EVALUATION OF THE COUNSELLING SERVICE
FOR CHILDREN WITH VISUAL IMPAIRMENT AND THEIR FAMILIES: BY SERVICE USERS, PARENTS AND TEACHING STAFF
November 2004
CONTENTS PAGE
1. Introduction 3
2. Evidence of the need for a Counselling Service 4-5
3. Service Provision 6
4. Profile of Children/Adults Providing Evaluation Feedback 7-8
5. Themes that Emerged from Evaluation Feedback by 9-10
Service Users
(A) Improved behaviour at school and/or generally 10-11
(B) Children have become happier, calmer with improved
self-esteem and an ability to deal with any difficulties
that they face 11-12
(C) Improved parenting 12-13
(D) A perception of the Counselling Service for Children
with Visual Impairment as an extremely valuable and
effective service 13-14
(E) A greater need for the service both more generally and
for the service not to stop suddenly once a child
exceeds the age of 13 years 15
(F) Children enjoyed various activities as part of the
Service 15
(G) Home life has improved following counselling 15
(H) Various worries still remain for some children 16
(I) Miscellaneous 16
6. Comments by Service Provider Staff 17
7. More Recent Service Provision 18-19
8. Final Comments 20-22
Appendix 1
Flow chart of service provision 23
Appendix 2
Evaluation of Counselling Service for Children with 24-29
Visual Impairment
Tables
Table 1: Profile of children and adults 8
Table 2: Profile of current service users 19
Table 3: Attendees of Counselling Courses 21
1. INTRODUCTION
The mental health problems of children are now indisputably recognised as an area of growing concern. Recent government and independent studies indicate that some 20% of children and adolescents in the UK suffer mental health problems, which may result in anti-social behaviour and have direct cost implications for government departments[1].
The Counselling Service for Children with Visual Impairment and their Families was established in April 2002 to address the mental health problems of children with visual impairment.
Demand for such a service has been recognised at a multi-agency level and includes recognition by the following organisations:
A) Local Education Authority (LEA) – Specialist Support Service (SSS),
Visually Impaired Resource Bases and Priestley Smith Special School
B) Department of Health – Paediatric orthoptic departments in
Birmingham hospitals
C) Voluntary Agencies – Royal National Institute for the Blind (RNIB) and
Birmingham Focus on Blindness
This report will:
· Look at evidence which already exists and examines to what extent there is a need for emotional/mental health support for children with a visual impairment and their families
· Explain the service provision that is offered by the Counselling Service for Children with Visual Impairment and their Families
· Present evaluation feedback from children, families and teaching staff who have experienced this service
· Consider the impact of the service from the perspective of service providers
· Look at the evaluation outcomes in the context of sustainability and inclusion
This report clearly examines the extent to which the Counselling Service for Children with Visual Impairment and their Families provides an important and beneficial service.
2. EVIDENCE OF THE NEED FOR A COUNSELLING SERVICE[2]
There is clear and growing evidence to show that children and young people who have a visual impairment and their families have a significantly increased need for emotional and/or mental health support. The following information was provided with the kind and helpful assistance of Royal National Institute of the Blind (RNIB).
Blind and partially sighted children and young people have the same needs and aspirations as their sighted peers. They also have the same rights to opportunities and choices. However, a recent study by RNIB showed that there are still a number of barriers that prevent this and seriously affect their confidence[3].
'Shaping the Future'[4], which was broadly representative of all parts of the UK, asked over 1,000 blind and partially sighted 5 to 25 year olds, or their parents, about their experiences needs and aspirations in areas such as education, leisure, transport and attitudes. The responses showed that attitudes and low expectations of other people can undermine self-confidence and lead to a lack of self-esteem.
May of the respondents stated that they frequently experienced prejudice and bullying. Nearly three in five secondary pupils and students in further and higher education had been bullied, whilst half the parents of the primary school children believed that their child had been bullied. Bullying can cause major problems, including loss of confidence and self-esteem and, more seriously, psychological problems. Other research (Nabuzoka and Smith 1993, Whitney et all, 1994) showed that young people with special needs were twice as likely to report instances of bullying as children with no special needs[5].
The blind and partially sighted children and young people in the survey are also reported as having feelings of loneliness, sadness and anxiety. Around one in three sometimes felt lonely and anxious, and almost four in ten sometimes felt sad.
Another recent study by a team of researchers from Oxford Brookes University and Imperial College London, interviewed 103 families with visually impaired children in four areas of England[6]. In the year prior to the study, the families had used a wide range of services and had seen on average 6.5 different professionals, including specialist eye doctors, opticians, specialist teachers for visually impaired children and health visitors. The study raised a number of areas of concern, with a third of parents disappointed with “poor communication with professionals”, a quarter criticising services for being “unsupportive” and promising help that had then not materialised, and a fifth highlighting the “inaccessibility of services”'.
Particularly relevant to this report is the widespread disappointment with the way in which both their own needs, and those of other family members, were overlooked. In particular, the issue was raised of a need for counselling and support to help parents and siblings deal with the ''shock'', guilt and anxiety they felt following the identification of their child's vision impairment[7].
Research relating specifically to parents of children with disabilities has just been undertaken by the charity Contact a Family[8]. The survey asked over 2,000 parents what effect they thought having a child with disabilities had on their relationship. Of these, 31% thought it had caused some problems and 9% felt it had led to separation. 76% had experienced stress or depression since having a disabled child, and 88% felt that the two were linked.
When parents were asked to rank the most important factors which they felt could help, 'emotional support' was listed second, and other important factors included 'support and information around diagnosis', and 'professional support'. The full 'top ten' needs identified by parents were as listed below:
1. A break, or more breaks, or more flexible breaks
2. Emotional support / counselling
3. Support and information around diagnosis
4. Fewer financial worries
5. Help and support from families and friends
6. Professional support
7. Support for the father
8. Recognition of the whole family's needs
9. Practical help at home
10. Information about services and entitlements.
Other than the literature discussed above, there seems to be very little research and literature with regard to the support requirements of children and young people who have a visual impairment and their families. In fact in the context of mental health research this area of mental health/emotional needs seems to be relatively neglected. However, as the above discussed reports and qualitative feedback in this report itself suggest there is a strong need for services that offer emotional/mental health support.
3. SERVICE PROVISION
The Counselling Service for Children with Visual Impairment and their Families is at a formative stage of development. Currently one counsellor has been employed four days a week to establish a Service and to action a “high priority” caseload. Two further counsellors have recently taken up post and each offer counselling one day a week. The service is now operating successfully on this basis, the intention being to develop this small team to cater fully for demand across Birmingham.
The Service has already identified 400 children and young people as having “significant visual impairment” in the city, of which some 140 children may have mental health issues to address (full Service Report available[9]).
The Counselling Service for Children with a Visual Impairment and their Families provides the following:
- One-to-one counselling for children and/or family members
- Group work for children and/or parents
- Regular supervision for staff in four resource bases and the Specialist Support Services (SSS)
- Support for mainstream staff on counselling courses
- Training for staff in schools, hospitals and voluntary agencies
(Please see flow chart of service provision, appendix one, page 23)
Despite the variety of service provision listed above, the focus of this report will be on evaluation feedback that relates to the one-to-one counselling. This emphasis has been chosen since clearly it is vital to show that the counselling intervention itself is effective and beneficial. Before considering whether it would be desirable and helpful to provide training and advice to other members of staff in order to enable the service to be offered more widely, we must be clear as to how effective the counselling itself is according to children/adults that have received the service. The direct impact of the service will be measured by analysing the feedback from service users, parents/carers and teaching staff. The possible impact of training provision and advice and guidance for teaching staff will be considered briefly at the end of this report, once we have discovered if and (if so) to what extent the counselling intervention itself helps the children and their families.
4. PROFILE OF CHILDREN/ADULTS PROVIDING EVALUATION FEEDBACK
This report is based upon evaluation feedback from eight children and two adults who received one-to-one counselling from the Counselling Service for Children with Visual Impairment and Their Families from the period April 2002 to June 2004. As will be explained below, this is 76% of service users during this specific period. Both of the adults are parents of children who have a visual impairment.
On average, each child/parent/family had around 15 one-hour sessions – though this is a general figure and varies according to need. During the period 13 service users were engaged in counselling and 15 service users had already finished. 6 further referrals had been made and after a period of assessment, it was decided that counselling was not appropriate and they were either referred to other agencies, or continued to be cared for at school. There were also 2 children on the waiting list. The 8 children and 2 adults who have provided feedback for this report were 76% of all service users who received one-to-one counselling during the particular time period from April 2002 to June 2004. The remaining 3 service users that have not provided feedback were not included for the following reasons:
· 2 children moved away almost directly after completing counselling. This happened quite quickly and so there was little opportunity for a contribution towards evaluation feedback
· 1 other child moved schools. The school is where the counselling took place. Therefore once again there was little opportunity to request evaluation feedback
The above 3 children have not been followed up with regard to the completion of feedback outputs. There are two main reasons for this. Firstly, the service itself is a small and very busy service with little time to follow up previous service users that have either moved away or moved schools. In the context of the sensitive nature of this service, chasing evaluation feedback would not be simply a case of forwarding questionnaires to new addresses. Secondly, 76% has been considered as sufficient for the purposes of this evaluation, particularly in the context of feedback responses that demonstrate clear and strongly supported themes.
Details of the children and adults are shown in table 1: Profile of children and adults (page 8).
1
N/COMMON/Natalie/Disability/Counselling Service for Children with Visual Impairment and their Families
Table 1: Profile of children and adults
GENDER / AGE(years) / ETHNICITY / DISABILITY / REASON(S) FOR REFERRAL TO COUNSELLING SERVICE
1 / M / 13 / White UK / Physically disabled/Partially sighted / Parents refused permission for counselling until child exhibited violent behaviour and was suspended
2 / M / 12 / Pakistani / Registered blind / Child suspended – on verge of expulsion. Parents bewildered and willing to try anything
3 / F / 11 / Indian / Visually impaired – not registered: syndrome / Threat of suicide. Quick intervention needed and given
4 / F / 8 / White UK / Registered partially sighted / Child has been through mental health system under previous psychiatric care. Anxiety and aggressive behaviour
5 / F / 8 / White UK / Child-degenerative visual impairment / Mother and child received counselling to deal with disability
6 / M / 8 / White UK / Registered partially sighted/Diagnosed autistic / Child very isolated and unhappy at school, with few friends.
7 / F / 13 / Irish / Child registered blind, degenerative visual impairment / Child very depressed. Initially offered school suggestion/strategies. Parents not keen on counselling, reluctantly agreed after pressure from the school. School and the child wanted counselling.
8 / M / 12 / Pakistani / Registered blind / Referred for aggressive, inappropriate behaviour. Child and parent unsure of how counselling could help
9 / F / ADULT / White UK / Registered blind mother / Mother needed help as well as her 8 year old child with degenerative visual impairment
10 / M / ADULT / Mixed Race / None recorded / Mother very depressed over incident in which her young child was blinded in one eye. Counselling offered to her, not the child (child affected by mother’s depression – weeping, over protectiveness, etc.)
1
N/COMMON/Natalie/Disability/Counselling Service for Children with Visual Impairment and their Families
5. THEMES THAT EMERGED FROM EVALUATION FEEDBACK BY SERVICE USERS
Evaluation feedback for the Counselling Service for Children with Visual Impairment and their Families is collected on an ongoing basis. As already stated, this report covers a specific set of service users who received counselling between April 2002 and June 2004. Feedback in this section has been provided by children/young people, teaching staff and parents. Throughout the report the term “children” will be used to refer to children and young people. Eight children and two parents received one-to-one counselling and have made comments about the service. Parents and teaching staff of the children have also provided important feedback about the children who used this service. Analysis and/or comments from service providers themselves will be shown in a separate section (section 6).