings both about the organisation as a whole and its specific services. Based on these findings, we then make a judgement on the outcomes of WHAC. Finally a conclusion is offered and a number of recommendations are made.

1.1 The funding streams This section presents a brief synopsis of the funds and their objectives. Three of the funds are multi-annual and support women’s mental health and well being in Northumberland, but some are more specific than others about how funds are targeted and what outputs are expected. The exception is the funding for work in Seaton Valley, which is to provide well being support to people living in that rural location with little access to services of this kind. Table 1.1 WHAC’s funding streams between 2008 and 2011 Fund Duration Amount Target group Geography Big Lottery

Apr 2008-March 2012 £222,218

Women

Northumberland

WNF

Mar 2008-Sept 2009 Oct 2009-Mar 2011

£190,000 £183,455

Economically inactive women

The county’s most deprived areas

Fair Share

June 2010-Apr 2011

£12,000

People in rural areas

Seaton Valley

Care Trust

Annual grant 2000+

£20,000

Women

Northumberland

Ministry of Justice

April 2010-March 2011 £29831

Women exNorthumberland offenders or at risk

See http://www.barefootresearch.org.uk/wp-content/uploads/SWAN-Report-Single-Pages.pdf

1.1.1 The Big Lottery The Big Lottery funded WHAC to implement a Women’s Health Improvement Programme (WHIP). This initiative started in 2008 and will end in 2012. The fund allowed WHAC to develop the following:

• The development of a one-to-one support service to complement WHAC’s existing therapeutic counselling service.

• The provision of support, advice and guidance covering debt and family law advice (this is done in collaboration with DAWN Advice), budgeting and benefit advice and how to live healthily on a low income. • The strengthening and development of the core of the organisation through staff and volunteer development. The grant is used to fund salaries, volunteer recruitment, training, marketing and service delivery. The project contributes to the following Big Lottery programme output areas: Outcome 1 Outcome 2 Outcome 4

People having better chances in life with better access to training and development to improve their life skills Stronger communities, with more active citizens, working together to tackle their problems Healthier and more active people and communities

There are a series of target outputs associated with WHIP, which are presented in section 3.2.

1.1.2 The Working Neighbourhoods Fund2 (WNF) WHAC has been embedded as part of the programmes of regeneration, health and employability in Northumberland since 2004. WHAC’s role has been to provide mental health and well being support to women and broker in additional services. WHAC has been commissioned to do this under successive funding streams overseen initially by Wansbeck Initiative and Wansbeck District Council and then Northumberland County Council. This funding has always been to support women in the most deprived areas of Northumberland. The WNF funded WHAC to deliver the Training for Personal Progression project between September 2009 and March 2011. This project delivered a package of support to women to help them to enter or retain employment, take up education, training or volunteering and also to access other services which could help them overcome the challenges and barriers they face. For this project, there has been an emphasis on engaging people through creative and fun lifestyle courses and events and then helping them access other 2

This was a government fund totalling £15 billion between 2008 and 2011 to support employment initiatives. The funding stream ended in March 2011.

services as required. The package of support varies depending on the needs of the individual, but can include one-to-one counselling support, healthy lifestyle sessions, confidence building and a range of other training courses. The overall aim was to improve mental health and well being and overcome multiple barriers to personal development. WHAC delivered this package of support in collaboration with DAWN Advice (see box 4.4) and the Northumberland Care Trustâ&#x20AC;&#x2122;s Condition Management Programme3 and in partnership with the Northumberland Employability and Work Service (NEWS). The approach in Wansbeck became adopted at regional level in the Regional Employability Framework (REF) in 20074. WHAC contributes to this framework by helping clients who need high levels of support to enable them to take a more active part in society, increasing their confidence and self esteem and helping them to set and attain individual goals. These elements are commonly either the first step towards a personâ&#x20AC;&#x2122;s progression into training or employment or what is required to help people stay in employment. The REF is visually represented below and WHAC mainly contributes to the stages of engagement, action planning and employability services (and although it is not counted by WNF, they also contribute to retaining people at work). Figure 1.1 REF: Effective case management in getting and retaining people in work

This was jointly run by the Department of Health and the Department for Work and Pensions, aiming to provide additional support for those on Incapacity Benefit to help them back to work. It ended at the start of 2011. 3

Skills North East, 2007, Employability Action North East: Regional Employability Framework, Skills North East.

There are a series of outputs associated with the WNF funded activities, which are presented in section 3.3.

1.1.3 Northumberland Care Trust Northumberland Care Trust has supported WHAC with an annual grant for over 10 years. The grant for the current year (2011/2012) totals £20,150 and this purchases a certain number of counselling sessions. There is currently a Service Level Agreement and the Care Trust has agreed to continue this grant for the next three years. The aims of the grant are:

• • •

To provide women with free quality counselling, personal development education and information on issues contributing to their general health and well being. To encourage women to take responsibility for their own physical, mental, emotional and social health and well being and to help them develop a positive attitude. To be supplementary and complementary to the services provided by Health and Social Services.

Additional ways in which the Care Trust has supported the work of WHAC include the provision of a Health Trainer who was located at WHAC one morning per week and collaborating through their Condition Management Programme. There are outputs associated with the Care Trust grant, which are presented in section 3.4.

1.1.4 Fair Share WHAC received funding in 2010 to implement the Health Promotion in Seaton Valley Project. Fair Share is a Big Lottery fund administered by the Community Foundation, which is targeted at 77 areas across the United Kingdom which have missed out on Lottery funding in the past. The Fair Share programme aims to: • • •

Build capacity and sustainability by involving local communities in decisionmaking about lottery funding. Build social capital by building links within and between communities to promote trust and participation. Improve liveability by improving the living environment for communities.

There is a local Fair Share panel in Seaton Valley (where the project is located) which is made up of local community representatives, voluntary sector support projects and the Community Foundation. This panel decides on which local projects will be funded.

Fair Share funded WHAC’s Education and Training Officer on a one day a week basis, to support local community groups develop health promotion activities. The project works in the areas of New Hartley, Seaton Delaval and Holywell, Seaton Sluice and Seghill. There are outputs associated with the Fair Share funds, which are presented in section 3.5.

1.1.5 Ministry of Justice Support for Women Around Northumberland (SWAN) is one of two projects in the North East which have received funding from the Ministry of Justice under their Diverting Women from Custody Programme. The objectives of SWAN are to reduce the re-offending of female offenders or those at-risk of offending through providing a range of diversionary and preventative interventions. The project became operational in February 2010 and has received funding until March 2011 (it is likely that the project will receive continuation funding until 2012). SWAN is delivered by a partnership of voluntary sector organisations including: ESCAPE Family Support (the lead agency); the Women’s Health Advice Centre (WHAC); Fourth Action; and Relate. The project team consists of a Project Coordinator, three Women’s Intervention Workers and a Project Counsellor. SWAN was evaluated in December 2010 and full and summary evaluation reports are available on WHAC’s website. There are outputs associated with the WHAC’s involvement in SWAN, which are presented in section 3.6.

1.2 The evaluation This evaluation was carried out by Barefoot Research and Evaluation, an independent specialist organisation based in the North East of England5. The evaluation consisted of a series of techniques and methods which included:

• Semi structured interviews with partner agencies 6 • Focus groups, semi structured interviews and participatory appraisal sessions with project staff, trustees and volunteers

• Semi structured interviews with representatives of community organisations • Semi structured interviews with associated strategic and operational organisations such as Northumberland County Council and Northumberland Care Trust. • An analysis of project records and monitoring information.

For more information on the organisation, see www.barefootresearch.org.uk

i.e. those organisations that make referrals into or accept referrals from WHAC.

The results of the focus groups and semi structured interviews have been thematically analysed and coded and are presented in this report. The terms service users and clients are used throughout this report: the latter refers to those receiving counselling and the former are all other people that use WHAC’s services. The names used in the case studies in this evaluation report are fictitious and are used to protect the identity of the subject of the case study.

2.0 Context and background WHAC’s office is located in Ashington and has several other outreach venues including Children’s Centres, GP surgeries and community centres. Ashington is situated in South East Northumberland. Both the town and the sub region have high deprivation scores 7 for a range of key indicators including health and employability8 . South East Northumberland has been the focus of a number of regeneration and development initiatives over the last 20 years. For the purposes of this evaluation, one of the most relevant of these was the Wansbeck Initiative (the Local Strategic Partnership - LSP) which was responsible for bringing partners together to narrow the gap in inequalities between the UK and Wansbeck’s most deprived areas on a range of themes, including health, employment, crime, housing and education. It received and allocated Government funding and also helped direct public sector funding in the Wansbeck locality9 to areas of need. The Wansbeck Initiative ceased operating in April 2009 following Local Government Reorganisation in Northumberland, when seven councils became a unitary authority and seven LSPs became one county-wide LSP. However, both Wansbeck Initiative and Northumberland Strategic Partnership which succeeded it as the county-wide LSP, included the two strategic aims of improving health and reducing economic inactivity. There was an acknowledgement that both health and employability were strongly interconnected and both impacted on each other. For example, it was known that the locality of Wansbeck had high numbers of people on Incapacity Benefit, classed as inactive claimants and who, without support would remain on benefits, potentially forever.

Of the Indices of Multiple Deprivation.

For more information on the local context, see http://www.barefootresearch.org.uk/docs/ WHACreview.pdf 9

This was a local authority area which pre-dated the 2008 unitary authority of Northumberland and included the areas of Ashington, Bedlington and Newbiggin-by-the-Sea.

Wansbeck was part of a national research project carried out in 2007 by Sheffield Hallam University10 which identified that 11 percent of the working population was on Incapacity Benefit. The report says: ‘The findings point to a stock of incapacity claimants that is often extremely detached from the labour market, and to many individuals who face formidable obstacles in moving towards employment. Approaching half of all claimants have been out-ofwork for more than ten years, and more than half have no formal qualifications. Ill health is widespread. Fewer than one-in-five say they would like a job, now or in the future, and fewer than one-intwenty are actively looking for work. In particular, the share of incapacity claimants in Wansbeck who express an interest in working is the lowest the research team have ever recorded. What appears to be happening is that in Wansbeck, and elsewhere, the incapacity claimant figures are increasingly becoming dominated by men and women who find it difficult to maintain a foothold in a competitive labour market – the less skilled, less healthy and (to some extent at least) the less motivated’ (page 5). Thus, in relation to employability, the emphasis needs to be on pre-engagement and engagement. In recognition of this and other work-related issues, local partners from the statutory and voluntary sector set up the Wansbeck Works initiative to create a coordinated response to the problems of both employability and ill health. Currently, in the context of the unitary council, the Northumberland Strategic Partnership developed the 2010-2015 Northumberland Economic Strategy. In that strategy, it states it will deliver effective countywide employability support tailored to support individuals and target interventions for the hardest to reach and disadvantaged communities 11. The strategy also makes an explicit recognition of volunteering as a route to economic well being. It says ‘volunteering helps to raise confidence, self esteem, physical and mental health and social skills and can provide a crucial stepping stone towards employment’ 12. In relation to health, Northumberland Care Trust has specific strategic priorities concerning women’s health and these are reflected in the regional health 10

Beatty, C., Botterill, K., Fothergill, S. and Powell, R. 2007. Wansbeck’s Incapacity Claimants Centre for Regional Economic and Social Research, Sheffield Hallam University with Donald Houston and Paul Sissons, Department of Geography, University of Dundee. 11

The 2010-2015 Northumberland Economic Strategy, page 42.

Ibid, page 46.

strategy, Better Health, Fairer Health. From a public health perspective, there is a recognition that women experience a specific and evolving set of health problems, which currently include obesity and related illnesses (such as diabetes and hip and knee problems leading to loss of mobility), smoking-related illness, alcohol misuse and poor mental health. There is also a recognition that poor health in women has far reaching impacts on families and communities, such as impacting on their caring and household administration duties (as women generally have more caring duties for children, parents and grandparents than men and also are more involved in managing the household economy). This is also amplified if the illness leads to incapacity or disability (which many of the aforementioned illnesses affect). Women’s ill health also negatively impacts on the health of men in the household, as it is often the woman who encourages the partner or husband to seek medical support. If the woman suffers from ill health, then they are less likely to be concerned about the health of others in the household. Women’s ill health prevention activities therefore are important in achieving many public health and public service objectives. In other words, preventative work is both important in addressing female-specific ill health and in reducing access of critical services (such as acute hospital services). Box 2.1 Better Health, Fairer Health The NHS created a 25 year plan to improve the health and well being of people in the North East. The strategy Better Health, Fairer Health focuses on ten key themes which are seen as having the most relevance to improving health and well being and implementation is being guided by ten regional advisory groups. The ten key themes in the 25 year plan are: • • • • • • • • • •

Economy, culture and environment Mental health, happiness and well being Tobacco Obesity, diet and physical activity Alcohol Prevention, fair and early treatment Early life Mature and working life Later life A good death

Each theme cuts across different services, support and interventions provided by a range of organisations and agencies in recognition of the fact that the health service cannot achieve the necessary change by working alone. Source: http://www.northeast.nhs.uk

WHAC is ideally located both in a geographical and service delivery sense, to address both health and employability. WHAC enables women to stay in

employment or find new employment through providing health interventions, by providing structured and accredited volunteering opportunities and by providing training and education. Importantly, WHAC provides women with the support and information to be able to address both their own health and the health of others and this support covers most of the health themes mentioned in box 2.1.

2.1 The services of WHAC WHAC provides a range of services to women aged from 14 years upwards from an end terrace house just off the Ashington high street. It also delivers a selection of services in an outreach capacity at such venues as Blyth hospital, Children’s Centres in Ashington, Bedlington, Blyth and Cramlington, community centres in Seaton Valley and GP surgeries. The services of WHAC include: ➡

Counselling (funded by the Big Lottery and Northumberland Care Trust): this is a free service for women who may be referred by other agencies, such as GPs and Job Centre Plus, or who may self refer. Counselling is provided by a team of volunteer counsellors/psychotherapists, some of whom are completing training requirements and others who are fully qualified. WHAC has a total of six qualified counsellors and one qualified psychotherapist (the latter who was recruited from the Northern Guild of Psychotherapists). In 2010, a total of seven trainee counsellors completed WHAC’s Counsellor Training Programme, which runs alongside the volunteer’s Foundation Degree Course. WHAC currently has a team of 18 counsellors/psychotherapists. WHAC has also recently recruited a qualified child psychotherapist who is able to work with younger clients. WHAC’s counselling complies with the strict standards of the British Association of Counselling and Psychotherapy. Most clients attend sessions at WHAC’s offices but there are some clients who are seen via outreach. Clients attend an average of eight counselling sessions, although this can be much longer; sessions are only brought to a close if the client is ready. WHAC has also recently recruited a qualified Holistic Therapist who is working with counselling clients offering them a range of treatments, e.g. Indian Head Massage, Reflexology and Aromatherapy (this is a free service and complementary to the counselling, aiding women’s recovery).

➡

Support and Advice Service (funded by the Big Lottery and WNF): WHAC provides women with support and direction to access a range of services, including family law, debt advice, information on healthy eating, further education, back to work and personal development courses. Women are provided with as much support to access these services as they require, for example, more vulnerable clients may need handholding to appointments and others may simply need the relevant contact information and once WHAC has helped women find the services they need, they can make contact themselves. Women who access this service 16

may be existing clients (via counselling, group work or courses) or they may self refer. Since 2008, there has been an emphasis on providing support and advice to help women back into work. This support is offered both face-to-face and over the telephone. Some of the support services are delivered in partnership with DAWN Advice13 who provide face-to-face support for people seeking help with housing, family law issues, debt advice, welfare rights and employment issues. For example, staff from DAWN Advice meet with clients at WHAC to advise them of their entitlement to benefits and guide them through the process of claiming and appealing where necessary. Clients are supported throughout the process by volunteers and staff from WHAC. In relation to debt, staff and volunteers help clients compile financial information, complete forms, liaise with other organisations and can accompany clients to court, banks or solicitors if the client wishes. The level support each client is given is tailored to their individual needs. Some clients are able to work directly with DAWN directly but others need continued support. ➡

One-to-one support (funded by the Big Lottery and WNF): this is delivered by volunteers who meet with clients who do not need formal counselling but do need the support of a ‘friend’ or mentor. These may be new clients who are referred or who self refer or they may be women who have had counselling who often need continued support when their sessions end.

➡

Training and education (funded by Big Lottery and WNF): WHAC delivers a number of education and training courses. Participants either contribute a nominal fee or if they are on benefits then costs are waived. Activities are both provided from WHAC’s premises, such as the relaxation courses, and via outreach, such as Tai Chi at the Ashington Institute. Training and eduction courses since 2008 have included: Basic IT (delivered through New Deal) Building confidence and self esteem 1 and 2 Building confidence day Building confidence to find work Christmas crafts Creative writing Eat well 4 less Feel good about yourself Healthwise Henna art It's my life - preparing for employment

DAWN Advice is an independent charity, which provides legal advice, casework and representation. The work is free, confidential, independent and impartial for people who qualify for funding under the Legal Aid scheme.

Labyrinth Life coaching Managing stress and anxiety Managing stress whilst seeking work Money matters My future in my hands Relaxation Tai Chi Yoga ➡

Health promotion activities (funded by Fair Share): these are provided in collaboration with four community organisations in Seaton Valley. There have been a series of health promotion activities which have been delivered from community venues including Tai Chi, Yoga and keep fit. These activities were based on community needs assessments and were developed with the community centre committees.

➡

Volunteering opportunities: WHAC provides the opportunity to volunteer in a variety of ways, including as a counsellor, an organisational support volunteer, a volunteer mentor or as a trustee.

Box 2.2 Fair Share The aim of the Health Promotion Activities Project was to support the local communities of Seaton Valley to develop their own health-related activities. The project was delivered with minimal resources; one day a week from WHAC’s Education and Training Officer with backup and support from the WHAC administration team and the Volunteer Coordinator. WHAC started the project by meeting the four community centre committees of New Hartley, Seaton Delaval and Holywell, Seaton Sluice and Seghill. At these meetings it was decided to carry out a needs assessment and survey of the local communities. From this research, it was identified that there was a local demand for exercise and healthy eating classes. WHAC then arranged for Yoga and Tai Chi classes and healthy eating demonstrations. WHAC had a budget to provide the trainer and associated expenses for six week courses. All were well attended and in three out of the four community centres, the Yoga and Tai Chi courses will continue independently of WHAC and as an activity run and owned by the local community.

2.2 Staffing and administration WHAC is made up of the following staff: ‣ ‣ ‣ ‣ ‣ ‣ ‣

Administrator - part time Cleaner - part time Education and Training Officer - part time Finance Officer Manager SWAN Project Worker/Counsellor - part time Volunteer Coordinator

They currently have a total of 33 volunteers, which includes 19 counsellors and five organisational support volunteers. WHAC is governed by a board of nine trustees (also volunteers) which meet monthly. It should be noted that WHAC’s Manager and Volunteer Coordinator have had prolonged periods of extended sick leave between 2008 and 2010. Although this was a difficult time for the organisation, all staff and volunteers with support from the board, cooperated and effectively managed the situation. The Manager and the Coordinator have now recovered.

2.3 Referrals Referrals into WHAC come from a wide variety of services, with most people being referred either by a GP or referring themselves. GPs and other public health agencies refer women to WHAC for counselling and therapeutic support.

The numbers of mental health service referrals has now increased as a result of MHCO (who deliver the Government’s Increasing Access to Psychological 19

Services programme in Northumberland) referring their clients into WHAC (see box 4.3).

Box 2.3 The Matrix Standard The Matrix Standard is a national award for the effective delivery of information, advice and/or guidance on learning and work. In August 2010, an assessor approved the accreditation for the two different categories of Matrix Standard; Internal Services to Staff and External Services to Clients. The assessor stated that very few organisations receive both standards first time and that this was a significant achievement. This was a rigorous assessment and involved the production of significant evidence of standards and protocols, as well as interviews with Trustees, staff, volunteers, clients and partner agencies. The assessor profiled in particular the strengths of the organisation as being support for staff, volunteers and clients, training and support for volunteers, excellent relationships with partners, high quality production and publication of evaluations and using soft outcomes and case studies to demonstrate issues and impact.

3.0 Outputs This section presents the outputs of WHAC, both global outputs for the organisation as a whole and the outputs connected with each funding stream.

3.1 Total outputs The following table presents the total outputs of WHAC between April 2008 and March 2011.

Table 3.1 WHACâ&#x20AC;&#x2122;s total outputs: 2008 to 2011 2008/2009 2009/2010 2010/2011 Total Counselling No. of counselling clients

135

123

108

366

No. of counselling hours

747

730

606

2083

No. volunteer counsellors

No of courses/workshops

Attendance at courses/workshops

169

228

174

571

No. of attendances

673

726

678

2077

No. of clients

293

373

394

No. of contacts Health trainer sessions

451

574

607

1060 1632

No. of sessions with clients

116

171

No. of clients

129

139

137

405

No. of attendances

238

260

290

Telephone Support and Advice Service Centre usage (no. individual visits)

2846 3020

4768 4695

5074 4792

788 12688

Support and relaxation groups No. of groups

No. of sessions

194

178

118

490

No. of volunteers

Trustees

Support volunteers

Volunteer counsellors

No. of hours worked*

1460

1440

1522

4422

Courses and workshops

Support and Advice Service (SAS)

One-to-one sessions

12507

All volunteers

Employability (economically inactive women only) Signposted to jobs/volunteering Engaged in WHAC services

221

249

Gained employment

Progressing to learning/training

122

136

Getting accredited training

Progressing to volunteering opportunities

Referred to other services

100

* excluding meetings and training

3.2 Big Lottery outputs, 2008 to 2012 Table 3.2 displays the outcomes and outputs associated with the Big Lottery funds. The right column also shows whether those outputs have been achieved. It should be noted that the objectives presented were changed in early 2010 after supportive negotiations with the Big Lottery. Table 3.2 Big Lottery outputs 2008 to 2012 and level of achievement Output* Achieved Yes/no 250 women will have improved Yes, since 2008 WHAC has seen a total of mental health as a result of 366 clients. These show improvements in accessing all the services their Warwick-Edinburgh Mental Health and Well Being Scale scores, signifying improvements of mental health. 18 new volunteers will improve their Yes, since 2008 WHAC has trained and life skills and receive training to supported a total of 60 volunteers** deliver services 650 women seen for health sessions Note: since 2008, WHAC has provided a will show improved diet, nutrition and total of 433 women with support and exercise behaviour training on health issues. However, the Condition Management Programme ended in 2010 and the level of availability of the Health Trainer was reduced dramatically in 2008/2009. 200 families will benefit from Yes: since 2008 a total of 268 women have womenâ&#x20AC;&#x2122;s increased knowledge on been seen by DAWN (150 received debt budgeting, benefit information and advice and support, 82 received family law family law advice advice and 26 received advice and support about housing and benefits). Increase WHACâ&#x20AC;&#x2122;s community Yes, WHAC has increased its participation involvement through attending and strategic influence (see section 4.3). strategic fora Accredited training course for Yes, achieved 2010 volunteer counsellors Accredited training course for Forecast to be achieved in 2012 organisational support volunteers by March 2012 * Note: there is no double counting in these figures, all figures relate to individual women. * * Excluding Trustees

3.3 Working Neighbourhoods Fund outputs, 2008 to 2011

The outputs associated with this funding stream changed in 2009 when the local administration changed to a unitary local authority. The Wansbeck Initiative WNF employability programme (April 2008 to September 2009) was delivered entirely 22

within the district of Wansbeck and the County Councilâ&#x20AC;&#x2122;s WNF employability programme (October 2009 to March 2011) was delivered in South East Northumberland and specific deprived rural areas in the North and West of the county. Table 3.3 displays the project target output together with the degree to which they have been achieved. Table 3.3 Working Neighbourhoods Fund outputs, 2008 to 2011 Outputs for Wansbeck April 2008 to September Achieved Initiative programme 2009 WNF No. of counselling 700 Yes: actual number 2083 sessions Health trainer sessions 210 Mostly: 171 No. completing confidence 70 Yes: actual number 79 building course No. completing well being 70 Yes: actual number 78 course No. of clients signposted 0 Yes: actual number 71 to training/jobs/ volunteering Outputs for October 2009 to March Achieved Northumberland County 2011 Council programme WNF Target group engaged 250 Yes: actual number 249 Target group referred to 100 Yes: actual number 100 other services Target group receiving 250 Yes: actual number 249 employability support Target group progressing 110 Yes: actual number 125 to training/learning provision Target group progressing 20 No: actual number 13 to volunteering Target group attaining (additional target) Yes: actual number 3 accredited qualifications Target group securing paid (additional target) Yes: actual number 8 employment

3.4 Northumberland Care Trust outputs The Care Trust had the following outputs (table 3.4 displays these and also the degree to which they have been achieved). Table 3.4 Northumberland Care Trust outputs, 2008 to 2011 Outcome Description Achieved Yes/no Counselling 403 counselling sessions Yes â&#x20AC;&#x201C; WHAC has provided a total of sessions per year 2083 counselling sessions, accessed by 366 women. This represents an average of six counselling sessions per client. The Care Trustâ&#x20AC;&#x2122;s annual grant has purchased counselling for 67 women a year.

3.5 Fair Share outputs Fair Share had the following outputs (table 3.5 displays these and also the degree to which they have been achieved). Table 3.5 Fair Share outputs, 2010 to 2011 Outcome Description Achieved Yes/no Health 225 people benefiting Yes: 250 people accessed healthimprovement from health-related related activities (the project delivered: activities three Yoga courses, four Tai Chi courses, two healthy cooking courses, three keep fit courses and six events)

3.6 Support for Women Around Northumberland outputs, 2010 to 2011 The SWAN project had outputs relating to the overall project, which was delivered in partnership with three other organisations, the lead being Escape Family Support. WHAC is therefore a contributor to the outputs listed in table 3.6. Although the specific percentage reduction in reoffending was not specified as a target for the project, the project has achieved a 70% reduction.

Table 3.6 Support for Women Around Northumberland outputs, 2010 to 2011 Outcome Description Achieved Yes/no Finance, debt and benefit 30% to progress within 3 Yes – 33% support months Children, families and 30% to progress within 3 Yes – 53% relationships months Supporting sexual and 10% to progress within 4 Yes – 56% domestic violence months Attitudes, thinking and 80% to progress within 3 Mostly: 71% behaviour months0 Skills and employment 80% to progress within 12 Mostly: 65%* months *Due to complex needs and behaviour around drug, alcohol abuse, housing and debt, some women need longer to stabilise to be able to progress to skills and employment.

Case study: Bridgette, multiple vulnerabilities Bridgette is a 48 year old woman with complex problems who has been receiving counselling and other support services for the last three years. Bridgette has been in a very abusive relationship which she has now left as a result of making decisions enabled through counselling. She accessed the family law and debt advice service with Dawn Advice at WHAC and she is being supported through divorce proceedings and its financial implications. Bridgette stopped her counselling sessions in December but because of a crisis over the Christmas period, she started coming again in the New Year. WHAC has supported Bridgette in many ways in addition to the counselling provided. She has been accompanied to the Crisis Intervention Team in Northumberland (made up of the Police, local authority agencies and housing) because of a disclosure of a suicide attempt and this resulted in moving the Bridgette to a safer environment. WHAC has also supported her to access the Safeguarding Adults Team to provide additional support. Bridgette is a very vulnerable client who frequently phones WHAC for support. She has been intensively worked with and it is the opinion of the support worker at WHAC that without their intervention and continued support, she would have accessed a series of critical services, such as A&E and the Police.

4.0 Evaluation findings This section presents the findings of the evaluation based on interviews and analyses of project records. They are sub divided into general findings, findings from service users and findings from partner agencies.

4.1 General findings

•

WHAC has achieved or is on target to achieve its agreed outputs: WHAC has fulfilled its funding obligations and in many cases have exceeded them (see section 3). This is an important function for an organisation commissioned to provide specific services or who is in receipt of a grant.

•

WHAC supports women who experience a range of complex problems: Graph 4.1 displays the range of issues that women present with at the counselling sessions. General poor mental health including stress, depression and anxiety are the most common issues, followed by relationship problems, self esteem, bereavement and domestic violence. There are also a number of clients who are seen because of alcohol abuse, sexual violence, childhood sexual abuse, work-related and physical health problems. Their other services also support women with other needs, such as family law and debt advice and education and training. Where relevant and appropriate, WHAC monitors the development of its clients and levels of recovery through their own Flower Power mental health monitoring tool (see appendix one) and by using the Warwick-Edinburgh Mental Health and Well Being Scale. Both these methods demonstrate that clients’ physical and mental health improves as a result of WHAC’s interventions.

•

WHAC is a highly professional organisation with comprehensive staff and volunteer support systems: this is evident on a number of levels, from the trust and respect afforded WHAC by other organisations, to the systems and processes in place. There is a staff handbook which covers all polices (sickness, maternity leave, parental leave, adoption leave, flexible working for parents and carers, compassionate considerations, dealing with extreme circumstances, bullying and harassment, grievance and disciplinary policies and procedures) induction and probation guidelines, and supervision and performance appraisal systems. There are also one day sessions for WHAC staff and volunteers called ‘WHAC Welcome’ which helps people feel part of the organisation and also brings equality and well being in the workplace. It was reported by several individuals within WHAC that one of the main strengths of the organisation is the “quality of the relationship that exists between volunteers, staff and trustees” and it was also reported that “there is a desire to keep that”. There are a range of measures and examples of trust demonstrated from other organisations, from the Northern Guild of Psychotherapists choosing

WHAC for student placements, to Safer Northumberland asking WHAC to set up a survivors group for their domestic violence programme. Graph 4.1 Issues presented by women at counselling, 2008 to 2010 Mental health problems Self esteem/body image Domestic violence Physical health problems Drug/alcohol issues Caring responsibilities Relatives affected by abuse/trauma Eating disorders Anger management 0

150

225

300

•

WHAC operates in a similar way to a one-stop-shop: it does this through offering a series of other services that address health and other needs. For example, women can access counselling, debt and family law services, further education courses, relaxation groups and access a health trainer. These all contribute to recovery from ill health.

•

WHAC is able to respond effectively to client and service user needs: WHAC has the flexibility to respond in a reactive manner to the needs of clients and service users. For example, WHAC ran both day time and evening confidence building courses in response to need and also increased the course length in response to feedback. The range of services also provides a choice depending on need and stage of recovery, for example, for some women group work is suitable and for others individual work is more appropriate. This also means that services are available to cater for need at each stage of the progression into good health and support recovery.

•

WHAC delivers a variety of well attended courses: during 2010/2011 WHAC has run 15 courses including new courses in arts and crafts, life coaching and managing stress as well as the popular courses in self development, confidence building, relaxation, creative writing and others (see section 2.1).

•

WHAC has provided women with support they needed to stay in employment: there was evidence to indicate that WHAC kept some women in employment. Without WHAC’s intervention, a number of women would

have left work due to mental health problems. This function is not captured in project output figures but is nonetheless an important outcome of WHAC’s work.

•

WHAC’s services are provided to and accessed by all: it was reported by one senior manager interviewed that “WHAC transcends social boundaries”. In other words, women of all socio-economic groups, of different ages and ethnicities benefit from the services of WHAC making them an egalitarian and equitable organisation 14.

•

WHAC’s counselling services are being accessed by increasing numbers of young people: it is worthy of note that since 2009 there has been an increase in the numbers of young people accessing counselling. For example, in 2009/2010 a total of 15 percent of all counselling clients were aged under 25 and in 2010/2011, the percentage rose to 26 percent. It is also noteworthy that approximately two thirds of these young people were survivors of sexual violence.

Case study: Eve, living in care Eve is 14 years old and lives in care. She came to WHAC as a result of a former volunteer at WHAC recommending the service to her and who encouraged her to go for counselling. Eve was assessed and it became clear that her only source of support was an educational worker who had tried to support her as best she could. However, Eve required a different level of support. Eve has a complex set of problems including the experience of sexual violence, drug and alcohol abuse and family breakdown, which resulted her in being taken into the local authority’s looked after system for her own safety. Eve has been receiving counselling for five weeks and is progressing well.

•

The listening ear service did not develop as envisaged: this was originally included as a part of the Big Lottery funded initiative. The reasons for this include a lack of private space in the WHAC premises and a shortage of volunteers to specifically focus on this service. Instead, the service has consisted of general support and advice provided to clients and service users by staff and volunteers. The same objectives have been achieved but using a slightly different approach.

The one exception to this is an absence of disabled access in their premises.

4.1.1 Fair Share specific findings

•

The project used a participatory development approach: WHAC used a truly participatory project approach by supporting the community organisations identify and develop their own initiatives. This allows the initiatives to be sustainable as the development comes from the local community. The project was also based on sound and thorough local needs assessments. These assessments had their own beneficial impacts, such as increasing the knowledge within local communities of the local community organisations (of which many people professed to have no knowledge) and increasing the organisation’s knowledge of the needs of the local community. Working in a participatory way entails considerable investment from the project worker in terms of demonstrating their investment and commitment to the local community. There were occasions when for a variety of reasons (including the heavy snow of the winter of 2010) people did not show up to the events or classes. Thus patience and commitment from the project worker is required to continue the activities despite non attendances. As in good participatory development, the project has increased the capacity of the four community organisations that were part of the project in a number of ways. These include: increasing their portfolio of activities available to the local community; increasing their revenue; using the buildings when they were previously unused; and increasing their knowledge of and contacts with trainers.

Case Study: Laura, a counselling client Laura is 31 years old with three children under five and has experienced a number of crises which led to breakdown. These cumulative crises included an acrimonious divorce, the loss of her job and the loss of her children through Social Service involvement. Laura was initially brought to WHAC by a Sure Start support worker. WHAC’s Volunteer Counsellor worked with Laura, supporting her emotional needs during counselling sessions as well as addressing her additional needs and making appropriate referrals. There were times when Laura was unable to attend the WHAC centre due to financial struggles and on these occasions the WHAC would find a venue within walking distance from Laura’s home. Whilst attending WHAC, Laura has seen a solicitor with DAWN Advice for debt and family law advice. Since coming to WHAC, Laura has now moved out of the marital home, secured premises of her own, progressed into paid employment and is looking at obtaining shared residency of her children in the future.

•

The project achieved its objectives and has had wide ranging health impacts: the project has expanded and increased access to exercise and diet in local communities. The project has stimulated local communities to take control of their own access to health-related activities and now those communities continue and have plans to expand those activities started by the project. For example, Yoga and Tai Chi classes are continuing where previously there would have been none and Real Food Works (a social enterprise whose aim is to improve healthy eating) has taken bookings from other local community groups, such as the Blind Society and a local youth club.

•

The project resulted in the increased use of community resources for health-related activities: one community venue said that the project had resulted in between 20 and 30 additional community centre users each week. There was also evidence to indicate that the new participants attracted by the health promotion activities went on to access other activities at the community centres. One manager of a community venue said “[the project has] made a greater awareness [in the local community about the centres] and made a greater usage”.

•

There was widespread appreciation for the project worker: those interviewed spoke highly of the nature, approach and commitment of the Education and Training Officer. WHAC’s investment in the community groups was recognised and appreciated, both the project worker’s role in arranging the sessions and the WHAC administration in Ashington in taking bookings and handling the general administration. This function was particularly appreciated as the numbers of people that make up the community centre management committees are low and members often have full time jobs and so their time availability is low. One treasurer of a community organisation commented “the committee really warmed to Dianne [the project worker]”. They continued “we have a really positive relationship … she has re-energised the committee because of her enthusiasm … she’s empowered us”. The regular project updates were also appreciated by the Seaton Valley Fair Share reference group.

•

Community organisations would like the relationship to continue: there were reports by community organisations that they want to continue the work together. One manager of a community organisation said “it’s a progressive relationship, we want to see it continue”.

•

WHAC’s initiative fulfilled the stated objectives of Fair Share. These included, to build social capital by building links within and between communities to promote trust and participation; and improve liveability by improving the living environment for communities.

Case Study: Martha, a support volunteer who gained employment Martha is 54 years old and lives in Ashington with her partner. Her last employment was with the NHS a number of years ago, but due to stress and difficulties at work she was unable to continue and she stopped working. Martha began claiming Disability Living Allowance and Income Support. Martha applied to be an organisational support volunteer at WHAC in 2004. Her aim at that time was to gain more skills and knowledge, gain confidence, meet new people and to ‘do something useful’. Initially she started with general administration tasks which included computer work, dealing with telephone enquiries and processing expense claim forms. Since she started volunteering, Martha has enrolled on several of WHAC’s courses for her own personal development and has earned a series of qualifications including: • • • • •

NCFE Level 1 Certificate in Interpersonal Skills NCFE Level 2 Certificate in Adult Literacy NCFE Level 2 Certificate in Adult Numeracy OCR Entry Level Certificate in ICT OCR Level 1 Certificate for IT users: File management and e-document production • OCR Level 1 Certificate for IT users: Creating spreadsheets and graphs • OCR Level 1 Certificate for IT users: Databases Martha has now been offered employment with WHAC to work specifically with debt advice clients.

4.1.2 Working Neighbourhoods Fund specific findings

•

WHAC assisted the County Council and Northumberland Employability and Work Service achieve its strategic employability objectives: WHAC engaged with economically inactive claimants and provided support to tackle both mental and physical health and employability barriers experienced by women in the most deprived parts of the county. This engagement happened on many different levels, from oneto-one support, participation on employability or health courses, provision of counselling and support, advice and guidance. Since 2008, WHAC has engaged with over 500 women. Many of these have been referred onto employability support services (such as Job Centre Plus or private sector employment support organisations such as A4E or to volunteering, learning and training opportunities). The counselling volunteers at WHAC also commonly go on to paid employment if they are not already employed and tend to progress in their employment if they are. This demonstrates an additional employability function, that of up skilling women and enabling professional development. A County Council representative said “we are very happy with the outcomes [of WHAC]”. 31

•

The Working Neighbourhoods Fund has contributed to the sustainability of WHAC and levered in additional funds: in early 2008 WHAC came very near to closing due to insufficient funds, redundancy notices were issued and new clients were no longer accepted. Wansbeck Initiative as a partnership felt that WHAC’s services were too important to lose and agreed to fund WHAC for a further 18 months through WNF. WHAC went on to be one of the selected employability projects to be supported under the new WNF programme for the County Council between October 2009 and March 2011. This funding has ensured the sustainability of the organisation and enabled it to attract further funds, such as from the Big Lottery and the Ministry of Justice, as well as smaller pots of funding such as Nancy Barbour Trust and Fair Share (total of £280,466 between October 2009 and 2011). The Working Neighbourhoods Fund also enabled WHAC in 2008/2009 to refurbish the public areas in the building. In other words, WNF has enabled capacity development within WHAC which has ensured the sustainability of mental health, well being and employability services for women in the locality.

•

WHAC was able to effectively adapt its services to provide a focus on employability: WHAC’s core service is women’s health but as ill health and worklessness are closely associated with each other, WHAC was able to incorporate both when working with clients. The County Council representative said “WHAC has been very flexible and responsive to a shifting emphasis on employability”.

•

WHAC has effectively used the Hanlon System for recording: WHAC started using the Hanlon System in 2008. It was a condition of WNF funding and WHAC are increasingly using it to examine outputs.

Box 4.1 An evaluation by staff, trustees and volunteers An evaluation workshop was carried out with a total of 30 volunteers, trustees and staff in the Spring of 2011. The workshop gave participants, many of whom had been involved in WHAC for over 20 years, an opportunity to critically evaluate the services of WHAC. The responses have been thematically analysed and are presented below. These findings reflect the organisation’s perspective on its services.

What WHAC does well

The counselling service is excellent: there were a number of reasons given for this including: attraction and retention of volunteer counsellors of the highest calibre (it was noted both their stringent application process and the referral relationship with the Northern Guild of Psychotherapists helped to ensure this); the range of volunteers ensures that the right volunteer can be matched to the right client; and the WHAC Volunteer Counsellor Training Programme which underpins the entire service. Services are accessible to women and are free: participants felt that there were no barriers to people accessing WHAC’s services. This encouraged people to come to WHAC as opposed to other services in the community where people may be reluctant to go for a number of reasons, including embarrassment, fear and anxiety. WHAC now also provides counselling on weekends and out of office hours that increases accessibility. WHAC has an excellent local reputation and is unique: it is a well respected service and WHAC is a key agency in Northumberland in partnership working arrangements, both operationally and strategically. Participants also identified that no other agency provides the same services in a similar way and as such WHAC fills a niche in mental and physical health services (particularly the former), employability services, support and advice and in providing training and education courses. WHAC provides an integrated service and is more than just counselling: they also provide a series of other services and key to those is a general support function that they provide to women if it is required. In other words, if a client or service user requires intensive support then it will be provided. Furthermore, those services are not time limited and this is important for those that use WHAC, to not feel hurried and to have somewhere to come in times of crisis. WHAC focuses on the whole person and its services allow all practical and emotional needs to be catered for, either in-house or with the support of WHAC. WHAC offers its services in a positive and supportive environment: participants felt that the environment provided by WHAC was key to its success. It was identified that WHAC has a welcoming and friendly atmosphere with excellent staff and volunteers. This gave WHAC an approachable ‘human face’ which was highly appreciated by service users and clients; it was noted as non formal but professional. WHAC has excellent volunteer and staff support systems: WHAC has been very purposeful in the creation of both comprehensive volunteer and staff training and support systems. This support was identified by participants as exemplary and made staff and volunteers feel valued and appreciated.

Box 4.1 continued Where WHAC needs to improve

Reduce their waiting list for counselling: currently WHAC has a waiting list of between eight and 12 weeks (although urgent cases are prioritised). This has been caused by a sustained and secure funding period (between 2008 and 2011) which enabled WHAC to build up volunteer counsellor numbers and expand the client base (both from an increase of referrals from partner agencies and an increase in self referrals as the local reputation spread). Recruit organisational support volunteers: these are needed to assist with both administrative and service development duties. However, due to staff capacity issues, it has not been possible to recruit. It was noted that this issue (and the previous point) could be solved by the appointment of an additional Volunteer Coordinator. Improve the building: it was recognised that the current premises are often inadequate to house a modern professional office and a service delivery function. It was also noted that there was no disabled access. The lack of space was identified as a contributory factor to why the listening ear service failed to develop. However, it was recognised by participants that the physical space was also an advantage in that it was low key and allowed for anonymity.

What WHAC needs to do

Increase staff capacity to enable the recruitment of additional volunteers: currently it was felt that the Volunteer Coordinator was at capacity in terms of the number of volunteers she could effectively support and manage. Additional staff resources would enable WHAC to both recruit more volunteers, carry out more initial assessments (that a fully qualified counsellor must do), see more clients and reduce their waiting list. Move into new areas, develop new links: this was based on positive experiences gained during the SWAN and Fair Share projects, both of which demonstrated that WHAC was effective at using an outreach model and also at delivering services to men (in the case of Fair Share). There was also an identified need for WHACâ&#x20AC;&#x2122;s services in other areas across Northumberland, such as Blyth and Newbiggin. Improve the physical infrastructure: to include a comfortable waiting area, quiet areas and disabled access. This could either be achieved through expansion or new capital build. Develop a service for men: this was based on both successful current outreach operations (e.g. Fair Share and courses run in the community) and on need. It was felt that men in Northumberland need a service such as WHAC and this could be developed from outside of the current premises (either through outreach or through occupation of alternative premises). Develop counselling and courses for targeted groups: develop the service for different groups such as: young women from 14 years upwards by providing counselling after school hours; young people from the looked after system; counselling for men (see section 5.2 for a further explanation).

4.2 Findings from clients and service users Client and service user feedback was gauged through a number of means, from direct interviews to an examination of feedback and evaluation forms. We make the following findings:

•

The services of WHAC are highly regarded by clients and service users: this appreciation is reported both from WHAC’s base in Ashington and of its outreach work. In a 2010 survey of WHAC users, respondents said they chose to use WHAC’s services because they are welcoming, discreet and non judgemental and because they enjoy being there. In the same survey, most respondents reported that WHAC’s services are either outstanding or very good. WHAC’s health promotion activities and the health-related courses were also reported to be appropriate, accessible and well regarded. Women and men have attended a variety of engaging and enjoyable activities in the community, from Tai Chi to healthy microwave cooking. Comments included: “it’s relaxing and fun, you meet people and that makes you feel physically better”; “I’ve thoroughly enjoyed my start of retirement”; and “I have gained in confidence and enjoyment weekly … an excellent tutor”. One important aspect to the activities of WHAC was reported to be their accessibility, for example one service user reported “I don’t feel the activities are above me, I feel able to go”.

•

WHAC’s interventions encourage people to progress into employment, volunteering or further education: the responses in the training and education evaluation forms demonstrate that the courses encouraged people to progress onto other courses or to volunteering. For example, in 2010, in a sample of 92 WHAC course participants, nearly half (n=44) stated that they intended to enrol on further courses at WHAC, a quarter of participants (n=23) said they intended to enrol in further education courses outside of WHAC, almost 20 percent (n=17) said they now intended to volunteer and a total of 11 percent (n=10) said they intended to find employment.

•

The health promotion activities and the health-related courses improved people’s health: there were many reports from people that they felt in better health as a result of participating in the health-related activities. There were many reports from people with specific, disabling health problems about the accessibility of WHAC’s activities. Comments included: “The movement has at times given me a feeling of warmth, at times strength, at times a feeling of serenity … despite my problems with arthritis”; “I practice [Tai Chi] at home in the mornings and it sets me up for the day … I do more things now which I wouldn’t have attempted before” and “I have

Rheumatoid Arthritis and this class is one of the few things I can participate in, allowing gentle exercise without inflaming my condition”.

•

The counselling is reported by WHAC’s clients to improve their mental health and allows them to recover: this has a series of positive impacts on women and their families. Comments included “I found the counselling very helpful, to open up to someone takes a lot, but they were very understanding, they listen and help you to understand your anxiety and your fears”; and “Being able to talk openly about problems, feelings, guilt and anxieties with someone who listened, was not judgemental was a great relief and helped regain my confidence”. There was evidence from service users (e.g. see box 4.1) that because of WHAC’s intervention, people feel less isolated, more part of society and often able to return to work (after periods of ill mental health), volunteering or education. There is significant data from WHAC to indicate that women’s mental health shows improvements after counselling. WHAC uses its own Flower Power monitoring tool, in addition to the Warwick Edinburgh Scale, which demonstrates impact. Graph 4.1 Flower power scores pre and post relaxation course

Friends and family Body image Mood Confidence Physical health Self esteem Social life Relationships Money Home environment 0

Before course

After course

Source: WHAC client dip sample Note: low scores indicate poor mental health, higher scores show improvements.

Case Study: Maria, a young adult carer Maria is a young adult carer for her mother and was 20 when she came to WHAC for counselling. She was referred into WHAC by a local GP because of her poor mental health. She very upset with low self esteem and expressing feelings of being 'smothered' by the needs of her immediate family. Maria had effectively cut herself off from friends and spent no time on leisure activities for herself. Maria became ill and was off sick from work. The counselling initially focused on how Maria felt about her burden of caring, placed on her by family. Through gently challenging the client in their use of language i.e. replacing 'ought' and 'should' with 'could' and 'will' the client began to take back control of her life. One session in particular stood out when the counsellor expressed concern that Maria always talked about what her mother would think and feel and not what the she herself felt or thought. The middle sessions of the counselling focused on Maria's loss of identity and the isolation of not being able to tell people how she felt. The use of role play during counselling enabled her to finally talk to her supervisor at work about what had happened at home. Maria returned to the next session really happy because she had talked to her supervisor and she said that it was the first time that an adult had actually listened and helped her rather than placing the burden of others’ expectations on her. As a result of exploring coping strategies and ways for her to be more assertive about her own needs, Maria realised that she had a right to a life of her own. This was a breakthrough and over the weeks Maria started to see friends, set boundaries around the demands of her parents and has become aware of her own resources to deal with her problems. The latter sessions of counselling focused on strategies to help Maria not to collude with the expectations of others. Maria acknowledged that if was okay to feel angry with her parents and to say that sometimes she needed to be the child and not the adult in the relationship. The last two sessions focussed on Maria's goal to go back to work. Maria had written about why she had been off sick on an application form for a care worker job and was happy to get an interview. Maria had doubted herself believing that people would never give her a chance after she had been off sick.

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WHAC’s long term presence was particularly appreciated by clients: many women who use WHAC’s services reported a major benefit to them was feeling secure in the knowledge that they could go back to WHAC for support in times of need. Indeed, there is evidence to suggest this practice is common, i.e. at times of crisis in their lives women re-engage with WHAC for top-up support. For example, one client said “It was a comfort to know that even though I had completed my course of counselling sessions, I am able to contact the service again if I feel I need to”. There was evidence from clients to indicate that this function stopped them from experiencing mental breakdown and using critical services. For example, one service user reported “if WHAC hadn’t been there, I would have tried to kill myself” (and this is a relatively common response from clients and service users).

Box 4.1 Feedback from a service user “I am very grateful to everyone at WHAC for their help and for providing such a warm, nurturing atmosphere. I will always be most grateful to [name of counsellor] for helping me to get my life back on track. When I started sessions with her last November I was suspicious of everyone, had no direction, was sinking financially and didn’t want to leave the house. I am now much happier, am out doing something worthwhile each day, have asked for help with finances and have had three job interviews. Without her help none of this would have happened and I feel very lucky to have been referred to WHAC by my doctor, I feel I have been given a precious gift – that of hope. Thank you”.

Case Study: Jane, a volunteer into employment Jane came into WHAC in April 2008 for an initial volunteer interview; she had been unemployed for several years and was looking to change professional direction. Jane was successful in her volunteer interview but initially because of childcare issues she felt unable to attend the training course. WHAC provided childcare to enable her to attend the course and she progressed onto the six week Volunteer Counsellor Accredited Training Programme. Upon completion of this, Jane attended a final interview and began client work at WHAC in August 2008. As Jane progressed in her counselling, she became more confident and she was competent enough to take on more complex issues with new clients. Jane successfully gained her Foundation Degree in Counselling and now works as a Community Family Support Worker.

4.3 Findings from partner agencies

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WHAC is a trusted and respected organisation: this trust is felt on a number of levels, from having the trust of women and girls who use the WHAC’s services to other professional organisations trusting WHAC with their often vulnerable clients. It was commented by one interviewee that WHAC was a “trusted broker”. This has significant implications, i.e. that women trust WHAC sufficiently to engage with them and then trust WHAC’s choice of organisation that they are referred to. WHAC is also held to be an organisation of integrity and committed to its client group.

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WHAC is unique in Northumberland: it was unanimously reported that WHAC is unique in the services it provides. All agencies said that there was 38

no other agency that did what WHAC did. Again all agencies interviewed said that they would like to see WHAC’s services available in all parts of the county. A senior manager within the Northumberland Care Trust reported “they are the only organisation [in Northumberland] that specifically targets women and their health issues”. The Domestic Violence Coordinator from Safer Northumberland reported that they were an important partner as no other agency provides longer term recovery support (instead offering more crisis intervention support) for survivors of abuse. This function as a provider of post abuse counselling is important for Ashington particularly as the Police Sector currently has one of the higher incidences of domestic violence in the county (incidence is high across South East Northumberland generally).

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WHAC offers a highly professional service: this is one of the important reasons for the high level of trust awarded WHAC by other organisations. WHAC adheres strictly to BACP guidelines, has a comprehensive volunteer support system in place and is the recipient of a number of awards including: ➡ ➡ ➡

➡ ➡

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The Matrix Standard 2010 The Nancy Barbour Award 2010 Northumberland Healthy People, Healthy Business Silver Award 2009 (WHAC is completing the Gold Award in 2012) Wansbeck Works Partnership Award for Best Practice 2008 National Council for Further Education (NCFE) Approved Centre 2010/2011 Women’s Mental Health Conference 2009 Service User Involvement Award

WHAC’s Volunteer Counsellor Accredited Training Programme received the following comments from the NCFE’s internal verifier, ‘We were unanimously full of praise for the tutors, learners felt respected and valued and as a result they felt confident and well prepared to begin their work as WHAC counsellors’. The Programme was short listed for the Northumberland Business Awards. WHAC’s Creative Writing class was also visited by the Workers Education Association 15 assessor to quality assure the course; they classed WHAC’s standard of delivery as ‘outstanding’.

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WHAC actively contributes to policy development and partnership working across Northumberland: WHAC provides representation on a number of steering groups and local initiatives including: Community Health Voice, South East Northumberland Health Improvement Group, Northumberland Mental Health Promotion Steering Group, Northumberland Volunteer and Community Sector Consortium (NVCSC), Northumbria

A voluntary sector provider of adult learning in the North East.

Health Care Trust (representing NVCSC), Health and Well Being Sector Board (representing NVCSC), Ashington Credit Union, Vision Group, Worklessness Group (to March 2009), Northumberland Employment and Work Service (from April 2009). Box 4.2 Northumberland Healthy People, Healthy Business Award The Northumberland Healthy People Healthy Business Award scheme has been developed by the Northumberland Care Trust to give recognition and endorsement to those workplaces that motivate workers in developing a sustainable culture of health and well being by: • Reducing ill health both in workers/the public caused, or made worse, by work • Helping people who have been ill (caused by work or not) to return to work • Improving work opportunities for people currently not in employment due to ill health or disability • Using the work environment to help people maintain or improve their health.

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WHAC has increased local partnership working: WHAC is proactive at developing partnership working arrangements and this includes organising a number of local partnership information and advice days. For example, WHAC brought together nine local organisations to run a Money Matters Day for the local community in March 2009 and on another occasion in 2010 WHAC arranged a health and advice day where a number of county and local organisations were present. The first day comprised of information and advice to beat the credit crunch and the organisations presented workshops giving debt advice, information about grants and loans, banking and hints on how to save money. One partner organisation said, “There was a friendly and informal atmosphere … it was well organised with excellent information”. Another example of how WHAC encourages partnership working is a presentation given to GPs and as a result of this, WHAC has been offered the use of rooms at Widdrington Station Surgery and Nursery Park Surgery.

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There has been an increase in the number of people accessing family law and debt advice: as a result of the partnership working between DAWN Advice and WHAC, people have accessed legal advice who would not normally have accessed it. Resolution of entrenched issues, such as rent arrears or dysfunctional relationships, has a major impact on the health and well being of women. As such the relationship between DAWN Advice and WHAC is organisationally beneficial and ultimately beneficial to women.

Box 4.3 Mental Health Concern Oakfield (MHCO) and Increasing Access to Psychological Services MHCO delivers the Government’s Increasing Access to Psychological Services initiative in Northumberland. They mostly receive referrals from GPs for patients with moderate to mild mental health problems. A team of 10 full time equivalent staff provide Cognitive Behavioural Therapy to people either over the telephone or face-to-face for clients with greater need. The CBT is delivered through six to eight sessions on the telephone which last for around 30 minutes. There was a recognition that the service they provide and those of WHAC’s were different and aimed at different clients. MHCO refer clients to WHAC that are either unsuitable for CBT counselling (and this can be for a range of reasons depending on the client and trauma experienced) or after they have completed their sessions and they want to progress to other activities (such as the group work or courses that WHAC provides). A WHAC representative said “most of our clients have suffered complex trauma, so they need a different level of support and counselling”. MHCO gave an example of client who had been referred into them by a GP to illustrate: “it was an older woman living with a terminally ill sister, she needed help and support to prepare her for her sister’s death … there was no-one to see her except WHAC and they took her straight away”. MCHO continued “we don’t offer relationship or bereavement counselling, we don’t offer long term support, financial advice, we don’t deal with abuse … but WHAC does”. A MHCO representative said “we use them for all sorts of things, I am very lucky to have them in Ashington … we need them all over Northumberland”.

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The Northumberland Care Trust and WHAC have a mutually strong relationship and have cooperated in project delivery, such as in the location of the Health Trainer at WHAC and supporting WHAC clients with their Condition Management Programme, and also as a commissioner of services, i.e. the annual grant to provide health and counselling services. Representatives from the Trust reported that WHAC helps them achieve their public health objectives and access the hardest to reach. For example, one manager said “a lot of clients don’t feel comfortable with GPs or nurses, or they might feel they are being judged … but not at WHAC, so they go there”. Another manager from the Trust said “they enhance the services we provide”. There was a desire from both parties to maintain and develop the relationship.

Box 4.4 DAWN Advice and WHAC DAWN Advice is a charity that provides free legal advice to people who lack the means to seek private legal advice. Much of their work concerns family law and debt advice. DAWN Advice and WHAC have been working together for 10 years. Both organisations have a mutually supportive relationship: WHAC provides DAWN Advice with access to a group of people who would not normally access legal services; and DAWN Advice provides WHAC’s clients with family law and debt advice. For many clients and service users of WHAC, their family situations (e.g. relationships, marital situations, domestic abuse or child care arrangements) or debt problems are closely linked with poor mental health. Either the familial or debt problems are causing their poor mental health or ill health means that women are not able to find solutions to problems. In terms of practical arrangements, a DAWN Advice family law solicitor takes appointments and goes to see clients at WHAC. In this way, people are seen in a familiar, safe and supportive environment and this removes many barriers to accessing legal services (such as cost or embarrassment). One solicitor said “normally people wouldn’t go to the solicitor, rather they would ‘handle’ the situation or by the time they got to the solicitor, it would be the first point of contact”. In relation to this latter point, it was noted that many women are in too much of an emotional crisis and are often unable to understand legal issues. WHAC provides the women with the support that they require to be able to access and understand family law or debt advice. Again the solicitor commented “[with our other clients] you ask them who is helping you through this [crisis] and they say either no-one or they are on the GP waiting list for counselling”. DAWN Advice reported “WHAC bring women to the point when they can access and talk about their legal issues … we see women there who aren’t ready to talk to a solicitor, they do the counselling then they come back and see us, when they’re ready”. This is further evidence of WHAC’s bridging role.

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WHAC is important for a number of other organisations and helps them to achieve their objectives: this occurs on a number of levels, for example, by providing a free counselling service, WHAC assists Community Psychiatric Nurses, GPs and other mental health services in the work they do with their clients. WHAC provides a longer term, more comprehensive package of psycho-social support for women suffering poor mental health. Often community psychiatric services are only short term or brief interventions and they cannot provide the wrap around support that WHAC provides. If WHAC did not cater for these women, the burden on community health services would be higher.

WHAC assists other organisations access vulnerable and hard to reach women such as DAWN Advice and Northumberland Care Trust’s Health Improvement Programme and thereby assists them in accessing their client group. WHAC also helps other organisations manage their caseloads by accepting clients, such as for MHCO (see box 4.3). One agency representative said “[WHAC] helps us manage our cases and keeps our numbers down, which means we can see more people”. WHAC is also important to employment agencies such as Job Centre Plus as they provide a key service in getting hard to reach people ready for work. They are also important to further education establishments as they provide volunteering opportunities for trainee counsellors. WHAC also provides a key service for victims of domestic violence and this assists the Police, the Multi-Agency Risk Assessment Conference and other domestic violence services. WHAC provides a different type of service that is not available elsewhere: long term, therapeutic counselling, in a neutral environment.

4.4 Outcomes Based on the findings, we can make a series of judgements about the outcomes achieved by WHAC. ๏

WHAC connects hard to engage people with universal services: one agency reported “WHAC is the missing link … it is the bridge between formal services and people that wouldn’t normally walk through the door”. It does this because it is an accessible and trustworthy local community service which brings people in. Once involved with WHAC, clients can then access a range of other services such as debt advice, family law advice, further education and health information. One senior manager with Northumberland Care Trust said “the kind of people they see are the complex healthcare cases that are exactly who we want to do preventative healthcare with”. In addition to these services, WHAC provides women with support to access other community services. This is not simply a signposting function, in that clients are given contact details, moreover it is a handholding service and women will be accompanied to where they need to go on the first occasion, if required .

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WHAC plays a major public health role by improving the health of its clients: and this happens on a number of levels. The Northumberland Care Trust representative reported that women’s health issues were constantly changing and WHAC were in a good position to respond to new health challenges. Clearly, WHAC’s most significant health impact is in improving the mental health of women through counselling. However, either at the same time as the counselling period or afterwards, WHAC engages women which then provides the opportunity to discuss female specific issues such 43

as binge drinking, smoking, obesity (diet and exercise) and diabetes. It was reported that WHAC allows women the space to think about themselves and their own health (instead of thinking about the welfare and health of others, see section 2.0). In addition to this and related to the above bullet point, WHAC picks up particularly women with poor mental health who would otherwise go undetected. It was reported by a series of agencies that the clients of WHAC are unlikely to present themselves at routine medical services as in need of mental health treatment. As such WHAC intervenes at an important point in women’s lives; with no intervention many of their clients would have presented at critical services (e.g. A&E, Police). This has obvious cost saving implications to local and national services. One professional reported “those people who get missed have got serious problems”. Another said “WHAC are [sic] advocates of public health”. WHAC’s public health role however extends past the counselling service and also includes its education and training and individual support services. ๏

WHAC has led to increased employability of local people: this has occurred through the provision of counselling to individuals with mental health issues, providing a route to engage with people who may not otherwise get involved (creative and fun events and activities), confidence raising and short health courses, bespoke training courses for specific groups and volunteering opportunities. They broker support to services which cannot be provided in-house through WHAC and DAWN but which may be vital for a woman to be able to move on. They also provide progression routes through the Northumberland Employability and Work Service to other opportunities for learning, training, volunteering and employment. A 2010 WHAC evaluation16 reported ‘WHAC plays a key role within the employability infrastructure, providing a vital service to women over 14 who are experiencing a wide range of difficulties which affect their mental and physical health and affect their ability to seek or retain work, as well as to have a fulfilling life’ (page 2). On a more immediate level, around 10 volunteers at WHAC secure employment each year. This is in addition to the number of women they help stay in employment.

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Baharini, D. 2010. Women’s Health Advice Centre Training for Personal Progression, Interim evaluation, Northumberland County Council.

at both the engagement and pre-engagement stages (see figure 1.1) and at moving people into more productive roles. ๏

WHAC ensures positive social reproduction and builds social capital: these sociological terms refer to the ability of a group of people to successfully maintain their status as a cohesive group and continue to function in that way (in other words how communities survive and grow) and social capital refers to connections within and between social networks which helps make communities more resilient. By impacting positively on women who are often either mothers or heads of household, WHAC is ensuring the family’s survival and growth and by implication assisting the local community by providing strong constituents. Poor mental health has a detrimental impact all those involved, i.e. the woman herself, her children, partner, wider family and friends and on local communities. Similarly, assisting people remain in existing work or find new employment has additional positive impacts on social reproduction. As one partner agency manager said “they increase people’s emotional resilience and improve outcomes for families”. Another agency reported “they have a huge social impact … strengthening relationships and improving bonds between people”.

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WHAC improves and adds value to the work of other organisations: there were many instances found during this evaluation where associated organisations reported that WHAC enhances their services. The organisations are diverse and range from social enterprises (who report that they have expanded their services and geographical reach because of WHAC) to public health bodies and employment agencies with associated targets, which WHAC helps them achieve. In a similar vein, WHAC fulfils, in an operational sense, the strategic objectives of its funders. For example, WHAC fulfils the Big Lottery outcome areas of: People having better chances in life, with better access to training and development to improve their life skills; Stronger communities, with more active citizens working together to tackle their problems; Improved rural and urban environments, which communities are better able to access and enjoy; and Healthier and more active people and communities. It provides a similar function for the Working Neighbourhoods Fund and the Northumberland Care Trust.

5.0 Conclusion and recommendations 5.1 Conclusion A major finding of this and previous evaluations has been WHAC’s position of high esteem and trust afforded it by other organisations. This trust has developed because of a long track record (over 25 years of successful operation), the high level of professionalism and their impact on improving women’s health. WHAC is also resilient and the organisation and staff have shown great fortitude to continue delivering services at times of near closure (due to a lack of funding) and staff shortages (due to sickness) and when local government and partnership reorganisation in 2008/2009 caused difficulties in the continuity of services and networks of providers across the county. Another key finding is how WHAC provides a bridging function between women and formal health and other services. This has been a dominant function of WHAC since they opened in 1983, when it was commented that “people [women] were scared of doctors”17 . In the early days of WHAC many of the issues related to female specific health issues such as advice on abortion, miscarriage and menopause. Those health issues are changing and now women are coming with different health issues such as diabetes and joint problems. They are also seeking support to change their lifestyle, improve their diet and reduce their alcohol intake. WHAC has been shown to be effective at responding effectively to women’s changing health needs. This bridging or brokerage function not only applies to health but also to employability and legal services and to other administrative and supportive services that exist. This has resonance to organisations with a responsibility to provide services to those hard to reach or non engaged (e.g. many of those on Incapacity Benefit and the new inactive benefits). In other words, one of WHAC’s key advantages is that they carry out engagement and pre-engagement work with women very effectively, they provide a ‘feeder’ function to such agencies, whether they are health, employability or other services and they also broker in additional support services from a much wider network of providers based on the client’s needs, rather than simply signposting. In a future world of commissioning, this is advantageous as WHAC can both engage and refer clients to lead agencies. They can also take on clients to provide relevant support for those who may be registered with other agencies or through lead contract holders, but for whom mental health and the other support provided by WHAC would be key in helping their clients progress.

Hartworth, C. 2008, WHAC; A 25 year review. Page 12 (http://www.barefootresearch.org.uk/ docs/WHACreview.pdf)

The evaluation has found that one of the great values of WHAC is that they engage with women who would not normally engage. They not only do this effectively, but they also help women get well. Improvements in physical and mental health are the result of the client or service user with the support and guidance of WHAC tackling the root of their problems, whether these are a result of suffering childhood abuse, the experience of debt, relationship problems or domestic violence. As a result of this, the improvements made are likely to be sustainable. Which leads to another major finding: that WHACâ&#x20AC;&#x2122;s continued presence provides a safety net for those clients who may need periodic support or who suffer from crises and require intermittent support (or at least be secure in the idea of having it). Thus, the relationship between the client and WHAC is seen as continuous and supportive. As a result of the issues presented in this evaluation, we can conclude that WHAC is in an excellent position to provide key public health and employability services in South East Northumberland and also county-wide (the latter through ongoing expansion via outreach and with a mixed gender service). Indeed, not only are they key to engaging with targeted populations, but they also have a proven track record in good partnership working and delivering commissioned public health and employability services.

5.2 Recommendations WHAC is recognised by clients, commissioners and service users alike as an excellent and unique service in Northumberland. As a result of this, there are very few actions to recommend in relation to improvements of existing services. The recommendations that we do have are: 1.

The need to increase capacity within the organisation through appointing additional staff. There is potential to expand the services to cover a wider geographic area and to develop the range of services provided and client groups served currently. However, without additional core staff, this will be difficult in terms of the lack of capacity. It is recommended that there is staff support for the Manager and Finance Officer to enable them to focus on the strategic direction and development of WHAC. In terms of the provision of both counselling support and the other volunteering opportunities within WHAC, an additional Volunteer Coordinator would be of value. This would have many positive impacts including the ability to significantly reduce the waiting list of clients requiring counselling support, expand the types of volunteers and relieve some work pressure from existing staff, as well as enabling service development.

The need to resolve the issue around space for the delivery of services is pressing. During this evaluation there have been a number of issues raised 47

about the current premises, such as no disabled access, no waiting or quiet area and, as an original terraced house, its layout is unsuitable for a modern, professional purpose. However, it is also noted that there are a series of benefits to the current location that include its low key and anonymous nature and low rent. Alternatives should be considered, such as the current location being used as a headquarters rather than a space to deliver services and that arrangements be made through partnerships with other organisations, or independently as WHAC, to secure the use of a range of locations to deliver the services to clients. In relation to WHAC as a whole, there were a number of future areas for development identified during this evaluation. ➡

The development of an outreach counselling and support project: there is a need across communities in Northumberland for a similar service, aimed at both women and men from the ages of 14 upwards. It is difficult to judge how such a service would become embedded and accepted and how well used it would be. As such the project would have to be trialled for 12 months to test it. Additional funds could be accessed for a specific pilot or WHAC could begin preparations in readiness to deliver such a service (e.g. draw up publicity and identify and cost venues).

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The development of a family law and debt outreach project in collaboration with DAWN Advice. This is a distinct service from the above and needs to be seen as such. Justifications for this are the success of their current collaboration, the need to provide psycho-social support in conjunction with family law and debt advice and the geographical isolation experienced by many people across Northumberland who require such a service. This service has particular potential considering the effects of the public funding austerity measures (and an increased propensity for debt, unemployment, associated poor mental health and family breakdown).

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A service for men: many of those interviewed reported a need for a similar service for men. For example, an MHCO representative said “there are loads of men on our client list who could do with counselling”. A service for men would have to be delivered in an alternative venue or through outreach, with referrals initially coming through GPs, MHCO or through selfreferral. This may have staffing implications such as needing male personnel and branding implications (MHAC could become the brother organisation to WHAC).

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Counselling and support services could be targeted at specific groups, such as care leavers and bespoke packages of support could be offered (this would need to be discussed and located in the current redevelopment of their marketing strategy). Examples of such groups are: young people from 14 upwards in care; care leavers; carers (including young adult carers); 48

people on probation; families; survivors of sexual violence; survivors of domestic abuse; and men (some mock up flyers are shown in appendix two). Services including counselling, group work/courses and self help/ support groups. These bespoke packages need to be designed and individually costed to allow commissioners to spot purchase. All these areas for development are complementary and they all could be achieved as part of a general organisational expansion. Although equally, they can each be pursued as individual elements. However, it is recommended that WHAC positions itself (i.e. gets ready) to be able to deliver public health and employability services across Northumberland. As such, WHAC would be able to deliver such a service at short notice. It should be noted that WHAC is already familiar with a number of these different ways of working and has itself expanded albeit in a small way. For example, WHAC delivers outreach counselling via the SWAN project in a number of community venues and also they work in different community venues for the Fair Share project. In other words, WHAC has already demonstrated that it can effectively work in a number of different ways. To end as we began this report (with comments), we will quote a manager for the Northumberland Care Trust: “if WHAC weren’t there … where would women go”. Currently WHAC mostly delivers its services around South East Northumberland, and Seaton Valley, so the previous comment relates to the women of these localities. If WHAC were a presence in other areas across Northumberland, it would allow a lot more women (and men) to be able to go somewhere instead of nowhere.

Appendix one: Flower Power Assessment Tool18

How are things for you?

Friends 5

Accommodation

Family

4 4 4

3 3

Money/Debt

5 4

Children

3 2 1

My Life

1 2

4 How does your offending 5 makes you feel?

3 4

Name:____________________________ Date:_____________________________

1 1

Your Relationship with partner

5 Alcohol

Mental Health

2 3

4 5

Physical Health

5 Drugs

Circle the number showing how you feel about each at present 1²Very Poor 2²Poor 3²Average 4²Good 5² Very Good

Although this has SWAN branding, it was developed by WHAC.

Appendix two: Examples of publicity for bespoke packages

Boost self confidence courses for looked after children WHAC offers a six week course for boys and girls in the looked after system or care leavers. Week 1: Gaining confidence Week 2: Looking inwards at our own feelings Week 3: Looking outwards at relations wit others Week 4: Safety and respect Week 5: We are beautiful Week 6: Our futures For further information, contact: Cath Carnaby WHAC 1 Council Road Ashington Email: Tel:

Recover and grow self confidence courses for survivors of abuse WHAC offers a six week course for women from the age 14 upwards. Week 1: Gaining confidence Week 2: Looking inwards at our own feelings Week 3: Looking outwards at relations wit others Week 4: Safety and respect Week 5: We are beautiful Week 6: Our futures For further information, contact: Cath Carnaby WHAC 1 Council Road Ashington Email: Tel:

NXcb`e^ Xe[ kXcb`e^ counselling for men WHAC offers a counselling service aimed at men from 14 upwards. Upon referral, a qualified counsellor will carry out an assessment and match the client with a suitable counsellor or psychotherapist. Counselling sessions can be held at premises in Ashington, in GP surgeries or other community venues. For further information, contact: Cath Carnaby WHAC 1 Council Road Ashington Email: Tel: