SROI national specialist family service 2013

HugoMinney,PhD,RPP,AccPracSROI
2013
NationalSpecialistFamilyService
(PhoenixFutures)SROIForecast
‘Where parents are addicted to drugs and alcohol, family
breakdown may be the unfortunate consequence. Parents
need support to help them overcome their substance addiction,
but taking the child away permanently may stir up problems for
the future, for the child because of the difficulties they face
within the child care system; for the adult because of the
removal of a major motivation for recovery, keeping their family
together; and for the public purse because of the costs involved.
Phoenix Futures National Specialist Family Service (NSFS) is
very successful at helping parents overcome their drug use in a
safe environment for all, teaching them to become adequate
parents, and discharging successful families. Longitudinal
studies show that the families stay together. This SROI report
uses feedback from stakeholders, audits and published
literature, that demonstrate the benefits to individuals and to
society, and the significant cost effectiveness of NSFS.’
.
The Social Return Company
www.thesocialreturnco.org
Phone 0191 389 8108

Assurance Statement 1 | P a g e
Assurance Statement
“This report has been submitted to an independent
assurance assessment carried out by The SROI Network.
The report shows a good understanding of the SROI
process and complies with SROI principles. Assurance
here does not include verification of stakeholder
engagement, data and calculations. It is a principles-based
assessment of the final report”.
The SROI Network is the international assurance body for Social Return on Investment
studies and reports. More information can be found at http://www.theSROInetwork.org.
COPYRIGHT
This document is copyright © Hugo Minney 2013. It may be reproduced in whole or in part
with appropriate acknowledgement.
First Edition ISBN 978-1-291-66370-9
December 2013

Executive Summary 2 | P a g e
Executive Summary
Purpose
For some families, unfortunately, breakdown happens. It can be for a whole host of reasons,
and society is responsible to make sure that children are safe, and that their development
isn’t delayed.
The Phoenix Futures National Specialist Family Service (NSFS), run by Phoenix Futures
and based in Collegiate Terrace in Sheffield, take one group of parents at risk of family
breakdown – problem drug users (including problem drink users) (PDU) – and help them to
overcome their dependence on drugs so they can be good parents to their children. Parents
and children stay in the family units in Collegiate Terrace, and get the support they need to
prepare them to live as families without the spectre of addiction hanging over them.
This document is a forecast of the Social Return on Investment (SROI) of the NSFS. It
reports on the safety and outcomes for children, the outcomes for parents who are
recovering problem drug users (PDU), and the balance of cost benefit for local authority
services which pay for NSFS.
Audience
This executive summary should be accessible to policymakers, local authority chief
executives and commissioners, social workers and key workers, and to interested members
of the public. If any areas are unclear, please feel free to ask the author for clarification.
The main report is more detailed and relevant to policymakers, commissioners and social
workers, and similar family rehabilitation services.
Methods
This SROI forecast complies with the principles, and follows the process for preparing an
SROI report[1]. We used semi structured interview techniques (face-to-face and by phone)
to speak to people and organisations affected by the service. We collected audits to
measure success both from NSFS statutory reporting database and social care. And we
obtained audits on families discharged successfully from NSFS, to find out if they stayed
together.
In all, the scope of this report covers the outcomes for 41 adults and 42 children,
representing 33 families. Children’s ages ranged from birth (referred directly from hospital
maternity unit) to 13, and families up to 3 children.
As well as interviews directly with service users in NSFS, we used previously recorded
videos of children’s responses, and some additional interviews through key workers. We
interviewed social workers at the NSFS facility and people who had referred families to the
service (children’s workers, adult services and substance misuse workers). We included the
managers of children’s services, of adult services and substance misuse programmes in
local authorities, safeguarding in the local authority, other agencies and similar services,
solicitors acting on behalf of parents, and experts from Ministry of Justice and Department
for Education. We were confounded by the number of social workers who refused to be
interviewed, presumably because they feared we were journalists ‘dishing the dirt’, and are
very grateful to the 38 people who gave a total of 61 valuable interviews, in addition to the
video reviews
We cross-referenced the feedback from interviews with the statutory minimum data set and
additional information held by NSFS for the period, and published literature on drug use,

schools and truancy, the criminal justice system, and rehabilitation. We calculated costs
using actual figures, estimates, and published information, adjusted for changes in the
consumer price index (CPI). We used an estimate based on QALY*
to calculate the
advantages or disadvantages to adults and children, who do not spend real money or gain
real money. We looked at possible cause of variation, for example uncertainty in our
estimates, or different ways of calculating a total, and their impact on the return on
investment and social return on investment.
In the course of the research, we identified that key stakeholders proved difficult to contact
directly. “Successful graduates” – people who had already been discharged from NSFS
clean of drugs and with their children, could not be contacted during the time period given.
We do have data from a sample of these showing how many families are still together up to
4 years after graduation. We also did not obtain interviews from people who self discharge
from NSFS, and were not able to find out what had actually become of them. These are
recommendations for a full evaluation to follow. We felt that the interviews with social
workers (both adult and children) were limited in scope for reasons already given, and some
stakeholders excluded on the grounds of materiality (schools, doctors) could have been
interviewed to either confirm or contradict this materiality assumption and to round out the
information obtained from other interviewees.
The information was shared with 18 stakeholders in the form of a first draft of the report, and
recommendations were made to change the emphasis even though all agreed that the
fundamental information was correct. The second draft was shared with a 9 stakeholders
before being submitted for SROI assurance. The SROI assurance process identified some
gaps and the stakeholder interviews which filled these gaps confirmed many of the existing
conclusions, although provided a much more solid evidence base to support this.
All calculations are compliant with the agreed SROI methodology and have been verified by
the stakeholders concerned. We calculated the potential impact over a five-year period
* QALY – Quality Adjusted Life Years – for this publication we use the average of the range in
publications, £15,000-£30,000 in 2004, or a range in 2012 prices of £18,800 – £37,600

following discharge, and used a discount rate of 3.5% to give a Net Present Value (NPV) for
each outcome.
What we found
Interviews with many people, representing different interests, identified the core outcomes.
Quantitative results
Some outcomes apply to all substance misuse rehabilitation services, for example the one-
time cost (residential rehabilitation) is expected to reduce the ongoing costs of providing
support for drug users in the community, managing the cost of crime, and health needs.
Although they apply to all substance misuse rehabilitation services, NSFS has a particularly
high successful graduation which made a difference to the value for money. Social workers
and commissioners highlighted the quality of the progress and discharge reports in
comparison to other services, and the audits showed 80% successful discharge and 70% of
graduates still drug free after up to 4 years.
Some outcomes could be applied to any service designed to reunite a child with their parent,
such as a saving on the high cost of placing a child in foster care or care homes, or
arranging adoption for a child in need. Once again, NSFS stands out as having an
exceptionally high success rate of 80% of families united following placement, and 70% of
families still together after up to 4 years (79% of children). In financial terms, this tips the
equation considerably.
Some outcomes of the NSFS service were unique. Both parents and key workers gave us
evidence that NSFS’s programme to equip parents to return to independent living is
particularly good, and this is reflected in the latest post discharge audit of families. They
particularly highlighted the training to manage family budgets, thought to be even more
important with changes to Universal Benefit payments.
Children’s safety
Perhaps more important than the success rate in pure financial terms, we found evidence
that children placed with NSFS are safe from potential harm – perhaps more so than they
would be in any other environment.
NSFS is a supervised and monitored environment, where children are in a structured
community living a family life and bonding with their own parents. They are placed in local
schools and registered
with local doctors.
Parents learn parenting
skills, budgeting and
household management
skills, at the same time as
overcoming their substance misuse addiction. Children appreciate this time spent with their
birth parents, even if they are later placed with someone else (and the success rate of
reuniting families at NSFS is excellent – and they stay together). In the opinion of some,
NSFS represents a safer and more nurturing environment than that experienced by many
children in stable families – a view supported as developmentally delayed children catch up
with the norms for their age.
Families generally stay together, and safeguarding workers have not reported any issues on
their visits, apart from occasions when they removed the children which represent the 30%
of families which don’t stay together.
Inevitably, some parents can’t stay clean of drugs, and either self discharge or are
discharged by NSFS, and their children are placed with carers. In these cases, we used a
“Children blossom – they grow visibly in Phoenix Futures”
Mandy Craig, Head of Safeguarding, Sheffield City Council

counterfactual hypothesis that there is an additional risk of despair and suicide attempt for
adults who may feel that they have failed at their last chance to keep their children. For the
children, delays placing the child with their permanent carer might cause problems of
attachment and bonding and the stability of placements – the children may end up in care
homes because they won’t settle with foster or adoptive parents. This counterfactual
assumption is contradicted by more recent studies that indicate that children need to bond
with their birth parents, after which they will form normal relationships.
These counterfactual negative impacts have been included when calculating the cost
effectiveness of the service, using internationally researched estimates for the cost of suicide
attempt, and an assumption about the additional difficulty of placing children after a delay.
The calculations
This is a forecast calculated using audits and reviews based on a three year period, for
projection forwards. Total costs over the 3 year period within scope were £2,044,586. This
included how much the Local Authorities spend for the placement of adults and children at
NSFS (both the amount billed to the Local Authority and the amount retained from Benefits
payments – for all people resident during the period in scope); a value assigned on the basis
of how much the parents are willing to give up in order to attend NSFS (the amount they
were spending on drugs and other addictive substances) – “expressed preference”, and
inputs from other stakeholders.
The sum total of the positive outcomes, ie those outcomes that were favourable to the
stakeholders, was £8,676,093 (over a maximum 5 year timeframe*
– the actual duration
depended on the outcome. This calculation also includes discounting for Net Present Value
using a discount rate of 3.5%). This included reduced need for expenditure by:
 Local authority Adult Services – saving money because the adults have kicked the
habit and are now clean, which reduces cost of short-term housing and failed
tenancies.
 LA Adult Services – can save on the cost of providing ongoing community
rehabilitation since these adults are now clean
 LA Children & Families services – can reduce resources providing care for children
who instead live with their birth parents.
 Criminal Justice System is able to reduce court and custody because clean ex-users
no longer commit crimes
It also has an effect on quality of life:
 LA Adult Services – take into account the Quality of Life improvement when making
decisions, so this has been factored in
 Adults and children living as families are willing to give up income and make greater
expenditure (expressed preferences) in order to live as families
 Adults willing to give up income (expressed preference) to be able to live a
community life free from substance addictions.
The sum total of negative outcomes, ie those outcomes which were more costly as a result
of NSFS, was £590,059 over a similar 5 year timeframe. This included
* We used a maximum of 5 years even though the impact of some outcomes could last longer,
because this is a forecast to identify the best approach to a full evaluation. Using a longer timeframe
would result in a higher SROI ratio

 additional costs to provide safeguarding services for the newly reunited families.
 counterfactual possibility that adults who failed to control their addictions would be
more depressed.
 counterfactual possibility that children placed in NSFS who then went on to carers
because their parents weren’t able to look after them would be unable to form normal
adult bonds.
These are based on the most likely outcome – a sensitivity analysis is performed to examine
other possibilities.
Values used for Outcomes
This leaves us with a net balance of £8,083,033 (the value of all of the outcomes added
together). In line with standard methods for SROI calculation, the ratio is based on the sum
total of outcomes divided by the total costs. This gives an SROI ratio of 3.95 – for every
£1000 invested in placing adults and children as families in NSFS, the net benefit to local
authorities and society is £3,950.
Looking more specifically at the return on investment to individual stakeholders:
 Families who managed to graduate successfully (get clean of drugs and drink, learn and
embed parenting skills) who then went on to live as a family and stay together invested
£430,000 (drug spend they committed to giving up during their time at NSFS), and gained a
five year value of over £2.1 million from the joy of being parents, the effect of children living

with parents, and being able to work and contribute to the community. This represents a
ratio for this stakeholder alone of 4.92:1
 Local Authority Adult Services Department/DIP invested a little over £764,800 on
placements of adults, and could be expected to avoid spend and release resources of
£2,331,862 by reducing demand on homelessness and community drug rehabilitation
services when adults have come clean of drugs and drink. This represents a Return On
Investment of 3:1 directly to Adult Services (over up to 5 year period following successful
rehabilitation) relating to their spend on outcomes.
 Local Authority Children & Families department invested £641,500 in placement of children,
and avoided spend and released resources of £2,977,485 because children did not need to
be placed in care (a ratio of 4.6:1). This total included the extra costs borne by this
department for extra safeguarding visits to families newly settled
 other beneficiaries include the children, the criminal justice system, the national economy,
the NHS, and social care, although in this forecast some stakeholders were not asked to
value their impacts so values could not be ascribed.
The SROI Ratio
This gives an SROI ratio of 3.95 with a minimum ratio of 0.71 and a maximum of 7.73.
This means that for every £1 invested, including both the actual financial investment by the
Local Authority Adult and Children’s services, and the expressed preference (willingness to
pay) investment by adults in controlling their addiction and giving up drugs and substitutes in
order to be in NSFS, they get a value back of £3.95. This value back includes costs
avoided, quality of life improvements, and happiness which itself is measured by what other
families are willing to pay in order to get the same results (living with their children and
parents, living in the community and able to get a job).
Note that the SROI ratio sensitivity analysis has a more complete explanation than that
provided in the version submitted for assurance. The inputs to the calculations remain the
same.
The minimum SROI ratio
The minimum SROI ratio is driven by assigning greater prominence to the counterfactual
negative impacts. When adults self-discharge, we wondered if they might be more
depressed because of repeated failure, and if this assumption is made then it gives a
substantial negative impact. We also followed through a (now repudiated) theory that
children who are placed with their parents but the placement doesn’t work will react to the
disruption in their early lives by being unable to bond with adults. If true, this would mean
that they could not settle with foster parents and would not place in adoption circumstances,
and as a result they would need to be cared for in care homes which are hugely expensive.
However this is a counterfactual argument since the more recent evidence indicates that
even a short time of placement with birth parents in a safe environment (such as NSFS)
helps the child to bond with adults more than if they don’t have time with their birth parents,
even if the family is then broken up and the child is placed for adoption or with foster
parents.
The maximum SROI ratio
For the maximum SROI ratio, we assumed a best case scenario. In the absence of an
estimate for the Quality of Life value that LA Children’s Services assign to improvement in
children’s lives, this is still excluded which accounts for the relatively small uplift from the

Most Likely ratio. In most cases, only small changes to each outcome were apparent, and
the amount of these changes should be explored in a full evaluation.
Key factors affecting the SROI Ratio
Investment in obtaining drink/ drugs – for the report we assumed the actual cost of the
drugs – however from the point of view of the adult, it is only the investment in “a mugging”
or “a robbery”, which should be a much lower value. This change would raise the SROI
Ratio to SROI Ratio = 5.27.
Counterfactual Components are benefits (or in this case, negative benefits) which are
included as a possibility, but are actually unlikely. In this report, these are the potential for
depression and suicide, and larger numbers of community detention orders for those who
self-discharge early, and children failing to bond with foster parents because of the delays in
placement. Excluding counterfactual components gives an SROI Ratio of 5.61.
Quality of Life for Children – with few numbers on which to base a claim, we have
excluded a factor for Quality of Life for children, although it would be reasonable to base it
on similar effects for adults. Including this component would give an overall SROI Ratio
of 5.71.
Key comparisons
This study has also made a comparison with alternative schemes including:
 Breaking the Cycle (Addaction)
 Family Drug & Alcohol Courts (FDAC – Camden Islington & Westminster)
 Family Intervention Projects (FIPs)
 Hidden Harm (Compass in Lambeth)
 M-PACT (Action on Addiction)
 Motivational Interviewing
 Option 2
 Parents under Pressure
 Trevi house, Plymouth
 The Virtual Community (Wired-In)
 parenting assessment units

Conclusions and Recommendations
NSFS represents a safe and structured environment where suitable parents can safely learn
to become parents and manage their substance addiction, and where children are protected
and can go up with normal activities within a loving family. NSFS teaches parenting skills
alongside coping mechanisms to overcome substance addiction, and the children grow and
blossom, and catch up their development norms, although many showed delayed
development at the point of referral.
The Family Justice Review, and the Children and Families Bill passing through Parliament at
the moment both recommend that rehabilitation and reconciliation of children with parents
should be carried out before court proceedings start, and should include detailed
assessment during the process to ensure that information is available to the court at the start
of proceedings. The Ministry of Justice confirms that NSFS and rehabilitation / reconciliation
in Collegiate Terrace will provide an excellent basis for evidence in the event that
reunification is unsuccessful and court proceedings are needed.
At present court proceedings (55-56 weeks average) become the focus for reunification
attempts leading to rushed decisions, and in many cases the timescales between hearings
mean a decision is taken not to attempt reunification. NSFS represents a safe environment
for attempted reconciliation, and a gold standard assessment for evidence and appropriate
expert reports for submission to the court proceedings.
In financial terms, NSFS is cost-effective. Local authority Adult and Children’s services
combined can expect to spend £42,600 per average family placed with NSFS, and to see a
return to the local authority of £160,800 (averaged across successful families and failed self-
discharges) in terms of reduced cost of housing and other adult programmes, saved costs of
looked after children, and improved quality of life within the few years immediately following
placement.
Recommendations to NSFS
The report highlights a number of aspects of NSFS work which the stakeholders find
valuable, and which the service itself was not aware that they were doing differently from
other providers.
1) The quality and detail of reports, whilst expensive to produce, is considered valuable
by stakeholders including the Commissioner, and the family themselves to review
progress
2) Placing the families in a residential situation, often some way from the environment in
which they offended, enables them to break old habits. Children and parents both
benefit from the structured environment and round-the-clock focus on overcoming
substance addiction combined with parenting skills
3) NSFS empowerment programmes are considered excellent. The rate of successful
discharge both clean of drugs and as a family, and the rate of families staying intact
(perhaps with Social Services involvement) is generally higher than the average for
other rehabilitation services
4) The most commonly requested improvement is a ‘step down’ solution, a post-
discharge support service for when people are settling into the community outside of
Collegiate Terrace. This would be a progressive programme including active and
proactive education/activities, monitoring, and access to professionals. This may
cause more people to take up residence near to Collegiate Terrace in Sheffield, and
contractual arrangements for Sheffield City Council should be sought. For people
referred from London boroughs, NSFS should set up roundtable discussions with
representatives from all Children’s Services in London with the aim of setting up post-
discharge support to cover referrals from London, settling back in London.

Recommendations to local authority Children’s Services
5) The first priority of every service is to ensure the safety and appropriate development
of the child. Placing the child with their birth parent, particularly during the first three
years of life, is likely to impact their ability to form attachments for the rest of their life.
The NSFS provides a safe and supervised environment for this attachment to
develop, which provides benefits for children and for their subsequent care, even if
the family reunification is unsuccessful
6) NSFS has shown that reunification and long-term stability is possible and even likely,
given the right conditions.
Recommendations to local authority Adult Services
7) NSFS is cost-effective in a direct and immediate way for the commissioning
authorities. The direct return on investment (the amount saved through reducing the
demand for homeless programs and community drug rehabilitation services, and
placing children with their birth parents instead of the care system) is greater than
five times the investment within five years of the client being placed
8) Expert opinion amongst key workers and management in local authorities is that the
service has a high rate of success in rehabilitating adults whilst safeguarding children
from harm, and provides an excellent and sustainable course of treatment

Recommendations for national policy
9) the Family Justice Review is widely misunderstood, and many local authorities and
judges are removing children from parents prematurely in order to meet a 26 week
target for placement with permanent carer. The guidance needs to be clarified, even
before it is passed through Parliament; emphasis should be placed on the benefits to
parents and children, to local authorities and the public purse, and to the evidence
needed for family Justice proceedings, from using services such as NSFS
Recommendations for a full evaluation
This report was based on limited access to stakeholders because of the nature of the study,
and the returns listed are only those from stakeholders we interviewed.
We believe that a more detailed study would give a clearer picture of the return on
investment. Particular questions that need answering include the real impact of people who
self-discharge having been unable to overcome their addiction, the impact of delay in
placement on children’s ability to bond with adults (or conversely, the positive effect that a
few weeks or months with a birth parent in a safe environment has), and the possible impact
on a wider range of stakeholders. It is also likely that a more detailed study will reveal a
higher SROI ratio.
Hugo Minney
Kirstan Butler
4 Nov 2013

Table of Contents 12 | P a g e
Table of Contents
Assurance Statement 0
COPYRIGHT 1
Executive Summary 2
Purpose 2
Audience 2
Methods 2
What we found 4
The calculations 5
Conclusions and Recommendations 9
Table of Contents 12
Context 15
The Drug Problem 15
Who is Phoenix Futures? 16
What is the National Specialist Family Service? 16
What is SROI? 18
What happens when someone gets referred to Collegiate Terrace (the National Specialist
Family Service)? 18
The Law and Changes to the Law / Policy / Best Practice 24
A forecast or an evaluation? 24
Scope of this Report 26
Broad Theory of Change 26
Numbers and dates 26
Alternative Family Support for Substance Misuse 28
Ashcroft House, Cardiff 28
Breaking the Cycle (AddAction) 28
Family Drug and Alcohol Court (FDAC – Camden, Islington & Westminster) 28
Family Intervention Projects (FIPs) 29
Hidden Harm (Compass, in Lambeth) 29
M-PACT (Action on Addiction) 29
Motivational interviewing (MI) 30
Option 2 30
The Parents under Pressure Programme (PUP) 30
Trevi House, Plymouth 30
The Virtual Community (Wired In) 30
Parenting Assessment Units 31
Identifying stakeholders 32

Those directly involved 32
Those materially affected by the service but not directly involved 34
Stakeholders interviewed but excluded from the analysis 35
Numbers of Stakeholders and Information Gathering process 37
What changes for stakeholders? 38
Families who graduate successfully and stay together 38
Stakeholder group – Families who graduate successfully but split apart later 47
Adults who self-discharge 49
Local Authority Adult Services including Substance Misuse Team (referrer) 51
Local Authority Children & Families Team (referrer) 58
Ministry of Justice, Courts (Criminal Justice System CJS) and Police 63
Review and Transparency 65
Embedding the results of this report and making changes to services 65
Inputs and Investment 67
The Impact Map 69
The SROI Ratio 70
Sensitivity Analysis 70
Conclusion and Recommendations 73
Recommendations for a full Evaluation SROI 76
Appendix I. Interview Format and Example 77
Questions Service User 77
Social Return on Investment 78
Questions Semi Structured Interview (Health or Social Care Commissioner): 79
Questions Semi Structured Interview (Health worker): 79
Interview Date(s) 81
Background 81
Investment 81
Return on Investment (impact on Child) 81
What else is going on? 84
Appendix II. Outcomes, parameters and impact calculations 86
Families who graduate successfully and stay together 86
Stakeholder group – Families who graduate successfully but split apart later 90
Adults who self-discharge 92
Local Authority Adult Services including Substance Misuse Team (referrer) 94
Local Authority Children & Families Team (referrer) 99
Ministry of Justice, Courts (Criminal Justice System CJS) and Police 103
Appendix III. Notes on the methodology and calculations 107

Appendix IV. References Used 109

Context 15 | P a g e
Context
The Drug Problem
Drug misuse is a public health problem, a criminal justice problem and an economic
problem. The social, economic, health and crime costs of class A drug use were estimated
to be around £15.4bn in 2003/04, with problematic drug users (PDUs) accounting for 99 per
cent of total costs. In turn, drug-related crime accounts for 90 per cent of costs associated
with PDUs[2-4]. The average number of acquisitive crimes reported by drug-misusing
offenders is almost six times higher than for non drug-users.
The most recent published estimate suggests that there were 327,466 PDUs in England in
2004/05, and around 330,000 in 2009[5]
The illicit drug market is estimated to be worth £4.6bn in England and Wales and £5.3bn in
the UK as a whole. This is roughly 33% and 41% of the size of the tobacco and alcohol
markets respectively[2, 6, 7].
Treatment for Adults
Substance misuse affects people in different ways. Some people use drugs only
temporarily, for example as a rite of passage or a life stage, whereas others become
dependent on drugs. People who become dependent on drugs may become parents
through choice (because they want to start a family), or by accident (they may be involved in
prostitution, or their chaotic lifestyle may mean the contraception is less likely to succeed).
Of those who become dependent on drugs, some can overcome their dependency (come
clean) through community support, and others require a more intense course of community
rehabilitation.
A first response for a parent as with another adult is a community rehabilitation programme,
where people are educated in the effects of drugs, and may be given a substitute such as
methadone.
If a parent does not respond to treatment, they often require ongoing community support
because of their involvement in crime, lack of ability to budget, likelihood that they are not in
work, additional health needs because of substance misuse, and potential homelessness.
Treatment has the strongest evidence base in terms of the VfM it provides. Nonetheless,
more can be achieved with current resources by improving services and continuing to
develop the evidence base. This does not necessarily mean reducing the unit costs of
treatment per se because some of the cheaper treatment services are not necessarily
delivering successfully or cost-effectively. It does mean ensuring that comparable levels of
performance are being delivered for comparable unit costs, and challenging all services to
adopt practices and achieve the levels of performance of those which are performing the
best. This will require a greater emphasis on the measurement and tracking of treatment
outcomes. [6]
The problem for Children and Child services commissioners
Substance dependency may be combined with the ‘toxic trio’ of poverty, mental health
issues, and domestic violence. This is a risk for the safety of a child, and the child is typically
taken away from their parent: in some cases, subsequent children may be taken away from
their parent on the assumption that the risk continues.
Problem Drug Users (PDU) often require residential rehabilitation. They are taken away
from the environment that causes them to abuse or seek escape, and placed into a
structured environment for education and for giving up the drugs. In many cases the parent

is placed into residential rehabilitation, and the children taken away and placed with foster
parents, relatives, or put up for adoption. For a parent, loss of the child may take away their
motivation to give up drugs. For a child, being taken away from the substance misusing
parent may result in feeling unwanted and unable to integrate with society.
The child may be placed with relatives such as grandparents. There are risks with this
approach, since grandparents may themselves be the cause of the parental substance
misuse in the first place, perhaps through abuse or example.
Apart from the human cost to parent and child, there is a genuine financial cost.
Children often require placement with foster carers or in the care system because the
parents are unable to look after them. The local authority is responsible for the costs, which
may be considerable over 18 years.
One of the services that helps problem drug users to manage their addictions and come
clean, and children to reunify with their parents and form bonds of attachment and potentially
live a normal family life, is Phoenix Futures National Specialist Family Service at Collegiate
Terrace (NSFS).
Who is Phoenix Futures?
Phoenix Futures puts a great emphasis on successfully helping people to manage their drug
(and alcohol) cravings, so they can make a contribution to society and regain control over
their own lives. In their own words:
We are successful because our service users are successful.
Understanding and measuring the diverse range of benefits we create is a key focus for us
as an organisation. The following report will give you an insight into the range of benefits we
help create for individuals, families, communities and society as a whole, from one of our
services, the National Specialist Family Service (NSFS).
Our services enable people to define their own unique recovery journey and create a stable
environment to build for a better future. Understanding that each individual’s experience is
unique to them and providing them with highly effective person-focused service, in a
committed and caring style, is what makes us special as an organisation.
This is because as a recovery focused organisation offering services in communities, prisons
and residential settings, with a positive approach to partnership working, we are uniquely
placed to create fully-integrated services that offer clear and flexible pathways to meet our
service user’s diverse and unique needs.
Our services are structured flexibly in order to meet the needs of the community in which
they operate. However, common to all our services is a commitment within our staff to go the
extra mile to create opportunities for our service users whether that be the opportunity to
unlock talent through education and employment, to rebuild families, to engage positively in
the community or to find a stable home. In short we offer much more than substance misuse
treatment, we help people build full and meaningful lives.
With this report we demonstrate that we put the achievements of our service users at the
forefront of what we do. It is knowing that they are our reason for being that makes us so
effective and will enable us to remain so in the future.
What is the National Specialist Family Service?
Based in Sheffield, and serving the whole of England, our residential National Specialist
Family Service houses Mums, Dads and couples who wish to address their substance
misuse whilst living with their children. We provide the opportunity for parents to remain the

primary providers of care for their children, whilst receiving appropriate guidance and
support. More than just a service this is also a home for our families, situated in a pleasant
residential area with excellent connections to local schools and health services and an on-
site Ofsted registered crèche for 0-to-8 year olds.
In order to meet our prime objective of keeping families together in the long term, we target a
range of treatment outcomes including:
• Substance use
• Criminal behaviour
• Accommodation
• Education
• Health
• Employment
• Managing money
• Routine and structure
Our GP prescribes and oversees detox. Our staff are split into expert teams for the functions
of Therapeutic interventions, Parenting Support and Childcare. Our emphasis is on safety
and we provide 24/7 waking night cover.
Parents benefit from cognitive behavioural interventions and particularly help with co-
occurring problems such as depression and anxiety. We also provide keyworking and care
planning, building a therapeutic relationship, Parenting coaching through the Triple P
(Positive Parenting Programme)*
, as well as life skills such as cookery and nutrition and
health and safety.
We use the Therapeutic Community (TC) method which encourages personal responsibility
and behavioural change, with structured living providing a safe and monitored environment.
Physical activity is encouraged with scheduled activities for adults and children.
The children can use our Ofsted Registered Creche, and school-age children attend a local
school. We offer family focused intervention and support with health needs.
Overall averages since the service began are (not necessarily the same as the figures from
the cohort within the scope of this report):
• 50% of children entered the service with some developmental delay
• 80% of children left on or above developmental targets
• 10% of families come into the service with care of their children and
• 72% leave the service with care of their children
NSFS ensures that children have the opportunity to form attachments with their parents
which are the foundation for future relationships. It provides a safe family environment for
some of the most severely damaged families, and the vast majority of families successfully
rehabilitate: the parents have the parenting skills and support that they need to be good
parents, and have learnt to control the drug dependency; and the children are able to live a
normal family life including schooling and socialising. For those referred to this service, for
whom it is a last chance, the alternative for parents is probably continued drug use in till
death aged on average 40 years old; and for children, it is a lifetime in the Looked after
Children service with the consequent loss of trust, inability to form relationships, and
educational attainment and employment prospects.
* This is provided by Sheffield City Council. Costs are included in the Impact Map and reflected in the
total cost of delivering the service used for preparing the SROI ratio

What is SROI?
SROI is a way of understanding what benefits you get from a service. It identifies and
records benefits like happiness, longer living, having more choices, as well as the kind of
benefits that you can put a number against. SROI then tries to estimate a number to put
against the benefits that are more difficult to measure.
SROI is based on seven key principles:
1. Involve stakeholders: instead of relying on the NSFS to say how valuable they are
themselves, SROI asks the people who benefit (the social workers and key workers,
clients in the service, commissioners and policy makers) to tell the SROI practitioner
what they think the benefits are, and how much they are worth.
2. Understand what changes: I asked about what difference the NSFS made. Lots of
things are changing all the time, and I want to know what is due to NSFS and what is
happening anyway. I also find out what is a good change (changes that makes
things better) and what is a bad change (makes things worse).
3. Value the things that matter: many times people can tell us about something that
changed for just one person, or something that is exciting to the person I’m
interviewing, only it doesn’t make much difference to the person who has to live with
it. With SROI we try to measure things for the people who have to live with them;
and we ask them to say how much it is worth to them.
4. Only include what is material: I want to make sure that every benefit we include
actually makes a difference. This means making sure that we include every negative
consequence as well as every positive consequence, and understand what
difference it makes. It also means leaving out things that aren’t actually important to
the stakeholders, or are simply not very valuable. We did this by asking people and
checking and double-checking that everything we included is important.
5. Do not over claim: often lots of things change at once. SROI works out which things
happened BECAUSE OF the change we’re investigating, and what would happen
anyway so we don’t include it as a benefit. I’ve used a term Attribution to estimate
how much of a change is due to NSFS – and again it is up to the person to decide,
not up to me. We’ve also made sure we don’t count things twice - when one leads to
another you should only count the last one. With SROI, we are very careful about
this.
6. Be transparent: everywhere I’ve used a number, I can show where it came from,
and why I used it. I've also spoken to the person and/or organisation who gave me
the number, to check I've used it correctly. I’ve checked it against numbers from
other people, to check that it makes sense.
7. Verify the result: Everything in this audit came from the people we interviewed, and
they checked it, and checked each other's answers. They also looked at the whole
report, to make sure it makes sense.
What happens when someone gets referred to Collegiate
Terrace (the National Specialist Family Service)?
The NSFS is the last chance for many people, their last chance to stay together as a family.
Mothers and fathers who are addicted to drugs or alcohol are often considered to be a
danger to their children, either because of neglect or risk of causing harm. In nearly every
case referred to NSFS, courts have decided that this is the last chance the parent has to live
a family life with their children, and the parent wants help to give up their dependency on
drugs and to become adequate parents. The child safety is paramount, and children

services are very careful to make the right decision, when referring the child with their parent
or parents to NSFS.
NSFS offers this chance for family life. 90% of the families referred have already lost their
children, and hope to gain them back through the closely monitored and structured
programme that NSFS offers – both to help them overcome their dependency on drugs, and
to learn to be parents and create a safe environment for the children. Similarly, many of the
children come because they want desperately to be with their birth parent, and are already
showing signs of developmental delay, and NSFS addresses that too[8].
Parents are more likely to overcome the drug dependency and come clean, and to stay that
way, whilst recognising their responsibility to family life [9, 10]. More controversially, children
who fail to form bonds with their birth parents may never recover their ability to develop
normal human relationships, and even if taken away from parents at an early stage and
placed with foster parents, may fail to connect and end up in care homes [11-14].
What problem is NSFS trying to solve?
Apart from the human aspect of giving families a chance at a family life, there are real and
substantial costs associated with family breakdown and with problem drug use.
Parents suffer, in terms of their poor health and likelihood of an early death[15], and in terms
of reduced quality of life because of their lack of control of their own lives. In SROI terms
this can be represented as a ‘cost’.
Children suffer, in terms of not feeling that they belong because they are not with their birth
parents, the consequences of living in a family with a parent with substance misuse
problems, or the damage caused by being unable to bond with people and grow up in a
family [11]. In SROI terms this can be represented as a ‘cost’.

Table 2.3: summary of main areas of potential impact on health and development of parental
problem drug use (adapted from Cleaver at Al, 1999) – from “Hidden Harm” [16]
age
(Y)
Health education and
cognitive ability
relationships and
identity
emotional and
behavioural
development
0 –
2
Withdrawal
symptoms
Poor hygiene
Suboptimal diet
Routine health
checks missed
Incomplete
immunisations
Safety risk due to
neglect
Lack of stimulation
due to parental
preoccupation with
drugs and own
problems
Problematic
attachments to
main caregiver
Separation from
biological
parent(s)
Emotional
insecurity due to a
unstable parental
behaviour and
absences
Hyperactivity,
inattention,
impulsivity and
aggression more
common
3 –
4
Medical and dental
checks missed
Poor diet
Physical danger
due to inadequate
supervision
Physical violence
more common
Lack of stimulation
Irregular or no
attendance at
preschool
Poor attachment
to parents
Child may be
required to take on
excessive
responsibility for
others
Hyperactivity,
inattention,
impulsivity,
aggression,
depression and
anxiety more
common
Continued fear of
separation
Inappropriate
responses due to
witnessing e.g.
violence, theft,
adult sex
5 –
9
School medicals
missed
Dental checks
missed
Poorer school
attendance,
preparation and
concentration due to
parental problems
and unstable home
situation
Restricted
friendships
Child may be
required to take on
excessive
responsibility for
parent(s) or
siblings
More antisocial
acts by boys;
depression, anxiety
and withdrawal by
girls

age
(Y)
Health education and
cognitive ability
relationships and
identity
emotional and
behavioural
development
10
–
14
Little parental
support in puberty
early smoking,
drinking and drug
use is more likely
Continued poor
academic
performance, e.g. if
looking after parents
or siblings
higher risk of school
exclusion
Restricted
friendships
poor self-esteem
and low self-
esteem
Emotional
disturbance,
conduct disorders,
e.g. bullying,
sexual abuse or
more common
high risk of
offending and
criminality
15+ Increased risk of
problem alcohol
and drug use,
pregnancy or
transmitted
diseases
Lack of educational
attainment may
affect long-term life
chances
Lack of suitable
role model
Greater risk of self
blame, guilt,
increased suicide
risk
Local Authority Adult Services have a statutory obligation to pay for support for
homelessness and drug users in community programmes of various types.
Local Authority children and families services will spend resources for care system
provisions for the children who are separated from their parents (care home accommodation,
payments to foster parents, the support for adoptive families).
Local Authority housing departments will incur costs because problem drug users often have
trouble with household budgeting and fall into arrears on rents which they are then unable to
pay, and other circumstances leading to a failed tenancy, legal costs, short-term
accommodation and B&B accommodation.
The Criminal Justice System (police, court service, prisons) recognise a substantial cost
incurred because of the crimes committed by drug users in order to fund their habit. This is
quite apart from, and in addition to, the costs of loss and damage by the victims of crime,
and the costs these victims incur to prevent a future occurrence of crime[2, 7, 17].
NSFS aims to rehabilitate former drug users into the communities where they choose to live,
so that these costs will no longer be incurred by these public authorities.
The NSFS programme
Everyone arriving for a 6 month programme at NSFS goes through three stages, and for
each stage there are specific objectives, markers of achievement and written work.
Induction (weeks 0 – 6)
Many parents arriving at NSFS are still on methadone (drug substitute), although some are
completely clean and detoxed. Some bring their children with them, others have to
demonstrate progress whilst their children are held in care (often in Special Care Baby Units
(SCBU) in hospital where both parents would have limited access to them anyway) before
their children are allowed to join the parents.
The induction period is a time when NSFS gets the parent into the logistics and physical
routine of change – care planning, meeting and getting to know key workers, detox,

adjustments to community life and away from the often chaotic lifestyle of a substance
misuser (whether alcohol, opiates or other drugs).
Adults are often distrustful and angry; the interviews report “doing time” and “being sent to a
prison”. The children may be bewildered, or resigned to their life experience of change after
change.
Some adults may have a shorter induction if they have already completed their chemical
detox before entering.
Primary Stage (weeks 7 – 20)
The Primary Stage is probably the most challenging for parents, and also the most
transformative. One interview reported “I’ve been in loads of rehab, and half the stuff they
do here I’ve never heard of before”.
This is where they write their Life Story, reflect on it, and read it out to their peer group.
They discuss the circumstances and situations in their lives, and the decisions they made
that ended in substance abuse. They start to address the fundamental issues and take
responsibility for choices that they themselves made. Some of the activities in this phase
mark NSFS out from many drug rehabilitation programmes – the group activities and
structured approach to facing your demons seems to result not only in the high rate of
completion and drug-free discharge, but also to the low rate of relapse.
They also realise how serious their situation is – how parenting that they thought was
“adequate” is actually dangerous for the child. Parents learn how to parent and children
settle into routine; going to school on time, fed and tidy. Babies get into the routine of
regular crèche (the NSFS crèche and childcare are Ofsted registered) whilst their parents do
their duties and rehabilitation programme.
This is the time when recovery is embedded and planning for rehabilitation begins.
Senior Stage (weeks 21-26)
The senior stage takes everything from the primary phase and makes it habit. Techniques
for recognising triggers and cravings help adults to resist temptation; education and
qualifications (such as Triple P) build confidence; self reflection builds determination.
The local authority which referred the family may dictate where they will be discharged to,
but there are still many things that need organising and NSFS helps the families to plan their
own futures, rather than doing too much for them – what are their resettlement plans and
where they will live, tenancy arrangements, previous or other children, schools and doctors,
clubs and activities, what specific after care.
Nationally, they have access to Surestart, Homestart and Kids Clubs. In Sheffield there are
specific clubs for children of families blighted by substance misuse including What About
Me[18] and CandYP [19].
Why would someone refer to Family Service?
Typically referrals are made by social services key workers. If a key worker decides that a
specific parent is likely to respond well to the rehabilitation service (typically because they
are very committed to getting their child back and are likely to provide a safe environment for
the child once they overcome their drug dependency) then they will bring up the case with a
children and families key worker to agree whether the family can be referred. The obstacles
to a referral are high – both key worker for the parent and key worker for the child need to be
in agreement that this is in the child’s best interest, is safe, and that the parent is likely to
respond to the support and teaching given at NSFS. Unfortunately some services report that
they don’t refer the child if the child is not costing the local authority, for example if they are
currently placed with a relative, in spite of the potential risk that placement with a relative

may represent (Stakeholder Interviews – for example where the child is placed with the
same grandparent who may have caused parental substance misuse through abuse or
example).
The aim of NSFS is clearly on reuniting families where it is safe to do so. They have strict
criteria both for admission and for retaining someone in the rehabilitation environment, and
will accept a referral only where those criteria are met.
The main reason for a referral is a very human one – to let families participate in society
together rather than apart[20]. But cost must be a consideration – with the levels of saving
that each department and society as a whole could expect to make following a successful
reunification and rehabilitation, and with the high rates of success that NSFS enjoys, it
makes economic sense to use this service.
Why would they refer somewhere else?
There are many other substance misuse rehabilitation services, ranging from community
programmes which rely on the drug user themselves to make the change, to compulsory
services in prison.
Section Alternative Family Support for Substance Misuse on on page 28 lists a number
of mainly community services which address these issues.
For the most difficult cases (those requiring residential support) there appear to be only
three, NSFS, Trevi House in Plymouth and Ashcroft House in Cardiff, which are residential
situations for reunification of the family. These combine support for a parent to overcome
their substance misuse problems at the same time as learning or re-learning how to be a
parent, and a safe environment for children..
Of the three, Trevi House and Ashcroft House receive mothers and small children often pre-
court proceedings, whereas NSFS accepts mothers or both parents, small children and
families which can include older children (up to 10) and is able to accept the most difficult
cases (including post court proceedings).
Local Authorities and charities referring families to these services should look carefully at the
success rates.
Community services are certainly lower cost, but may have 50% or lower success rates on
discharge from the service, and often poor results from relapse later. For example, patients
receiving methodone report that most continue to take other drugs and are involved in crime
[21].
Residential services have much higher success rates. NSFS reports 83% success (clean of
drugs) at discharge, and a follow up of 10 families by Sheffield City Council shows that 70%
remain drug free and with their children (79% of children still with their family – two families
had 3 children each) at the time they audited, 1 – 4 years after discharge [22]
The network and post-discharge support from NSFS
Six months isn’t long to overcome an addiction that has been a problem perhaps for years.
Six months is typically the maximum that a family stays in NSFS, during which time they
need to learn the skills and behaviours they will need, but after that, they need to go out into
the wide world with all of its distractions and temptations, and put those skills to use, and
turn those behaviours into habits.
That’s where NSFS empowerment comes in. Families are encouraged to do their own
research before deciding where to settle, and the doors (and phone lines) at Collegiate
Terrace are open for people to get a bit of support when they need it – a steer when they are
feeling uncertain.

That can make a real difference, the difference between the escapism of drugs, and the
strength to face this new obstacle and keep on the track of staying clean and keeping the
family together.
This is not sufficient. NSFS regularly refer on to Turning Point and DISC which support ex
substance abusers. Many interviewees highlighted the need for ongoing post discharge
support, and this is one of the recommendations from this report. However, post discharge
support can only be provided if someone is prepared to pay for it.
The Law and Changes to the Law / Policy / Best Practice
In general, people believe that the best situation for children is to be with their parents.
Where the parents are unable to provide a safe environment, whether because of poverty,
mental health, or domestic violence (the “toxic trio”), then either the parents need to change
or the children need to be removed to a safe environment[14]. A number of high profile
cases, and perhaps most obviously Baby P in 2009, have caused social workers to play safe
and remove children from their families and place them in the care system[23].
In general it is better to place a child with their potential permanent carers sooner rather than
later[24, 25]; this is taking shape in the 26 week guidelines for completion of court
proceedings in the forthcoming Children and Families Bill [26]. These guidelines have been
widely misinterpreted; at present, court proceedings are the focus of attempts to reunite a
family or place the child with foster parents, and the timetable for court proceedings may
lead to rushed decisions and inappropriate rehabilitation attempts, or delays in taking a child
away from a dangerous situation. As a result, many Children’s Services opt to take the
child away from the parent in order to have them settled in foster care or adoption.
The Children and Families Bill, and Family Justice Review, have set a target to reduce the
length of time that court cases take (from over 55 weeks at present). It asks responsible
authorities to assemble their evidence and make decisions on reconciliation or removal of
the child before coming to court. Our interviewee from Ministry of Justice stated that a
service such as NSFS should be considered a Gold Standard both for attempting
reunification (because it is a safe environment where the child won’t come to harm and the
success rate is high), and as evidence for presentation to court in the event that the child
needs to be taken away. The intention is that decisions are taken at a pace appropriate to
the child safety needs and adult rehabilitation needs, and not dictated by the next stage in
court proceedings. With a success rate above 80% in Phoenix Futures, this means that
80% of cases do not need to go to court in the first place.
The cheapest solution may still be to help parents to overcome their problems and become
parents of their own children[27]. This may also be the best solution for adults who are more
likely to recognise their responsibilities in the presence of their family [10, 13], and children,
who form the ability to attach to adults which is the foundation for all of the human
relationships in the rest of their life and their subsequent performance educationally and in
the workplace[11, 28, 29].
A forecast or an evaluation?
The change in the court interpretation of the law, brought about as the Children and Families
Bill makes its way through parliament, has had a dramatic effect on what happens to
families. Guidelines released during the preparation of this report indicated that court time
would be reduced to a maximum of 26 weeks (6 months) from the present 55-56 weeks, and
courts interpreted that to mean that they did not have time to attempt to reconcile the child
with a parent or give the parent time to stop their drug use, which resulted in a dramatic
reduction of the numbers of parents, children and families in NSFS when the researcher
wanted to interview them.

As a result, the researcher was only able to interview 8 parents (representing all stages of
rehabilitation / family reunification), identified by the staff, and no children (since all children
in NSFS at the time were babies), and is reliant on previously filmed interviews of children
and previous interviews performed by staff.
All but one of the benefits that accrue to all stakeholders depend on good outcomes for
families – for parents coming clean of drugs and substitute drugs, and for children growing
up in a stable family environment. In view of the small sample, we can only take the
evidence that we have and use it to forecast the likely result of this service and at the same
time make recommendations for the information needed for a full evaluation.

Scope of this Report 26 | P a g e
Scope of this Report
Broad Theory of Change
The hypothesis that this forecast explores is that:
Activities
 NSFS runs programmes for conquering alcohol or drug addiction
 NSFS teaches parenting skills
Outputs
 Parents (adults) come clean and stay clean of alcohol or drugs, for a long period
 Children can stay with their parents and be safe and grow up in the community
 Parents may gain a qualification
Outcomes
 Parents don’t require ongoing community drug rehabilitation programmes,
homelessness and healthcare that they would if they were still dependent on drugs
 Children live with their natural parents instead of becoming looked after children,
adopted or in foster care or in care homes
 Less crime because parents earn money through legitimate means and don’t need
the amount of money needed to feed a drugs habit
Impacts
 Families integrated with their local community
 Children enjoying healthy, safe and structured upbringing including education and
out-of-school activities
 Savings of costs to Adult Social Services because parents are ex-users and are able
to contribute to their community
 Savings of costs to Children’s services because of less need of safeguarding and
looked after children costs
 Reduction in ill-health, mental ill-health and crime
Numbers and dates
Although Phoenix Futures includes a number of rehabilitation services (for adults, and for
parents with children – National Specialist Family Service NSFS) and for a period provided
the National Specialist Family service over two sites, this report evaluates the costs and
benefits of:
● The National Specialist Family Service (NSFS) (rehabilitating substance misusers
along with their children and partners)
● At the Sheffield delivery site – Collegiate Terrace
● Within the period 1 April 2009 to 31 March 2012 (three years). Note the evaluation
relates to people who are both admitted and discharged within the time frame:

Scope of this Report 27 | P a g e
 Both those admitted for drug use and for alcohol use
 Families discharged successfully
 Individuals who self-discharge, and if the only parents, then the children who
cannot be reunited with their parent (unsuccessful)
 Individuals where the service makes a recommendation that they should not stay,
and the commissioning authority agrees and removes them (unsuccessful)
 With two follow-ups of successful discharges
 Graduation Event – everyone who has been successfully discharged in a given 12
month period (April to March) is contacted 12 months after the end of the period.
For some, this is up to 24 months after their discharge, and is always a minimum
of 12 months after their discharge. Their status at this point is recorded – whether
drug free and still parenting their children or not
 Sample of those who settled in Sheffield City Council area – all families who were
successfully discharged to Sheffield either because this was where they were
referred from or because they decided to relocate to Sheffield. This was a spot
audit in Spring 2013. In some cases, families had been discharged for up to 4
years. Of note – comparisons can be made with a spot audit done in 2008
Numbers of people admitted and discharged during the period
This includes adults and children: successful graduates where families discharge together,
and self-discharged adults where the children have to be returned to the place of their
residency order.
Substance Type Female Male
Alcohol 1
Opiate 25 5
Not specified in notes 8 2
Total number of children
Age group Number
Under 5 31
Over 5 11
Total number of families = 33

Alternative Family Support for Substance Misuse 28 | P a g e
Alternative Family Support for Substance Misuse
The Children Act 1989 indicated that children should be placed with their parents as a
priority, and was followed by the Children Act 2004 which supported the development of a
number of service and solutions which promoted this[23]. A review of child development
outcomes comparing children of PDU with children in the care system appears to support
this policy.
Services available (usually within a limited local area) include*
:
Ashcroft House, Cardiff
Provide support to mothers with newborn babies or young infants, taking referrals from
around the UK (typically England and Wales).
It aims to provide the practical help and a safe environment in which women can build on
existing life skills and overcome social and life difficulties. The overall aim is for residents to
be able to live independently, caring for themselves and their children and free of the
dependencies that led to their admission to Ashcroft House.
Breaking the Cycle (AddAction)
AddAction Breaking the Cycle (BtC) is aimed at people in their own homes, who can benefit
from signposting and emotional support for whole family to help a parent to quit. The BtC
workers signpost to Children’s Services and family support as well as substance misuse
rehabilitation.
In the course of 12 months, 850 families have completed plus another 150 are in process.
Cost to local authority £4,000 per client family, although AddAction is supported by Zurich
Community Trust which suggests that the actual inputs from an SROI analysis point of view
will be higher. It suggests that if this service were to expand then it may need to impose a
higher cost. The family remain resident in their own home.
Approx success rate: 53% have achieved their treatment goals, and 76% show significant
progress towards recovery.
Family Drug and Alcohol Court (FDAC – Camden, Islington
& Westminster)
The Family Drug and Alcohol Court (FDAC) is a specialist problem-solving court operating
within the framework of care proceedings. It is a new approach to care proceedings, in cases
where parental substance misuse is a key element in the local authority decision to bring
proceedings. It is based at Wells St Family Proceedings Court in London and a pilot was co-
funded by government and three pilot local authorities. The pilot has since expanded.
The goals of FDAC are to help parents address their parental substance misuse and related
problems to increase the chance of family reunification at the end of the proceedings. If
* Many of these descriptions of services are from “Breaking the Cycle” [20]. Kydd, S., N. Roe,
and S. Forbes, A Better Future for Families. The importance of family-based sinterventions in tackling
substance misuse, in Breaking the Cycle: A better future for families. 2012, The Breaking the Cycle
Commission; AddAction. p. 76. The others are from [13]. Martins, C., Strategic Prompt: Parental
Substance Misuse. 2013, Research in Practice. p. 6. And the author’s own research.

parents fail to engage, then the goal is to place the child more swiftly in a permanent
alternative family. Its special features include:-
 a multidisciplinary team attached to the court providing speedy expert assessment,
support to parents, links to relevant local services, and parent mentors who have
overcome similar difficulties in the past
 judicial continuity
 frequent non-lawyer review hearings with the same judge
The non-lawyer hearings provide an opportunity for the parent, the FDAC keyworker, social
worker and judge to review the progress of the case, to problem-solve. They aim to help
motivate parents to change, as well as reminding them of their responsibilities.
Family Intervention Projects (FIPs)
The FIP projects are designed to tackle antisocial behaviour with the express aim of helping
high-risk, disadvantaged problem families who are often seen as ‘lost causes’.
FIP pilots uncovered a link between antisocial behaviour and multiple problems that include
drug and alcohol misuse. 53 FIPs launched in 2006-07, of which 24 by local authority and
22 to voluntary sector (eg Action for Children). Public spending cuts in 2010 led to a number
being forced to close down.
FIPs are seen to be cost-effective, for every £1m invested £2.5m savings to local authorities
and the State [3, 30].
Their success rate is on a par with other community rehabilitation, with an average 40%
reduction in the number of families experiencing drug problems, and an average 48%
reduction for those experiencing alcohol problems [31, 32]
Hidden Harm (Compass, in Lambeth)
Another community-based service, working in schools. The “Child Centred Approach” of
Hidden Harm works with 5 – 19 year olds who have parents or carers with previous or
current problems with drugs or alcohol, where the children have been affected emotionally,
behaviourally, mentally or socially.
Since 2010, it has seen 50 young people. Parents must consent to their child’s attendance
and the Common Assessment Framework is used. Parents are signposted to family therapy
or parenting course.
M-PACT (Action on Addiction)
The Whole Family approach of M-PACT (M-PACT stands for Moving Parents and Children
Together) aims to meet the needs of children living with parental substance misuser either
currently or historically. It is also community-based, and seeks to help families to come to
terms with parental addiction, rather than to rehabilitate the substance misusers.
The process consists of brief psychosocial/ educational interventions: an individual family
assessment at the start and review at the end with 8 group sessions in between (9 weeks
total)
59.5% of children say that M-PACT helped them come to terms with their parents’ problem.
80% completed a minimum of 6 sessions. There is evidence of improved school
attendance, children coming off ‘at risk’ register, and parents seeking access to treatment.
Approx 125 children have been through M-PACT programmes up to mid 2012

Motivational interviewing (MI)
This has been shown to be effective with engaging people with problem behaviours,
including alcohol and drugs problems, who may be hostile to treatment. This may be helpful
in addressing parental substance misuse as parents and even children are known to be
wary, denying or resisting support. The use of MI in conjunction with other services may
also prove effective.
Option 2
Targets families where parents are substance misusers and social workers are considering
the need to remove children. In comparison with other services, Option 2 reduced the time
children spent in care, although it did not reduce the proportion of children who entered care.
The service is valued by families and appeared to engage families that other professionals
had found difficult to work with. It also provides significant cost savings to the local authority.
Caution is needed when interpreting these results, as the impact on welfare of children
remaining at home has not been measured.
The Parents under Pressure Programme (PUP)
This is an intensive, home-based intervention currently being trialled by the NSPCC that
addresses multiple domains in families with methadone maintained and alcohol dependent
primary carers, and children under the age of two. An Australian evaluation showed a
reduction in the risk of child abuse and family behaviour problems. Families receive support
from the NSPCC and treatment from drug and/or alcohol teams.
Trevi House, Plymouth
Trevi House provides rehabilitation and parental assessment for mothers with drug or
alcohol dependency issues, together with their children.
Trevi House is both a home and safe place; where mothers and their children remain
together as a family unit, whilst substance misuse and related issues are addressed.
The needs of residents are individually assessed prior to entering Trevi House to draw up a
mutually agreed Integrated Care Plan.
Trevi House offers a structured rehabilitation programme mixed with flexible residential
programmes arranged to facilitate the transition to an independent life, free from substance
dependency.
In addition to group therapy, one-to-one counselling and associated work, the programme
also includes both leisure and social activities, all of which help to develop confidence and
skills to cope successfully with substance-free daily living.
The Virtual Community (Wired In)
Not a programme but rather an online communication programme to help people understand
their problems and communicate.
Also aims to break down the stigma associated with substance misusers and “to create a
society that better facilitates recovery from substance misuse problems” [Wired In]. Wired In
recognises that 12 weeks or 6 months of rehabilitation is just the beginning, and that the
community in which you find yourself will most likely determine your chances of success. By
providing a supportive and understanding community, Wired In expects to improve the
chances of success.

Parenting Assessment Units
There is a world of difference between the Parenting Assessment Units and all of these
services, however PAU is included in this section because many social services
departments appear to blur the distinction.
Parental Assessment Units consist of 12 weeks of residential observation to determine if the
child will be safe when placed with the parent on a permanent basis.
The 12 week residential includes some parenting classes and creates an atmosphere of
structure and routine which is generally thought to be vital to the successful development of
children in families, such as ensuring the children attend school and parents respond to child
“crises” in ways that demonstrate the parent’s priorities. However the residential period does
not specifically aim to rehabilitate substance misusers nor to change their parenting abilities
or priorities.
All of the above rehabilitation services include assessment, and the residential ones include
assessment reports which many courts will accept in place of a PAU. Ministry of Justice has
confirmed that an assessment from a residential unit such as NSFS should be considered
the “gold standard”.

Identifying stakeholders 32 | P a g e
Identifying stakeholders
Relevant stakeholders are people who either influence or are changed by the service being
examined by the SROI researcher. A test of relevance is whether they would be different if
the service were not available or they had not made use of the service. For example,
mothers determined to keep their children who overcome their dependence on mind altering
substances are affected by the service. They are relevant stakeholders. Staff in a hospital
A&E who provide support for drug users but don’t make a direct connection with NSFS
(because the people in NSFS are clean and no longer using hospital A&E for drug-related
situations) are not affected and are not relevant.
For each stakeholder, we seek to understand how they are affected by the change, and what
this means for them. We also seek to understand how this may impact on others, to
discover if there are more stakeholders that we need to consider.
Inevitably some individuals and even whole groups of stakeholders proved difficult to
access, but wherever possible we have obtained at least three different views representing
each group of stakeholders, which enables us to triangulate the results (compare if two or
more are broadly similar, rather than simply taking an average). The Supplementary
Guidance on Stakeholder Involvement [33] suggests that the best method of deciding how
many people to interview is a saturation method (keep on interviewing until no new
information is obtained).
For each stakeholder or stakeholder group, we also considered whether they were material
to the final outcome. Materiality is determined by whether including that stakeholder, or
excluding them, would make a difference to the conclusions of the report [34]. In this
example, the family doctor (GP) is very important to a young family, so should be considered
a stakeholder. However all of the substance detox work is done by NSFS and the impact on
children psychologically is managed by NSFS, so the family doctor did not have to change
the way they looked after families based in NSFS and could treat them as any other young
family. Therefore the family doctor and doctor’s practice is not materially affected by NSFS.
The value that SROI assigns to a stakeholder and stakeholder group is the value that they
themselves accept and agree to. This means that the researcher speaks to those affected
by or who affect the service.
Interviews were then planned and carried out with Relevant and Material stakeholders. We
interviewed stakeholders and discussed the outcomes that they considered that NSFS
produced, who they would impact on, how we could measure them and their effects, and the
value of that benefit or negative impact. We also interviewed additional stakeholders
identified during the interviews.
Those directly involved
The service users in NSFS are the adults and children, the parents who want so desperately
to get their children back and living with them that they are willing to try this last chance to
control their addictions, and the children who want to be with their parents.
In order to understand the outcomes for these families better, I’ve put them into three
groups. The outcomes relevant to each group are described in the section “What Changes
for Stakeholders?”
The whole NSFS programme is designed to give parents two crucial skills – to manage their
cravings which are the substance addictions, and to be adequate parents. This includes
getting structure and routine into the family life, skills to run a household, and learning or re-
learning parenting skills.

At first, we were not able to obtain interviews directly with this group, who are vulnerable
adults, aware of their own mistakes and who may want to distance themselves as far as
possible; we relied on interviews by key workers, of service users towards the end of their
rehabilitation. Staff are not trained in benefits management or SROI (although naturally are
trained in interview technique) and were given a script to record responses.
The reports from these key worker interviews enabled us to identify possible further
stakeholders, such as the local authority services and Criminal Justice System, and other
people we could interview to understand the impacts better. However this stakeholder group
are critical and it is possible (even likely, judging by the language used in the reports) that
key workers will have identified positive aspects and not dug deep during the interview to
find out more about negative aspects. In particular, no attempt was made to gain a
subjective assessment of the value of coming clean and keeping your children.
In October 2013, 9 interviews were obtained with parents at NSFS. These were all the
parents in NSFS at October 2013 (out of 15 total adult residents in NSFS), although the
scope of the study only included parents admitted and discharged between April 2009 and
March 2012. None of these parents had school-age children or older staying with them – all
had babies, although some had not yet managed to satisfy the court and have the baby
transferred to stay with them. Some did have older children looked after by grandparents, in
foster care or adopted. These parents represented all stages of the NSFS programme, with
the newest admission only admitted 2 weeks prior to the interview, and the longest resident
due to discharge (successfully) within 4 days of the interview. It also included one parent
who had been brought in on a 12 week programme.
The scope of the analysis used for this forecast represents 3 years (36 months) and 41
adults and 42 children, in total 33 families of whom 27 were successfully discharged. The
SROI researcher obtained:
 interviews with adults in the service at various stages 9
 interviews carried out by staff (potential for bias) 3
 sight of a video of adults discussing the service (potential for bias) 9
 sight of a video of children discussing the service (potential for bias) 6
Families who graduate successfully and stay together
Parents who overcome their addiction during their time at NSFS and are able to set up a
family home with their children afterwards. Safeguarding visits and other social services
visits confirm that they continue to provide a good family home and the children are safe.
Sheffield City Council and NSFS “graduation event” (12-24 months after graduation) audits
confirm the numbers.
We estimate (by using the proportion of the Sheffield City Council Audit applied to the
successful graduates) that this group represents 25 adults and 28 children, in 19 families.
Families who graduate successfully, but lapse later
At the end of the residence at NSFS the family meets the necessary conditions and they set
up a family home, but the parents lapse back into their addiction and the children need to be
taken into care. In all cases, the lapse occurs within 6 months of graduation from NSFS, and
in at least one case, workers at NSFS were able to alert Social Services at the location
before the family set up family home there, and the parents’ relapse was spotted within a few
days. Because of this close attention, the children are never at risk.

We estimate (same calculation as above) that this represents 11 adults and 8 children in 8
families.
Adults who self-discharge and their children
Parents are unable to overcome their addiction and leave NSFS without their children – if the
children have joined them then the children will have to go back to wherever they were
before.
Most adults identify early on in a placement with NSFS that they can’t cope – in many cases
because the rules on abstaining from the misuse of substances is enforced rigorously. In
practice, adults who stayed to successful graduation averaged 176 days at NSFS, whereas
adults who self-discharged averaged 36 days at NSFS. Out of 41 adults who used NSFS
within scope (the dates of admission and discharge), 6 self-discharged. Out of 42 children
who used NSFS within scope (the dates of admission and discharge), 6 had to return to care
because their parents had self-discharged. It is normal for children to join parents a few
weeks after the parents have arrived at NSFS and been assessed, so a larger number of
parents than children would be expected to self-discharge within a month of arrival.
This group represents 6 adults and 6 children in 6 families (directly from the minimum data
set).
Those materially affected by the service but not directly
involved
Local Authority Adult Services including Substance Misuse Team
(referrer)
A referral to NSFS can come from either a Local Authority Adult Services department, or
from a Substance Misuse team. In two cases, the referral was actually initiated by Children
& Families (see below).
These teams are responsible for ensuring successful referrals, and are also responsible for
the support needed by substance misusers and homeless people in the event of an
unsuccessful discharge.
In every case, Local Authority adult services staff clarified that they were not allowed to talk
about specific clients or specific referrals (this is not required for the SROI report). Most
people approached refused to be interviewed, probably because they suspected that the
interviewer was a journalist writing an exposé.
12 local authorities were identified for stakeholder interviews, of which 7 were interviewed
consisting of 6 first interviews and 4 sets of feedback on the draft reports.
Local Authority Children & Families Team (referrer)
We encountered a similar issue of a refusal to cooperate with interviews when we spoke to
staff from Children & Families departments. Staff would not return phone calls, and when
they did, commenced the conversation by clarifying that they would not discuss an individual
client.
Children & Families departments often resist making a referral on the grounds of safety and
cost. The adult(s) is the substance misuser, and the Social Worker or substance misuse
team can only make a referral to NSFS if they can persuade their opposite number in
Children & Families (ie the worker and team responsible for the child(ren) of those specific
parents) to also refer into the Family Service. However in two cases the referral was initiated
by the Children & Families service, and Adult Services were pleased to also refer the parent.

The children & families department is responsible for looked after children and safeguarding
children at various degrees of risk. Their budget is impacted when children are in care,
whether in fostering, preparation and completion of adoption, or in care homes. They also
fund the staff who visit children considered to be potentially at risk whether formally
assessed as “at risk” or not.
9 local authorities who had referred families to NSFS were identified for stakeholder
interviews, of which 3 were interviewed. All declined to give feedback on drafts of the report
on the grounds that the particular staff involved with children had moved on to other roles or
other organisations.
In addition, one local authority had a large number of relocations in following discharge from
NSFS, and were responsible for providing safeguarding visits. This authority provided audits
of how many families stay together following discharge and were able to provide valuable
information on the risks to children of staying with a former substance misuser, and their own
observations of the effectiveness of NSFS.
Ministry of Justice, Courts (Criminal Justice System CJS) and Police
The Ministry of Justice has direct responsibility for the Court proceedings, and in particular
for the safety of children of parents where the child may be at risk.
The people we interviewed recommended that we review the work of the FDAC and the
evaluation report produced by Brunel University, which proved a valuable source of
information on care proceedings and enabled us to infer impacts. We were also delighted to
interview the lead author of the FDAC evaluation[35] who provided additional information on
impacts. Brunel University has also been funded to provide evidence of post discharge
results, which is in preparation at the moment.
Ministry of Justice also clarified any misinterpretation of the guidance on court proceedings
which is in the Children and Families Bill[26]. As a result of the discussions and the findings
of this report in its successive drafts, key changes have been made both to the primary
legislation and to the guidance surrounding the legislation which affects how many parents
have a chance to keep their children and try to reunite their families, and are consequently
motivated to give up substance abuse.
The two interviewees (Ministry of Justice and Brunel University) both gave primary
interviews to develop the report, and reviewed drafts to improve the report.
Stakeholders interviewed but excluded from the analysis
A number of stakeholders were interviewed and provided valuable information which we
used to support other interviews, fill in gaps in information from the relevant and material
stakeholders, and to assist with assessing costs and values of the service both positively
and negatively.
Although relevant to NSFS, we were not able to demonstrate that they were materially
affected. A full evaluation could explore this further.
Staff at NSFS delivering the programme
Staff are trained social workers with additional training in rehabilitation after substance
misuse, and in helping young families. They are involved directly with the parents and
children, and affect the way the programme runs.
Staff were pleased to explain their position with respect to the benefits they believed all
parties received: children, adults, the commissioners, the various support departments.
Interviews with staff included the Service Manager, a Therapeutic Practitioner Key Worker,

and a Children’s Worker. Key workers had formerly interviewed adults in the service for the
SROI research.
Staff gain through job satisfaction and employment. However on consideration of the
deadweight (what they would be doing if they were not at NSFS – they would be doing
social work of some nature and helping families), the direct effect on staff was not
considered material. Their interviews are valuable to provide background for the interviews
and interpretation for other stakeholder groups.
The researcher obtained interviews with 5 staff representing different professions, and two
reviewers.
Parental Support
The group of stakeholders we refer to as “Parental Support” includes solicitors, prison
service, and schemes to get people into work.
In general, stakeholders in this group were not directly affected by NSFS. However, they
have an insight into how parents and children are affected, and the likely costs and service
uptake to the local authority and other support services. They are in most cases relevant to
the NSFS, but the actual change that they receive, based on the interviews both with these
stakeholders and with others, suggests that the changes are not material.
One first interview (primary data) and two review of drafts of the report were obtained.
Children Support
Also involved with NSFS providing ongoing support for the children are the schools (for
school age children) and family doctor (GP). Babies and toddlers and children pre-school
age are looked after by the crèche and nursery which is run by NSFS, and is fully OFSTED
registered and inspected.
Schools are relevant because interviews with staff and the staff interviews of parents and
children indicate that many children are behind their expected educational and emotional
milestones when they arrive at NSFS, whether they come from the family home or from care.
During the 6 months’ stay at NSFS, school age children catch up with their emotional and
educational expectations.
However the difference that this makes to the school is probably not material. There are
national statistics for the expected amount of truancy and exclusions for children of
substance abusers, and the likely calculated cost to the school and education authority.
Children of families at NSFS do not exhibit these levels of truancy or exclusions (it is
carefully monitored by the service) and their parents are no longer substance abusers, so
although schools are a relevant stakeholder, they are not a material stakeholder.
Our request for interviews with the school were refused.
The family doctor and practice (GP) also has a significant impact on the development of the
young family. As with schools, the family doctor has a large number of young families with
different challenges and successes. The costs to a family doctor of the extra visits by
substance abusers has been quantified[7], but families at NSFS made use of the family
doctor within the bounds of any other young family with children of a similar age.
Substance misuse and parental behaviours are managed by NSFS, so it is unlikely that the
family doctor and practice were materially affected by these families.
Our request for interviews with the family practice were refused.

Central government policy on substance misuse
National Treatment Agency (NTA – now part of Public Health England) sets the guidelines
for treatment of substance mis-users, and is therefore constantly evaluating the outcomes
from different services. They were able to explain how NSFS supports national policy, and
what other services act in competition, or are complementary to NSFS. They clarified that
the material impacts are on the court proceedings and local authorities (and of course
parents and children), rather than on themselves.
Two primary interviews informed the development of the report, and two interviews reviewed
the drafts and confirmed changes.
Similar services providing rehabilitation for mothers and babies
There is little competition for referrals, as mostly the social services make a referral to a
service because they are aware of its existence.
Although NSFS is the only service which accepts children older than 18 months and dads as
well as mums, many of the challenges experienced by NSFS are also experienced by the
two mum and baby services: Trevi House and Ashcroft House (see “Alternative Family
Support”).
There are only two alternative family support units, and both gave interviews for this
research. A total of three interviews, including two interviews reviewing the report.
Numbers of Stakeholders and Information Gathering
process
Not including the video evidence, we spoke with 38 individuals representing organisations,
carrying out 34 first interviews (gathering information) and 18 review interviews (reviewing
the report and suggesting improvements and clarifying). The video evidence adds 9 adults
and 3 children (who spoke) to this total.
The initial interviews followed a semi-structured interview format. The reports were recorded
as illustrated in Appendix I: Interview Format and Example, and were then collated into a
matrix of interviews and stakeholders/ stakeholder groups, to determine how many
stakeholders described each outcome, and what the impact was.
All interviews included questions about the importance of a particular impact and the
duration/ attribution (as shown in the Interview Format in the appendix), although many
interviewees were unable to answer these questions. Extensive research of published
literature and unpublished reports filled in the gaps.

What changes for stakeholders? 38 | P a g e
What changes for stakeholders?
Families who graduate successfully and stay together
These stakeholders describe two periods – when they are in NSFS, when one set of
outcomes occurs, and after they leave and set up home.
The parents described the positives and negatives of their time in NSFS.
Out of 9 parents interviewed, 6 had older children who were already subject of a residency
or court order placing them with another carer. In all cases, the baby that had brought them
to NSFS (the child where they had realised the determination to try to kick the drugs habit)
had either been taken away from them or their only chance to keep the baby was to come
into NSFS, and two of the interviewees had not yet managed to have the baby placed with
them at NSFS.
Only a certain type of person comes to this intensive rehab. You have to want a family, you
have to want children.
The quality of the programme
One interviewee made the most telling statement about NSFS: “I’ve been in loads of detox
and rehab. Half the stuff you do here I’d never even heard of”. NSFS (and probably the rest
of Phoenix Futures) supports people to face their demons and to learn to manage
themselves, the situations they get in, and their cravings. As another interviewee put it, most
rehab is like “coming to a prison to stay clear of alcohol, but this is much more”. She had
doubted herself that she could manage, and others said that they hadn’t managed to get off
methadone in the community, although of the interviewees, most had started detox before
they arrived.
Interviewees said how supportive it was to see other people completing and discharging
successfully – there’s much more of a sense of community, “it’s an environment where other
people have used [drugs]. You are not judged. It’s a child friendly and safe environment,
and your parenting skills improve”.
They learn to look for strategies to cope with every day; the programme is intense but
gradual so very few people drop out. They learn about child protection. They learn to open
up and speak to people instead of bottling it up then exploding, and conversely they learn
what is unacceptable behaviour (“they said I was too aggressive, in your face, but they didn’t
turn their backs”). You learn a lot off your peers. It was another person on the recovery
programme who went with one parent to the cemetery to grieve the child she lost 10 years
before – they say it’s a small community with more 121 time.
They have the opportunity to take on responsibilities. One of these is the Link Role, who
goes around each day recording everyone’s feelings, and making sure they do their jobs for
the group. All the programmes help you become a better person and help you look at the
behaviours you thought you didn’t have, and give you structure and keep you busy rather
than doing drugs.
There are also opportunities to do qualifications. Most of the interviewees had low
educational attainment, so the Triple P (Positive Parenting Programme) qualification was
valuable. One had started other qualifications.

SROI national specialist family service 2013

SROI national specialist family service 2013

More Related Content

SROI national specialist family service 2013