Way back in 2000 I was commissioned to conduct a two-year evaluation of the projects supported by the Drug and Alcohol Treatment Fund (DATF) in Wales. My colleague Becky Hancock and I evaluated the Option 2 project that had been set up by Rhoda Emlyn-Jones. Here is Rhoda talking about Option 2 during her conversation with my colleague Wulf Livingston in December 2023.
Option 2 [8’45”]
Prior to the development of Option 2, Rhoda’s team was out-of-step with colleagues. What Children’s Services wanted from them was an immediate response, because it was a crisis for the child, whilst what Rhoda’s team needed from them was to understand the nature of the change for the parent. What needed to happen was a better beginning and understanding of the importance of people managing their own risk towards their desired outcome. ‘So it’s not an event that change, it’s a process. But you keep things safe along the way, from the family’s point of view.’
One day, a member of Rhoda’s team approached her about a referral from Children’s Services. She had met the mum and said to Rhoda that if she was going to make a difference—and reach the stage where the mum’s children were not removed—she was going to have to work every day with her for the next few weeks. Rhoda told her that this type of service was needed.
They developed their approach, looking at Home Builders—a home- and community-based, intensive family preservation services treatment programme in America—and various psychological therapies that worked. The service name Option 2 was decided upon, since it said to colleagues ‘at the point that you are about to remove children, there is another option. And come to us and then we’ll do some intensive work.’
Rhoda had an excellent team of staff and a very clear intervention over four weeks. They would work one family at a time, 24/7. Option 2 was IT for the duration of the four weeks. All families had the phone number of the Option 2 worker.
There was a huge amount of safety planning right from the beginning. Focus was then ‘on them, as a family—how they function, their values, their strengths, where the priority risks are for them, how they are going to overcome them themselves with us alongside.’ The family then began to put their alternative behaviours in place, which they had never had the opportunity to do, whilst holding a safety net of their safety plan. If things got difficult, the children knew what to do.
Outcomes were reached four weeks in—family functioning, children thriving, key issues resolved. The deep intervention was stopped, and the team member then came back one, three, six and 12 months later to check how things were going. ‘What is it about you that is keeping this change going? What are you facing in terms of challenges? What plans have you got to deal with those?’ At six months, there was sometimes a bit of a wobble, in which case a worker might go back in for a few days. At 12 months, year-on-year for ten years, 75% of families were holding their outcome behaviours and functioning.
Wulf worked with people who were given labels by others like ‘most complex’ or ‘lots of needs’. When he first met them, he realised that one of the things that stopped them achieving anything was the fact that they would have anywhere between 6-12 appointments in a week with 6-12 different people, resulting in multiple 45-minute conversations. How detrimental would that be, particularly when compared to having many hours of one conversation with one person that could turn into something meaningful.
Rhoda describes people being tied up in a ‘scattergun-referral process’ and their ability to be a better parents being judged on whether they turned up to interviews. One woman she knew, who was self-medicating for mental health problems, had two children, one who had special needs. It was demanded of her that she turn up at a clinic at 10.00 and 16.00 each day to pick up the drug that would prevent her self-medicating. She had no money, and children in schools in different parts of Cardiff. People she was supposed to meet said she had missed her appointment again.
Wulf points out that someone in the system probably labelled her as ‘unmotivated, not wanting to change’. Rhoda says the woman loved her children. Option 2 was able to change the situation very quickly and the family moved to a very strong place.
‘You have to start where people are, and not assume that services define motivation…. The trust that builds between one [Option 2] worker and one family is unprecedented. And that trust provides total disclosure. So, within a week you know everything. And when that deep disclosure comes, there was masses of supervision back in our team, shared reflective practice where we talked that through, and the question for all of us was: “Does that disclosure indicate a new issue that we have to rethink, or can that be wrapped up in the intervention? Let’s not knee-jerk here.” But then we had to consult with all the other professionals around the family to help them understand that.’
Rhoda continued: ’There was a lot of the evidence that the system was the problem. Not the workers within the system, and not the families within the system, but the system itself.’
You can read about the Option 2 evaluation that Becky Hancock and I conducted in the last section of Part 6 of My Journey.