First Step provides counselling and therapeutic support for male survivors of sexual abuse who live in Leicester, Leicestershire and Rutland. Over the last two years the organisation has expanded beyond its core Counselling Service, to include the new Support Service, the Advocacy Service, and Peer Support Groups. An independent evaluation was commissioned, covering the period 1 April 2019 to 31st March 2021. The key findings from the evaluation report, conducted by 3 Worlds Consulting, are summarised in this executive summary.
Download the full report: First Step Evaluation – Final April 20221
Organisational change
The last two years have been a time of very significant organisational change, the service developing from a single Service Coordinator to a team of four. Introducing and integrating these new posts has been a significant undertaking and it has taken some time for individual roles and responsibilities to become clear. The move to remote working, as a result of the Covid 19 pandemic, presented additional challenges for communication and developing a team culture. However, the efforts of all team members have resulted in more robust systems and significantly greater capacity, allowing the new Service Manager to transition into a more strategic role. The organisation has embraced the expertise of new members of staff, strengthening operational practice, particularly in relation to training and supporting volunteers.
The coronavirus pandemic
First Step responded rapidly and robustly to the initial national lockdown in March 2020, moving its services to telephone or video conference, according to the wishes of individual clients. Resources were provided to volunteers to work safely from home and online training in how to conduct counselling remotely was provided. The staff team maintained contact with volunteer counsellors through weekly check-in calls and online volunteer peer group sessions. The staff team worked closely with colleges to ensure that trainee counsellors were properly supported and supervised. Having learned the lessons, First Step was able to move seamlessly into remote working for the second and third lockdowns in November 2020 and January 2021, allowing a considerable degree of stability and consistency for clients.
Volunteers and clients alike were initially apprehensive about the move to remote working. Some clients struggled with poor network coverage or finding a private place for sessions, worrying that family members, particularly children, would overhear. However, others have enjoyed having sessions at home and found remote sessions far more accessible, removing the need for travel or taking time away from work. Whilst there was broad support for returning to face-to-face sessions, client express gratitude for the support they have received.
Volunteers found the transition challenging but were impressed by how quickly a robust remote service was introduced and had few suggestions for how the process could have been improved. Whilst some volunteers continue to feel that offering counselling remotely is not appropriate, the vast majority reported that it had been possible to provide safe and effective support in this way.
The referral and assessment process
Client referrals and support needs
Over the period First Step received 265 referrals, 65% of whom were self-referrals, the vast majority having experienced childhood sexual abuse. The service has seen a growing number of referrals from young men, presumably triggered by recent attention given to male sexual abuse in TV shows and on social media. The vast majority (80%) of referrals were White British. Further consideration should be given to the barriers that Black and Asian men face in disclosing experiences of sexual abuse.
Client presented with a very wide range of circumstances, many having an accumulation of life issues including homelessness, unemployment and family conflict. They tended to approach the service at a point of crisis. The vast majority presented with significant mental health issues. Self-harm was reported by nearly half of all clients. The prevalence of serious, long-term physical health conditions was also very high.
The pandemic had a marked impact on client support needs, removing safety nets and coping strategies. In some cases clients have been forced back into close contact with their former abusers as a result of the lockdown. The toll taken on mental health was particularly noted during the third lockdown. However, public messaging about mental health during this time appears to have reduced the stigma associated with asking for help.
The assessment process
A total of 248 assessments were completed. A key feature is the rapid turnaround from referral to assessment, 93% of clients being assessed within seven days, 37% being assessed on the same or following day as referral.
First Step places great weight on its assessment process, being the foundations for a client’s experience of the service. Clients reported glowing praise, including a sense of relief and validation after the assessment, finding this to be a positive intervention in its own right, giving them the confidence to continue to engage with the service. The key features of the assessment process include: the highly accessible and discreet location of the office; the warm welcome that meets the client as they walk through the door; the informal, light approach that puts the client in the lead; and the fact that a decision regarding support is made at the end of the session.
The Counselling Service
Client engagement
Over the period 265 clients engaged with the counselling service through 3,958 sessions. Around half (56%) of these were face-to-face, with 20% by telephone and 24% via video conference.
Review of 127 cases opened and closed in the period, found that 15% of clients did not enter support after assessment, with 57% completing at least six sessions. Whilst the team are confident that client completion rates have improved over the last year, further reflection on this reasonably high level of dropout is warranted.
Client feedback
Clients rate the counselling service very highly with universal agreement that it was easy to talk to the counsellor, that they had enough time to explain things, that they felt safe and comfortable, and that they felt valued and heard. Many clients welcome the open format of counselling, being allowed to speak freely with minimal direction from the therapist. This, in and of itself, was empowering, in sharp contrast to their experiences of controlling abuse, and of statutory sector mental health services.
“Your work brings light to dark places and hope and a future to this once broken man. Thank you for your loyalty and dedication you have shown to me. You’ll be on my New Year Honours list!” (Client feedback)
The Support Service
This new service provides six weeks of therapeutically informed support for individuals deemed unsuitable for counselling at the point of referral. This may be as a result of drug or alcohol issues or high levels of suicidal thoughts. The primary aim is to help them become ready to engage with the Counselling Service. To date, 62 individuals have been supported. The service reports a dropout rate of only 10%, with the vast majority completing sessions and moving into counselling. The service also offers six months of extended support with a volunteer, as an alternative progression route. However, only two individuals have been supported in this way to date. This area of the service requires further development in the coming year.
The Advocacy Service
In recent years, clients had made numerous requests for help with a wide range of broader life issues. As a result of this demand First Step introduced the new Advocacy Service. To date, 22 clients have been supported through 34 sessions. Support is tailored to individual support needs and has included: writing letters of support for GPs and housing applications; completing benefits applications and ‘capability for work’ questionnaires; help with the becoming self-employed; exploring going back to college; plus referrals to specialist legal advice and food banks.
The transition to implementing advocacy support as a distinct service has been slower and more challenging than anticipated. Demand for the service has been lower than expected. It is unclear whether there is insufficient need for the service to justify a separate worker, or whether clients do not recognise their support needs or feel ashamed to ask for help. Recommendations for strengthening this service include strengthening the needs assessment process and creating opportunities for the Advocacy Worker to forge a relationship with clients.
Peer Support Groups
Previous feedback from clients indicated an interest in peer support groups. Client consultation was conducted at the end of 2019, and a range of approaches were trialled using the large room at the back of the building. This included an online group during the first lockdown. However, engagement in these activities has been limited.
The team recognises the need to diversify group activities, based around a focal activity and have explored a number of ideas, including an allotment project. Unfortunately, implementing these ideas has been delayed by the lockdown restrictions.
Volunteers
As at March 2021, 35 volunteer counsellors were actively engaged with First Step, with around 50 volunteers having supported the service over the period. Counselling volunteers often come to First Step as trainees who need to complete a number of practice hours to qualify. Placement volunteers were attracted to First Step because of its focus on male sexual abuse, whilst also finding the service to be particularly enthusiastic and welcoming of trainees.
First Step is committed to the principle that volunteers should never be out of pocket, covering all expenses including training and clinical supervision. First Step places great weight on clinical supervision, recognising this as a key strategy to ensuring quality standards are maintained. Whilst face-to-face training was not possible during the lockdowns, every volunteer was provided with a budget of £100 to complete online training of their choice, and books covering various topics related to trauma and recovery were sent to all volunteers.
Volunteers report glowing praise for the support provided by First Step, noting how they feel valued as individuals, and as a core part of the team. They state that the support provided is “head and shoulders” above what other placement providers offer, which encourages many to continue to volunteer after they have completed their qualifications.
“The support and care is there for the volunteers. I really felt nurtured and held. Having that feeling means I can do the same for somebody else.” (First Step volunteer counsellor)
Partnership working
First Step works with a wide range of partner organisations, on a strategic basis and in relation to individual client cases. Feedback from partner organisations was extremely positive with 85% of partner survey respondents rating the service as five stars. The vast majority (92%) strongly agreed that the service provides high quality, specialist support. They report that the referral process is quick and easy; that communication is open, effective and informative; and that First Step is responsive and flexible, providing helpful information and advice regarding referred clients. They stressed that the service is “passionate” and that it “really cares” about its clients, noting that the service is run with “professionalism and heart”. The vast majority (85%) agreed or strongly agreed that, without First Step, male survivors of sexual abuse would have nowhere else to go.
Impact on the client
The service has had a profound impact on its clients. The key outcomes identified during the evaluation are summarised below:
Strengthened health and well-being
Clients reported particularly strong changes in relation to their mental health, feeling happier and calmer, 83% of clients reporting improvements in their PHQ9 depression scores, and 80% in their GAD7 anxiety scores. Clients reported far greater insights into their own thoughts, feelings and behaviours with strengthened coping strategies. Some impact was also noted on improving physical health.
Strengthened self esteem and self-care
Clients reported significant changes in their perceptions of themselves with 82% reporting they have made positive lifestyle changes.
Strengthened empowerment
Clients reported a marked impact on their confidence, feeling more able to make their own decisions with the vast majority (89%) feeling more able to deal with day-to-day life issues. At the same time, 85% reported feeling more able to ask for help if needed.
Strengthened safety
Clients reported significant impacts on their sense of safety with reductions in self harming and reliance on medication or substances as coping mechanisms.
Strengthened support networks
Clients reported marked improvements in their relationships, including happier home lives and greater confidence to make new friends, with two thirds of clients feeling less isolated.
Increased access to support
Clients reported that they are getting more support from others services as a result of engaging with First Step, with reduced use of crisis or emergency services
Recommendation for the future
The evaluation identified a number of recommendations for strengthening ongoing developments. These include:
- Embedding the Advocacy Service
- Developing and evaluating the Support Service
- Diversifying and embedding peer support groups
- Expanding awareness of the service across diverse communities
- Continuing to develop new initiatives – for example, piloting a Counselling Service in prisons, and introducing additional specialisations within the team for clients with complex mental health problems
Download the full report: First Step Evaluation – Final April 20221