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An EVALUATION OF THE CHALLENGE THROUGH SPORT INITIATIVE

Jez Buffin and Matthew Reeves

University of central lancashire - AUGUST 2018

Contents

Background 2

The role of sport in reducing criminal activity, anti-social behaviour and substance misuse 2

The evaluation framework 4

Project participants 7

Outcome and impact 11

On whether participants became more active as a result of the project 11

On participants overall subjective sense of wellbeing 15

On participants wider socio-economic circumstances 16

Case studies 19

Reasons for success? 23

Recommendations for improvement 25

References 26

Appendices 29

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Executive Summary

The Challenge through Sport Initiative (CSI) is an ambitious and innovative project designed to encourage active and healthier lifestyles for adults recovering from drug and alcohol misuse. Funded through Sport England as part of its Get Healthy, Get Active work programme, CSI is managed and co-ordinated by Active Lancashire (formerly Lancashire Sports Partnership).

An evaluation of the project was undertaken by the University of Central Lancashire. The evaluation ran from June 2015 to June 2018. The evaluation collected data from participants in the project at baseline registration, and three months, six months and twelve months follow up using a questionnaire derived from the Single Item Sport England Measure, the Short International Physical Activity Questionnaire (IPAQ) and the Cantril Self-Anchoring Striving Scale.

2628 people registered with the project and completed a questionnaire to provide baseline data. The large number of participants that the project managed to attract and engage is evidence that the project managed to successfully overcome many of the barriers commonly experienced by programmes with similar objectives. Follow up data was successfully gathered from 982 of participants at three months and from 1053 and 753 participants at six and twelve months respectively.

The project attracted a good spread of participants across all age groups, although the profile of those engaged in the project is slightly younger than that of those who are engaged in drug and alcohol treatment services. This suggests that the project may have something unique to contribute to the successful earlier engagement and retention of younger substance misusers in treatment. The gender and ethnicity of participants who engaged in the project is similar to the profile of those engaged in drug and alcohol treatment services.

12.2% of participants reported having a disability, although it is likely that this figure is under-reported. Most participants had left school either without any formal qualifications or with less than 5 GCSE’s, CSE’s or ‘O’-levels.

The project was successful at retaining participants from a wide variety of housing situations in the programme (including people who were homeless). Thus 2% of all participants who registered for the programme were homeless at baseline and homeless participants made up 1.9% of those who completed 12 months.

Participants who were retained, even for three months, were active more often and at higher levels. Between to 39.5% and 51.6% of participants were active at baseline and this proportion rose steadily over twelve months. At three month follow up the proportion of participants who were active had risen to 68%. At six months the proportion had risen to 71.7% and at twelve months the proportion had risen to 80.1%.

Levels of activity for the cohort as whole also rose steadily across the twelve months. While the proportion of participants classified as having low levels of activity fell from 38% to 12.2% at twelve months, the proportion of participants reporting high levels of activity rose from 31.2% to 47.7% and the proportion of participants reporting moderate levels of activity rose from 30.7% to 42.6%. 90.3% of participants were moderately or highly active at twelve months. While participants with low or moderate levels of activity at baseline were supported to achieve higher levels of activity at three, six and twelve months, participants with high levels of activity at baseline were supported to maintain these levels.

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The proportion of participants who had participated in sport within the last seven days increased sharply from 43.3% at baseline to 79.6% at three months, 87% at six months 88.9% at twelve months.

The self-reported wellbeing and life satisfaction of participants improved over time. The mode score for wellbeing at baseline registration was 5. The mode score for wellbeing at twelve months was 7. Those with the lowest levels of activity at registration appear to have benefited the most. The mode score for those with low activity levels at registration was 4 at baseline and 7 at twelve months. The mode score for those with moderate activity levels at registration was 5 at baseline and 7 at twelve months. The mode score for those with high activity levels at registration was 6 at baseline and 7 at twelve months.

The proportion of participants not working at all fell from 54.3% at baseline to 39.8% at twelve months. This was mainly due to the increases in the proportions of participants who were in part-time work or who were volunteering at twelve months. The proportion of those working part-time rose from 6.6% at baseline registration to 12.6% at twelve months while the proportion of those volunteering increased from 8.1% to 22.2%.

A major feature of the project was the encouragement of participants in to volunteering and employment. As one of the workers put it:

“One of the great successes of the project for me has been the way that we have seen people develop from participants, to becoming volunteers and then paid support workers. We know of 80 people who have gone on to gain employment. Some of them are only part time hours. But still that’s 80 people. And that’s just the ones that we know about.”

The project has had a wider impact in building recovery capital by encouraging and facilitating contact between participants and Lancashire User Forum, providing a structure for users in recovery and putting such people in touch with other people who they recognised as ‘like them’ and who they could see were doing well. The proportion of participants who had been in contact with Lancashire User Forum during the last six months rose from just 13.2% at baseline registration to 30.6% at twelve months. Along with a range of other indicators this can be used as a proxy for measuring increased recovery capital in terms of peer and social support. Five case studies provide illustrative examples of other ways in which the recovery capital of participants has been enhanced.

The male in case study one describes a number of services and agencies that he has made contact with through his work as a volunteer with CSI. He describes how his confidence has improved. Not only has he seen benefits in his own life, but now he has started to help other people. He is more active and has a wider pool of people and services that he can draw on. He is illustrative of the way that CSI has both reached out to potential participants in other projects and has helped to sign-post people in to services for support.

The male in case study two describes how being involvbed with CSI has helped him to re-connect with his estranged son. Like the male in case study one, he has a wide pool of support that he can draw on now, including a range of both professional and peer support.

The male in case study three has managed to re-establish a relationship with his partner and son. He finds that the structure of the programme, having something to do and meeting new people has helped him to avoid relapse.

The woman is case study four describes how CSI has re-connected her to the world around her and has drawn her out of her ‘methadone treatment bubble’, where she had been stuck for several

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years. Getting involved in the project has helped her to build her confidence. She no longer feels that she us useless. She has met new friends and now has a sense of belonging.

The female in case study five has also grown in confidence. Becoming involved in CSI has given her a sense of purpose and value in life. She can see how being valued has helped her own recovery and how it can help other people too.

Such ‘visible recovery’ has long been recognised as a significant factor in promoting and sustaining positive change for problematic drug and alcohol users.

One of the key ingredients in explaining the success of the project is role of the support workers and, through this, the focus that the project had on building relationships with people. Support workers played a critical role in reaching out to participants, giving encouragement and facilitating project activities. They also acted as a source of advice and support for participants experiencing problems and were often able to help participants sort problems out or sign-post them in to other services.

It is also crucial to acknowledge the importance of the infra-structure that sat behind the support workers. CSI employed a full-time project co-ordinator, whose role extended far beyond simply co-ordinating the day-to-day activities of the team. Her role was critical in providing both practical and emotional support to the team around a wide variety of issues. Many of the volunteers and support workers had not worked before and needed high levels of support to enable them to grow and develop in their new roles. This might extend from something as basic as being able to log on to a computer or knowing that it was important to ring up and tell someone if they were going to be off sick, through to helping someone deal with complex welfare benefit difficulties, family problems or full blown relapses.

Recommendations

The costs of drug and alcohol misuse are difficult to estimate because of the range of impacts. Drug and alcohol misuse can cause a wide range of harms to the individual, those close to them, and wider society. These include impacts on physical and mental health, unemployment, homelessness and criminal activity. In 2011 the Home Office estimated the total annual cost of illicit drug use in United Kingdom to be in the region of £10.7bn. The cost of alcohol related harm is thought to be £21.5bn. There were 2,592 drug misuse deaths involving illegal drugs in England and Wales in 2016.

Given the project outcomes, commissioners should continue to invest in CSI, which represents good value for money.

The project workers and volunteers had a number of ideas for how the project could be improved however and these should be considered in any the future developments. Beyond simply having more resources so that they could have more support workers and run more sessions with more people in more venues the team suggested the following:

That the project could benefit from having a more structured progression route. All of the project workers and volunteers could point to individuals who they knew had gone on to undertake a volunteering role or who had gone on to either full or part-time employment. The statistical data from the project supports this and indicates that some very successful outcomes have been achieved. The project team could see the benefits of developing a formal partnership with either an employment training service or perhaps with an employment agency so that progression could be built more formally in to the project as and when participants were ready. As it is, much had been achieved, but this had often been done by the project team without having much knowledge or skills in the area.

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That more resources be put in to the evaluation. Project staff and volunteers complained that completing the questionnaires had been time-consuming and had detracted from the time that they had to facilitate activities and attend to participant needs. They would have liked a team of specialist people to come in and collect the data, rather than rely on the project staff and volunteers. The team also felt that many of the questions in the IPAQ tool had been difficult to explain to participants and said they would like to see a simpler tool developed for any future evaluation.

A third recommendation related to communications and better marketing. The team felt that they had not made the most of their achievements and that they could have done more to showcase what they were doing and what they were achieving to the outside world. This, they felt, might have helped to reduce some of the on-going stigma surrounding substance misuse and recovery as well as help to ensure more sustainable funding of the project.

A forth recommendation concerned the provision of a better infrastructure for the project. Although the project had a central base and hub, many of the workers and volunteers worked out in the community. Many were reliant on partner organisations to provide them with access to office space or access to a computer. While some organisations were welcoming and opened their doors, embracing all that CSI had to offer, others were not so forth-coming. More structured partnership arrangements with clearer expectations and service level agreements was one suggestion for how this might have been addressed.

A final recommendation was that the project broadens its focus out beyond substance misuse. The project team recognised how a number of other groups might also have been able to benefit from the project had the project been open to and targeted at them. People with mental health problems and the long-term unemployed were just two of the groups who the team mentioned.

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Background

The Challenge through Sport Initiative (CSI) is an ambitious and innovative project designed to encourage active and healthier lifestyles for adults recovering from drug and alcohol misuse. Funded through Sport England as part of its Get Healthy, Get Active work programme, CSI is managed and co-ordinated by Active Lancashire (formerly Lancashire Sports Partnership).

The project employs a full-time project co-ordinator, a part-time administrator, several part-time support workers and a number of volunteers to run a wide range of sporting and physical activities across Lancashire. Most of the support workers and volunteers are themselves in recovery and the project therefore has a strong emphasis on peer led activity. The programme of activities has always been flexible, responding to the interests of participants, but has included, amongst other things, walking groups, cycling, swimming, climbing, badminton, netball, football, gym sessions, kick boxing, rounders, snooker, pool, golf and table tennis.

While responsibility for overall management and accountability sits within Active Lancashire, CSI benefits from the advice and guidance of a range of partners, including a project steering group whose membership has consisted of representation from the offices of the Police and Crime Commissioner for Lancashire, Public Health Lancashire, Lancashire County Council, Lancashire Drug and Alcohol Action Team, and a number of drug and alcohol service providers and user groups.

The role of sport in reducing criminal activity, anti-social behaviour and substance misuse

Sport and physical activity are often positioned as mechanisms for tackling a range of societal issues, from obesity to improved educational attainment. One area where sport and physical activity interventions have been prominent is in tackling crime and anti-social behaviour, particularly substance-related disorders (Strohle, Hofler, & Pfister, 2007; Brown et al., 2010; Linke & Ussher, 2015; Weinstock et al., 2016). Issues of criminality and anti-social behaviour, including substance abuse, are complex and, as such, there are no simple x-y outcomes. However, sport and physical activity have been shown, in different settings, through different activities, and with different populations to be effective at dealing with criminal activity and anti-social behaviour by giving participants a positive identity, feelings of empowerment, and developing a range of physical, social, and employability skills (Jamieson et al., 2007). It is important to note that sport and physical activity interventions should not be seen as a panacea for all criminal and anti-social behaviour but, instead, offers a valuable alternative when seeking to motivate, engage, and inspire offenders and those at-risk of offending.

Much of the work in this area has tended to focus on the impact sport can have upon young people, crime prevention, and reoffending. Coalter (2007) suggests that there are three claims that are often made in relation to sport and its potential impact upon crime:

Sport’s contribution to personal character development and ‘positive development’ (a ‘fertiliser’ effect).

Sport’s contribution to reforming ‘at-risk’ populations (a ‘carwash’ effect). Sport’s contribution to fostering social capital leading to future occupational success and civic

engagement (a ‘guardian angel’ effect).

Positive development assumes that sport has a ‘fertilizer effect’ and that, if added to people’s daily lives and experiences, character and potential will grow and develop in more socially desirable ways (Coakley, 2011). Such positive development may include: the creation of sport-specific skills that can be converted into physical capital; an improvement in overall physical wellbeing, general health and

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fitness; improved self-confidence, body image, and self-esteem; and character development through instilling discipline, teamwork, and responsibility (Coakley, 2011).

The reformation of at-risk populations suggests the power of sport to cleanse character and wash away defects – the carwash effect – in order to allow individuals to become acceptable within mainstream society. This claim focuses on developing structures that creates values and goals within their lives; it does so by teaching self-control, obedience to authority, and conformity to rules within an environment that is supported by positive role models (Coakley, 2011).

Developing social capital through sport and physical activity, it is suggested, leads to experiences and relationships that better embed individuals within society by providing personal success and civic engagement. These are reliant on the development of physical capital that can be used to acquire social and cultural capital. This, in turn facilitates a formation and development of social networks that have reach beyond the realms of sport. This ‘guardian angel’ effect projects individuals into success-orientated and civic-centred directions to better their lives (Coakley, 2011; Coalter, 2007). Social capital development amongst adult populations is often characterised by intragroup ‘bonding’ as opposed to intergroup ‘bridging’ processes (Putnam, 2000; Putnam & Goss, 2002), though it is possible for both to occur under certain circumstances (Beaudoin, 2011; Palmer & Thompson, 2007; Vermeulen & Verweel, 2009). Many initiatives have been loosely based on the ‘midnight basketball/soccer’ models developed in the USA, where they appeared to demonstrate a reduction in crime (Morgan, 1998; Wilkins, 1997; Hartman & Depro, 2006).

In considering the causes of crime, Asquith et al., (1998) identified a complex and interdependent series of psycho-social ‘high risk factors’ which include: hyperactivity, high impulsivity, low intelligence, poor parental management, parental neglect, offending parents and siblings, early child bearing, deprived background, absent father and maternal substance abuse in pregnancy. Many interventions fail to recognise the complex issues that might have converged to bring about offending or anti-social behaviour and are unclear about the desired behaviour a sport-based intervention programme are supposed to change.

There have been calls from those interested in desistance from crime for evidence-based approaches. As such, there has been a requirement to find a ‘hook for change’ for offenders or potential offenders that engages them and builds a pro-social identity, as well as contributing toward building positive social networks.

Whilst Coalter (2007) presents the three claims as discrete entities, there are often overlaps in the desired outcomes or intentions of intervention programmes. Furthermore, the desired outcomes from sport-based interventions to reduce crime and anti-social behaviour require individuals involved to integrate the lessons learned into their daily lives – and only when these lessons are internalised by a large enough population will the positive attributes become beneficial to the wider communities in which individuals live (Coakley, 2011). Often participants can be identified as ‘at-risk’ as well as needing to develop their social capital. This combination of outcomes is not unusual. Previous work related to substance abuse has pointed to the need for adjunct therapies and lifestyle modification approaches, such as sport and physical activity, due to high rates of relapse, and physical and mental comorbidities among substance use sufferers (Zschucke, Heinz, and Strohle, 2012).

Whilst sport as a hook might be seen as a favourable approach, it is important to recognise that the relationship between sport and positive development is contingent on a myriad of factors (Holt, 2008; Kane & LaVoi, 2007; Weiss, 2008), including: type of activity; orientations and actions of peers;

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significant others; coaches; programme administrators; norms and culture associated with particular sports or sports experiences; socially significant characteristics of sport participants; material and cultural contexts under which participation occurs; social relationships formed in connection with sport participation; meanings given to sport and personal sport experiences; manner in which sport and sport experiences are integrated into an individual’s life; and changing definitions and interpretations of sport experiences that occur during the life course (Coakley, 2011: 310). Furthermore, it is important to note that interventions that do not install long-term, ongoing support mechanisms for delivery will see short-term benefits that are lost once the intervention ceases. Thus, the main objective of intervention programmes must be to embed sport into the lives of individuals as a long-term diversion from criminal or anti-social behaviours, or a mechanism to enable the intervention to become self-fulfilling once organisational structures (i.e. administration) are removed.

Programmes which have combined therapeutic and physical activity-based interventions have demonstrated that participants display significantly improved quality of life, which is an important predictor of sustained recovery (Muller & Clausen, 2015). The use of physical activity in the treatment of substance-abuse is suggested as easy to apply, yet many participants struggle to begin to engage in such activities (O’Brien et al., 2010). Poor adherence and drop out have been identified as common factors, even within residential intervention and treatment programmes - with residential programmes already removing many of the potential barriers to participation (e.g. time, access to facilities) (Weinstock et al., 2016). Furthermore, O’Brien and colleagues (2010) indicate that many participants discontinue their involvement in such programmes before realising or recognising the potential benefits. These issues have been suggested to be correlated with the delivery mechanism, with many programmes adopting home-based or individualised gym-based programmes, where group participation and engagement might be more intrinsically motivating for participants who wish to continue participating in sport and physical activity (Nowakowski-Sims & Bullard, 2018). In their study examining the impact of physical activity in the treatment of drug addiction, Williams and Strean (2006) argued that activities should be chosen that are consistent with the function of the overall treatment programme and have direct relation to the treatment goals (e.g. building confidence, managing stress and anxiety). They also highlighted the need to understand the context of drug use and any possible relationship with any previous sport or physical activity (e.g. drinking and team sports) so as to avoid classically conditioned responses.

The evaluation framework

An evaluation of the project was undertaken by the University of Central Lancashire. The evaluation ran from June 2015 to June 2018. The evaluation collected data from participants in the project at baseline registration, and three months, six months and twelve months follow up using a questionnaire derived from the Single Item Sport England Measure (Milton et al., 2011), the Short International Physical Activity Questionnaire (IPAQ) (Craig et al., 2003) and the Cantril Self-Anchoring Striving Scale (Cantril, 1965).

At each point participants were asked questions about how often they had taken part in any sporting activities within the last seven days, how much time they had spent doing vigorous, moderate or walking activities in the last seven days and how they perceived their overall health and wellbeing on a scale ranging from zero to ten. A copy of the baseline and follow up questionnaires can be found in appendix 1.

Data was collected from project participants at baseline by CSI project staff before the participant took part in any of the project activities. Follow up data was collected by CSI staff at three, six and

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Figure 1: The Evaluation Framework

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Potential participants interested in project

Baseline assessment completed at registration by CSI project staff or volunteers before participant commenced on programme

Single item measure Short IPAQ Cantril Self-Anchoring Striving Scale

Project activities commenced – including walking groups, cycling, badminton, swimming, climbing, badminton,

netball, football, gym sessions, kick boxing, rounders, golf and table tennis

First follow up assessments completed by CSI project staff or volunteers at 3 months


Second follow up assessment completed by CSI project staff or volunteers at 6 months


Third follow up assessment completed by CSI project staff or volunteers at 12 months


Project activities continue – including walking groups, cycling, badminton, swimming, climbing, badminton,


Project activities continue – including walking groups, cycling, badminton, swimming, climbing, badminton,


Data

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twelve months most often face to face at follow up sessions where this was possible and the participant was still attending activities, but sometimes over the telephone where the participant had either dropped out of the programme or proved more difficult to follow up. CSI project staff received training from the University of Central Lancashire in how to collect the data, which was repeated several times, either as a refresher or for new staff. Completed questionnaires were passed on to the University of Central Lancashire, who entered the data in to SPSS (Figure 1).

Data was processed in accordance with the clearly defined scoring and cleaning protocols (The IPAQ Group, 2015). Total metabolic equivalent scores (METs) were calculated by calculating and then adding together MET scores for walking, moderate and vigorous activities as below (Figure 2).

Figure 2: How total metabolic equivalent scores (METs) were calculated

For time spent walking 3.3 x minutes spent per day x number of days on which walking occurred

For moderate activities 4 x minutes spent per day x number of days on which moderate occurred

For vigorous activities 8 x minutes spent per day x number of days on which vigorous activity occurred

Cases where the number of claimed minutes for either walking, moderate or vigorous activities was greater than 180 minutes (3 hours) were truncated to 180 minutes. Entries for cases where the number of minutes of activity claimed was less than 10 minutes were re-coded to zero. Cases where the total number of claimed minutes per day for all activities exceeded 960 (16 hours) were excluded.

Once total MET scores were calculated, participants were assigned to a category of either low, moderate or high activity levels according to the rules below (Figure 3).

Figure 3: Rules for deciding whether participants were assigned to a low, moderate or high level of activity category

Category Rule1. Low No activity is reported OR some activity is reported but not enough to meet

category 2 or 32. Moderat

eEITHER(a) 3 or more days of vigorous activity of at least 20 minutes per day(b) 5 or more days of moderate activity and/or walking for 30 minutes per day(c) 5 or more days of walking, moderate or vigorous activity and a MET score of at least 600

3. High EITHER(a) 3 or more days of vigorous activity and a met score of at least 1500(b) 7 or more days of walking, moderate or vigorous activity and a MET score of at least 3000

Ethical approval for the project was gained from the PSYSOC ethics committee at the University of Central Lancashire.

A full dataset for the whole cohort in presented in appendix 3. Outcome data those who reported low, moderate and high levels of activity at baseline in presented in appendix 4. Appendix 5 contains data only for those who were successfully followed up at twelve months. The data in

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appendix 4 and 5 is included so that it is possible to assess whether the programme worked as well for participants who were relatively inactive at baseline as it did for those who were already active. It also makes it possible to analyse the type of participant who was retained across the full 12 months and reach some further conclusions about whether the programme worked equally well for all groups of participant. The section below summarises the main points, making references to the tables and figures in the appendices as appropriate. Figures are labelled in accordance with the order that they appear in appendices, not the order that they appear in the text.

The data is supplemented by a number of case studies that are included towards the end of the report. These are designed to reflect more qualitatively the journeys of a small number of project participants and project staff; to help shed some light on some of the less tangible benefits of the project, and to give insights in to the key reasons for why the project has been successful. Two focus groups were also held with a group of project staff (including both paid workers and volunteers) and data from these focus groups is included as appropriate to help clarify or expand certain points.

Project participants

Figure 4 shows the total number of people who participated in the project overall, the month in which they registered and the month in which they were followed up. 2628 people registered with the project and completed a questionnaire to provide baseline data. Figure 4 shows that the project had fairly uneven number of new participants registering during its first six months between July 2015 and January 2016, with spikes in August 2015 and January 2016, and that it picked up steadily from March 2016, peaking in January and February 2017. The uneven start is indicative of the inevitable difficulties associated with getting a new project of the ground. The steady increase in numbers from March 2016 is indicative of the increasingly strong links that project staff were able to build with a range of potential referring agencies and of the increasingly good reputation that the project was building with participants, many of whom spread the word to other people.

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Figure 4: Number of participants registered and followed up each month

Registration (2628) 3 months (982) 6 months (1053) 12months (753)

The large number of participants that the project managed to attract and engage is evidence that the project managed to successfully overcome many of the barriers commonly experienced by programmes with similar objectives (O’Brien et al., 2010).

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The case study data presented later in this report, along with the data from the focus groups with project staff and volunteers suggests that a number of factors may have been important here. The fact that most of the volunteers and support workers are themselves former drug and alcohol misusers appears to have been significant. Potential participants seem to have been able to identify and relate to project staff and this appears to have contributed to participant belief that the project was ‘for people like them’. Both paid and volunteer project staff spoke about how they focussed on developing relationships with potential participants, going out and visiting them several times over long periods of time, encouraging them to take part.

“We make contact. We hand hold people. We don’t expect people to cross the bridge to us. We cross the bridge to them and then help them to cross. It’s all about relationships. Relationships with participants and relationships with other services.”

An evaluation of an earlier CSI pilot project (Buffin, 2014) lends further support to this. According to Buffin (2014) the enthusiasm of others and being told about the programme by people who participants trusted was an important factor in helping them to decide to give it a go.

“I had seen the posters around, but it was when I heard other people in recovery talking about it that I decided to give it a go.”

“I was going to recovery meetings and the [worker here] was talking about it along with someone else in the group who also comes.”

“Someone in one of the groups that I was going to mentioned it.”

Once at the sessions, it was important that the staff and volunteers that participants had met and who had told them about the sessions were also there and were joining in.

“[The worker here] does not just tell you about it and then leave you to get on with it. He is here too and he is joining in and getting involved.”

Other factors identified as being critical to the successful engagement were: making good links to potential referring agencies, including existing recovery communities; running inclusive events that were open to children and families; providing events at no-cost; laying on transport to get people to events; and ensuring that activities were focussed on having fun (Buffin, 2014).

Follow up data was successfully gathered from 982 of participants at three months and from 1053 and 753 participants at six and twelve months respectively. This is illustrative of some of the problems encountered in collecting follow up data. Participants were not always available to provide follow up data at the due point (hence only 982 provided data at three months although 1053 provided data at six months) and, as was to be expected, there was some attrition. Some participants inevitably dropped out: hence 753 were followed up at 12 months.

This was exacerbated by the success of the project in attracting new participants. The more new participants that the project attracted, the greater the number of participants that needed to be followed up. Increasing amounts of data needed to be gathered by a team of (largely) volunteers from participants who were turning up at project activity sessions to participate in an activity, not to complete a form or a questionnaire. It is testament to the dedication and commitment of the project staff and volunteers that they managed to collect data from such a large number of participants. One of the recommendations for improving the project suggested by project staff and volunteers at one of the focus groups was that a dedicated team was employed to collect data for the evaluation. Project staff and volunteers explained how difficult it was to gather data from

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participants who had turned up to take part in an event, not to fill in a form, and how trying to get participants to complete the evaluation detracted from the time that project staff had to run and facilitate activities.

Participants were drawn from across Lancashire, with the largest proportions coming from Preston (20.2%; n=503), Blackpool (14.9%; n=373), Blackburn (14.1%; n=351), Burnley (13.9%; n=345) and Lancaster (11.4%; n=284). These were all areas where the project team targeted resources in terms of support worker and volunteer time and where the project developed good links with both local services and local sports facilities.

Blackpool

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Figure 5: Area partipants came from n = 2496/2628

The project attracted a good spread of participants across all age groups (Figure 6). 9.9% (n=259) were young people under the age of 16. These were the children of older participants and are indicative of some of the ways that the project successfully engaged with families, which is one of the factors that many of the participants said was important to them in being able to access some activities.

<16 17-18 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 >600%

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Figure 6: Age of participants at registration n = 2626/2628

Generally, the profile of those engaged in the project is slightly younger than that of those who are engaged in drug and alcohol treatment services (NDTMS, 2017). 11.5% (n=303) of those engaged in

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the project were aged 19-24, compared with 6% of those engaged in adult treatment services. The project may therefore have something to contribute to the successful earlier engagement and retention of younger substance misusers in treatment.

The gender of participants who engaged in the project (male = 69.5%; n=1825: female = 30.5%; n=801) (Figure 7) matches that of those engaged in drug and alcohol treatment services (NDTMS, 2017).

Male Female0%

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Figure 7: Gender of participants n = 2626/2628

The ethnic profile of participants (Figure 8) is also broadly similar to that of the profile of those in treatment (NDTMS, 2017), with 91.2% (n=2366) identifying as white.

White Mixed Asian Black Other0%

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Figure 8: Ethnic Group of participants n = 2594/2628

12.2% (n=294) of participants reported having a disability, the definition for which was taken from the Equality Act 2010 as having a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on the participant’s ability to do normal daily activities. Drug and alcohol misuse was expressly excluded as disability however. Comparisons with national figures are difficult here. The NDTMS monitoring system which records the percentage of adults in treatment as having a disability at 18% uses a different system of classification to measure disability (NDTMS, 2017). Furthermore, the figure for project participants is undoubtedly indicative of some under-reporting. At the same time as reporting whether or not they had a disability participants were also asked to

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list any medical conditions that they had and to detail any medicines that they were currently on as part of the health and safety checks for the project. A large number of participants who did not identify as disabled reported conditions and medicines that are very likely to mean that did have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their ability to do normal daily activities by any objective measure.

Most participants (39%; n=955) reported that they had left school without any formal qualifications (Figure 10). 19.5% (n=477) reported having left school with less than 5 GCSE’s, CSE’s or ‘O’-levels. Comparative data with the population of adults in drug and alcohol treatment services is not available, although a study by Bould et al (2010) suggests that many problem drug users have experienced difficulties at school, including truancy, exclusion, bullying and undiagnosed conditions such as dyslexia. Such poor school experiences have often not deterred those in recovery taking up training later in life however Bould et al (2010).

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Figure 10: Level of education reported by participants when they registered n = 2445/2628

28.7% (n=718) of referrals came through a personal contact or recommendation, including a friend or family member or a CSI worker or volunteer (Figure 11). This was echoed in the interviews carried

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Figure 11: Main referral sources (2505/2628)

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out with participants and the focus groups conduced with project staff, which also emphasised the importance of personal contact as a gateway to the activities. Personal contact was important

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because of the encouragement, re-assurance and persistence that often came with it. Of the remaining 71% of referrals, 44.7% (n=1118) came from just seven agencies. Co-operation and partnership with organisations who are in touch with problem drug and alcohol users is therefore also key to the generating participation (Buffin, 2014).

Outcome and impact

On whether participants became more active as a result of the project

Figure 15 shows the proportion of the whole cohort who were classified as being active at baseline registration and three, six and twelve month follow ups. Being active was defined as having done at least 30 minutes of activity that was enough to raise the participant’s heartbeat on two or more of the last seven days.

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Figure 15: Whether the participant was classified as being act -ive at registration and follow up

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51.6% (n=1286) of participants were classified as active at baseline. This proportion rose steadily over twelve months. At three month follow up the proportion of participants who were active had risen to 68% (n=668) and at six months the proportion had risen to 71.7% (n=755). At twelve months the proportion had risen to 80.1% (n=601).


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For the smaller sub-group of participants who were successfully followed up at twelve months only, a similarly successful outcome was observed, although the starting baseline proportion of participants who were classified as active before becoming involved in the programme was slightly higher at 56.9% (n=422) (Figure 53). The project can thus be seen as successfully increasing the proportion of participants who are classified as active, although, perhaps not surprisingly, those who are classified as active at baseline are slightly (5.3%) more likely to stick with the project for twelve months.

Figures 16, 30, 31, 32 and 51 compare the levels of activity (low, moderate or high) that participants achieved at baseline, three months, six months and twelve months. Figure 16 shows the data for the whole cohort, while figures 30, 31 and 32 for those participants who had low, moderate and high levels of activity at baseline respectively. Figure 51 shows the data only for those participants who successfully completed twelve months of activity.

From figure 16 it can be seen that the levels of activity for the cohort as whole rose steadily across the twelve months. While the proportion of participants classified as having low levels of activity (the blue columns) fell from 38% (n=944) to 12.2% (n=127) at twelve months, the proportion of participants reporting high levels of activity (the grey columns) rose from 31.2% (n=767) to 47.7% (n=356) and the proportion of participants reporting moderate levels of activity rose from 30.7% (n=754) to 42.6% (n=318). Thus 90.3% (n=674) of participants were moderately or highly active at twelve months.


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Figure 16: Relative levels of activity reported by particiapnts in last 7 days at registration and follow up

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Figure 30 shows that the proportion of those who were classified as having low levels of activity at baseline (100%; n=934) had fallen to 15.3% (n=35) at twelve months. Conversely, the proportion of those who were classified as having high levels of activity rose from 0% (n=0) to 34.1% (n=78) over the same period.

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Figure 30: Level of activity for participants who had low activity levels at baseline (n=934) at 3, 6 and 12 months

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Most of those who were classified as having moderate levels of activity at baseline either maintained the same level of activity across the twelve-month period or increased it. Figure 31 shows that 47.5% (n=112) were still exercising at moderate levels after twelve months, while 44.9% (n=106) were exercising at a high level.

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Figure 31: Level of activity for participants who had moderate activity levels at baseline (n=754) at 3, 6 and 12 months

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Most (62.6%; n=164) of those who had high levels of activity at baseline were able to maintain this at twelve months (Figure 32). 30.5% (n=80) had dropped their exercise levels to moderate, while only 6.9% (n=18) had dropped them to a low level.

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Figure 32: Level of activity for participants who had high levels of activity at baseline (n=767) at 3, 6 and 12 months

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Participants who sustained engagement with the project for twelve months were slightly more likely to have been more active when they registered (Figure 51). Thus 31.6% (n=232) of those who completed twelve months had low levels of activity when the commenced the programme compared with 38% (n=934) of the overall sample, while 36% (n=264) had high levels of activity compared to 31.2% (n=767) of the sample as a whole.


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Figure 51: Relative levels of activity reported by particiapnts who completed 12 months at registration and follow up

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Figure 17 shows that the proportion of participants who had participated in sport within the last seven days increased sharply from 43.3% (n=1067) at baseline to 79.6% (n=783) at three months. The proportion continued to rise to 87% (n=909) at six months 88.9% (n=666) at twelve months.

Perhaps not surprisingly, the biggest increase in sport uptake occurred amongst that group who were least active when they registered (see Figures 36, 37 and 38 in appendix 3). The figure for those who had participated in sport in the last seven days rose from 21.4% (n=196) at baseline registration to 77.9% (n=250) at three months and 87.9% (n=204) at twelve months.

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Figure 17: Whether participants had taken part in sport in the last 7 days at registration and follow up

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Evidence from the data suggests that the programme has been very successful in both raising the exercise levels of participants who were either not active at all or who were only active at low levels prior to coming on to the programme and at maintaining the activity levels of participants who were already active at moderate or high levels. If anything, it is likely that the projects’ success in this respect has been under-reported. Despite claims that the IPAQ questionnaire is a reliable and valid tool for measuring levels of physical activity among 18 to 65 year-old adults in a range of diverse settings (Craig et al., 2003), the project team had concerns that many participants had a tendency to over-estimate their levels of physical activity at baseline registration. On the face it, given the fact that the project deliberately targeted people with drug and alcohol related problems as participants, the idea that 51.6% (n=1286) of them had undertaken 30 minutes or more of physical activity which was enough to increase their breathing rate, excluding activity that was undertaken as part of housework or in connection with physical activity at work, on at least two days in the past week, seems counter-intuitive.

In light of this, project workers carried out a brief survey (appendix 3) with a number of project participants who had already completed baseline registration forms to check their understanding of and answer to question 1 of the short IPAQ questionnaire. Similar to the question about disability, project workers believed that participants had a tendency to over-estimate activity levels at baseline. Responses to the survey support this assertion and suggest that participants tended to over-estimate baseline activity levels for two reasons: firstly, that many of them did not understand what is actually quite a complex and wordy question; and secondly, that many participants were embarrassed by their levels of inactivity and over-estimated their baseline activity levels in order to compensate for this.

A second analysis of activity at baseline was completed with a cut off of three or more (as opposed to two or more) days of activity in the last week in which participants had undertaken at least 30 minutes of activity sufficient to raise their breathing rate as a measure for being active. Using this measure, the percentage of participants who were active at baseline reduces from 51.6% (n=1286) to 39.5% (n=983).

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On participants overall subjective sense of wellbeing

Cantril’s (1965) Self-Anchoring Striving Scale was used to gain a subjective measure of how participants perceived their lives overall, at baseline registration and follow up. Using a scale ranging from zero to ten, with zero representing the worst possible life for the participant and ten representing the best, participants were asked to place themselves somewhere on the ladder.

The blue columns in figure 18 represent participant responses at baseline registration. Subsequent follow ups at three months, six months and twelve months are represented by the orange, grey and yellow columns respectively. It is evident from figure 18 that the self-reported wellbeing and life satisfaction of participants improves over time: the orange (three months) columns lie to the right of the blue (baseline) columns; the grey (six month) columns lie to the right of the orange (three month) columns; and the yellow (twelve month) columns lie to the right of the grey (six month) columns.

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Figure 18: Overall wellbeing score of participants at regis-tration and follow up using Cantril ladder

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The mode score for wellbeing at baseline registration was 5. The mode score for wellbeing at twelve months was 7.

A similar pattern can be observed for all participants, whether they were categorised as having low, moderate or high levels of activity at baseline registration (see figures 39, 40 and 41 in appendix 3). Those with the lowest levels of activity at registration appear to have benefited the most. The mode score for those with low activity levels at registration was 4 at baseline and 7 at twelve months. The mode score for those with moderate activity levels at registration was 5 at baseline and 7 at twelve months. The mode score for those with high activity levels at registration was 6 at baseline and 7 at twelve months.

The links between physical activity and wellbeing are well documented. A number of studies have shown the relationship between physical activity and both physical and mental health (Meshe et at, 2017; Bauman, 2004; Spence et al., 2005, Mental Health Foundation, 2013). The outcomes from this project are positive and in-line with earlier studies.

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On participants wider socio-economic circumstances and recovery capital

Figures 13 and 50 below show the housing status for the cohort as a whole and for participants who remained engaged with the project for twelve months respectively. Although 65.8% (n=475) of all participants were in their own home at 12 months compared with 49.3% (n=1227) at baseline it is difficult to make claims that engagement in the project has any causal effect on this improved housing status. It is worth noting that the project was successful at retaining participants from a wide variety of housing situations in the programme (including people who were homeless) over twelve months, however. Thus 2% (n=51) of all participants who registered for the programme were homeless at baseline and homeless participants made up 1.9% (n=14) of those who completed 12 months.

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Figure 13: Housing status of participants at registration and follow up


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Although the proportion of participants working full time (Figure 14) fell slightly from 15.7% (n=386) at baseline registration to 13.4% (n=100) at 12 months, it is more likely that this is related to wider economic trends and the continued period austerity than anything else. Male unemployment in the North West rose by 2.5% during the 12 months to June 2018 for example, although the rates for females remained unchanged (Lancashire County Council, 2018).

Encouragingly, the proportion of participants not working at all fell from 54.3% (n=1337) at baseline to 39.8% (n=297) at twelve months (Figure 14). This was mainly due to the increases in the proportions of participants who were in part-time work or who were volunteering at twelve months. The proportion of those working part-time rose from 6.6% (n=163) at baseline registration to 12.6% (n=94) at twelve months; and the proportion of those volunteering increased from 8.1% (n=199) to 22.2% (n=166).

Similar patterns of employment were observed across all participants, regardless of their level of activity at baseline (i.e. low moderate or high) (Figures 27, 28 and 29 in appendix 3).

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Figure 14: Employment status of participants at registration and follow up


A major feature of the project was the encouragement of participants in to volunteering and employment. A number of project workers were able to identify individuals who had gained employment as a result of the project. As one put it:

“One of the great successes of the project for me has been the way that we have seen people develop from participants, to becoming volunteers and then paid support workers. We know of 80 people who have gone on to gain employment. Some of them are only part time hours. But still that’s 80 people. And that’s just the ones that we know about.”

Another spoke proudly about an individual that he had been working with.

“There was this homeless guy in [names town]. He had been on the streets for years. He couldn’t communicate and his health and hygiene was off the wall. He stank. I got him in to treatment and then went to see him while he was in rehab. He started coming to activities and he started making contact with people and learning life skills. He is working now. He is independent. He has his own house and he is back in contact with his kids.”

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Another pointed out a young male participant.

“He had real anger issues. He took part in the football and for some reason football seems to bring out the worst in some people. Anyway, he could see the anger in some of the other participants and he used to go over to them and help calm them down. Somehow he was able to do that. I can’t get over how he had progressed. We got him to start volunteering. He has a knack of getting on people’s level. He has just started a job as a support worker in [names town]. His starting salary is just under £17k.”

Figure 12 shows the proportion of participants who had been in contact with Lancashire User Forum during the last six months. This was used as a proxy for measuring increased recovery capital in terms of peer and social support. For the cohort as a whole, this figure rose from just 13.2% (n=315) at baseline registration to 30.6% (n=225) at twelve months.


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Increased contact with Lancashire User Forum was not the only way in which participants increased their recovery capaital however. The case studies below are illustrative of the substantial benefits that users identified. The male in case study one describes a number of services and agencies that he has made contact with through his work as a volunteer with CSI. He describes how his confidence has improved. Not only has he seen benefits in his own life, but now he has started to help other people. He is more active and has a wider pool of people and services that he can draw on. He is illustrative of the way that CSI has both reached out to potential participants in other projects and has helped to sign-post people in to services for support.

The male in case study two describes how being involvbed with CSI has helped him to re-connect with his estranged son. Like the male in case study one, he has a wide pool of support that he can draw on now, including a range of both professional and peer support.

The male in case study three has managed to re-establish a relationship with his partner and son. He finds that the structure of the programme, having something to do and meeting new people has helped him to avoid relapse.

The woman is case study four describes how CSI has re-connected her to the world around her and has drawn her out of her ‘methadone treatment bubble’, where she had been stuck for several years. Getting involved in the project has helped her to build her confidence. She no longer feels that she us useless. She has met new friends and now has a sense of belonging.

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The female in case study five has also grown in confidence. Becoming involved in CSI has given her a sense of purpose and value in life. She can see how being valued has helped her own recovery and how it can help other people too.

Case study one is male in his 40’s.

He has been involved with CSI for 18 about months. He got introduced to the project while he was in rehab. Two CSI project staff had come in to explain what was available to the residents. He started getting involved in football, kicking a ball around every Wednesday. He says it was important for him to get involved in something and to meet like-minded people.

“It rubs off a little bit. I started to get a little bit of encouragement, you know, stories of life….where people were at, so I could identify with that. And then, like I say, I just came along, got involved and it’s just grown from there really. It’s like, you know, that snowball effect. The more you get involved, the better it becomes.”

He says that being involved in the project helped to build his confidence and six months ago, after he moved on to the second stage of his treatment, he started to volunteer.

“I have been involved in all sorts. Football, fishing, badminton, Cloudspotting festival, sports day down at Witton Park. Various stuff where all the agencies get together and have like open days and stuff. I go along to them and you know, I’ve just helped out by like, talked to people and presented stuff to them….you know, networking and that kind of stuff. And I’ve forged a lot of good links with service users and service providers like the Salvation Army, Howarth House, Regent House, Inspire Drug and Alcohol Services, Thomas Project…places like that. I just get out as much as I can really. If I’m in Blackburn, I’ll just like nip in to them paces like Regent House all the time, especially if we’ve got like new timetables and stuff and let people know what we’ve got on offer.

I always see people who like know me in the community as well, so I’ll stop and have a chat with them. And a lot of the time, because I’m in recovery, some of these people I know, and I’ve been active with them in the past, and they see me and like they ask me what I’ve been doing so I tell them all about Lancashire Sport and Thomas and everything it’s given me and for some people, it plants a little seed, you know what I mean. And some people have started to get a bit of recovery through it now. They’ve started to come along to sessions, you know. It’s like… there’s lads here today from Howarth House…there’s one who I just went in to off the street…cos I was just round the corner from the Salvation Army I thought, I’ll just nip in and have a word, spoke to the staff..you know, it’s took a while, it took about 6 or 8 weeks of just nipping in every Monday morning, and saying what we’re about and stuff, but it’s starting to pay off. You know, they’re starting to come through now. I think it’s just that, you know, you just have to plug away at it all of the time. It’s just being patient around it, you know, and not giving up. Cos people did that for me.”

He describes how being involved in CSI has helped to build his confidence and his inter-personal skills.

“It’s built my confidence. You know, my inter-personal skills. Being able to talk to people on a one to one level and that kind of stuff. I really enjoy what I am doing. What I’m

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doing now, I love it. You know, being able to go out and, you know, help somebody who’s less fortunate than me…in a worse position than me. Looking at where I was at, 12 months ago, I think that’s massive. I wouldn’t have been able to talk to you and look you in the eye. My confidence was really low. Now, I can go out, speak to people. I have confidence. My self-esteem is quite good now. Whereas before, I wouldn’t be able to talk to anybody like this. I would’ve shied away from that kind of stuff. Now I can stand up in front of a crowd and explain to people what CSI is about. Like I said, I can go in to the hostels and explain to people what we are doing. You know, and the staff in drug and alcohol services….they knew me. They knew me as client whereas now they see me as someone involved in CSI and we can work together in partnership.”

He is very active now. He goes the gym four or five times a week. A year ago, when he was still in treatment he wouldn’t have been able to run around for an hour and play football, whereas it’s not really an issue for him now. Back in the days when he was using drugs he had two heart attacks and ended up in a coma. He has stopped using now and he doesn’t have to see the cardiologist anymore.

He has taken what he has learned and is putting that towards helping others.

“I had a lad yesterday who has been struggling. He has just had all his benefits stopped. He saw me in town and he said, can I have a word. I didn’t know about all the financial side, but I took him along to Inspire and they are going to help him with all his benefits and stuff. It took half an hour out of my day, but it’s nothing.”

He describes how the project has connected him to other people.

I meet new people all time. We have a good laugh. We chat all the time. We have a Facebook group.

He says that he is learning all the time: learning new skills and learning how to deal with different situations. He is volunteering for between 15-20 hours a week.

‘I am happy to give up my spare time. For me it’s not a chore, you know, I just enjoy it. Lads come up to me all the time. They see me as really approachable. And if it’s not my area I know where I can sign-post them too. You know, different agencies and stuff, which is something else that I have learnt. I know who to speak to for whatever situation they may be in. And if they are a bit wary, I go with them, you know, cos it can be quite daunting sometimes…if you’ve got a substance misuse problem and you don’t know where to go.’

In the future he would like to develop his skills further. He is thinking about undertaking a football or fitness coaching course. He wants to broaden his horizons further and develop and use his skills to help others in the community.

Case study two is male in his late 40’s.

He became involved in CSI virtually as soon as it started up in Preston, about three years ago. He has been involved in lots of activities, including rock climbing, rounders, football, badminton and swimming, plus many others that he can’t remember. Rock climbing holds a special place for him

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because he has been able to do this with his son, from whom he had become estranged. Rock climbing has enabled him to re-connect and build a new relationship with him.

He describes how important the CSI worker was in encouraging him to get involved:

“The worker was easy to talk to and that. And we just got on. He just kept coming up and letting people know what was going on.”

Like the person in case study one, he describes how important it was that he could connect with people who he saw as ‘like him’.

“It was just being included and encouraged by CSI that did. At first I had to sit out every now and then and take a rest. But I got loads of encouragement. I was always encouraged by the people who were running the events. They are always encouraging you and allowing you to do things and that. They’d say, you’re doing really well. You’re not too bad for an old man. I get called the old grandad (laughs) because of my age and stuff like that, but that’s just part of the football banter. I kept coming back and slowly the levels and came up.

X (names worker) runs the football sessions and any problems now, I can just go and talk to him…have a chat with him. He will always point me in the right direction. And Y (names another worker), I know she is just at the end of a phone call. I can speak to her.

Meeting up with other people is important. It motivates you. You know, we all have those days when we don’t want to get out of bed or do anything. But you know you will meet other people and you don’t want to let them down and stuff. That’s what got me here. If you are feeling a bit fed up, everyone is quick to identify if someone is a bit low and they give you a lift.”

Having been involved for so long he was approached by the project staff who encouraged him to start volunteering. He has recently organised a number of rounders sessions over the summer.

He says that he wants to get more involved and give back.

“You know, because I have benefited, my mental health and all that, it is good to watch others grow. I have seen so many lads coming through. It’s brilliant. I would like to get more involved in coaching. Doing a few training sessions and stuff like that. I am always game for trying something new. I had never tried rock climbing before.”

He reflects back thoughtfully on his recovery journey, which began more than five years ago.

“It seems like a whole life that I packed in. I am not drinking any more. My lad has noticed a huge improvement in me and we spend time together now. He can see me turning in to a real Dad now. He would say that I am more honest, more open. He would say I’ve got more friends. When I was married and drinking I only had a couple of friends. Now I’ve got loads. And they are based all over the place. Because we travel around with the sport, they are all over the place. CSI has given me something to aim for. It has helped me not to pick up a drink or anything, cos I know that if I started to pick it up, I wouldn’t have all this….my football friends, rock climbing. It is all too special to me now.

When I started out in treatment I thought I wouldn’t be able to hack it [getting involved in

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sport]. Especially at my age and with my alcohol addiction. I thought, no, I am too far gone and that. But I have surprised myself with running up and down the pitch and that. And with doing other sports as well, it’s all good. I am building my fitness levels back up, which I thought I had lost. I can do 8 or 9 hours a week now….with football, rock climbing, swimming. It’s amazing. Going from zero to 8 or 9 hours.”

Case study three is male in his early 20’s.

He has been involved with CSI for about 14 months. He does kick boxing, football, snooker and pool and the gym. He says that before he got involved with CSI he wasn’t really doing anything, apart from taking drugs. He was in rehab when he first found out about CSI. One of his friends had got involved in the football and he encouraged him to come along too. He is doing activities about four times a week now. He is sure that without CSI he would have relapsed.

“If I wasn’t involved in CSI I would have relapsed, that’s a given. I have got friends here, who genuinely are my friends. They don’t want anything off me, apart from my well-being. It has saved my life.”

He describes how CSI has helped him to turn his life around.

“Everything has changed. Me and my partner split up and I came to a moral decision that I needed to change. I went in to rehab. When I came out of rehab, although I wasn’t physically taking anything my head was still in addiction. I needed something to do to help with that. That’s where CSI came in. Initially I started with the football, but then I just jumped on to everything. I don’t take drugs any more. I don’t drink any more. I am active all the time. We have a little boy and although we are not together I can see him. I used to isolate myself a lot. Now I don’t. I am out and about. I have people that I see. These are the sorts of things that I have got from CSI. You can’t ask for a better bunch of people around you.”

He goes on to describe how the structure of the activities has helped him.

“It is a big part of everyone’s lives now. What I do now, I can set the day out around the activities. You know, you can plan around it. Like Monday’s….Monday’s are probably one of my most productive days. ‘Cos I do football 1-2, then again 4-5. Then I do snooker and pool. It’s a really productive day. Then Tuesday, I know what I am doing on Tuesday because of the activities. It gives me structure. People should give it a go. Especially if they are a bit isolated or a bit lonely because they are the nicest bunch of people you could ever meet. It gives me connections and gets me active. It gives me confidence and self-esteem.”

He is looking forward to continuing his role as a father. He hopes that in the future he might be able to get a job. He recently started volunteering for CSI.

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Case study four is a female in her 40’s

She begins by describing how she had been on a methadone script for 12 years. She says that she was stuck in services. She didn’t want to engage with anybody and didn’t want to engage with services. She thought that she would stay on a script until she died. She didn’t want to come off it, she said, she was scared.

She says that it was CSI that changed her whole perspective on things and made her feel worthy.She felt worthless before.

“I wouldn’t go to any of the CSI groups at first because I thought I was rubbish at sport and stuff. But [names worker] encouraged me to go. I was in my own isolated bubble. And it was CSI that opened the doors for many other things. It made me have a sense of belonging and that I wasn’t rubbish. I started to make friends. and went along to lots of sessions and started meeting new people. And I started to see that actually there is a way out because this person has done it and this person has done it.”

She says that she always felt resentful when she was in services because she didn’t want to be there.

“It was all cloak and dagger and I was like covering it all up. I didn’t want to engage in services because they were always threatening to take your script away if you didn’t do this or didn’t do that. And CSI was nothing like that.”

Case study five is a female in her 40’s

She describes how she had spent a long period of time on a psychiatric unit. She says she was an alcoholic. She felt like she didn’t have a place in life and didn’t have any value.

My confidence was so low. CSI gave me that confidence. That somebody believed in me and that helped build my own confidence.

She described how her growing confidence helped her to find work. It also helped her to deal with other things in her life.

I was strong enough to deal with other stuff that was going on…like other relationships that I had found very difficult to deal with.

She saw how her growing strength and confidence meant that she began to be seen as a role model. This changed her perspective of herself as an addict as well.

I thought I was the lowest of the low because that is what people told me. And it’s developed from there really. I can see how the value placed in me has helped me. And I can see how that sense of being valued has helped other people too.

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Discussion

It is clear that the project has been successful at attracting and retaining participants and that those participants who were retained, even for three months, were active more often and at higher levels. These outcomes were sustained and built upon for participants who were retained for six or twelve months.

CSI has successfully overcome many of the challenges and barriers to engagement that projects with similar aims and objectives have faced (O’Brien et al., 2010). There is evidence that the project has achieved success through each of Coalter’s (2007) mechanisms: that is, through the fertiliser, car wash and guardian angel effects. Participants report improvements in overall well-being, confidence and fitness. Participants have found structure and discipline in their lives and show increased levels of engagement in a range of socially acceptable activities (including sport, employment and volunteering) (Coakley, 2011).

The proportion of participants not working at all fell from 54.3% (n=1337) to 39.8% (n=297) and the project achieved an increase in the number of participants in part-time work and volunteering (from 14.7%: n=362 to 34.8%: n=262).

The project has also had a wider impact in building recovery capital by encouraging and facilitating contact between participants and Lancashire User Forum, providing a structure for users in recovery and putting such people in touch with other people who they recognised as ‘like them’ and who they could see were doing well. Such ‘visible recovery’ has long been recognised as a significant factor in promoting and sustaining positive change for problematic drug and alcohol users (Maunders, 2013).

That the project has achieved success in a number of ways is beyond doubt. The data thus far has shed only limited light on what might be some of the reasons for the projects’ success however.

In order to try to answer this question a focus group was held with project support workers and volunteers. They identified a number of factors, but key amongst them was the role of the support workers and, through this, the focus that the project had on building relationships with people. As one support worker put it:

“We are all about the people and the connections. Making people welcome. Many organisations are focussed on gathering evidence for this and that and are all about achieving certain targets. People end up getting lost and passed from pillar to post. For us, the outcomes are almost secondary. What comes first is the person. People come back to us because they can relate to us.”

Developing this thought further another project worker said:

“It’s all about our lived experiences. People have been through the same thing. There is a high level of identification with us and the participants. I always give a bit of myself away to people when I go and speak to them. They can see that we human. We have all been part of CSI. We know that it works from our own experience. We share the same language.”

The workers and volunteers agreed that they were all passionate about the project.

We have all seen it working and we convey that. Everyone is so enthusiastic about the project. People believe in us. Service users and services.

Support workers played a critical role in reaching out to participants, giving encouragement and facilitating project activities. They also acted as a source of advice and support for participants

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experiencing problems and were often able to help participants sort problems out or sign-post them in to other services.

Buffin (2014) supports this. In an evaluation of the CSI pilot project he pointed out the personal approach was critical: participants said that they had been encouraged to attend the sessions because someone had spoken to them personally about it. The role of the support workers was critical here:

“I had seen the posters around, but it was when I heard other people in recovery talking about it that I decided to give it a go”

If the role of the support workers and volunteers in giving the project a personal touch is important, it is crucial to acknowledge the importance of the infra-structure that sat behind this. CSI employed a full-time project co-ordinator, whose role extended far beyond simply co-ordinating the day-to-day activities of the team. Her role was critical in providing both practical and emotional support to the team around a wide variety of issues. Many of the volunteers and support workers had not worked before and needed high levels of support to enable them to grow and develop in their new roles. This might extend from something as basic as being able to log on to a computer or knowing that it was important to ring up and tell someone if they were going to be off sick, through to helping someone deal with complex welfare benefit difficulties, family problems or full blown relapses.

Another significant factor in the success of the project was thought to be the fact that the sessions were made fun and that no one was put under pressure.

There is a relaxed atmosphere. There is no expectation that people will be the best. It is just about turning up, giving it a go and making friends with people like you.

The team also thought that the simple and open referral process was important.

“People can just turn up. There are no restrictions. No hoops to jump through. We keep it all very simple.”

In evaluating the pilot project, Buffin (2014) suggested that the project works most effectively as part of a broader recovery programme. Wider connections and links to other activities and programmes that also support recovery are extremely important. Of equal significance, he suggests, is the organic and flexible nature of the programme (Buffin, 2014). It needs time to develop and grow. Attendance at sessions can fluctuate week by week, particularly in the early stages, and one session can often act as the gateway to others. It is important that sessions are made fun and that participants can dip and out of activities and have the freedom to try something new without feeling under pressure to continue.

Other critical success factors appear to have been the ability to link in with existing recovery communities:

“Being able to engage with service users has been important. You know, having access and knowing the key services to go to and build links with. I have been a part of the community, so that being known by a lot of people, I have got that visible track record in recovery myself”

The provision of inclusive activities that are open to the families of people in recovery and the provision of free events has also important.

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Recommendations

The costs of drug and alcohol misuse are difficult to estimate because of the range of impacts. Drug and alcohol misuse can cause a wide range of harms to the individual, those close to them, and wider society. These include impacts on physical and mental health, unemployment, homelessness and criminal activity (Barber, Harker and Pratt, 2017). In 2011 the Home Office estimated the total annual cost of illicit drug use in United Kingdom to be in the region of £10.7bn. The cost of alcohol related harm is thought to be £21.5bn (PHE, 2018). There were 2,592 drug misuse deaths involving illegal drugs in England and Wales in 2016 (Barber, Harker and Pratt, 2017).

Given the project outcomes, commissioners should continue to invest in CSI, which represents good value for money.

The project workers and volunteers had a number of ideas for how the project could be improved however and these should be considered in any the future developments. Beyond simply having more resources so that they could have more support workers and run more sessions with more people in more venues the team suggested the following:

That the project could benefit from having a more structured progression route. All of the project workers and volunteers could point to individuals who they knew had gone on to undertake a volunteering role or who had gone on to either full or part-time employment. The statistical data from the project supports this and indicates that some very successful outcomes have been achieved. The project team could see the benefits of developing a formal partnership with either an employment training service or perhaps with an employment agency so that progression could be built more formally in to the project as and when participants were ready. As it is, much had been achieved, but this had often been done by the project team without having much knowledge or skills in the area.

That more resources be put in to the evaluation. Project staff and volunteers complained that completing the questionnaires had been time-consuming and had detracted from the time that they had to facilitate activities and attend to participant needs. They would have liked a team of specialist people to come in and collect the data, rather than rely on the project staff and volunteers. The team also felt that many of the questions in the IPAQ tool had been difficult to explain to participants and said they would like to see a simpler tool developed for any future evaluation.

A third recommendation related to communications and better marketing. The team felt that they had not made the most of their achievements and that they could have done more to showcase what they were doing and what they were achieving to the outside world. This, they felt, might have helped to reduce some of the on-going stigma surrounding substance misuse and recovery as well as help to ensure more sustainable funding of the project.

A forth recommendation concerned the provision of a better infrastructure for the project. Although the project had a central base and hub, many of the workers and volunteers worked out in the community. Many were reliant on partner organisations to provide them with access to office space or access to a computer. While some organisations were welcoming and opened their doors, embracing all that CSI had to offer, others were not so forth-coming. More structured partnership arrangements with clearer expectations and service level agreements was one suggestion for how this might have been addressed.

A final recommendation was that the project broadens its focus out beyond substance misuse. The project team recognised how a number of other groups might also have been able to benefit

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from the project had the project been open to and targeted at them. People with mental health problems and the long-term unemployed were just two of the groups who the team mentioned.

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http://www.ipaq.ki.se/

Appendix 1

Copy of data collection tools

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CSI Participant Registration Form This form is to be completed by all participants. It is for our internal use only and used to record results of the project, which is funded by Sport England. The information you provide will not be shared with anyone outside of the delivery, evaluation or reporting of the project. Please tick here if you are not happy for us to share this information with our partners on the programme (e.g. Red Rose Recovery, University of Central Lancashire, National Governing Bodies). ☐ Please complete all the questions below and write clearly in the spaces provided.

Your Personal Details

Q1. What is your name? Surname: ______________________ Forename: _________________________

Q2. What is your email address: ________________________________________

Q3. What is your mobile Number: ______________________________________

Q4. Are you male or female? (Please tick one) Male ☐ Female ☐ Other ☐Q5. Date of Birth: _____ /_____ /______

Q6. What is your current address? ___________________________________________ Postcode: _________

☐Living in own home or rented ☐Living with parents ☐Homeless ☐Hospital ☐

Living in hostel/ sheltered accommodation ☐ Staying with friends or relatives

Q7. Where have you been referred to the programme from? Please circle one of the below.

Inspire/CGL RRR Discover Horizon Thomas Project JFH Young People Services

Housing Agency NHS The Well Family/Friend Other – please state: ________________

Q8. Have you attended a Lancashire User Forum (LUF) meeting in the last 6 months? ☐ Yes ☐ No

Q9. Which ethnic group do you consider yourself to belong to? (Please tick ONE below)

White

☐ English/Welsh/Scottish/Northern Irish/British ☐ Irish ☐ Gypsy/ Irish Traveller

☐ Any other white background, please describe ______________________________________

Mixed/Multiple ethnic groups

☐White and Black Caribbean ☐ White and Black African ☐ White and Asian

☐ Any other Mixed/Multiple ethnic background, please describe _________________________

Asian/Asian British

☐ Indian ☐ Pakistani ☐ Bangladeshi ☐ Chinese

☐ Any other Asian background, please describe ______________________________________

Black/ African/Caribbean/Black British

☐ African ☐ Caribbean

☐ Any other Black/African/Caribbean background, please describe ______________________

Other ethnic group

☐ Arab ☐ Any other ethnic group, please describe ______________________________________

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☐ LSP CHECK – Dated……………. ☐ VIEWS ☐ UCLAN

Form completed by CSI………………………………………..(Print name)

Q10. Do you consider yourself to be disabled?

By this we mean, do you have a physical or mental impairment (other than addiction to non–prescribed drugs or alcohol) that has a ‘substantial’ (i.e. more than minor or trivial) and ‘long-term’ (i.e. 12 months or more) negative effect on your ability to do normal daily activities. ☐ Yes ☐ No ☐ Prefer not to say

Medical Details and Emergency Contact Details

Q11. Do you have any illness, health problem or disability that limits your ability to join in any activity? ☐Yes☐No Are you substance misuse dependant? ☐Drugs ☐Alcohol ☐None

Relevant medical Information: _______________________________________________________________ ______________________________________________________________________________________________Please include any allergies/injury problems

Emergency Contact Name:____________________________________

Phone Number: ______________________________ Relationship to you: ______________________________

I have completed the medical details above and I consent that in the event of any illness/accident, any necessary treatment can be administered, which may include the use of anaesthetics. ☐

Q12. Which of these statements best describes you (tick one)

☐ I left school without any qualifications ☐ I left school with between 1 and 4 GCSE’s/CSE’s/’O’-levels☐ I left school with 5 or more GCSE’s/CSE’s/’O’-levels☐ After school, I went on to college to do either ‘A’-levels or some kind of training course (including apprenticeships)☐ I went on to study at either a university or a polytechnic

Q13. Which of these statements best describes you:

☐ I am employed full time (30+ hours per week) ☐ I am employed part time (under 30 hours)☐ I am unemployed/not working at all ☐ I am a full time student☐ I am a part-time student ☐ I am undertaking some voluntary work ☐ I am retired

PHOTOGRAPHY/FILMING – There may be filming and photography at some CSI activities which may be used in publicity materials e.g. leaflets, newsletters or on official websites. Lancashire Sport advises all activity providers to ensure that images are not accompanied by names or details however it may be possible that those viewing the film or photography may recognise you.Please tick here if you DO NOT give permission to be filmed or photographed during CSI activities. ☐I accept that there are some elements of risks involved when taking part in any of the CSI activities. I have been fully informed of the risks involved and I agree that Lancashire Sport Partnership do not accept any liability for any injury caused.

I agree to represent CSI to the best of my ability and to respect and treat everyone equally & fair. I will not use inappropriate language or behaviour nor will I consume any alcohol or drugs of any kind whilst attending the activity. I do understand that if I fail to adhere to this I will be asked to leave the session.

IMPORTANT! Must sign. Signature: ____________________________ Date: __________________________

International Physical Activity Questionnaire

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We are interested in finding out about the kinds of physical activities that people do as part of their everyday lives. Please answer each question even if you do not consider yourself to be an active person. Please think about the activities you do at work, as part of your work, around the house or garden, to get from place to place, and in your spare time for recreation, exercise or sport. You are not expected to have done any activity prior to attending your first CSI session.

Q1. In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job.

Circle number 0 1 2 3 4 5 6 7

Q2. Think about all the vigorous activities that you did in the last 7 days. (Vigorous activities take hard physical effort and make you breathe much harder than normal so you can’t talk) Think only about those vigorous physical activities that you did for at least 10 minutes at a time.

During the last 7 days on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, fast bicycling etc?


☐ No vigorous physical activities – skip to Q4

Q3. How much time did you usually spend doing vigorous physical activities on one of those days?

______ hours per day / _______ minutes per day

Q4. Think about all the moderate activities that you did in the last 7 days. (Moderate activities take moderate physical effort and make you breathe somewhat harder than normal) Think only about those vigorous physical activities that you did for at least 10 minutes at a time.

During the last 7 days on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, playing doubles tennis etc? Do not include walking.


☐ No moderate physical activities – skip to Q6

Q5. How much time did you usually spend doing moderate physical activities on one of those days?


Q6. Think about the time you spent walking in the last 7 days. This includes at work, at home, to travel from place to place or any other walking that you might do for recreation, sport, exercise or leisure.

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During the last 7 days, on how many days did you walk for at least 10 minutes at a time?


☐ No walking activities – skip to Q8

Q7. How much time did you usually spend walking on one of those days?


Q8. Think about any sport that you have done in the last 7 days. (Sport is any competitive or non-competitive sporting activity including sessions of deliberate exercise such as running or jogging) Think only about those sport activities that you did for at least 10 minutes at a time.

During the last 7 days, on how many days did you take part in any sport?


☐ No sport – skip to Q10

Q9. How much time did you usually spend doing sport on one of those days?


Q10. The question is about the time you spent sitting on days during the last 7 days. Include time spent at work, at home, while doing courses work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading or sitting or lying down to watch tv.

During the last 7 days, how much time did you spend sitting on a weekday?


Please imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder represents the best possible life for you and the bottom represents the worst possible life for you. If the top is 10 and the bottom is 0, on which step of the ladder do you feel you personally stand at the present time? (Place a line through a step on the ladder).

Please tell us about any other activities you would be interested in participating in:

……………………………………………………………………………………………………………………………

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0 1 2 3 4 5 6 7 8 9 10

CSI Follow up Participation Form Thank you for signing up to CSI. It’s great to have you on board and we hope you are enjoying and benefiting from being part of this exciting project. Part of the project requests that a follow up form is completed every 3, 6 and 12 months. You are being asked to complete a follow up form because you have successfully been with the project for 3 months or more! Well done, brilliant achievement.CSI is designed to support you on your road to recovery by helping you to adopt a more active and healthier lifestyle – supporting the five steps to well-being. Those involved have reported developing confidence, self-esteem, feeling fitter and making friends! We know that it can be difficult sometimes for people to attend activities on a regular basis but without you we will struggle to make the case for sport and physical activity becoming an important part of the recovery process. This is your programme and needs to meet your needs – so please feedback to us anything you like or dislike about the activities. If you need some support/motivation to keep going, do talk to your Support Workers – they are happy to help.

Together we can make CSI a real success story!Together we can make YOU a real success story!

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CSI Participant Follow Up Form

This form is to be completed by all participants at 3 months, 6 months and 12 months follow up. It is for our internal use only and used to record results of the project, which is funded by Sport England. The information you provide will not be shared with anyone outside of the delivery, evaluation or reporting of the project. Please tick here if you are NOT happy for us to share this information with our partners on the programme (e.g. Red Rose Recovery, University of Central Lancashire, and National Governing Bodies). ☐ Please complete all the questions below and write clearly in the spaces provided.

Your Personal Details

Q1. What is your name? Surname: ______________________ Forename: _________________________

Q2. Are you male or female? (Please tick one) Male ☐ Female ☐ Other ☐

Q3. Date of Birth: _____ /_____ /______ ☐U16

Q4. What is your current address if you have moved in the last 3 months?

___________________________________________________________________________ Postcode: __________

☐Living in own home or rented ☐Living with parents ☐Homeless ☐Hospital ☐ Living in

hostel/ sheltered accommodation ☐ Staying with friends or relatives

Q5. Have you attended a Lancashire User Forum (LUF) meeting in the last 6 months? ☐ Yes ☐ No

Q6. What agencies are you linked to? Please circle one of the below.

Inspire/CGL RRR Discover Horizon Thomas Project JFH Young People Services

Housing Agency NHS The Well Family/Friend Other – please state: ________________

Q7. Which of these statements best describes you:

☐ I am employed full time (30+ hours per week) ☐ I am employed part time (under 30 hours)

☐ I am unemployed/not working at all ☐ I am a full time student

☐ I am a part-time student ☐ I am undertaking some voluntary work ☐ I am retired

Signature: ____________________________ Date: ___________________________

International Physical Activity Questionnaire

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☐ LSP CHECK – Dated……………. ☐ VIEWS ☐ UCLAN

☐ Telephone ☐ In person ☐ No Contact made

☐ 3 month ☐ 6 month ☐ 12 month

Form completed by CSI………………………………………..(Print name)

)

Notes:

We are interested in finding out about the kinds of physical activities that people do as part of their everyday lives. Please answer each question even if you do not consider yourself to be an active person. Please think about the activities you do at work, as part of your work, around the house or garden, to get from place to place, and in your spare time for recreation, exercise or sport.



For the next questions, please think about the activities you do at work, as part of your work, around the house or garden, to get from place to place, and in your spare time for recreation, exercise or sport.

Q2. Think about all the vigorous activities that you may have done in the last 7 days. Think only about those vigorous physical activities that you did for at least 10 minutes at a time that made you breathe really heavy and work very hard.

During the last 7 days on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, fast bicycling etc?


☐ No vigorous physical activities – skip to Q4

Q3. How much time did you usually spend doing vigorous physical activities on one of those days?


Q4. Think about all the moderate activities that you did in the last 7 days. Think only about those vigorous physical activities that you did for at least 10 minutes at a time that made you breathe harder than normal and had to put a bit more effort in.

During the last 7 days on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, playing doubles tennis etc? Do not include walking.


☐ No moderate physical activities – skip to Q6

Q5. How much time did you usually spend doing moderate physical activities on one of those days?


Q6. Think about the time you spent walking in the last 7 days. This includes at work, at home, to the shop, to travel from place to place or any other walking that you might do for recreation, sport, exercise or leisure.

44

During the last 7 days, on how many days did you walk for at least 10 minutes at a time?


☐ No walking activities – skip to Q8

Q7. How much time did you usually spend walking on one of those days?


Q8. Think about any sport that you have done in the last 7 days. (Sport is any competitive or non-competitive sporting activity including sessions of deliberate exercise such as running or jogging) Think only about those sport activities that you did for at least 10 minutes at a time.

During the last 7 days, on how many days did you take part in any sport?


☐ No sport – skip to Q10

Q9. How much time did you usually spend doing sport on one of those days?


Q10. The question is about the time you spent sitting on days during the last 7 days. Include time spent at work, at home, while doing courses work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading or sitting or lying down to watch T.V.

During the last 7 days, how much time did you spend sitting on a weekday?


Please imagine a ladder with steps numbered from zero at the bottom to ten at the top. The top of the ladder represents the best possible life for you and the bottom represents the worst possible life for you. If the top is 10 and the bottom is 0, on which step of the ladder do you feel you personally stand at the present time? (Place a line through a step on the ladder).

Please tell us about any other activities you would be interested in participating in:

……………………………………………………………………………………………………………………………..

45

0 1 2 3 4 5 6 7 8 9 10

Appendix 2

Short survey to check participants understanding of IPAQ at baseline

46

Activity levels before becoming involved with CSIGuidelines prior to completion:

Support worker to take a copy of the registration form originally completed by the participant to show original answer given.

Support worker to explain question Q1 to participant (see below).



Participants name.................................................................................. Original answer (Q1)………………

Q1. Did you do any physically activity before you started with CSI that was enough to raise your breathing rate?

Q2. Did you understand the activity level question (Q1) on the registration form when you originally completed it?

Q3. If you were NOT active but said you were, why do you think you gave this answer? Did you know why you were being asked this question?

Q4. If you could complete your registration form again when starting CSI would you give a different answer? What would this be?

In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk

47

walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job.


Appendix 3

Whole Cohort Data

48

Jul-15

Sep-15Nov-1

5Jan-16

Mar-16

May-16

Jul-16

Sep-16Nov-1

6Jan-17

Mar-17

May-17

Jul-17

Sep-17Nov-1

7Jan-18

Mar-18

May-18

Missing

0

20

40

60

80

100

120

140

160

Figure: 4 Number of participants registered and followed up each month


Blackpool

Lancaster

Hyndburn

Leyland

Presto

n

Burnley

Blackburn

Accrington

Chorle

y

Wymott

Other0%

5%

10%

15%

20%

25%


49

<16 17-18 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 >600%

2%

4%

6%

8%

10%

12%

14%

16%

18%


Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%



10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


50

Yes No0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 9: Whether participants reported having a disability when they registered n = 2214/2628


5%

10%

15%

20%

25%

30%

35%

40%

45%


51

10%

10%

20%

30%

40%

50%

60%

70%

80%




10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


low up


Own homeParents

Homeless

Hostel/s

heltered

Friends/r

ealtivesPriso

nOther

0%

10%

20%

30%

40%

50%

60%

70%



52

Employed FT

Employed PT

Not workin

g

Student FT

Student PT

Voluntary work

RetiredCarer

Emp'd/Educ'n (P

rison)

0%

10%

20%

30%

40%

50%

60%




10%

20%

30%

40%

50%

60%

70%

80%

90%


Active Not active

53


10%

20%

30%

40%

50%

60%


Low Medium High


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 17: Whether participants had taken part in sport in the last 7 days at registration and follow up

Yes No

54


5%

10%

15%

20%

25%

30%

Figure 18: Overall wellbeing score of participants at regis-tration and follow up using Cantril ladder


55

Appendix 4

Outcomes data for three sub-groups:

Participants who has low levels of activity at baseline (n=934);

Participants who had moderate levels of activity at baseline (n=754); and

Participants who high levels of activity at baseline (n=767)

56

Low (934) Moderate (753) High (767)0%

10%

20%

30%

40%

50%

60%

70%

80%

Figure 19: Gender of participants with low, moderate and high activity levels when they registered at baseline(n=2544)

Male Female

<16 17-18 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 >600%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Figure 20: Age of participants with low, moderate and high activity levels when they registered at baseline (n=2451)

Low (934) Moderate (751) High (766)

57

Own home

Parents

Homeless

Hostel/s

heltered

Friends/r

ealtivesPri

sonOther

0%

10%

20%

30%

40%

50%

60%

70%

80%

Figure 21: Housing status for people who had low activity levels when they registered at baseline and follow up

Reg (921) 3m (309) 6m (329) 12m (229)

Own home

Parents

Homeless

Hostel/s

heltered

Friends/r

ealtivesPri

sonOther

0%

10%

20%

30%

40%

50%

60%

70%

Figure 22: Housing status for people who had moderate activity levels when they registered at baseline and follow up

Reg (745) 3m (307) 6m (316) 12m (221)

Own home

Parents

Homeless

Hostel/s

heltered

Friends/r

ealtivesPri

sonOther

0%

10%

20%

30%

40%

50%

60%

70%

Figure 23: Housing status for people who had low activity levels when they registered at baseline and follow up

Reg (759) 3m (307) 6m (347) 12m (253)

58

Reg (877) 3m (296) 6m (317) 12m (227)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Figure 24: Whether participants with low activity levels at baseline had been in contact with Lancashire User Forum in the last 6 months at regis-

tration and follow up

Yes No Series3

Reg (720) 3m (304) 6m (323) 12m (223)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 25: Whether participants with moderate activity levels at baseline had been in contact with Lancashire User Forum in the last 6 months at

registration and follow up

Yes No Series3

Reg (719) 3m (274) 6m (352) 12m (257)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 26: Whetherparticipants with high activity levels at baseline had been in contact with Lancashire User Forum in the last 6 months at regis-

tration and follow up

Yes No Series3

59

Emplo

yed FT

Employed PT

Not worki

ng

Student FT

Stude

nt PT

Voluntary

workRetired

Carer

Emplo

yed/ed (Pris

on)0%

10%

20%

30%

40%

50%

60%

70%

Figure 27: Employment status for participants with low activity levels when they registered at baseline and follow up

Reg (916) 3m (317) 6m (329) 12m (232)

Emplo

yed FT

Employed PT

Not worki

ng

Student FT

Stude

nt PT

Voluntary

workRetired

Carer

Emplo

yed/ed (Pris

on)0%

10%

20%

30%

40%

50%

60%

70%

Figure 28: Employment status for participants with moderate activity levels when they registered at baseline and follow up

Reg (744) 3m (317) 6m (327) 12m (234)

Emplo

yed FT

Employed PT

Not worki

ng

Student FT

Stude

nt PT

Voluntary

workRetired

Carer

Emplo

yed/ed (Pris

on)0%

10%

20%

30%

40%

50%

60%

Figure 29: Employment status for participants with high activity levels when they registered at baseline and follow up

Reg (758) 3m (317) 6m (359) 12m (262)

60

Low Mod High0%

10%

20%

30%

40%

50%

60%

Figure 30: Level of activity for participants who had low activity levels at baseline (n=934) at 3, 6 and 12 months

3m (319) 6m (333) 12m (229)

Low Mod High0%

10%

20%

30%

40%

50%

60%

Figure 31: Level of activity for particcpants who had moderate activity levels at baseline (n=754) at 3, 6 and 12 months

3m (315) 6m (329) 12m (236)

Low Mod High0%

10%

20%

30%

40%

50%

60%

70%

Figure 32: Level of activity for participants who had high levels of activity at baselne (n=767) at 3, 6 and 12 months

3m (319) 6m (359) 12m (262)

61

Reg (930) 3m (321) 6m (334) 12m (231)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Figure 33: Whether participants with low levels of activity when they registered were classified as active at baseline and follow up

Yes No

Reg (753) 3m (317) 6m (332) 12m (236)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Figure 34: Whether participants with moderate levels of activity when they registered were classified as active at baseline and follow up

Yes No

62

Reg (767) 3m (319) 6m (364) 12m (264)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 35: Whether participants with high levels of activity when they registered were classified as active at baseline and follow up

Yes No

Reg (917) 3m (321) 6m (332) 12m (232)0%

10%20%30%40%50%60%70%80%90%

100%

Figure 36: Proportion of participants who had low activity levels at baseline who have participated in sport in the last 7 days at registration

and follow up

Yes No

63

Reg (747) 3m (316) 6m (330) 12m (235)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 37: Proportion of participants who had moderate activity levels at baseline who have participated in sport in the last 7 days at registration

and follow up

Yes No

Reg (747) 3m (316) 6m (330) 12m (235)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 38: Proportion of participants who had moderate activity levels at baseline who have participated in sport in the last 7 days at registration

and follow up

Yes No

64


5%

10%

15%

20%

25%

30%

Figure 39: Overall wellbeing score for participants with low activity levels at baseline at registration and follow up using Cantril ladder

Reg (859) 3m (321) 6m (327) 12m (228)


5%

10%

15%

20%

25%

30%

35%

Figure 40: Overall wellbeing score for participants with moderate activity levels at baseline at registration and follow up using Cantril ladder

Reg (725) 3m (314) 6m (329) 12m (233)


5%

10%

15%

20%

25%

30%

Figure 41: Overall wellbeing score for participants with high activity levels at baseline at registration and follow up using Cantril ladder

Reg (738) 3m (316) 6m (361) 12m (263)

65

Appendix 5

Outcomes data participants who were successfully followed up at 12 months

66

Jul-15

Sep-15Nov-1

5Jan-16

Mar-16

May-16

Jul-16

Sep-16Nov-1

6Jan-17

Mar-17

May-17

Jul-17

Sep-17Nov-1

7Jan-18

Mar-18

May-18

Missing

0%

2%

4%

6%

8%

10%

12%

Figure 42: Percentage of partcipants registered and followed up each month


Blackpool

Lanca

ster

Hyndburn

Leyla

nd

Preston

Burnley

Blackburn

Accrington

Chorley

Wym

ottOther

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%


67

Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%


<16 17-18 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 >600%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%



10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


68

Yes No0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 47: Whether participants reported having a disability when they registered n = 688/753

10%

10%

20%

30%

40%

50%

60%

70%

80%




5%

10%

15%

20%

25%

30%

35%

40%

45%


69

Own home

Parents

Homeless

Hostel/s

heltered

Friends/r

ealtivesPris

onOther

0%

10%

20%

30%

40%

50%

60%

70%




10%

20%

30%

40%

50%

60%

70%

80%

90%


low up


Employed FT

Employed PT

Not worki

ng

Student FT

Student PT

Voluntary work

RetiredCarer

Emp'd/Educ'n

(Pris

on)0%

10%

20%

30%

40%

50%

60%



70


10%

20%

30%

40%

50%

60%

70%

80%

90%


Active Not active


10%

20%

30%

40%

50%

60%


Low Medium High


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Figure 55: Whether participnats had taken part in sport in the last 7 days at registration and follow up

Yes No

71


5%

10%

15%

20%

25%

30%

Figure 56: Overall wellbeing score for partcipants registration and follow up using Cantril ladder


72

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