Long term benefits need to be taken into account when evaluating family support projects

Editor—Many voluntary sector initiatives offer community support, but we are aware that not all those who need help are ready to receive it. The Amalthea Project, discussed by Grant et al, was developed to bridge this gap by facilitating access to the voluntary sector from primary care.¹ Grant et al's evaluation of this project makes a real contribution, measuring both the benefit to patients with psychosocial problems and the costs of such projects.

Grant et al confirmed that using referrals facilitators results in both clinical and social improvements for patients, but they concluded that it costs more than the usual care offered by general practitioners. The experiences of the Hackney WellFamily Service, a family support project we developed jointly with the Family Welfare Association, suggest that this is short- sighted. It fails to take into account the long term benefits to the community and the consequent reduction in the burden on all support services if the cycle of deprivation can be broken.

The WellFamily Service also offers referral facilitation but combines this with practical and emotional support to help families build their own resources and find ways around their problems. This approach has been well received by people of different ages and ethnic groups, and it has reached families who might otherwise have been excluded by poverty, limited education, or lack of confidence.

In an 18 month evaluation, 113 patients or families used the service and 20 participated in semistructured interviews.² Several themes emerged. We found that focusing on the whole family provided an opportunity to support those who were hard to reach, such as the mother of a delinquent teenager, and that providing non-statutory help may overcome a client's resistance to authority and give those deemed to be “at risk” a sympathetic hearing in an accessible environment.

Another advantage of a practice based service is the change that it facilitates within primary care; in our case, this has contributed to the development of a more family centred approach throughout the primary care team. Our approach emphasises wellness and the normalisation of help seeking, concepts that also underpin the work of health visitors. Because of these similarities we have also explored working with health visitors to expand the service, an approach which draws on a government white paper.³ Grant et al have shown that such a service incurs costs that are not recouped by primary care, but if services like the Amalthea Project, or like ours, are to be made more widely available, we need mechanisms that allow us to share the costs between the social and healthcare budgets.