Research briefing
Research briefing
Emotional Support and Counselling
project (ESaC)
September 2010
Introduction
RNIB commissioned University of Liverpool to evaluate a pilot
project funded by GlaxoSmithKline. The aims of the pilot were to
explore the impact of emotional support and counselling services
provided as part of an integrated low vision pathway and to provide
evidence to support policy makers, commissioners and
practitioners for the future development and delivery of low vision
services. At the two sites involved (Sight Service in Gateshead and
RNIB’s Low Vision Centre serving the residents of Camden and
Islington in London) a part-time counsellor has worked as part of
an integrated Low Vision Service (LVS).
Method
The CORE-OM (Clinical Outcomes in Routine Evaluation –
Outcome Measure) was used to measure changes in subjective
well-being, problems/symptoms, functioning and risk (to self and
others). A total of 35 service users (55%) provided CORE-OM data
at both baseline and post-intervention assessment. Data for this
Full CORE Sample was collected between April 2008 and May
2010.
In addition a range of qualitative investigations were undertaken
including a review of service user needs and expectations prior to
and post intervention (n=32), in depth exploration of users'
experiences of the ESaC services (n=14), interviews with service
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providers (n=15) to understand their views on how the ESaC
services fitted into wider low vision services, questionnaires with
relatives and friends (n=7) to consider the impact of visual
impairment on their relationships and their perception of the impact
of ESaC services on service users.
Of the 190 people referred to the ESaC services during the pilot
149 became clients. Most clients (77%) received counselling and
remained in the service for 13 weeks. The remainder received
emotional support and stayed with the service for nearly 7 weeks.
The majority of referrals came from within the LVS with fewer
referrals from GPs and hospital eye clinics. In Gateshead, where
an Eye Clinic Liaison Officer (ECLO) in post at the local eye
hospital, they were the main source of external referrals to the
ESaC service, accounting for 12% of all referrals but in London,
where there is no ECLO in post, no referrals came from hospital
sources. When introducing the ESaC service to service users, LVS
staff used strategies which normalise and downplay what is
involved, often avoiding using the term ‘counsellor’ in order to
introduce people to the service who may not otherwise seek
counselling.
Key messages from the research
 The Full CORE Sample clearly represented a clinical
population, showing relatively high levels of psychological
distress, which are also reflected in the qualitative data. By the
end of therapy these levels of psychological distress had
improved markedly (mean CORE total scores reduced from
53.34 to 30.83 from baseline to post-intervention assessment).
This statistically significant improvement was seen in all four of
the assessment domains and represents a considerable
improvement in psychological well-being during the course of
counselling. The improvement in well-being is also reinforced by
the findings from the Needs and Expectations data and by the
qualitative interviews with service users, which illustrate vividly
how service users feel they have benefited from the ESaC
services. These two participant quotes are indicative of
feedback:
‘I was given to understand that most of the things happening to
me were normal and human’.
‘I felt more motivated and didn’t have suicidal thoughts/feelings
during my time with the counsellor’.
 At the baseline assessment the two major issues people
wanted help with were visual impairment and depression or low
mood. At the post-intervention assessment people gave more
specific, positive responses and spoke of wanting to feel better,
gain confidence, cope, make sense and move on.
 Sight loss is a transitional process. It is clear that the ESaC
services have a role to play in supporting people at all stages
through this journey and this indicates a need for continual
access to ESAC services rather than just at point of diagnosis.
 There are some unique features that distinguish the ESaC
service from generic counselling available through primary care.
a) Accepting and adapting to sight loss – The ESaC services
played a valued role in enabling people to accept and adapt to
their visual impairment by helping people to adapt emotionally
to sight loss in different ways, according to the individual’s
particular experiences. Strong themes emerging from the
service user interviews were the emotional and practical impact
of no longer being able to read easily; the way in which loss of
sight can affect relationships, particularly those between
parents and children; the way in which bereavement affects
people’s ability to cope with visual impairment, adding to their
feelings of loss; and the additional burden that physical ill-health
brings, leading in some cases leading people to a new need for
emotional support.
b) Flexibility – The flexible approach includes the use of
telephone counselling, following-up service users who do not
arrive for sessions, undertaking home visits, tailoring the
number of sessions offered to the needs of the individual
service user and allowing people to chose the level of support
they wanted to engage with, from a lower level (emotional
support) to higher level (counselling). Evidence from the service
user data shows that this flexibility has been highly important,
particularly in drawing people into the service who might not
otherwise have sought counselling but who have gained
significant benefit from it.
c) Humanistic model of counselling - Service users valued being
able to talk to an impartial, non-judgemental listener and indeed
valued the counselling relationship itself. Clearly the humanistic
model of counselling adopted by the ESaC counsellors, which
emphasises the capacity of the individual for personal growth is
an effective and appropriate approach for the services.
In summary
The evaluation has demonstrated that the ESaC services are
serving a client group that clearly represents a clinical population.
ESaC services are both highly valued and are having a significant
impact on those who use them. By the end of their course of
counselling users of the services exhibit a significant reduction in
their level of psychological distress to the extent that they can be
said to have recovered. This change is statistically significant,
which means that it can be confidently claimed that if the services
were to be extended and offered to a similar client group similar
levels of improvement would be shown. Qualitative findings from
the evaluation reinforce the quantitative findings, indicating some
of the ways in which service users have received benefit from the
ESaC services and which may help to explain the levels of clinical
improvement. Further research to examine the case for a causal
link between the ESaC intervention and the significant reduction in
psychological distress is recommended.
The interviews with service providers show that emotional support
is part of all low vision work, although a distinction needs to be
drawn between the emotional support routinely provided by low
vision workers and the specialised emotional support and
counselling provided by the ESaC counsellors. The ESaC services
are clearly seen as a vital addition to the low vision services,
enabling people to make better use of other elements of the LVS,
particularly rehabilitation activities such as learning to use a white
cane. The potential for more integrated systemic work is clear and
further work is required to develop referral routes from GPs and
hospital eye clinics.
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