Research briefing
Emotional Support and Counselling project (ESaC)
September 2010
Introduction
RNIB commissioned University of Liverpool to evaluate a pilot project funded by GlaxoSmithKline. The aims of the pilot were to explore the impact of emotional support and counselling services provided as part of an integrated low vision pathway and to provide evidence to support policy makers, commissioners and practitioners for the future development and delivery of low vision services. At the two sites involved (Sight Service in Gateshead and RNIB’s Low Vision Centre serving the residents of Camden and Islington in London) a part-time counsellor has worked as part of an integrated Low Vision Service (LVS).
Method
The CORE-OM (Clinical Outcomes in Routine Evaluation – Outcome Measure) was used to measure changes in subjective well-being, problems/symptoms, functioning and risk (to self and others). A total of 35 service users (55%) provided CORE-OM data at both baseline and post-intervention assessment. Data for this Full CORE Sample was collected between April 2008 and May 2010.
In addition a range of qualitative investigations were undertaken including a review of service user needs and expectations prior to and post intervention (n=32), in depth exploration of users' experiences of the ESaC services (n=14), interviews with service providers (n=15) to understand their views on how the ESaC services fitted into wider low vision services, questionnaires with relatives and friends (n=7) to consider the impact of visual impairment on their relationships and their perception of the impact of ESaC services on service users.
Of the 190 people referred to the ESaC services during the pilot 149 became clients. Most clients (77%) received counselling and remained in the service for 13 weeks. The remainder received emotional support and stayed with the service for nearly 7 weeks. The majority of referrals came from within the LVS with fewer referrals from GPs and hospital eye clinics. In Gateshead, where an Eye Clinic Liaison Officer (ECLO) in post at the local eye hospital, they were the main source of external referrals to the ESaC service, accounting for 12% of all referrals but in London, where there is no ECLO in post, no referrals came from hospital sources. When introducing the ESaC service to service users, LVS staff used strategies which normalise and downplay what is involved, often avoiding using the term ‘counsellor’ in order to introduce people to the service who may not otherwise seek counselling.
Key messages from the research
· The Full CORE Sample clearly represented a clinical population, showing relatively high levels of psychological distress, which are also reflected in the qualitative data. By the end of therapy these levels of psychological distress had improved markedly (mean CORE total scores reduced from 53.34 to 30.83 from baseline to post-intervention assessment). This statistically significant improvement was seen in all four of the assessment domains and represents a considerable improvement in psychological well-being during the course of counselling. The improvement in well-being is also reinforced by the findings from the Needs and Expectations data and by the qualitative interviews with service users, which illustrate vividly how service users feel they have benefited from the ESaC services. These two participant quotes are indicative of feedback:
‘I was given to understand that most of the things happening to me were normal and human’.
‘I felt more motivated and didn’t have suicidal thoughts/feelings during my time with the counsellor’.
· At the baseline assessment the two major issues people wanted help with were visual impairment and depression or low mood. At the post-intervention assessment people gave more specific, positive responses and spoke of wanting to feel better, gain confidence, cope, make sense and move on.
· Sight loss is a transitional process. It is clear that the ESaC services have a role to play in supporting people at all stages through this journey and this indicates a need for continual access to ESAC services rather than just at point of diagnosis.
· There are some unique features that distinguish the ESaC service from generic counselling available through primary care.
a) Accepting and adapting to sight loss – The ESaC services played a valued role in enabling people to accept and adapt to their visual impairment by helping people to adapt emotionally to sight loss in different ways, according to the individual’s particular experiences. Strong themes emerging from the service user interviews were the emotional and practical impact of no longer being able to read easily; the way in which loss of sight can affect relationships, particularly those between parents and children; the way in which bereavement affects people’s ability to cope with visual impairment, adding to their feelings of loss; and the additional burden that physical ill-health brings, leading in some cases leading people to a new need for emotional support.
b) Flexibility – The flexible approach includes the use of telephone counselling, following-up service users who do not arrive for sessions, undertaking home visits, tailoring the number of sessions offered to the needs of the individual service user and allowing people to chose the level of support they wanted to engage with, from a lower level (emotional support) to higher level (counselling). Evidence from the service user data shows that this flexibility has been highly important, particularly in drawing people into the service who might not otherwise have sought counselling but who have gained significant benefit from it.
c) Humanistic model of counselling - Service users valued being able to talk to an impartial, non-judgemental listener and indeed valued the counselling relationship itself. Clearly the humanistic model of counselling adopted by the ESaC counsellors, which emphasises the capacity of the individual for personal growth is an effective and appropriate approach for the services.
In summary
The evaluation has demonstrated that the ESaC services are serving a client group that clearly represents a clinical population. ESaC services are both highly valued and are having a significant impact on those who use them. By the end of their course of counselling users of the services exhibit a significant reduction in their level of psychological distress to the extent that they can be said to have recovered. This change is statistically significant, which means that it can be confidently claimed that if the services were to be extended and offered to a similar client group similar levels of improvement would be shown. Qualitative findings from the evaluation reinforce the quantitative findings, indicating some of the ways in which service users have received benefit from the ESaC services and which may help to explain the levels of clinical improvement. Further research to examine the case for a causal link between the ESaC intervention and the significant reduction in psychological distress is recommended.
The interviews with service providers show that emotional support is part of all low vision work, although a distinction needs to be drawn between the emotional support routinely provided by low vision workers and the specialised emotional support and counselling provided by the ESaC counsellors. The ESaC services are clearly seen as a vital addition to the low vision services, enabling people to make better use of other elements of the LVS, particularly rehabilitation activities such as learning to use a white cane. The potential for more integrated systemic work is clear and further work is required to develop referral routes from GPs and hospital eye clinics.
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