‘Project Cariad’ evaluation report

Vikki Butler April 2016

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CONTENTS Acknowledgements 3 Executive summary 3 Section 1: Background context to the evaluation 4 Section 2: Assessing Outcome 1 ‘Carers have increased confidence and skills 6 that will help them both carry out their caring roles safely and enable them to take time off themselves as individuals’ Section 3: Assessing Outcome 2 ‘Carers have reduced stress levels leading to 13 better family relationships’ Section 4: Assessing Outcome 3 ‘Carers feel less isolated because they interact 19 with their peers and play a fuller part in their communities’ Section 5: Sustainable outcomes from Project Cariad 24 Section 6: Identifying additional project outcomes and good practice 29 Section 7: final conclusions and recommendations 33

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ACKNOWLEDGEMENTS C.A.R.P. Collaborations would like to thank the Swansea Carers Centre for the positive partnership working that was needed to complete this evaluation. We wish to thank the professionals in partner agencies of Swansea Carers Centre who took time to be interviewed and willingly shared their experiences and opinions in order for a full evaluation to be undertaken. Lastly, this work could not have been completed without the support and input of carers and former carers who have participated within Project Cariad. We are very grateful to participants for honestly sharing their personal experiences and opinions and freely giving their time. C.A.R.P. Collaborations research and evaluation team: D Murphy: Project management, fieldwork coordination, qualitative data fieldwork and analysis Vikki Butler: Secondary data analysis, data compilation, report production and editing Isabel Griffin: qualitative data fieldwork EXECUTIVE SUMMARY In 2013 Swansea Carers Centre secured funding for 3 years from The Big Lottery to deliver Project Cariad. Project Cariad created training opportunities for carers and offered holistic therapies with the aim of reducing carers stress levels, increasing their confidence and reducing their social isolation. The project aimed to engage with 870 carers, and by the end of the 3rd year had involved 743 carers in the Swansea area. It significantly over achieved in all targets and expectations for delivering training and therapy sessions; with the delivery of 314 training sessions for 774 carers and 292 holistic therapy sessions. Cariad staff have demonstrated exceptional good practice, implementing consistent high quality work, particularly with regard to participation, partnership working, project planning and reflective practice. Project Cariad has involved 20 volunteers, 55% of whom were carers or former carers. It has had a significant impact upon carers’ aspirations; with some participants continuing to volunteer within and beyond the Swansea Carers Centre, and others entering further education or paid employment. The project has achieved significant personal impacts- participants explained how they had higher confidence, more resilience, better coping mechanisms for managing stress and improved family relationships. To ensure sustainability, the project aimed to set up 6 peer support groups that would develop to be self-sustaining when the funding ceased, but by the end of year 3 it had developed 16 peer support groups. In order to increase capacity and understanding within partner organisations of the issues that carers face, the project aimed to train 160 health and social care staff. However, they surpassed this target, training 495 staff within different sectors and worked with more than 120 organisations. It is evident that the skill and expertise of staff have enabled project Cariad to achieve significant outcomes and enable elements of sustainability. However, further funding will be needed for certain aspects of the project to become embedded and for the development of the project’s successful outcomes. Of particular note is the need for funding to enable attendance at the peer support groups for those on low incomes, to pay for staff time for development of the groups and to cover payment of quality, qualified trainers. In terms of project development funding is needed to further the role of volunteers, facilitate on line peer support and establish practitioner carer support networks.

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SECTION 1: BACKGROUND CONTEXT TO THE CARIAD PROJECT AND ITS EVALUATION About Swansea Carers Centre and Project Cariad Swansea Carers Centre is a specialist voluntary organisation providing support to unpaid carers and former carers across the City & County of Swansea. The Centre offers free information, advice and support to make life easier for carers and the people that they are looking after. The Centre provides opportunities for carers to meet each other, share experiences and work together to get things changed for the benefit of everyone. All the services offered by the Swansea Carers Centre are completely confidential and range from offering benefits and grants advice, legal issues such as Lasting Power of Attorney, advocacy, counselling and support groups. In 2013 the Swansea Carers Centre was awarded money from The Big Lottery to deliver Project Cariad. Over a 3 year period this project has comprised of a number of activities including delivering training programmes, offering holistic therapy sessions, creating volunteer opportunities, developing peer support groups and raising awareness of the challenges carers face within partner organisations. The project activities have aimed to increase the well-being of carers, primarily through meeting 3 outcomes:

1. Carers have increased confidence and skills that will help them both carry out their caring roles safely and enable them to take time off themselves as individuals.

2. Carers have reduced stress levels leading to better family relationships. 3. Carers feel less isolated because they interact with their peers and play a fuller part in their

communities. About the evaluation of Project Cariad Swansea Carers Centre commissioned Community Action in Research and Policy (C.A.R.P.) Collaborations to undertake an evaluation at the end of Project Cariad. Researchers set out to:

1. Evaluate how well the project had met its 3 outcomes and their associated indicators. 2. Identify elements of good practice that have been highlighted by participants or professionals. 3. Assess which aspects of the project could be sustained and how. 4. Offer clear recommendations for continued funding.

To meet these evaluation criteria researchers undertook the following tasks:

Analysis of secondary data from monitoring and evaluation reports produced for The Big Lottery by Cariad staff on a quarterly and annual basis.

Analysis of evaluation forms from training courses and holistic therapy sessions across the three year period.

Facilitation of 3 focus groups with a total of 22 Carers. Of the focus group attendees 59% were caring for adults, 32% caring for children and 50% were caring for more than one person. 36% of the participants identified as having a disability or severe health problem themselves and twenty of the twenty-two carers were women.

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Observations and informal interviews at a Christmas event for service users and volunteers of the centre.

Telephone interviews were conducted with eight professionals who had been involved in Project Cariad in different capacities. Four were trainers who ran some of the courses, two were from other agencies that referred their clients to the courses and two were Swansea Carers Centre staff.

The evaluators compiled and analysed all the information gained from these different methods to create this report. Who did Project Cariad engage with? Project Cariad involved 743 carers from the City and County of Swansea. The table below gives more information about the project participants. From the end of year 1 staff undertook outreach to try and engage more of Swansea’s black and minority ethnic communities within their work and to recruit more male carers.

Identity characteristic Year 1 Year 2 Year 3 Average total

White UK 94% 89% 88% 90%

White non UK 0% 2% 6% 3%

BME communities 6% 9% 6% 7%

female 86% 87% 82% 85%

male 14% 13% 18% 15%

Under 25 2% 2% 4% 3%

25- 64 76% 75% 77% 76%

65 or over 22% 23% 19% 21%

disabled 28% 22% 74% 41%

Non-disabled 72% 78% 26% 59%

heterosexual 98% 98% 87% 94%

Lesbian, gay or bisexual 2% 2% 13% 6%

Welsh speakers 0% 12% 13% 8%

Whilst equalities monitoring is required, it should be noted that some carers did not want to answer these questions and found them invasive. In each year’s monitoring reports the Carers Centre commented that there is a need to include ‘Prefer not to say’ as a category within equalities monitoring that, whilst a necessary part of ethical practice, can skew the statistical information regarding participants’ profiles.

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SECTION 2: ASSESSING OUTCOME 1 ‘CARERS HAVE INCREASED CONFIDENCE AND SKILLS THAT WILL HELP THEM BOTH CARRY OUT THEIR CARING ROLES SAFELY AND ENABLE THEM TO TAKE TIME OFF THEMSELVES AS INDIVIDUALS’ This project outcome comprises of three indicators, which are discussed in turn below. In addition to the project indicators, there is data that highlights the importance of raising confidence, learning new skills and having time off from caring duties, which is detailed after discussion of the indicators. This section concludes with an assessment of whether Project Cariad has met Outcome 1. Assessing Indicator 1: 870 new carers access training/ workshops through Swansea Carers Centre

Total participants receiving training for increasing confidence

Total participants receiving holistic therapies or training for stress reduction

Total number of carers engaged

Target number of carers

Year 1 97 131 170 360

Year 2 203 157 289 360

Year 3 128 243 284 150

Total 428 531 743 870

This table indicates the number of carers that Swansea Carers Centre aimed to recruit to Project Cariad, the total number of carers that participated in each year and how many received training and holistic therapies. Carers could attend more than one training or holistic therapy session which accounts for the figures for total receiving training being higher than the overall number of carers using the project in each year. This indicator was not met since the project engaged 85% of its total target numbers. However, there are four mitigating factors in relation to missing this target that need some discussion: 1. Throughout the project there was effort made to balance supporting new carers who had attended

one training session and wanted to access other training opportunities with continuing outreach to new carers. As stated in the year 2 monitoring report:

‘…carers attend a training, their confidence grows, they meet with other carers and want to attend more than one session’.

For the overall project outcomes to be met, the project had to provide multiple opportunities for carers which reduced the available resources for undertaking outreach to new carers.

2. The work delivered was of high quality and highly valued by participants. Staff successfully balanced

quality with quantity and effectively maintained high standards of work whilst also undertaking outreach to increase engagement.

3. Substantial effort was made throughout the project to recruit new participants. For example, in year 1 leaflets were made and distributed via a trailer in the city centre, information stands in 4 local supermarkets and 2 hospitals. The project advertised on Gumtree and provided leaflets for partner organisations including Social Services teams for use in their carer assessments. Year 2 involved mail

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shots to 3,500 carers who are upon the centre’s information database, information in local newspapers and radio and an improved presence on multiple social media platforms. Year 3 involved increased partnership working with publicity about the project reaching a number of national and local statutory and voluntary services. It is clear that in all project years staff worked hard to try and reach the target of 870 carers involved in the project and each year new approaches were implemented to try and recruit more new carers to the project.

4. Maintaining attendance was a problem for all courses and holistic therapies. The nature of being a

carer means that often emergencies happen, and therefore some participants booked places upon courses but were subsequently unable to attend; often with very little notice. Project Cariad had numerous courses which had to be postponed or cancelled due to non-attendance. This had an impact on the overall number of carers that were recruited and is a reflection of the constraints facing carers in day to day life.

Whilst this indicator was narrowly missed, the Swansea Carers Centre undertook outreach to new carers in all project years, and analysed each year what could be improved upon to reach new carers. This is particularly evident in the number of participants, which significantly grew after year 1. Assessing Indicator 2- Delivery of 135 training sessions The table below details the number of training sessions delivered for each year of the project. Project Cariad aimed to deliver 45 sessions of training per year, a total of 135 for the project, but this target was exceeded, delivering 233% of the target by the start of the evaluation in year 3. Given that the project continued for another 4 months, it is likely that this target was further exceeded.

Total number of sessions delivered Target number of sessions

Year 1 93 45

Year 2 149 45

Year 3 to Dec. 2015 72 45

Total 314 135

The sessions comprised of taster sessions, workshops, multi session courses and events such as the launch of a carers emergency card scheme. It should be noted that the number of places available to carers each year was significant. For example, in year 2, 757 training places were offered to carers over the course of 149 sessions. These figures back up one of the factors effecting the recruitment of carers through showing that carers wanted more than one off sessions, and gained confidence to undertake multiple training opportunities. The training offered covered a spectrum of skills. They included arts such as African drumming and digital photography, practical knowledge such as emergency first aid, assertiveness, stress control and mindfulness, crafts such as basket making and outdoor skills such as Bushcraft. It can be concluded that Project Cariad provided a good breadth of courses and the majority of carers liked the balance between courses and training that were a lot of fun (e.g. Make-up Workshops, Drumming, Singing) and those that taught skills to better cope with their caring role (e.g. Dementia Awareness, Stress Control, Anger Management, Mindfulness, the 3 Principles).

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All the training courses had various scales for measuring the competence and experience of the trainer from the participants’ point of view. With the exception of comments on venue, food and parking, all of the courses were received positively with none receiving a poor response in terms of content or delivery. This suggests that there was consistent high standards maintained and that care had been taken to ensure the courses were directly required by the participants. Assessing indicator 3- 80% of carers completing outcome stars show soft skills improvement Outcome Stars is a method of evaluation that measures 5 key areas for soft skills and emotional well being improvement. It is a relatively complex method which is particularly effective for measuring the impact of long term interventions. However, it is not particularly effective at measuring the impact of one off sessions or short courses. Since the method was not best suited to many of the training and relaxation opportunities available within Project Cariad only 90 carers of a total of 743 participants (12%) completed an outcome stars over the course of the three years. The table below highlights that more than 80% of those participants who completed an outcome star showed an increase in soft skills, but since this is such a small percentage of the total number of people who received training or therapies, it is worth extrapolating further data from other evaluation methods that were used. It should also be noted that the outcome star results show less impact than the qualitative data and other evaluation methods, which suggests that the method may not be best suited to this cohort of participants. The method requested participants to rate themselves against different statements within 5 key areas before attending training and again after attending training. Each statement carries a different score, with 5 being high and 1 being low. If a course has an impact the score before training are lower than the score given after training. The table below details scores received against each statement before and after training from 12% of total participants. Table 3: Outcome star results from 90 participants who attended training courses

Outcome star well being topic and rating level

Before training

After training

No answer

Self-confidence:

5- I have confident in my abilities and self-worth 2 13

4- I am happy with the level of confidence I have in everyday situations

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3- I have some self-confidence and self-worth 51 36

2- I have little confidence or self-worth 18 2

1- I have no self-confidence or feelings of self-worth 5 1

Social networks and community: 3 after

5- I identify myself as part of a community, I am very happy with my friendships

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16

4- I identify myself as part of a community and interact with friends when I need it

17

36

3- I identify myself as part of a community but I am not as involved in social life as I would like to be

53

32

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2- I feel isolated from the community around me and do not have the support of a social network

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1

1- I do not want to be involved in community life or other social networks

1

2

Stress and Anxiety levels:

1 before 3 after

5- I know stress is part of everyday life and I am equipped to deal with it

0 18

4- I know stress is part of everyday life and I can normally deal with it

15 25

3- I know stress is part of everyday life and have some coping mechanisms

40 38

2- I am really stressed and need to know more ways to cope with it

27 5

1- I am constantly stressed and do not know how to cope with it 7 1

Relaxation:

5- I can relax easily 0 9

4- I can usually relax easily 10 32

3- I find it difficult to relax all the time but I can eventually sometimes 49 41

2- I find it really difficult to relax 27 6

1- I can't relax at all, I am always on edge 5 0

Skills and knowledge: (not asked to 27 participants attending stress control courses)

5- I have lots of knowledge in this area 1 8

4- I have good knowledge of this subject 2 25

3- I have some knowledge of this area but would like more

26 28

2- I have a little knowledge of this area 19 1

1- I have no knowledge of this subject 15 1

There is a clear trajectory of improvement in soft skills across all 5 areas of everyday life, and a marked improvement in self-confidence and stress and anxiety levels. However, since outcome stars was not a suitable measurement for the majority of courses other evaluation methods should also be examined in order to present a full picture of the increase in participants’ soft skills. Outcome 2 discusses stress levels, so other methods that detail specific reductions in stress are outlined in the following section. However, the following table details participants’ perspectives on whether they have had slight or significant increases in certain soft skills. This was asked to 41% of all participants who were involved in the project and is therefore a more reliable indicator of increase in soft skills than the outcome stars of 12% of participants. Each category of soft skill has gained 80% or more reported improvements (243 participants or more) which gives additional positive evidence to the limited outcome stars data.

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Table 2: evaluation results from 304 out of 743 participants when asked: ‘As a result of training I feel:’

Not at all

slightly Significantly Reports some improvement (slight or significant)

No answer

Had some ‘me’ time 3 49 220 269 32

More confident 18 105 144 249 37

Less stressed 10 116 138 254 40

Less isolated 17 95 147 243 43

Met new people 1 60 206 266 37

Learnt new skills 5 62 206 268 31

Sense of well being improved

11 93 167 260 33

Despite the methodological problems associated with this indicator, it is possible to surmise that 80% or more of participants who completed evaluation forms showed increased soft skills and therefore this indicator has been met. The importance of increased confidence Whilst there are 3 indicators associated with Outcome 1, the overall focus of the outcome is upon increased confidence and this arose as a crucial issue for carers. All of the participants in the focus groups reported increased confidence and improved self-esteem, and they stressed how important this was to support their resilience and quality of life. The levels of confidence gained varied from carer to carer, but for some it was clear that just attending a course raised self-confidence:

‘Just crossing the threshold was a literally a big step for me’. Carers felt they gained confidence from having training with other carers because they can understand each other’s’ day to day life and face similar challenges. There was broad agreement that doing the courses and training with other Carers was very important, particularly in the beginning of the process.

‘If you come in late and have to leave early, you don’t even have to explain, no one asks any questions, everyone there understands your situation, they sympathise with you, you don’t have to feel embarrassed.’ ‘Just being around others you know understand, understand why you’re crying - and there was a lot of that (all the group nodded here and smiled) you get handed tissues, no one asks, they just know, it lifts your anxiety, your depression’

Professionals also recognised the need for carers to learn alongside each other:

‘[carers are] Happier! For once they were doing something that was just for them! And it’s a safe place, they are with other carers, people who understand without being told, just how hard it can be. It’s respite.’

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It is clear that increased confidence came from attending courses as well as having an understanding peer group within courses. Carers explained how their lack of confidence was linked to the stigma of being a carer and how their role is not valued within general society. Learning to value their role and recognise its importance was a significant factor in their increased confidence.

‘It gives you the strength to overcome the stigma. It teaches you self esteem and makes you appreciate what you’ve done and that you are of value.’ ‘You felt validated on the courses, they changed your mind set on how you saw yourself, you saw that you were worth something and what you were doing was important work.’ ‘Finally being recognized as a person as well as a carer, I feel approved of and valued, not ‘just a carer’ but a person too, like any other person’.

Carers also gained confidence through learning new skills and activities which they would not normally have considered. An example two carers gave was the African drumming workshops which culminated in a public performance:

‘It’s the first time in my life I have ever done anything like this and it has made a massive difference to my confidence.’ ‘I could hardly believe [it], me, ME, drumming, at the Lord Mayor’s mansion house!’

Lastly, more than half the carers in focus groups cited fun and laughter as a key ingredient for increasing confidence and developing self esteem:

‘I feel like when the caring started the fun in my life stopped, now on these courses, I was having fun again.’ ‘I couldn’t remember the last time I laughed, it was such a good feeling, you come away feeling great, feeling good about yourself.’ ‘Just having a laugh, like an ordinary person would, I’d say to myself - right, now I can cope for another week’

The importance of being able to take time off Whilst not reflected within the 3 indicators for this outcome, a part of Outcome 1 is enabling carers to have time off as individuals for themselves and this emerged as a strong theme within focus groups, as well as reported upon within the assessment of improvement of soft skills. The importance of having time off is best exemplified within the following quote:

‘The courses made me think about myself, not being a carer, just myself, something I had never done before, they taught me to be kind to myself, make some time for myself, I’ve gone on to a Photography course, I find I am coping better generally.’

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Three main elements of having time off emerged from the focus groups. The first was the feelings of guilt and not deserving time to themselves, which were challenges addressed directly by the courses on The Three Principles, Mindfulness and Caring from Within. Carers explained:

‘I started off feeling guilty and selfish at first – and then I was running through the door!’ ‘Everything has always been for him and the family. When I started doing these courses it felt really strange to be doing something for me.’

The second element was that, because the courses were structured events with a start and finish time and that they had made a commitment to attending for the length of the courses, it made attending easier to justify taking the time off for themselves.

‘You can get lost in the caring role, but the structure makes it easier to take time out, you don’t feel so guilty, you have to be at a certain place for a certain time.’ ‘I realised that I made time for the courses, over 6-weeks, 8-weeks, now I say to myself if I could do it for them, I can do it for other things too.’ ‘You allow yourself time off because the course is on. You can say ‘I’m off, I’ve got to go to the course”. It’s very important and means a lot to me.’

Lastly, more than 45% of the participants spoke about the high cost of respite and that because this was being provided with the free courses it made a big difference as to whether they could take part or not.

‘Caring costs are really high so I couldn’t do this without the respite never mind the cost of a course.’

Summary assessment of meeting Outcome 1 There are 3 indicators associated with Outcome 1. The first indicator was partially met at 84%, the second indicator was exceeded by 133% above target and the third indicator, whilst hard to fully quantify due to methodological issues, was fully met. It is also clear that carers sought multiple opportunities for training and that the project delivered a high volume of quality, diverse training opportunities:

‘The courses gave me the confidence to go on to do other courses, they gave me an appetite for learning, now I am doing a creative writing course.’

The training opportunities had numerous positive impacts upon carers who described gaining confidence, learning new skills and understanding the importance for having time away from caring responsibilities for personal time. Carers felt they had regained their identity and better able to cope with their caring role. Given all of these factors together, it is possible to conclude that Outcome 1 had been achieved, and in some aspects exceeded targets and expectations.

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SECTION 3: ASSESSING OUTCOME 2 ‘CARERS HAVE REDUCED STRESS LEVELS LEADING TO BETTER FAMILY RELATIONSHIPS’ Project Cariad offered two different opportunities for carers to learn about reducing stress levels. Firstly, some of the training courses were specifically about stress reduction or managing anxiety techniques. The courses that were directly related to mental well being included learning coping techniques for dealing with stressful circumstances, such as mindfulness and assertiveness; and learning relaxation techniques- from yoga to supporting good sleep patterns. The second opportunity for stress reduction offered via Project Cariad was holistic therapies. In total, 8 different holistic therapies were offered– Indian head massage, Reiki, Reflexology, Swedish massage, hot stones massage, craniosacral massage, therapeutic massage and aromatherapy. They were delivered by qualified practitioners who volunteered their time and were available on a monthly basis in 3 different venues. Carers could access more than 1 therapy session, but priority was given to those who had not had any previous sessions. In assessing Outcome 2, evaluators have examined data relating to both the training courses which were directly about stress reduction and holistic therapies. Assessing indicator 1- 135 carers access stress awareness, stress control or relaxation activities The table below details the number of carers who accessed stress reduction and relaxation activities for each year and the total for the project. The table details the number of holistic sessions that were delivered each year, thereby showing that many carers accessed more than one session. The table also highlights that carers attended holistic therapies as well as training courses. This target has been significantly exceeded, reaching 393% of the project target.

Number of carers having holistic therapies

Total number of carers (training and therapies)

Number of holistic therapy sessions offered

Year 1 81 131 133

Year 2 93 157 130

Year 3 118 243 124

Total 292 531 387

It should be noted that this indicator has been exceeded even though there were problems with securing attendance. Some trainers reported that as carers’ self-awareness increased, they sometimes decided that they were not ready for change. Particular attendance difficulties were apparent within the mindfulness and stress control courses. Each year more carers accessed holistic therapies and stress reduction activities which is a result of good communication to carers from Project Cariad staff and an ability to retain and increase the number of volunteer therapists. Assessing indicator 2- 75% of carers who attend stress awareness or control sessions report reduced stress levels (project aim is 653 carers out of a total of 870 report reduced stress levels) This indicator is problematic to properly assess, due to different evaluation methods being used for different courses and the fact that only a percentage of participants completed evaluation forms for

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training and holistic therapies. The data is available for 227 carers who accessed holistic therapies out of a total of 278. Data is available from 306 carers regarding the reduction of stress levels through attending training courses, but these are not just the courses that were specifically focused upon stress reduction. However, some conclusions can be drawn from the available data which is examined firstly in relation to holistic therapies and then in relation to the training courses before conclusions are drawn. 82% of participants who had a holistic therapy completed evaluation forms. They were asked to rate their stress and anxiety levels before and after therapy as detailed in the table below. Only 1% of participants reported no change in their stress levels with an overwhelming 81% of total number of participants who had therapies reporting a decrease in their level of stress. This equates to 99% of all participants who completed evaluation forms for holistic therapies reporting decreased stress levels.

rating Before therapy After therapy

Very stressed 56 1

Quite stressed 76 2

Stressed but coping 74 10

relaxed 5 111

Feeling great 0 87

No completion of rating 16 16

73% of the total number of participants who accessed holistic therapies (or 89% of participants who completed evaluation forms from holistic therapies) reported improved well being when asked ‘Do you think this holistic therapy helped your sense of well being as a carer?’

Yes: 202 No: 3 Not sure: 12 Not answered: 10

A different evaluation question posed to participants of holistic therapies regarding reduced stress levels reported less of an impact, as detailed below, with less than 75% of total participants who had therapies reporting reduced stress. As a result of therapy I feel:

Not at all

slightly significantly Reporting some change (slight or significant)

No answer

Less stressed

15 32 135 167 (60% of total participants who had therapy or 74% of those who completed evaluations)

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Recharged and rested

14 33 145 178 (64% of total participants who had therapy or 78% of those who completed evaluations)

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Had some ‘me’ time

12 12 165 177 (64% of total participants who had therapy or 78% of those who had completed evaluations)

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With regards to the training courses, 306 participants of a total of 693 participants completed evaluation forms regarding stress reduction, 44% of the total participants who attended training courses. This section therefore reports on the numbers of participants who completed evaluations of

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training courses. 1% of participants who completed evaluation forms from training reported feeling more stress after training. Generally these participants had attended longer courses and they were affected by life events outside of the training course, and therefore their increased stress did not appear to stem from the learning they were undertaking. 13% of participants who completed evaluation forms from training courses reported no change in their stress levels whilst 86% of participants who completed evaluation forms reported a reduction in their stress levels, as detailed in the table below:

rating Before training 306 total After training 306 total

Very stressed 58 0

Quite stressed 93 20

Stressed but coping 121 84

relaxed 15 151

Feeling great 8 41

No completion of rating 11 10

Whilst not fully conclusive, the quantitative data suggests that 75% or more of participants reported a reduction in stress levels, particularly if the percentage of participants who completed evaluations is examined. There is a clear reduction of stress levels shown within the available data from training courses and therapies and this can be assumed to be replicated at similar percentage levels for those participants who did not complete evaluation forms. Additionally, the qualitative data clearly showed a reduction in stress levels. Unanimously participants in the focus groups agreed that their stress levels were reduced since taking the courses and experiencing the therapies. Participants were particularly appreciative of the training courses that raised awareness of how feeling stressed was a natural consequence of caring and that taught mechanisms and skills to reduce stress, as the following explanation exemplifies:

‘You can only handle stress for so long, you can become ill yourself, you can burn out, you feel trapped, a non-person. Stress management helps you to spot the signs early on so you can do something, get some help before you crack, take some action. Go to your GP, tell the Carer’s Centre.’

The courses cited as being most valuable in teaching skills for reducing stress were mindfulness and meditation, inside out – the 3 Principles, stress control, assertiveness, looking after me and caring from the inside out. Carers explained how they had taken the content of those courses and implemented them in their lives to create a lasting impact of reduced stress levels:

‘We’ve been given mechanisms to help us relax during and after stressful situations.’ ‘I don’t get on that train any more – learnt that from ‘caring from the inside out’. I listen to other people and I think ‘she’s on the train to London and she doesn’t know it. I’m staying on the platform.’ ‘You can lose yourself in the caring role, and everything becomes stressful, I’ve learned to manage my stress better, so I’ve become a better Carer.’

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In focus groups it was discussed that the simple act of coming on the courses, irrespective of which course, had the effect of reducing their stress levels. Many of the Carers also spoke about feeling cared for by others while on the courses as being very beneficial to their sense of well-being:

‘You have to be the pillar, the responsible one – you come here and someone else is responsible. You can just be – you can breathe.’ ‘Having a good laugh together (when asked, all agreed on its importance), without these courses I would have had another breakdown.’

The training and therapies had the most impact upon those carers who were feeling particularly stressed. Of the carers who took part in the focus groups; three had felt of the edge of a nervous breakdown, two others spoke of ‘not being able to go on’ and one had felt suicidal. The Cariad courses were described as ‘the light at the end of the tunnel’. Similarly, the quantitative data from evaluation forms suggests that the biggest impact of both training and holistic therapies was upon those participants who reported feeling quite or very stressed prior to their participation. These participants tended to move up the ratings more than those who reported that they were coping or relaxed at the start of training. The impact of therapy or training did not appear to change with particular courses or therapies, but by the self-reported stress levels of the participant prior to their participation. This could have an implication for targeting courses to carers who feel particularly stressed and providing other, or different, activities for those who feel they are coping with their caring role. Assessing indicator 3- The creation of 6 carers peer support groups The table below details all of the peer support groups that Project Cariad has helped to develop and support. This indicator has been exceeded by more than 267%, with a total of 16 peer support groups having been developed. There was clear progression within the support groups developed, with some carers support groups from year 1 no longer needing much subsequent support from Cariad.

Year 1 Year 2 Year 3

Carers Book Club X X X

Cwmbrwla Mental Health Carers Group X X X

Mental Health Carers Support Group X X X

Parent Carers Support Group (info given only) X X X

Gorseinon Carers group X

Carers Planning Group X X X

Carers Wales Swansea branch X X

Carers Mindfulness Practice Group X X

Self-help for Stress Control Group X

Carers Rights Planning Group X X

Aikido Weekly Group/Class X

Open ‘Armonies Choir X

Women of Principles Group X

Carers beading group X

Carers knitting group X

Gower carers group X

Total 8 9 12

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Other support groups, such as the Book Club, developed from year 1, and by year 3 was twinned with a carers Book Club in Cork, Republic of Ireland, and they had regular Skype and other social media contact. The stress reducing training courses had an impact upon carers who decided to develop their own practice groups of certain techniques, noticeably Aikido and mindfulness. This suggests that the project worked holistically, supporting peer groups to develop through the training courses rather than just through staff suggestion. The Women of Principles group grew out of a course that delivered stress control within three principles. The carers from this training course meet together and do different activities for friendship such as blackberry picking, sharing meals and creative writing. In the previous section, carers spoke about the importance of peer support for improving confidence. Through supporting the development of peer support groups Project Cariad was also directly supporting growth in confidence. Better Family Relationships Whilst not reflected within the indicators for this outcome, Outcome 2 also refers to improved family relationships due to reduced stress levels. There was little evidence in the secondary data that discussed improved family relationships, but carers spoke in depth during focus groups about the improved quality of their family relationships as a direct consequence of the training and therapies they had experienced. Firstly family relationships were improved because participants had taught the people they cared for the techniques that they themselves had learnt. This had the repercussions of enabling other family members to also have reduced stress levels which aided calmer day to day living experience:

‘I’ve passed those Mindfulness child-friendly techniques on to my daughter and it is really helping both of us.’ ‘I’ve taught the mindfulness skills to my son (he has autism and ADHD), the ‘3-minute breathing’ when he becomes anxious and agitated.’ ‘I taught my son the techniques I learned myself to stay calm, they have helped both of us, he can so easily explode.’

Secondly, some of the courses enabled an improved understanding of conditions people being cared for were living with. Of particular value were courses about autism and dementia. Through gaining an understanding of particular conditions carers felt better able to care for relatives and more able to cope with their own stress levels.

‘Wish I’d had the Dementia training years ago, it has made such a difference to how I am with my Mum. And I’ve passed the information on to my Friend, whose Mum is in the early stages, just learning that music helps the person, things like that ...’ ‘The Dementia Awareness training made me better able to understand my Mum’s condition, I get less stressed by her, so I was better able to deal with the situation.’

Lastly, there was agreement that when carers are less stressed themselves home life improved and family relationships became more harmonious. Some carers explained how their approach had changed:

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‘My attitude has changed completely and because I’ve changed they’ve (the family) changed – I’m more objective in dealing with their problems.’ ‘When you’re a Carer, the fun stops, now I’m having fun again for the first time in years and this has helped my Dad, we have something to talk about.’ ‘The knock on effect is not just benefitting the Carers but our families too.’ ‘If it hadn’t have been for Cariad I know I would have been divorced by now, I was so stressed. My home is a happy home now – my boys are happy and so are me and my husband.’

Other participants explained how they put into practice stress reduction techniques in order to maintain reduced stress levels:

‘I use the Mindfulness techniques every single day, I can’t imagine where I would be now without them.’

Summary assessment of meeting Outcome 2 There are three associated indicators to 0utcome 2. The first regarding the number of carers accessing stress reduction and relaxation activities has been significantly exceeded by 293%. The second, regarding the number of carers who reported reduced stress levels, is problematic to fully quantify due to methodological problems, but through deduction can be argued to have been met and the third, regarding the number of peer support groups has been exceeded by more than 200%. Additionally, there has been a clear sustained impact upon carers reduced stress levels and clear positive outcomes with regards to improved family life and positive family relationships. It can be concluded that Outcome 2 has not just been met, but has been significantly exceeded through both the volume of work delivered by Project Cariad, the quality of the training and therapies offered and the impact the project has had upon participants’ lives.

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SECTION 4: ASSESSING OUTCOME 3 ‘CARERS FEEL LESS ISOLATED BECAUSE THEY INTERACT WITH THEIR PEERS AND PLAY A FULLER PART IN THEIR COMMUNITIES’ Assessing indicator 1- 870 carers attend group training or workshops The table below details the number of carers who participated in training and group workshops. This indicator has been partially met with 606 carers receiving training; i.e. 70% of the target number of 870 carers. However, it should be noted that the figure rose significantly between year 1 and 2, suggesting that staff in project Cariad undertook work to increase the number of carers engaged in group sessions. Additionally, when the number of training places offered is taken into account, it is possible to deduce that a high number of training places were available and that carers undertook multiple courses. This is another indication of the tension within the project of needing to engage new carers whilst continuing to support existing carers. There is also a logical premise to be made; that if carers are to experience reduced social isolation they will want to attend more than one training course.

No carers who had training for stress

No carers who had training for confidence

No of training/ workshop places taken up by carers

No of individual carers who received training

Target no of individual carers receiving training

Year 1 77 97 174 127 360

Year 2 203 157 360 281 360

Year 3 113 127 240 198 150

Total 393 381 774 606 870

These figures do not include the number of carers who accessed online training. The original proposal to The Big Lottery for Project Cariad stated that on line training would be used alongside group and face to face training. Various online courses were delivered and whilst they had an audience, it was not possible to track their success or the impact that they had upon carers. The qualitative data was consistent that there was little interest in online courses and carers clearly preferred to meeting up with other carers. The online courses that were offered included an online video or DVD for home use of an 8 week Qigong for Stress Relief course, promotion of Marie Curie’s online end of life resources, a programme of self-guided online learning with tutor support with the Open University called Pathways to Success and the promotion of an online course, Caring for People with Psychosis and Schizophrenia. Even where these online courses linked to face to face courses that participants had attended, interest appeared to be low. Carers clearly stated that they wanted the time out of their homes and benefitted from face to face work with other carers. This is of importance to this outcome, since it appears online training does not address the isolation that carers feel or meet the need for carers to socialise and access different environments.

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Assessing indicator 2- 30 volunteers work across all project activities, 15% of whom are carers or former carers (i.e. 4- 5 people) By the middle of year 3 (when the evaluation data was being collected) Project Cariad had supported 20 volunteers, 55% of whom were carers or former carers. Volunteer roles included delivering holistic therapies, staffing the Carers Centre reception, administration, undertaking outreach and facilitating training. Whilst this indicator was a third below the target figure of 30 volunteers 40% of the volunteers worked for more than one year, reducing the turn-over of volunteers and thereby reducing the scope for new volunteers to become involved. Additionally, a far higher percentage of volunteers had been, or were currently, carers, which necessitated additional support from staff thereby reducing staff time to recruit new volunteers. It was found that carers who had engaged frequently with the centre wanted to give something back, had empathy and understanding for other carers, and acted as positive role models for life after caring. Whilst this indicator focuses upon volunteering within Project Cariad, it should be noted that some participants went on to volunteer in other parts of the Swansea Carers Centre and in external organisations, representing a large step forward. Examples of volunteering in partner organisations include mentoring within an environmental project, volunteering within a mental health group, and using newly learnt digital skills within a digital inclusion project for people with disabilities. External volunteering is not included within this indicator, but are a direct result of work undertaken by Project Cariad. Assessing indicator 3- 160 social care or health staff attend awareness training sessions 495 health and social care staff have attended awareness training sessions over the course of the project. A variety of staff teams attended these awareness raising sessions, with participants including City and County of Swansea Adult Social Services Social Workers, staff from Abertawe Bro Morgannwg University Health Board Swansea Locality; City and County of Swansea Human Resources Team; Social Care Planning Officers, Community Mental Health workers; Cwmbwrla Day Centre staff; Community Connectors; Carers Wales Swansea Branch; Protected Learning Time Session Network members (GPs and surgery staff), Job Centre staff, statutory sector organisations such as Land Registry and DVLA who are large employers in the Swansea region and 25 voluntary sector organisations. The target number of participants has been exceeded by 291%, a significant achievement. Additional focus should also be placed upon the level of outreach that Project Cariad undertook to enable local organisations from a range of sectors to network regarding the challenges that carers face. The initial intention was to reach health and social care staff but by including employers, voluntary organisations and community services in addition to health and social care, Project Cariad appears to have enabled a good local network of organisations supportive to carers to evolve enabling holistic interventions for carers within the Swansea area. Carers feel less isolated through interacting with their peers Whilst not associated with an indicator, this outcome is focused upon reducing isolation. The participants from the training courses felt that the courses had enabled a bonding between them as a group of carers in the Swansea area which lasted beyond the length of the courses and beyond

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involvement with the Swansea Carers Centre. Continuing distance and face to face contact via social media, phone and initially via the peer support groups lead to lasting friendships that were a hugely important outcome to many project participants. One carer explained how the courses helped to create friendships:

‘Doing the ‘Caring from the Inside Out’ course led to a group of us having a go at some other things – at the Glynn Vivian lantern making, Digital Streams photography and bead-making on the High Street.’ ‘I’m going to Zumba twice a week now, good for me physically and mentally, isolation leads to depression and poor health and then the family suffers because they depend on you, you are the main person, you can’t be ill, you can’t break-down, if you did what would happen then? And I even chat to the other women at Zumba! (laughs here)’

Even those carers who had not continued to take part in any of the peer networks reported that just knowing other Carers in their area had helped them feel less isolated:

‘I often see X at the Hospital, it’s so nice to see a friendly face, have someone to have a chat with, we remind each other of what we learned on the courses and the laughs we had’ ‘Sometimes we just text, or chat on Facebook, maybe meet for a coffee, chat on the phone. It offers me a social life that I just wouldn’t have otherwise.’

It was clear from the qualitative data that a significant number of carers would not have taken part in any social activities outside the home if these courses had not been offered by Project Cariad. Many carers simply cannot access training that is available in communities or adult continuing education because they feel unable to take the time out, such courses do not support or cater for carers needs, some carers have low confidence and do not feel such courses are ‘for them’ and they do not have the financial situation to be able to pay fees or respite care. Carers explained how important it was to reduce isolation by meeting other carers:

‘I spent so much time on my own and had become very isolated, so It’s been a wonderful opportunity to try new things and meet new people with similar and different problems’ ‘I tried things I never would have done otherwise – you get bogged down at home and don’t go out without a reason and talking to others who were in the same situation as me made me feel less alone.’ ‘I had become very shut away and I know I wouldn’t have gone out without the courses.’ ‘The courses change you, the give you hope. You see each person, how strong they are and then you see it in yourself, the others lift you.’ ‘The assertiveness course and meeting with other women really helps you… it has a ripple effect, we share information and ideas on how to cope.’

Professionals also commented upon how friendships grew and the nature of peer support between carers:

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‘Friendships, sometimes unlikely ones, [grow] like the one between a very young carer and a grand-mother carer.’ ‘[there are] Lots of unexpected outcomes - so many - the ability to BE with other Carers, in such a supportive environment. I noticed a very low dropout rate. Other surprises are they have set up support groups themselves, Mindfulness, a Book Club – all grown out of Cariad.’

Playing a fuller part in the community One of the objectives for undertaking activities aiming to reduce the isolation felt by carers was to enable them to play a fuller part within the community. Whilst there is not an indicator within this outcome that relates to being a part of community life, it is an issue that carers spoke about in relation to volunteering, further learning opportunities and paid employment. Carer uptake of volunteering Some carers spoke about how they had increased confidence through involvement with Cariad that had led them to seek other volunteering opportunities within Swansea’s communities. Some carers became volunteers within the Swansea Carers Centre but others wanted to explore opportunities external to their caring role:

‘I’m now a volunteer mentor at the Down To Earth Project I definitely wouldn’t have been doing that without the courses, my confidence was at an all-time low, I was at rock bottom.’ ‘I used to avoid the other mums in the playground, I never did anything, went anywhere, I had nothing to talk about. Now I have, I’ve done so many different things, I’m now a part of the community – I’m really involved in the school and with the mums.’

Carer uptake of other learning opportunities Not all carers are able to undertake further learning opportunities due to time and financial constraints. However, some carers enjoyed the training offered within Cariad and wanted to further their learning in both informal and formal learning settings:

‘The Mindfulness made me think about myself, I did the photography course and now I have gone back to college and I’m studying for an MA in photography and really enjoying it.’ ‘The courses gave me the confidence to go on and do other things, I am doing a creative writing course at the University.’

Carer uptake of paid employment Many carers are unable to undertake paid employment due to their caring role and associated responsibilities. However, a few carers felt that they could take some paid employment and one carer explained how Project Cariad enabled her to keep confidence and skills until such time that she was in a position to consider paid employment again.

‘The courses kept me employable, kept up my skills and I learnt new ones, I am now a support worker in the community.’

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Summary assessment of meeting Outcome 3 There were 3 associated indicators for Outcome 3, which aimed to reduce social isolation and enable carers to play a fuller part in the community. The first indicator regarding carers accessing training was 70% met, the second indicator regarding volunteer numbers was 66% met and the third indicator regarding the number of professionals and practitioners attending awareness sessions was exceeded by 191%. If the outcome is assessed only with reference to these indicators it can be judged to be partially met. However, the numbers themselves do not highlight the quality of the work undertaken, particularly in relation to cross sector outreach and networking through provision of awareness sessions. Additionally, the indicator numbers do not expand upon other aspects of reduced isolation such as attending multiple training courses, making lasting friendships and carer involvement within the wider community; which were challenges highlighted by carers within the evaluation and of great importance to them within day to day life and their positive emotional well being. The evaluators would therefore caution that although this outcome has been partially met in terms of quantitative indicators, it has been fully met within the experience of the participants and within the quality of the work delivered.

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SECTION 5: SUSTAINABLE OUTCOMES FROM PROJECT CARIAD One of the objectives of the evaluation of Project Cariad was to comment upon the sustainability of the project and offer recommendations for project continuation. Section 7 of this report contains evaluator conclusions and recommendations, but this section contains insights and comment regarding sustainability and documents the work that the Swansea Carers Centre has undertaken to try and ensure that the project activities do not all dissipate once the funding has ended. There are 4 aspects of sustainable working that require further comment- the function of the peer support groups, an explanation of what the project has undertaken to build sustainability into the funded activities, a discussion of cost benefit analysis and sustaining the personal impact of positive improvements to well being that participants have experienced. This section discusses each of these in turn. The function of the peer support groups A number of training courses have led to the formation of peer support groups and therefore Project Cariad has acted as a catalyst for carers to come together. Whilst the number of peer support groups is mentioned within the third indicator of project Outcome 2; Project Cariad has enabled many of the peer support groups to become self-sustaining. For example, harmony singing has continued to meet as a community choir, with no support from the Carers’ Centre. At the time of evaluation the choir included non-carers as well as carers and each participant paid a contribution to ensure the choir leader’s time was paid for. The Mindfulness group has continue to meet with the Carer’s Centre providing a free space until the end of March 2016; and, at the time of evaluation, the group were actively looking for an affordable venue so they could continue to meet. Lastly, the peer support group ‘Women of Principle’ which grew from the ‘3 Principles’ training course met independently on a regular basis to practice the techniques they had learned. Additionally, some peer support groups, for example the Book Club, had not just become sustainably functioning but also expanded the activities that they undertook. The Book Club started as a localised activity but became twinned with a club in The Republic of Ireland with regular social media contact between members. However, professionals were mixed in their opinions about the nature of self-sustaining activities. Some of the professionals pointed out that some courses were not able to be self-sustaining because they required specific resources or teaching, for example digital story telling. Some felt that carers would not get the tuition needed if a trainer was not paid and pointed out that if carers pay for things themselves some carers would be excluded because they would not have the money or free time to be able to join in activities. There was a polarisation of opinions regarding carers’ ability to sustain groups themselves. On the one hand, some professionals felt that carers have vulnerabilities that prevent them from managing certain types of self-sustaining groups:

‘Skills could be shared, but only to some degree.’ ‘Not really feasible for stress or mental health – [there’s] too many issues.’

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‘[I] have encouraged peer-support network, but it can be difficult as most have their own problems.’

Other professionals highlighted the importance of peer support for enabling resilience and raised confidence:

‘It is already happening [peer support networks]. A strong sense of kinship has emerged, it has become a Family, it’s a different way of getting to know people, you are sharing something unique to the group.’ ‘I think it’s the forming of communities, not just networking, it’s more about peer support.’ ‘Sharing knowledge has a knock on effect, to discover someone has the same problem as you. The courses and therapies have opened up a whole world of support.’

Whilst certain courses may require specific resources and mental well being is a factor in carers’ ability to facilitate self-sustaining groups, it was clear that carers gained huge benefit from peer support and it was one of the aspects of Project Cariad that carers themselves highlighted as of most importance. It was therefore highly effective of the Swansea Carers Centre staff to have facilitated peer support groups and planned their self sustainability wherever possible. Project Cariad staff supported the creation of the self-sustaining peer support groups through consultation with carers interested in being involved in the groups, through offering start-up funding to help groups become established and offering free premises. To enable groups to continue they have negotiated free use of the local Tesco’ community space and the local Glyn Vivian Art Gallery once it is fully refurbished by the summer of 2016. Project planning and effective delivery to secure sustainability From information within the annual monitoring reports it is clear that Project Cariad was strategic in planning sustainability from year 1. The project started networking and joint working with local training providers, such as the Local Health Board, charities and IT providers who would be in a position to offer free training for carers within the first 6 months and the popularity of certain courses, such as stress control and emergency first aid led to them being routinely included within quarterly training programmes. Additionally, staff have undertaken extensive effective partnership working to pool resources, information and strategy with other supportive local organisations. This approach is discussed further within the following section regarding good practice. However, these partnerships with organisations such as the Expert Patient Programme within the ABMU Health Board, Marie Curie and Carers Wales have enable free workshops and information sharing for carers. At the end of the project, partnership working will continue and carers will continue to benefit from the expertise of a range of organisations. Lastly, staff have also sustained the holistic therapies through the effective use and support of volunteers, although sourcing venues that can donate the use of their space is still problematic at the time of writing of writing this report. Cost benefit implications of Project Cariad There have not been the resources available to undertake a cost benefit analysis of Project Cariad. However, the evaluation did gather qualitative data from carers and professionals regarding the support

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that has been available through Cariad, and explored what the pattern of other service use might have been if Cariad had not been funded. Professionals unanimously felt that without the courses and training provided by Project Cariad, many of the carers and their families would have had to access additional support services, particularly GP surgeries, hospitals, community mental health services and social services. It should be noted that professionals felt it would be carers and their families who would have needed these supported services and therefore Cariad has been effective in strengthening carers resilience and this has had a knock on effect on supporting families too.

‘Most Carers are highly-stressed, at least 1/2 are accessing mental health services, so many could have had mental break-downs and this would have had huge implications for their families and those they were caring for. Additional support for those they were caring for would have to have been supplied by the Home Care Team, Social Services could have been involved, an additional strain on local Council resources.’ ‘Stress takes not only a mental and emotional toll on a person but a physical one also. Some of the Carers would have had to access Social Services, their GP or the Mental Health team. Carers feel set apart, isolated, they feel they have nothing to talk about to other people, feel other people wouldn’t understand. So a GP will refer to Social Services or to the Hospital, they are often referred to the Carers’ Centre.’

Carers also reflected upon how much the courses and therapies had contributed to their well-being and resilience. Some participants spoke about feeling they had been given a life line through their involvement with Cariad activities and many spoke about how Cariad had prevented them from going over an edge. Whilst these accounts and opinions are not robust in the way that an economic cost benefit analysis is, they should be taken seriously and consideration should be given to sustained service delivery and how this voluntary sector project has reduced use of a number of other statutory services. Sustaining the individual impact of increased confidence and skills and lowered stress and isolation The consensus within the evaluation forms from the training and therapies was that there was significant positive impact upon participants. Regardless of the course in question, almost unanimously participants described increases in confidence, new skills, making friends, feeling less stressed and less isolated; all of which have been discussed in sections 2, 3 and 4. However, participants also described feeling positive well being and positive self-reflection, suggesting a move towards greater positive self-awareness:

‘It made me feel happier. I forgot about my problems for the entire time. It was lovely to laugh and enjoy learning something new at the same time. Fabulous tutor. Can’t fault it – a hugely enjoyable experience.’ ‘I now feel I have been given permission to be the person I want to be, instead of always being the person others expect of me. Learned lots of techniques which I will practice in everyday life.’

Whilst it is difficult to state with certainty whether a course has a lasting impact, data from focus groups undertaken at the end of the project suggested that participants felt a number of positive impacts, and that these had lasted for longer than the duration of a training course. From the creation of friendships, self-sustaining peer group activities to individualised positive personal reflection and well being,

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participants clearly felt significant changes and improvements to their emotional well being. One person’s story acts as a case study that best exemplifies these sustained personal changes:

“Carly is in her late 60‘s. Her grandson died in a swimming pool accident when he was 5 years old, his Brother, John was 2 at the time. The boys’ mother, her daughter, developed cancer and died 5 years later when John was 7. She has been caring for him 3 days a week since. He is now 20 years old. She feels that for years she suppressed her grief, and only allowed it to surface when John became an adult. ‘It felt like a knife in my heart was being twisted and twisted. I used to go the GP every day, but I couldn’t speak, I had to write it down on paper. I didn’t want to live. One day as I about to cross the road to the surgery a bus came along, I wanted to throw myself under it, but I didn’t. That was the day my GP referred me to the Carer’s Centre.......If it wasn’t for these courses, I really don’t think I would be here’. Another Carer, Anthony, chipped in: ‘of all the people I’ve met on these courses you are the person I see the most change in, you never used to speak, now you chat and even laugh!’”

Professionals also described the personal impacts that the training opportunities had had upon individuals:

‘One young parent-carer got a teaching assistant qualification and has gone on to become a Teaching Assistant.’ ‘Another Parent … was so introverted, it was a big deal for her to just walk through the door. She started on the Anger Management course, then did Mindfulness and then she joined the Choir - just to see her standing there signing, I never thought I would see that.’ ‘Another woman who had been on long-term sick with stress, decided to go back to work using the skills she had learned, planning & problem solving in anticipation of the problems that might occur.’ ‘One Carer who went to the Dementia, Stress-control and Mindfulness went on to volunteer as a Befriender with the Alzheimer’s Society. Those courses gave her the Confidence to do something like that after 20 years a Carer.’

Such stories were not isolated occurrences and are proof of the transformative impact that the training opportunities had upon people’s lives and well being. Concluding remarks regarding the sustainability of Project Cariad Staff within Project Cariad have implemented an impressive level of sustainable outcomes from the funding available. These included the creation of inter-agency joint working information networks and holistic support available across the Swansea locality for carers; carer friendship groups and peer support activities; a sustained increase in personal well being and effective support for carers that has enabled less use, by both carers and their families, of mainstream and specialist statutory services. Whilst sustainable outcomes are not within the main project objectives, they are a cornerstone of effective project delivery and management and Swansea Carers Centre has managed to achieve various aspects of sustainability, on top of the agreed Project Cariad outcomes. However, there are certain activities that will need funding. Specifically these are personal and development support for volunteers,

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training for upskilled staff to maintain and implement their new knowledge, training for new staff in partner organisations as a result of turnover or new positions; funding for respite and carers who are on a very low income and cannot afford subscriptions or temporary carers, support for carers groups to host events, recruit and support new members and pay for venues or events.

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SECTION 6: IDENTIFYING GOOD PRACTICE In addition to the 3 project outcomes and the sustainable outcomes, Project Cariad developed areas of good practice that should be highlighted. These areas of good practice are aspects of expertise held within Swansea Carers Centre that enabled innovation and high quality project delivery. This section is based upon data from focus groups with participants and interviews with professionals and is therefore based upon the evidence; not evaluator opinion. Specific good practice can be identified in relation to Cariad’s partnership working, participative practice, the implementation of reflective practice, added value, the role of carer volunteers and the expertise of staff. Partnership working In addition to the training delivered to professionals and the joint working with organisations to provide free training, Cariad has undertaken partnership working with a vast range of agencies and organisations within each year of the project. Section 4 discusses how many staff from external organisations attended awareness raising training but in addition to raising awareness, the project undertook extensive partnership working. In the original project proposal to the Big Lottery Swansea Carers Centre stated that the aim was for 100 organisations to benefit from the project. However, it is apparent that many more than 100 organisations have been involved with Cariad staff. Partnership working started in year 1 through the creation of a resource bank and partnerships were explored and developed with a range of organisations including the Local Health Board, Workers’ Education Association and charities such as Marie Curie. Additionally, Project Cariad used community based events at mainstream venues to raise awareness of the challenges carers face. Examples of these events and organisations involved 4 Sainsbury’s supermarkets with fund raising activities, 2 hospitals and work with Love your Countryside. This approach was expanded upon in years 2 and 3 with the promotion of a carers emergency card scheme involving 3 hospitals, 40 GP practices, 31 community centres, Civic Centre and local libraries, a conference that featured 17 partner organisations, promotional information events in hospitals and across local GP surgeries, the launch of health passports for parent carers groups, funded by ABMU and Carers’ Week events with over 1,000 managers and HR staff at the DVLA. partnerships have also been established with a number of local third sector agencies such as Cae Tan, Swansea Community Farm, Roots Foundation, Red Café and Alzheimer’s Society. Project Cariad has had a good profile within the media with features in the Swansea Council for Voluntary Service Mental (SCVS) Health Forum Magazine, regular articles in the Parent Carers e-bulletin and SCVS news e-bulletin and promotion within the DVLA intranet. The male carers confidence workshop featured as a case study in the Carers’ Trust network partner conference and within ‘We Care’ magazine. The Book Club received Wales wide media attention with a feature on IT news. This level of partnership working has enabled a wealth of information exchange, to the benefit of carers, and ensured that Cariad facilitated the best training and support possible for local carers. Moreover, it has contributed towards cross agency holistic support for carers within Swansea. As a professional commented:

‘Partnership is so important in raising awareness.’

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The partnership approach has also raised the profile of Project Cariad, The Swansea Carers Centre and by doing so, the challenges faced by carers and enabled carers’ voices to be heard within wider platforms. Participative practice Project Cariad has involved carers’ opinions throughout the project, with regular consultation and feedback mechanisms enabling staff to plan activities according to carers’ aspirations and needs. This had a significant impact upon the effectiveness and relevance of the courses and therapies offered. For example, an online survey asked parent carers about which training they would like which led to the delivery of training on ‘Social Care – Your Rights’, ‘Supporting you to reduce Stress’, ‘helping your child with eating – mealtime routines’ and ‘welfare & benefits’. At the start of year 3, Cariad staff consulted about creative arts and well-being activities. Since carers had requested certain courses they were well attended and directly relevant. Additionally, Cariad staff have listened to participants from the training courses in order to ensure the courses they hosted were of direct relevance. They piloted an ‘administration of medication’ workshop, but feedback from carers demonstrated that the majority of the content was not relevant. Similarly, the free Carers Wales ‘Nutrition’ workshop received feedback that it was mostly relevant to older people with restricted nutrition and therefore very specialised, so it was not run again without specific demand. Emergency First aid and Stress Control were popular and highly relevant and therefore they featured regularly within quarterly training programmes. Methods of consulting with carers about the delivery of Cariad included questionnaires, staff visits to the peer support groups, consultation events, online surveys, evaluation forms, and mail shots throughout each year of the project. This participative practice led to carers naming the project in year 1 and participating within the Carers’ Centre beyond Project Cariad, for example, at the AGM in 2015, the 10 Year Anniversary Celebrations and conferences and events. Through including carers within the planning group they directly inputted into project delivery decisions, alongside Cariad staff and external agency professionals. Through using different methods, Project Cariad tried to ensure accessibility for participation and to enable carers in different circumstances to be involved in the direction of the project. They also removed barriers to participation through offering respite care for the people carers cared for, enabling them to attend consultation events as well as training and therapies. The effort that was made to enable participative practice clearly enriched the Cariad project through ensuring relevant and effective training but also highlights a highly ethical model of support that empowered carers and ensured their voices were at the centre of project delivery and planning. Implementation of reflective practice The evaluation held a wealth of evidence regarding implementing learning from reflective practice. This means that there was clear progress between the years of the project as staff reflected upon lessons learnt and potential innovations and subsequently implemented changes within the following year. For example, at the end of year 1 it was apparent to staff the monitoring systems and forms required improvement and this was implemented immediately. There was a 60% increase in training sessions

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available between year 1 and year 2 and a drive to recruit more carers in years 2 and 3, which proved very effective. Additionally, Cariad was successful in building upon the effectiveness of certain training courses through supporting carers to show what they had learnt at events and celebrations. For example, in Year 1 the pilot courses in ‘Positive Reflections’, ‘All Our Stories’ and ‘creative writing’ resulted in a celebration at the Midwinter Mingle where carers’ photographs were exhibited, their digital stories were shown and their poems read aloud. Similarly, in years’ 2 and 3 African drumming and harmony singing were included within events. Promotional materials included photos from workshops and bunting made out of carers’ quotes. These activities were additional to Project Cariad, and appeared to directly build upon the work being undertaken in Cariad and staff reflections on how to maximise the effectiveness of the project. Throughout the project there has been a tension between recruiting new carers and supporting existing carers. Whilst the target number for new carers was not reached, Project Cariad acted to ensure that the carers who had been involved were properly supported; particularly as one of the project aims was to reduce isolation. In order for social networks to be built, carers needed to spend time together within training courses and peer support groups. There is consistent evidence that each year staff reflected upon this conundrum and found different ways to overcome it. Effort to recruit to the project was greatly increased after year 1, and plans were made in increase the sustainability of peer support groups which proved very successful. Cariad staff did not just implement work to meet the three project outcomes, but undertook extensive reflective practice to ensure best possible delivery of the project. Added value activities Project Cariad used additional funding from certain bodies to add value to the work being undertaken. For example funding was sought from the Local Health Board to pay for particular courses and Countryside Connections gave funding to cover the costs for green woodworking, basket making and bush craft workshops to ensure carer participation within the local Love Your Countryside Gower Festival. They obtained funding from Communities 2.0 for a basic IT session and supported partnership work with Swansea Museum to seek funding for a dementia-friendly space. There was concern during year 1 that there was not sufficient engagement of male carers and therefore the project successfully applied for match funding from The Carers Trust to run a ‘Get Confident’ workshop for male carers only and in year 2 to undertake consultation work with male carers. Lastly, Swansea Carers Centre was chosen as Sainsburys local charity of the year in 2015 which enabled profile raising of Cariad’s activities and provided fund raising opportunities. Adding value to the funded project through match funding for specific activities has ensured both a quality and breadth of training opportunities for carers, enabled their participation within local festivals, raised awareness of the challenges carers’ face and raised the profile of the project.

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Quality of the project Carers and professionals spoke highly of the quality of the Cariad project in relation to the quality of the trainers delivering courses with many comments upon course evaluation sheets such as:

‘The Cariad trainers, providers and courses have been very well chosen and very nurturing,’ More specifically, great appreciation and praise was given to the staff of the Swansea Carers Centre regarding their skilled communication and ability to respond to the needs of the Carers:

‘Communication from Cariad has been first class- you get a reminder the day before and once you’re in the loop through Cariad you get all the updates and newsletters and information on all the national and local caring events. The information flow has been exemplary.’ ‘It’s a testament to the staff (the Carers Centre) being able to pick up on the needs of the carers.’

It is clear that Cariad was a highly valued project by both partnership agencies and carers who felt they had benefitted from working alongside very skilled staff. Conclusions regarding additional outcomes and good practice In addition to agreed project outcomes, Cariad achieved significant additional outcomes and implemented good practice. These successes stem from staff’s ability to network, implement reflective practice and effective joint working and to involve carers in all aspects of the Cariad project. Staff expertise has been highlighted as one of the key influences for these successes and achievements.

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SECTION 7: CONCLUSIONS AND RECOMMENDATIONS Summary conclusions regarding Project Cariad’s outcomes Project Cariad aimed to meet three outcomes regarding increasing carers’ confidence and skills, reduction in stress levels and reduced social isolation. It can be concluded that these outcomes have been met and that the project has had a significant and lasting impact upon the well-being of carers within the Swansea area. Additionally, the project has undertaken a range of supporting activities that have enabled substantial additional outcomes to have been met, as well as exemplifying good practice; particularly in relation to partnership working and participation. Due to the strategic implementation of work, it is highly likely that there will be a legacy from Project Cariad that will be carried by individual carers and organisations within the Swansea area. Firstly, carers and professionals felt that there has been a sustained impact upon individual participants who have gained confidence, peer support and new knowledge. In some instances, in addition to improved well being, this has enabled individuals to seek paid employment and volunteer roles within their community and experience positive life changes within their personal relationships with family members. The level of awareness raising and joint work with other organisations is likely to lead to carers generally gaining more support and understanding within other agencies and may enable a localized response to the different needs that carers have. These outcomes are hugely significant since they are suggestive of real, long term impacts stemming from a 3 year project. Evaluator recommendations These recommendations are based upon the evidence from the evaluation in terms of what has had the most impact upon carers and what next steps could potentially be taken to strengthen the legacy and build upon the successes of Project Cariad: 1. Carers greatly benefit from learning together and having time together. Any subsequent training or

support groups should specifically be for carers, led by staff who understand the challenges carers face and include non-carers only with the participants’ clear agreement.

2. Continuation funding needs to be secured for sustaining the peer groups of project Cariad. Whilst carers can run their own groups and some may be self sustaining, some central support is still needed primarily for practicalities, accessibility and development. Practicalities refers to money and resources that will be needed for things like communication across a group and between groups, venue hire (particularly if venues are needed to be accessible), guest speakers and activities to enable continued interest. Ensuring groups are accessible requires funding for the provision of respite care and payment for a trainer. Many carers live on very low incomes and are excluded from any activities that have associated costs. Lastly, groups dwindle if they do not have input to enable their development. Funding will be needed to facilitate new membership of existing groups and staff time will be needed to help the strategic development of groups. Continuation funding for these activities could extend and embed the participative practice that has been undertaken within Cariad.

3. To continue to purely address carers’ stress levels, there should be a focus upon courses that teach techniques for coping with stressful situations or that enable strategies for avoiding tensions to

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arise. Whilst all courses had some impact on reducing stress, it is clear that courses such as mindfulness, the 3 principles and stress control enabled carers to better manage their caring role and had a depth of impact upon reducing stress levels. Additionally, many carers taught these techniques to the people they were caring for; that then made family relationships more positive. The aspect of teaching techniques to family members could be added at the end of these courses, or provided as a follow up session and continuation funding could include this to further develop positive family relationships.

4. The courses that had the biggest impact upon all of the project outcomes were those that lasted for

more than 2 sessions and had a combined focus. A combined focus means that the courses required participants to learn different skills at the same time. For example, courses such as ‘Positive Reflections’, African drumming and harmony singing required participants to work together as a team, learn new skills, participate in creative expression and included having fun. These types of courses had a simultaneous impact upon reducing stress levels, increasing confidence and reducing isolation. This evidence suggests that if all three outcomes are to have an equal focus within a project it is these kinds of courses that should be delivered.

5. The vast majority of carers reported positive impacts from attending training. However, training had

the largest impact upon participants who described themselves as quite or very stressed, regardless of the course that they attended. This suggests that if high levels of individual impact are required by a project, courses could be targeted towards carers who report themselves as feeling very or quite stressed.

6. Continuation funding could be sought to develop the volunteering aspect of Cariad. The role of

volunteering is significant for enabling carers to develop aspirations. Some carers valued opportunities within the Carers Centre whilst others valued moving to roles outside of the centre. Developing volunteering has staff costs attached; but volunteer roles appear to enable carers to reduce their service use, further develop new skills and gain confidence. Volunteering also appears to act as an effective “moving on” device, enabling carers to reduce the support they have had.

7. Whilst no cost benefit analysis was undertaken, there is evidence that Cariad prevented high use of

other statutory and voluntary services; particularly with regards to mental health services and social care. Additionally, Cariad not only prevented other service use by carers but also by the people they are looking after. This has some implications for service planning and development and the role of Cariad in enabling resilience and building coping strategies for carers should not be underestimated.

8. There appears to be little benefit in online courses for carers. However, there is value in online contact between carers, particularly in relation to activities such as the Book Club. This source of peer support could be extended using social media and other technologies, although continuation funding may be needed to enable staff time to develop this and to ensure the upkeep of social media pages.

9. A highly significant amount of networking, outreach and partnership working has been undertaken

within Project Cariad. It is likely that this work has had an impact upon the Swansea locality within partner organisations; but in order for this increased awareness to be sustained within the long term, some continuation funding is needed for carer practice networks to be fully established and training provided periodically to account for staff turnover.