Theory of Change - the differences that STARS makes

The evaluation identified STARS’ direct benefits to its clients and also the indirect benefits to families, local communities and government services.

Benefits for Clients

Current and former clients of the STARS programme described a wide variety of different ways in which they had benefited from the work of

“I knew I couldn’t sort my addiction problems without somewhere stable to live.” [A&A Client]

Case Study Matt, age 30

Matt started drinking heavily and using drugs in his early teens following his parents’ separation. As his dependence on alcohol increased, Matt experienced high levels of anxiety, becoming in his own words ‘overwhelmed by feelings of panic and fear – being out of control’. He was unable to leave the house without a drink, he was upset and depressed, and lost all pride in his appearance.

Matt’s father and grandmother paid for him to go to Focus 12 rehabilitation service, after which he was referred to STARS which housed him in a flat in Bury, away from his former ‘crowd’. STARS also helped Matt find opportunities for further education, studying IT and also becoming a volunteer at Focus 12 and for local Narcotics Anonymous meetings.

Matt’s physical health improved dramatically. He now enjoys climbing and, as his new flat is a bit out of town, cycling.

Without Focus 12 and especially STARS, both Matt and his Dad think he would be back in his old town now, drinking again.

Matt says: ‘I feel good about myself again instead of crap. I used to just sofa surf and doss anywhere, but now I have a beautiful flat and like to look good.’ He sees his Mum, as well as his Dad regularly now and his Dad has seen ‘a massive change in him. He has grown up and progressed and is a model student at college. I can trust him more now.’

STARS. These benefits, or Outcomes, are shown graphically in the Theory of Change in Figure 1.

Interim Outcomes

In the early to mid stages of each clients journey on STARS they benefit from key outcomes that support them to progress further through the programme and towards

Stable and Secure accommodation, often combined with relocation to a different part of the county. Most intensive support housing is in two-person flats. Structure and meaningful occupation of time. Alongside the provision of accommodation, STARS helps introduce structure

recovery: into the lives of clients. This can include the provision of volunteering opportunities, attendance at Narcotics Anonymous or Alcoholics Anonymous meetings.

Engagement with treatment and recovery maintenance. Clients better engage with treatment services to maintain or further their recovery. This in turn helps reduce the likelihood and extent of reoffending.

Figure 1: Theory of Change for STARS’ clients

Provide Direct Accommodation

One-to-one Support

Advice & Advocacy

Rehousing Reduction in Offending (Drugs / Theft / Violent Crime)

Relocation

Stable & Secure Accommodation

Structure Engagement with Treatment Incl. NA / AA

Personal Care

(New) Positive Peer Relationships

• Volunteering • College • Group Activities • Training Positive Social Values

‘Normality’

Work Skills & Ethics Safety

Cross-Addiction

Stable Finances Physical Health • Nutrition • Hepatitis C • Drug / Alcohol Recovery

Mental Health & Wellbeing • Self-esteem • Confidence • Resilience • Courage • Giving Back Occupying Time

Employment, Education, Training

Relationships • Family • Children • Friends

Legend:

STARS Activity

Client Interim Outcome

Client Final Outcome

Relapse

Change experienced by STARS’ Clients

[[NB: We could include the fuller Theory of Change that incorporates outcomes for other stakeholders too. If so, we should include the sentence: This diagram also shows indirect benefits or outcomes for other stakeholders, including family members, local communities and government services. ]] Personal care. Many clients used the term ‘normal’ to describe their lives after entering STARS. The stable accommodation and support gave clients the tools and motivation to look after themselves e.g. to wash regularly, wear clean clothes, the ability to cook and eat and therefore have a better diet.

Positive social values and peer relationships. A key element of recovery and rehabilitation is building relationships with people who can support that recovery, including peers and professionals. STARS also brings about a shift in clients’ values, thereby building cultural capital7; for example, many said that they want to be open and honest and not lie anymore.

Work skills and ethic. The volunteering opportunities also re-introduce those with previously chaotic lives to the discipline of work, providing them with new skills. Combined with take up of education and trainin, this can begin to improve the chances of paid employment in the future

Final Outcomes

Through sustaining interim outcomes clients realise further changes in themselves or Final Outcomes. It is these outcomes that are measured and given a financial value for calculating services SROI.

Health and Well-being. The most significant changes for STARS clients relates to their health and well-being.

See: Granfield, R. and Cloud, W. (2001) Social Context and “Natural Recovery”: The Role of Social Capital in the Resolution of Drug-Associated Problems, Substance Use and Misuse, Vol. 36, pp1543-1570

Improvements to physical health include:

Reductions in substance misuse with 65% of clients being free from street drugs and **STAT** completely ‘clean’ and ‘dry’.

Increase in weight; Sometimes recovery has identified underlying health problems that will take longer to sort out, such as Hepatitis C, but with stability, clients are able to start to get treatment for these.

Improvements to mental health and well-being include:

A 40% increase in confidence and self esteem was cited by clients, using words such as ‘courage’ and ‘resilience’ to describe their enhanced well-being. Many also spoke of the renewed ‘hope’ which the stability and support provided by STARS had given them. Clients also commented on the opportunities they have been given to ‘give something back’ through volunteering.

Safety. Linked to health and wellbeing, clients often spoke about feeling safer since being supported by STARS. This is an interesting reversal of popular perceptions of substance using offender, which usually see them as perpetrators, rather than victims – in reality they are frequently both.

Relationships and Re-integration.

Clients frequently cited significant improvements in their relationships, with family and with new friends who support rather than hinder their recovery. Many clients spoke about gradually rebuilding the relationships with family members and children that had in some cases completely broken down.

A key aspect of recovery is becoming part of the ‘recovery community’, which is well developed in Suffolk. STARS encourages their clients to become actively involved in their local recovery community and there were numerous examples of them helping in different ways in Narcotics Anonymous and Alcoholics Anonymous groups, and volunteering as Recovery Champions and in other roles in treatment and related services, thereby using their experiences to strengthen that community.

Financial Stability and Employment

Some STARS clients have gained employment, achieved NVQs or are aiming to set up their own small businesses. Although the majority of clients remain on benefits, the support to access those benefits is highly valued, and having a postal address greatly assists this process.

Negative outcomes

For STARS only one and unsurprising negative outcome emerged from this research: the significant levels of cross addiction, most notably the replacement of Class A drug use by increased drinking. This is in keeping with national research8 and the STARS team work hard to address it, through a balance of encouragement and penalties and working with partner agencies.

For example, see the Drug Treatment Outcomes Research study (DTORS): www.dtors.org.uk “Me and my cousin came out of prison for the umpteenth time and were committing loads of crime – drugs and other stuff – and [were] using heavily. Police put us on ‘PPO plus’ because they were fed up with us – constantly harassed us and took everything off us. We were living in a tent cos family and friends had chucked us out cos they were fed up with us… If I hadn’t found STARS I would still be in a mess… To be honest I would probably be in jail for killing someone, or someone would have killed me, cos my life was very violent.” [Male ex-client]