Understanding outcomes

In this section:

  • The outcomes you might seek to achieve in your community, your service and for the families with whom you work;
  • Case studies based on the Comic Relief funded projects which illustrate how these outcomes were achieved.

First steps: The outcomes you are seeking to achieve as an Alcohol Hidden Harm service are likely to fall into the following categories:

  • Community Outcomes;
  • Service Outcomes;
  • Family Outcomes;
  • Parent and Carer Outcomes;
  • Outcomes for children and young people.

Ask yourself which of these outcomes you are hoping to achieve and which are your top priorities, in which you will invest the greatest proportion of your human and other resources? Remember that some of these outcomes can only be achieved if you meet the needs of your clients (e.g. service outcomes) and others may be essential to the effectiveness of your work with families (e.g. community outcomes)

Community Outcomes

These outcomes reflect the changes you hope to see in the community in which your project is based and could include:

  • Increased knowledge and awareness of alcohol hidden harm within the community in which you are working. Staff and volunteers of other agencies will know about specialist provision for alcohol hidden harm and how to make a referral.

Case study: Working in the community

Staff of an alcohol hidden harm service support other drug and alcohol services and professionals who work with children in the community with training about whole family therapeutic approaches, offering insights into the impact of parental substance misuse. This training supports the continuing high level of appropriate referrals from schools and extended school co-ordinators in particular.

  • Other professionals, staff and volunteers in schools, social care, and the voluntary sector will have a greater understanding of what constitutes hidden harm and will recognise when children and young people are at risk of hidden harm.

Case study: Working with schools

One service worked with schools directly to raise awareness of alcohol hidden harm. This approach enabled teachers to understand the issues and, importantly, to engage more effectively with other agencies and parents

  • Less stigma within the local community

Ultimately the desired outcome would be that children and young people and their families would be able to access services without fear of stigma. Steps on the way to this outcome could include mainstream agencies providing services that are responsive to the needs of those families affected by alcohol hidden harm. Training staff and volunteers can be critical in addressing issues of stigma, enabling them to feel confident in working with children and young people and families affected by alcohol hidden harm.

Case study: Overcoming stigma

In one city the manager of the adult alcohol service felt that there was still a great deal of stigma attached to parental alcohol use and for this reason he did not think that the partnership between the adult alcohol service and the hidden harm project had been particularly successful. However, the hidden harm project persisted in running services, developing strong partnerships with a young carers’ project and other projects working with vulnerable young people. Young people attending the groups run by the hidden harm workers spoke of the stigma related to parental alcohol use and the relief they felt meeting other young people who had similar experiences to them.

  • The community has an increased capacity to reduce the risk of alcohol hidden harm.

This could include knowing how to recognise alcohol hidden harm and where to refer families struggling to address alcohol hidden harm within the home. To achieve this outcome agencies would require training for staff and volunteers, resources, referral routes and protocols concerning procedures to be followed if staff and volunteers become aware that a parent / carer is drinking harmfully.

Case study: Reducing the risk of alcohol hidden harm

Partners of one alcohol hidden harm service recognised that the work carried out by the agency filled a significant gap in services in the county and recalled the frustration they previously felt when they were unable to offer specific support to children whose parents were misusing alcohol. The service was not only seen as a source of support for families in their current situation, but also as a form of early intervention to prevent the cycle of alcohol misuse being repeated.

  • The community has an increased capacity to meet the needs of those affected by alcohol hidden harm. Staff and volunteers are trained, services do not just identify needs but can also respond to the needs identified.

Case study: Support and training

A practitioner from an alcohol hidden harm service has worked closely with schools where she was offering therapeutic support to children whose parents misuse alcohol. As a result school staff members have been better able to identify and respond to the children’s educational needs.

  • There is increased social capital within the community – more bridges between agencies, stronger networks, increased buy-in from all sectors and from staff and volunteers concerning the importance of addressing alcohol hidden harm.

Case study: Greater awareness

One agency set out to ensure that all agencies in a borough developed stronger awareness of alcohol hidden harm. This resulted in alcohol hidden harm being included in a borough wide strategy. Children’s Centres included identification of alcohol hidden harm within their key objectives.

Service Outcomes

These are outcomes which affect your own agency. They include:

  • An increased knowledge base and capacity within your agency to address the needs of children and families affected by alcohol hidden harm. Staff and volunteers will have received the training, managerial and clinical supervision, support and guidance to enable them to identify and work with families affected by alcohol hidden harm. Staff and volunteers will have an increased skills base in addressing issues of alcohol hidden harm, as well as mental health and domestic violence.

Case study: In-house training

In one agency staff from the AHH project undertook extensive in-house training on AHH for staff and volunteers working across a wide range of settings including probation, treatment, outreach, family support and day care. This training was also provided to partner agencies. Evaluation of this training and feedback from participants was very positive.

  • Your agency will have gained a reputation for providing high quality services to families affected by alcohol hidden harm and will receive referrals in line with this.

Case study: Changing focus

One partner agency described how before the AHH project had been funded their focus was always on the adult with the alcohol problem, not on the whole family. Now the AHH project addresses the needs of the children within the family and local agencies know who to refer to when they become aware of families where children are affected by AHH.

  • Your agency will have anticipated the future needs of your client group and the local community and will have identified and secured the necessary resources to provide financial security as well as the necessary resources to deliver an effective service to meet the clients’ changing needs. This will include having developed the networks to sustain positive outcomes.

Case study: Anticipating needs

One of the host agencies for an alcohol hidden harm service has led on partnership funding bids to secure an on-going service for vulnerable families locally. This agency has also secured funding in a timely manner for a further 3 years for the core elements of its AHH project (to avoid any break in services for users) and has extended the capacity of the project through offering social work placements. Central to the project’s practice is an understanding that families need to be able to re-enter the service and be safe in the knowledge that it is possible to access support again even once their case has been formally closed. To obtain positive results for families the service recognises it needs to be sustainable and to anticipate and respond to the changing needs of families.

Family outcomes and outcomes for children

The Institute for Research and Innovation in Social Services (IRISS) recommends a negotiated approach to defining outcomes for parents who misuse substances.

  • Better communication

Families affected by alcohol hidden harm may find communication in general very difficult with parents and children shouting at each other or simply not talking, rather than communicating in such a way that children and young people feel heard and are listened to. Older children may no longer attempt to communicate with their parents and younger children may act out because they do not feel heard. Your agency could assist families towards healthier communication – providing parents with advice on how to parent young children.

Case study: Communication skills

One agency routinely refers all families to a parenting programme. Parents describe how the skills learnt on the course have had a very significant, positive impact on communication within their family. Skills include: kneeling down to talk to children at their level, looking at children when you speak to them, commenting on and rewarding good behaviour and making time to spend together as a family.

Many children and young people in families where there has been sustained alcohol hidden harm, simply do not talk about the issue. The family’s way of ‘coping’ may be to ignore the problem or create a taboo around any mention of the alcohol misuse. One of the very first outcomes you may achieve is that of providing a child or young person with permission to speak about these issues. You could also work with parents to ensure that they support and develop any tentative steps toward communication.

Case study: Talking about it

A mother whose partner and the father of her children has a serious alcohol problem, attended one of the AHH harm services with her two children. The children received one to one therapeutic support with a dedicated Hidden Harm worker. The mother described how before they sought help from this agency, she and the children would not discuss the father’s alcohol misuse. Even though most weekends they had to flee the family home they never discussed why. The children tried to protect their mother from their worries, by not talking about them. For this mother the big change has been that: ‘They don’t keep things from me as much now. They realise that if they tell me things it’s not going to hurt me like before. So they are a little bit more open with me.’

Case study: Too young to talk

A mother working with an alcohol hidden harm service was unwilling to talk to her 10 year old daughter about her alcohol misuse as she ‘is too young’. One daughter was looked-after for reasons related to the mother’s drinking. An older daughter was aware of the parent’s alcohol problem. Other family members also ‘protected’ the 10 year old from this information.

Other parents working with the same service reported the benefits of being more open with children of this age and younger, including that the children were able to talk about other worries.

  • Assisting older children in coping with their anger, as well as learning strategies for communicating with their parents in an effective manner.

Case study: Anger management

One mother described how the alcohol hidden harm service had taught her daughter anger management skills. These had had such a dramatic effect on communication in the home that the mother had asked her daughter to teach her these skills and they both now use them to avoid the arguments that had previously dominated their communication.

  • Expanded support networks

Families affected by alcohol hidden harm may have spent many years isolated and afraid to ask for help. There may have been no one outside the home that the children or their parents were able to talk to about the alcohol misuse and the complex needs arising from this misuse. Children’s safety and security can be significantly increased, and the potential hidden harm reduced, if non drinking parent/s and the children and young people themselves are aware of how support can be accessed.

Case study: Secrets

One hidden harm service worked with children to help them identify the difference between a safe secret and a secret they needed to share. This project also helped children and young people to identify trusted adults they could talk to. These trusted adults included school teachers, grandparents and Hidden Harm workers.

Extending a family’s support network is a family outcome but it also builds on the community outcomes. It is in communities where the mainstream agencies are better able to identify hidden harm and address it, that families are more likely to be able to extend their networks of support.

Case study: Support networks for families

One agency invested heavily in training teaching staff and developing strong partnerships with schools, in recognition of the fact that schools are a potential route of access to even very hard to reach families. By investing in schools this project is seeking to leave a lasting legacy of potential support for families affected by AHH.

  • Functioning families

Families that have been affected by alcohol use over many years may have stopped functioning in ways that protect the health and wellbeing of children and young people. There may be little or no routine, children may not receive regular meals and there may be no time spent together socialising or enjoying each other’s company. A positive outcome for the family could be a routine which includes regular meal times and bedtimes; clear, safe, containing boundaries; the introduction of family time where family members play a game together, go out together or eat a meal together. These positive outcomes can include children attending school regularly and better links between home and school.

Case study: 'Hard to reach' families

One alcohol hidden harm service invested in building the capacity of hard to reach parents to spend positive time with their children. School staff arranged family outings and once they won the trust of parents staff have then assisted them in developing and adhering to routines within the home. This has included regular mealtimes and bed times and also ‘family time’ which can be a walk to the park or a meal together.

  • Resilient children

While there does not exist a ‘catch all’ definition of what a resilient child looks like, there are some key factors or characteristics that are likely to indicate that a child is resilient. Below is a list of those characteristics which were used throughout the project in the form of an outcome tool to measure resilience in children:

    • Having close friends of a similar age;
    • Not feeling scared or anxious in new situations;
    • Not being bullied or teased;
    • Trying to be helpful to others who are hurt or upset;
    • Choosing to mix with others;
    • Coping well in stressful situations;
    • Having confidence in their own skills and abilities;
    • Being able to cope with change;
    • Having aspirations for the future;
    • Having at least one adult to talk to if they have a problem;
    • Not feeling worried a lot of the time;
    • Not feeling unhappy or ‘down’;
    • Being able to talk about how they are feeling;
    • Not living in a home where there is a lot of fighting and arguing;
    • Living in a home where people help and support each other.

As children receive the help and support they require to mitigate against the impact of alcohol hidden harm they can develop these resilient characteristics. There is evidence that with the appropriate support and resources children can and do develop resilient traits and that these can protect them from some of the consequences of alcohol hidden harm.

Case study: Resilience

One very vulnerable young woman was referred to one of the AHH projects as she was caring for her mother and younger siblings. Her mother was terminally ill and had a long history of drug and alcohol misuse. At the time of referral the young woman rarely left her house, did not socialise and had no plans for the future. After receiving one to one therapeutic interventions and attending a therapeutic group, where she met other young people affected by alcohol hidden harm, she described very significant changes in her life. She now has a group of friends she regularly socialises with. She can leave the house alone and catch a bus into town. She has been able to speak to the AHH worker and discuss her feelings and her worries. She is attending college regularly and has made some plans for the future. Having met others in a similar situation to her own she no longer felt so isolated and as if ‘I am the only one'.

  • Reduced alcohol hidden harm

To reduce the amount of alcohol hidden harm within a community is ultimately to reduce the number of parents and carers drinking in such a way as to cause harm to their children. None of the five alcohol hidden harm projects funded by Comic Relief set out explicitly to reduce parental alcohol misuse. However in addressing the impact of AHH on children and young people, some interventions led to a reduction in parental alcohol use. Also there was anecdotal evidence from the projects that by working in partnership with adult alcohol services it is easier to reduce the potential for alcohol hidden harm by also addressing parental drinking. While stand alone interventions with children and young people can and do enable children and young people to demonstrate greater resilience, to reduce alcohol hidden harm it appears a whole family approach is needed.

The achievement of this outcome is impossible to evidence for projects which were funded for three years. However, it is hoped that the lessons learned about how the services funded by Comic Relief developed will make a lasting contribution to this long term goal.

References from this section:

  • Velleman, R. and Templeton, L.. (2007) Understanding and modifying the impact of parents’ substance misuse on children Advances in Psychiatric Treatment 13 79–89