Suicide Bereavement Support Service: evaluation report - year 2

7. Conclusions and recommendations

This chapter sets out our conclusions and recommendations, aligned with and responding to the evaluation aims and key research questions.

Evaluation Aim:

• Understand whether the pilot has been implemented as intended and the elements of service provision that are working well and less well.

Research Questions:

• What contextual factors have influenced the implementation and delivery of the pilots?
• To what extent have the pilots delivered on their intended aim to provide a rapid response and liaison service for bereaved families?

The planned launch for the service was April 2021; however, it officially went live in August 2021. It was felt that the lead-in time for development and implementation was not sufficient, and this led to the launch of the service being delayed. A key factor was the recruitment challenges experienced during the implementation phase.

The service delivery model has been implemented and embedded as planned, and the evidence gathered during the evaluation period to date enables us to conclude that the service is providing a rapid response and liaison service for bereaved families.

Overall, most aspects of the service delivery are reported to be working well, with several aspects identified as strengths of the service. This includes:

• The approach, skills, and qualities of service staff.
• People receiving support dictating the frequency, duration and format of engagement, and support focussed and responsive to their needs.
• The flexibility and responsiveness of support.
• People having someone outside of their family and social network to speak openly and honestly with.
• Consistency in practitioners that people receive support from.
• Rapid entry to support from the point of a referral/self-referral being received by the service, and no waiting lists.
• No time limit on the support that a person can receive, reducing any pressure on the person and allowing them to move at their own pace.
• The robust and valued support mechanisms in place for staff and the encouragement and support to continually learn and develop.

A key component of the implementation has been a phased approach to developing and maintaining referral pathways into and out of the service. There has been much activity by the service to extend inward referral pathways and to raise awareness and visibility of it. While this has led to an increase in referral sources, it has not resulted in increased referrals to the service. In fact, over the duration of the pilot, overall levels of referrals have dropped, particularly through the Police Scotland pathway. This has been the biggest influencing factor on service delivery and the one area that could be working better.

The service experienced challenges during times of staff turnover. This delayed the extent to which data collection processes were embedded and created short-term capacity pressures in the service. However, service delivery was maintained despite these pressures, and there was no feedback to suggest that it led to any negative impact on people receiving support.

Evaluation Aim:

• Review whether the service is considered to be supportive and beneficial by participants.

Research Questions:

• Assess whether the service is providing flexible support and making the required connections with specialist services.
• What has been the experience and short-term outcomes for those using the service?

Over the duration of the evaluation, we have engaged with almost 30% of all of the people supported by the service at least once and a smaller proportion two or three times at different points on their support journey.

The consistency in the feedback we have received during the evaluation, supplemented by the SWEMBS data gathered, gives us no hesitation in concluding that:

• People have a positive experience and receive responsive person-centred support from the service, that is delivered with sensitivity and compassion.
• People receive support that is led by them and provides the flexibility required to respond to changing needs.
• The service has a positive impact on the emotional and mental well-being of the people it supports, as well as the extent to which they feel they can cope with and return to day-to-day life and activities. For some people, the impact is profound, with feedback suggesting that it has been the difference between living and dying.
• Wider support and service options are explored with people aligned to their needs, and support required to access is provided as required and appropriate.

A small number of people receiving support from the service also shared ideas for improving or enhancing the service, as described in the previous chapter, and these should be considered during the extension period.

Evaluation aim:

• Analyse available data and review and advise on the use of baseline and outcome measures for service monitoring and evaluation.

Research question:

• To what extent can the impact and benefits for families be evaluated, and are there improvements that can be made to routine monitoring?

SWEMWBS was the only tool used by the service to capture baseline and outcome measures for the people they support. The staffing changes experienced in the service in Ayrshire and Arran impacted the extent to which the process for undertaking SWEMWBS with people was fully embedded. While this has improved over time, there remains a higher volume of SWEMWBS data gathered in Highland. However, subsequent feedback from service staff suggests that the process is now fully embedded in both areas. The use of SWEMWBS is also seen to support conversations with people that help them to reflect on the progress they have made and to explore future support needs. However, SWEMWBS was not designed or intended for this purpose, and we would recommend that the service develop a bespoke tool to support reflection with people being supported or identify an existing tool that has been developed for that purpose.

The combination of qualitative data gathered through interviews with people supported by the service and the quantitative data gathered through SWEMWBS enables us to say with confidence that the service does generate a positive impact on emotional and mental well-being. Therefore, there may be limited value in maintaining the use of this measurement tool going forward. However, if the service is rolled out in the future, being able to demonstrate that outcome achievement remains consistent across different areas may be worthwhile.

In terms of wider service activity data, the consistency and completeness of data have improved over time as processes have become embedded. This has also been the case with demographic data. There are still some slight inconsistencies in how some data is categorised and recorded, but service leads and managers are aware and working to address this. Furthermore, data is not routinely compiled centrally to provide a whole service perspective. We recommend this is resolved to ensure the required systems and processes are in place to support this function in any scaling up or rollout of the service.

Evaluation aim:

• Provide recommendations for further national roll-out taking into account questions of scale and sustainability.

Research question:

• What are the key lessons for further roll out and scale up and sustainability of the service?

Service leads are confident that the overarching hub and spoke model, with defined central and local functions, alongside the consistent delivery model that has been embedded in each area, would enable the expansion of the service into other areas.

Questions remain about whether the delivery model can maintain the degree of flexibility and responsiveness that is valued by people receiving support when operating closer to capacity. This can hopefully be explored during the pilot extension, though the potential to do so will be dictated by referral volumes into the service.

The following have been identified as areas for consideration in relation to a rollout of the service based on the learning generated to date:

• How can potential demand in a given area be best assessed and ensure service staffing is reflective of that?
• How can the service provide equitable access to face-to-face support for all people that request it?
• Does the provision of face-to-face support dictate that there will need to be practitioners based in each area the service is rolled out to?
• What is the best approach to developing and maintaining referral pathways into the service and wider awareness?
• Is there value in having regional staff that are focused on establishing and maintaining referral pathways and raising awareness and the profile of the service?
• As the service expands, how can the relationships and peer support across practitioner staff in different delivery areas be maintained, and what would be needed to facilitate this?
• What are the strengths, risks, opportunities, and challenges of service roll out involving the introduction of new delivery organisations versus roll out of delivery that involves only Penumbra and Change Mental Health?
• What additional resources might be required for a centralised hub function to support expanded service delivery?
• What model and approach would be required to ensure effective governance of an expanded service?

The pilot evaluation is being extended, and providing insight into the areas detailed above will be a core aim and focus.

Summary of recommendations

The following summarises the recommendations for the SBSS:

• Explore with service staff what mechanisms could be put in place to give them more confidence or increased comfort about taking leave during periods of greater needs among the people they are supporting.
• The strengths of the model identified by people receiving support were considered to be essential components to be included in any roll out of the service. We recommend that capacity levels in the service are managed to ensure that the strengths identified can continue to be maintained.
• The service continues to carry out awareness-raising activities and activities to develop new referral pathways. It will be important that this activity is maintained as well as remedying the drop off in referrals received from Police Scotland
• Service monitoring and activity data is still being provided to the evaluation team in different formats and categorised differently. It is essential that this issue is resolved, and data is collected, categorised, and reported consistently before any roll out.
• While SWEWMBS has been used by service staff to support reflection and help people see how far they have progressed, it was not developed or intended to be used in this way. It is recommended that the service develop a bespoke tool to support this activity with people being supported or identify an existing tool that has been developed for that specific purpose.
• Consider the areas for improvement suggested by people supported by the service, such as making first contact with the service for support via email rather than over the phone.

How to access background or source data

The data collected for this social research publication cannot be made available by Scottish Government for further analysis as Scottish Government is not the data controller.