Complimentary Therapies

Hetty’s

Complimentary Therapies

Evaluation Report

November2009

“It takes you to a place where you meet your own self; I do matter.

Now I have the strength to go the journey. It’s changed my life.” – Therapies client

“I know it sounds very dramatic, but I think it saved my life.

It gives you your life back.” – Therapies client

Anne-Marie Ainger

Contents

Contents

Executive Summary

Introduction to the Complimentary Therapies Service

Expectations of the Service

Purpose of the Evaluation

Methodology

Evaluation Findings

Results from the Richer Assessments

Client Exit Surveys

Kinship Carers Conference Evaluation

Findings from Interviews

Implications for broader services

Conclusions

Appendix 1 – Interview Questionnaires

Executive Summary

“Until you try it, you can’t understand what a massive difference it can make.

It’s changed my life!” – Therapies client.

In 2003 Hetty’s introduced a range of complimentary therapies as a core component of its service provision with the aim to “relax the body, balance the emotions, clear the mind, aid stress relief and ease anxiety”. Since this date the demand for the service has grown, with the introduction of referred clients from other support agencies in 2008. An evaluation of the service was conducted to gather information on the perceived impact of the therapies on clients’ outcomes. The evaluation did not set out to prove categorically that complimentary therapies ‘work’, but rather, to identify patterns associated with participation in the therapies, which could warrant further investigation.

The evaluation found:

• A clear impact of the therapies on relaxation and stressincluding longer term improvements in client’sability to cope with challenges and manage their lives. Clients reported feeling encouraged and nurtured, partly as a result of the therapies, but also due to the way they are treated by the therapists themselves and the environment in which they are seen.
• Transformational changes in clients’ sense of confidence, happiness and well being, particularly in relation to overcomingthe stress related to their circumstances.
• Numerous examples of improved physical health were found, including better sleep, reduced pain or tension alongside unexpected impacts on various conditions including asthma, fibromyalgia and arthritis.
• This is accompanied by a significant reduction in the use of prescription drugs, especially pain killers and anti-depressants, the therapies being seen by many as a direct substitute for the latter.
• The therapies seem to provide a safe environment for people to express their emotions and concerns, which appears to be accessible to people who would not access traditional talking therapies such as counselling, or who attach stigma to the same.

Overcoming stress, anxiety and illness seems to have had a range of positive secondary impacts for clients on their home situations, including:

• Clients feel empowered by the techniques which they can learn in sessions and actively use them at home.
• Taking on new training and employment opportunities as a result of the energy, motivation and encouragement generated through the therapy sessions.
• Giving clients the courage to end damaging relationships and to fight for their homes and grandchildren.

The positive impacts of the therapies seem to exist for both clients who receive mainstream support from Hetty’s alongside those who only access therapies at the centre. Clients and external support workers alike were confident that a large part of their progress was attributable to the therapies. They appear to be a natural compliment to mainstream support services. Where clients actively engage in both types of support, they appear to make the greatest, most rapid progress. Accordingly, support workers see the therapies as part of a comprehensive care package and expressed concern that these services are not more widely available. The therapies seem to be effective as both crisis intervention and for well being maintenance. Some clients continue to use the therapies services after completion of their time with issues based support services, using it as a tool to maintain their wellbeing as they transition back into ‘normal’ life.

There has been a noticeable impact upon Hetty’s as an organisation,promoting care and support between staff members, and generating a relaxed working environment. Staff noted that many similar work places are stressful and challenging, however, the work environment at Hetty’s testified to the fact that this is not inevitable. The introduction of therapies has also enabled external agencies to see Hetty’s in a more authentic light, recognising it as a family support service, rather than as a drugs and alcohol service. This has allowed Hetty’s to access a different set of clients through alternative referral agencies such as GP’s.

Professional support workers also noted the benefits of the therapies in managing their own stress and enabling them to do their jobs more effectively. Several support workers noted that having therapieshelp prevent time off work from stress related illness or through better management of long term physical conditions, offering both a benefit to the individual and a cost saving to the employer.

Clients and support workers alike noted the natural scepticism of both agencies and individual clients about the therapies, many were highly sceptical themselves before taking part. Interviewees consistently stated, “Don’t judge it until you try it.” While not all clients who have participated in therapies have achieved the same degree of progression, the anecdotal reports presented in this evaluation suggest a degree of benefit which is worthy of further investigation.

The report concludes that the potential impact of complimentary therapies is both considerable and cost effective, and could be applied to a number of different settings for the benefit of both clients and staff as part of a commitment to workplace wellbeing, holistic support services, early intervention and preventative health care.

Introduction to the Therapies Service

“Some people find God; I found Hetty’s! I’m a different person from coming here.”

– Therapies client

Hetty’s is a support service aimed at the families and partners of drug and alcohol users, based in Mansfield but covering the whole of North Nottinghamshire. It offers a range of services to support individuals and families including a confidential helpline and text service, one to one support and group sessions. In 2003Hetty’s added the provision of complimentary therapies to its support package, including reiki, indian head massage, colour therapy, emotional freedom technique and reflexology. The sessions are provided on site in a specially designed treatment room.

Individuals accessing Hetty’s support services are invited to participate in complimentary therapies, which are either free or at a significantly discounted price. There is no restriction to the number or frequency of sessions, clients simply book a session as required. Family members of that client are also welcome to use the therapies service and in some cases several generations of the same family attend.

Since 2008therapy sessions have also been provided on Fridays for drug and alcohol users who are receiving support from, and are referred by,other support services such as the Drug Intervention Programme, Building Block Solutions and Face It, as part of their relapse prevention care. These clients do not access the core support services at Hetty’s, they only come to the centre for their booked therapy sessions.

Expectations of the Service

“It’s about making you feel better.” – Hetty’s staff member

Complimentary therapies make considerable claims regarding their potential impact on health and well being. However, this is not widely accepted in the mainstream medical profession. Public health agencies and the community at large are often highly sceptical regarding complimentary therapies. There has been some limited research into the impact of complimentary therapies on patient wellbeing, however, there is much debate over the accuracy of the results and testing procedures used. As a result, the jury is out as to whether complimentary therapies should be recognised as a compliment to mainstream services warranting public funding.

The Hetty’s service makes no grandiose claims, rather it states that the purpose of its therapies service is to “relax the body, balance the emotions, clear the mind, aid stress relief and ease anxiety”[1]. Accordingly, we would expect clients who attend sessions to achievethe following five states:

A greater state of relaxation

Reduced stress levels

Calmer thoughts

A balancing of extreme emotions

Reduced anxiety

Due to the challenging nature of their home lives Hetty’s clients often experience high levels of stress, distress and emotional conflict, leading to anxiety, depression or weakened health. This is particularly the case for the Friday clients who are often living chaotic lives dominated to a greater or lesser extend by their drug or alcohol use. To achieve some progress towards the five states defined above during the therapy sessions alone would be beneficial for these clients. However, it is expected that the therapies willhelp clients beyond the sessions, enabling them to achieve these improved states in their day to day lives.

Purpose of the Evaluation

At present publicly funded services are commissioned against evidence based practice. However, values based evidence is increasingly being recognised, especially in light of commitments to patient choice and self directed support.

This evaluation does not seek to provide proof of whether complimentary therapies ‘work’according to their broadest claims. Rather, it is a review of the perceived changes in clients’ wellbeing associated with their accessing complimentary therapies at Hetty’s. If similar associations were repeatedlyfound then it is reasonable to conclude that the therapy appears to be contributing in a particular manner. This would not constitute proof per se, but it would makes a case for serious consideration and further investigation. It would also provide values based evidence in support of the service.

Methodology

A variety of information types were reviewed to gauge the impact of the therapies service at Hettys. This included:

Interviews with Hetty’s staff members and volunteers - who have received therapy treatments themselves. Some of these staff members provide direct support to Hetty’s clients who have received therapies and were able to comment on the progress of those clients.

Interviews with the therapists – to gain their perception of the progress of individual clients.

Interviews with therapies clients – some of whom access the broader Hetty’s support and some of whom only access the therapy sessions.

Interviews with external referral agency support workers (drug and alcohol or bereavement support services) - who have referred their clients to Hetty’s for treatments as a compliment to their support services.

Interview with a PTC parenting group – which runs a weekly session from Hetty’s, clients accessing therapy sessions alongside the group session.

Review of case files – for a total of 16 clients who have taken part in therapies.

Review of Richter data – nine cases were reviewed.

Review of client exit questionnaires.

Review of Kinship Carers event evaluation forms.

Staff and therapist interviews

Four therapists, three staff members and one volunteer were interviewed. Two of the therapists are also staff members within Hetty’s broader services. All of Hetty’s staff members have taken part in taster therapy sessions to gain a sense of what they entail and some have continued to have sessions on a regular basis. Staff members were therefore able to comment on the therapies in relation to the progress of their clients, and as therapies clients themselves.

Client interviewees

A list of clients who were willing to be interviewed was provided by Hetty’s. It was possible to interview either in person or by telephone a total of 15current therapies clients, of whom eight have accessed the broader Hetty’s support and sevenhave only accessed the therapies, five of whom are referred clients from external agencies. Interviews lasted from 20 minutes to an hour, and the detailed comments of clients were captured, verbatim where possible. Interviewees were asked about their general experiences of the therapies, and then asked to comment on a range of specific types of potential impact. This included:

Emotional and mental health – e.g. stress, anxiety, depression, confidence, feeling in control/ able to cope, enthusiasm/ motivation.

Physical health – e.g. sleep, short term illness and long term conditions, use of prescription drugs.

General behaviour – e.g. taking part in social activities, and accessing services.

Home life – e.g. relationships with family members, atmosphere at home, security of housing.

Work and training – e.g. ability to carry out job, time away from work, security of job, accessing or attendance at training.

The detailed case files of all of these clients were reviewed, dating back several years in some cases, in order to identify patterns in their progression and additional factors which might explain changes in their progress. The case files of a further six clients were reviewed whom it was not possible to interview.

Referral agency interviews

A total of eight support workers from four different external agencies were interviewed, by telephone or by face to face interview. These support workers refer clients to Hetty’s for Friday sessions. In addition to general perceptions they gave specific examples of progress made by referred clients. Hetty’s invites support workers from other support organisations to take part in taster sessions to help them better understand the nature of the service. Some have continued to attend sessions as private clients and were able to give detailed comments on their personal experiences of the service.

Client exist questionnaires

If a client has not contacted Hetty’s for two months or longer an exit questionnaire is posted to them and this is carried out in batches periodically throughout the year. The January 2009 questionnaire was the first to include a question on the therapies. Questionnaires were sent out to 65 clients,24 were returned, of which only five clients had received therapies. The full set of returned questionnaires was reviewed to capture general perceptions of the Hetty’s service in order to identify any additional contribution from the therapies service.

Kinship carers event evaluation questionnaires

Reiki sessions were offered at a Kinship Carers conference inOctober2008. These clients are the parents of drug and alcohol users who also have carer responsibilities for their grandchildren. As a result they have additional and more complex needs than other Hetty’s clients. Hetty’s staff delivered therapysessions at the event. Evaluation questionnaires were distributed in which participants could rate the different events of the day. Eighteen participants returned their questionnaires of whom eight had received a therapy session.

Richter scale assessment

Since 2007 Hetty’s has tracked progress made by clients against a range of aspects of wellbeing using Richter Scale assessments. The client scores his or her sense of well being against different topics, such as how safe or how stressed they feel, on a scale of one to ten. The first assessment takes place at the start of their engagement with the service, and it is reviewed periodically over time to demonstrate distance travelled. This is a relatively new approach at Hetty’s and therefore there are only ten cases where follow up assessments have been carried out to date. The Richterscores of clients who had taken part in therapies were compared to the scores of those who had not. The data was reviewed for any patterns or trends in the results. A total of nine cases were considered, of which seven had taken part in therapies[2]. The magnitude of the change for each topic was considered for each client, and then compared to the intensity of their use of the therapies. A client attending an average of eight or more session in asix months period was classed as a high level of participation,three to six sessions as moderate and one or no sessions as low/ none.

Comparison was complicated by the variation in time intervals between reviews, and the number of reviews that individual cases had completed. There are also numerous reasons why changes occur in these self assessed states, many of which may be viewed as exogenous such as moving home, or the loss of a family member. Separating these effects is extremely difficult, as is discussed in the text box below. Timing is also key, the results will vary depending on whether the assessment is carried out on a ‘good day’. A very large sample size would be required to overcome these constraints and identify any clear effect of taking part in therapies. This was not possible and therefore it is inappropriate to form any strong conclusions from this data. The results are considered to be illustrative only.

Further considerations

There is limited quantitative data available therefore the majority of the findings are based on anecdotal reports. Further, the number of cases reviewed is below that required to claim any statistically significant association. Findings are open to self selection bias, in fact, several clients who reported dramatic improvements in their physical and psychological wellbeing were keen to take part and share their stories, eager that others should learn from their experiences. These constraints were taken into consideration when reviewing the evidence presented by clients.