Description of the programme
Shelter Scotland’s Healthy Finances pilot aimed to reach vulnerable and excluded clients who were unlikely to seek support with their financial and housing difficulties. (The target group tended to only engage with primary care services). Participants were aged between 16 and 64 years, and recruited via selected primary health care services such as GP practices and hospitals in the most deprived areas of Dundee and Glasgow. 153 participants received longer-term one-to-one support with financial and housing difficulties between January 2017 and January 2018.
The Healthy Finances pilot was designed to test two research questions:
- That placing a service within primary health care services helps to engage with clients that would not have previously engaged with financial capability services – ie. they were ‘under the radar’.
- That providing longer term support provides more sustainable positive outcomes than shorter interventions.
The process evaluation explored whether the pilot delivery model and its holistic support offer increased participant engagement over time and improved their situation. Collaboration with primary health care was also reviewed, to identify successful approaches to improve the targeting of referrals into this type of service. The outcomes evaluation assessed the extent to which the project achieved the intended outcomes and impacts identified in its theory of change, aligned with the Money Advice Service’s (MAS’s) Outcomes Framework, namely:
- Increased income
- Reduced debts
- Improved ability, motivation and confidence to manage money well
- More stable, affordable or appropriate housing secured
- Improved quality of housing
The evaluation took place between February 2017 and February 2018, and utilised the following methods:
- Quantitative analysis of 153 client forms (all clients who engaged for more than an initial meeting).
- 18 depth interviews with pilot staff: six pilot staff (three in each city) were interviewed at the beginning, mid-point, and end of the evaluation.
- Two case study interviews with pilot staff (one from each city) reflecting on 20 participant journeys (10 in each city) at the end of the evaluation.
- 18 interviews with staff in primary health care settings: six health sector staff (three in each city) were interviewed at the beginning, mid-point, and end of the evaluation.
- 17 participant interviews: seven participants were interviewed at the mid-point, and 10 participants at the end of the evaluation.
The process evaluation found:
- Referrals from GP practices, which accounted for the majority of referrals, were most likely to reach the intended group of new clients with unmet needs.
- Building a trusting relationship between frontline staff and participants enabled and encouraged participant to engage with the pilot for longer.
- Health staff perceived the referral process and communication with Healthy Finances to be effective overall, and fed back that delivery staff engaged well with those referred.
- The pilot helped relieve pressure on primary health care, and health staff would welcome a permanent Healthy Finances service. · Holistic support, including housing and financial support, helped participants improve their situation more broadly, such as reducing their food poverty, and increasing their mobility support and motivation to seek employment.
The outcomes evaluation found:
- Participants’ financial wellbeing and behaviour improved, aligned with increasing income and reducing debt.
- Participants who engaged over a longer period of time were more likely to achieve at least one of the outcome measures.
- For some participants, insufficient ability, confidence or motivation to manage their finances well appeared to be a consequence of their housing and financial issues, rather than a cause.
- Improved housing situation and financial wellbeing led to improved mental health amongst participants.
The evaluation identified a number of recommendations for policy and practice:
- The “struggling” segment of society according to the MAS segmentation model (MAS 2016), have a particular need for benefits advice.
- The need to remove barriers to accessing support for financial and housing difficulties. For example, offering support in close collaboration with primary health care worked well, as this route is less stigmatised.
- Establishing trust and regular contact with frontline staff facilitates the longer-term engagement of vulnerable clients.
- Providing holistic advice covering financial and housing issues can be more effective than restricting advice to a single issue, and can relieve pressure on primary health care.
- When collaborating with support services, primary health care settings value effective referral processes, and receiving feedback on clients’ progress.
- The Healthy Finances pilot addressed a gap in current provision, and demonstrated the need for this type of service.
Points to consider
- The actual number of outcomes achieved with clients might be higher, because not all outcomes were captured by the participant questionnaires.
- Monitoring participant outcomes over a longer period of time, and after support has ended, would be required to test the sustainability of outcomes.
- The case study interviews covered more than 10% of the overall client population. However, case study findings could not be quantified to assess participants’ outcomes in terms of ability, motivation and confidence to manage money well day-to-day. These results cannot therefore be generalised from to the wider population.
- Selection bias due to the way interviewees were selected might have resulted in overly positive findings in some areas. Caution should be used in considering the transferability of the model to other settings.
Health Finances Pilot final evaluation - full report