Understanding the impact of support provided by an eating disorder service
Having been selected as a winner of the GSK IMPACT award* in 2021 in recognition of its valuable work to support those affected by an eating disorder, SWEDA committed itself to further service development. As part of the process of being assessed for the award, SWEDA’s services and systems were scrutinised against broad criteria examining for example, how it delivers services, how it supports staff and volunteers and its partnership working. Feedback from this process reported that SWEDA was outstanding in most areas of its work, but there was one key service area that would benefit from some development; understanding, measuring and reporting its impact.
Sam, SWEDA’s Chief Operating Officer, told us:
"We needed to establish some clear, methodical data collection protocols to show our impact and understand how we were performing in terms of our therapeutic work with eating disorders"
SWEDA’s vision is to support everyone affected by eating disorders across Somerset and Wessex. The service engages with people affected by eating disorders, including those supporting a person with an eating disorder, by offering hope and enabling access to support services that empower recovery.
The charity has its head office in Shepton Mallet and due to its ever-growing service demand, SWEDA has also secured premises in Bristol, widening its reach in the Southwest. To meet demand in recent years, SWEDA has employed substantial additional staff and continues to expand.
In 2022 SWEDA celebrated 30 years of award-winning service provision.
SWEDA offers a range of support services for adults, children and young people with an eating disorder or who are concerned about someone with an eating disorder. SWEDA Therapeutic Support Workers provide:
- Counselling and eating disorder specific therapeutic interventions
- Support calls
- Support groups
Support and guidance sessions
*The GSK IMPACT Awards provide funding, training and development for charities doing excellent work to improve people’s health and wellbeing. The awards are funded by GSK and managed in partnership with The King's Fund. They are open to registered charities that are at least three years old, working in a health-related field in the UK, with a total annual income of between £150,000 and £3 million.
As part of SWEDA’s quest to design and implement a suitable outcomes measure framework, its then chairperson introduced service leads to CORC, having had experience of working with us in the past.
Nerissa, SWEDA Clinical Lead reflects:
"We had a fairly clear idea of which outcome measures we wanted to use before the process began but meeting with Lee [CORC Regional Officer] helped us to clarify our ideas and understand how we might fit the process together. It also helped us confirm that our ideas were appropriate for the data we wanted to collect".
CORC worked with SWEDA to establish a suitable outcomes development plan; this consisted of key stages:
- A workshop facilitated by CORC with SWEDA service leads to clarify and complete a Theory of Change for the service; this resulted in an agreed set of service outcomes (see below)
- A workshop facilitated by CORC with SWEDA service leads to design an outcomes framework based upon the identified outcomes; this made it clear what data was to be measured, when and how
- Data collection and capture: an 18-month period of capturing data from measures relating to support work; collating outcomes data along with available demographic data on service users, to be shared with CORC for analysis
- Data analysis: CORC analysed SWEDA’s data and produced a CORC Outcomes data report, analysing change on outcome measures
Outcomes and measures
The focus of CORC’s work with SWEDA was upon the direct support they provide to young people and adults experiencing disordered eating.
The main outcomes and corresponding outcome measures identified for the services for this group were:
Reduction in disordered eating behaviours
Eating Disorder Examination Questionnaire (EDE-Q and EDE-A)
Reducing psychological distress and improving functioning
Clinical Outcomes in Routine Evaluation CORE (CORE-OM and YP-CORE)
SWEDA’s own wheel of wellbeing measure for adult and CYP
Additionally, an Experience of Service Questionnaire (ESQ) was used to capture information on service user’s satisfaction and experience of support at SWEDA.
Analysis and reporting
The analysis and reporting showed SWEDA:
- Data from the EDE shows that, on average there, was a reduction in disordered eating between the start and end of support, for both young people and adults, and this change was statistically significant
- 82% of adults and 77% of young people recorded a reduction in psychological distress, as measured by the CORE-OM and YP-CORE
- Data from the Wheel of Wellbeing shows that, on average there, was an improvement in wellbeing between the start and end of support, for both young people and adults, and this change was statistically significant. 73% of young people and 78% of adults demonstrated improved wellbeing as measured by the Wheel of Wellbeing.
- 20-30% of young people and adults who received support completed EDE or YP-CORE questionnaires at two time points, which means that the above findings are not representative of all service users. 80% of young people and 66% of adults completed Wheel of Wellbeing questionnaires at both time points.
Clear charts, tables and commentary in the report made the findings easy to understand and interpret and suitable for sharing with a range of people.
"CORC provided us with some expert advice and reporting that has really helped us show how effective our work with people with eating disorders has been. It enables us to make better decisions about where to direct further work, how to improve what we do, and make more targeted funding applications as we grow. The information is invaluable because it comes from an independent, well-respected organisation. It supports SWEDA from all angles".
Services are naturally focused upon delivering the valuable work that they provide, and it can therefore often be a challenge for them to understand the impact this work is having on service users. SWEDA’s story is a real-world example of how a service has embarked on this process of determining, measuring, and reporting outcomes. As a result, there have been a number of benefits including:
- An improved understanding and demonstration of the impact the service has on people’s lives; robust outcomes data was able to show the proportions of service users who improved their eating disorder behaviours, psychological distress and wellbeing. The data can also be used to explore the characteristics of those service users that did not show improvement
- Informed discussions with staff about how support can be improved; the outcomes data was used to start meaningful conversations with team members about the impact that their support is having on which service users. Insights can be gained into the key ingredients of help and how this help could be improved.
- Demonstrating to service users and those that might need support, the extent to which support has helped others; reliable data can be used to show new and potential service users how SWEDA support helps people like them and what to expect.
- Evidence of impact for future fundraising efforts; outcomes data is incorporated into reports and bids to show how SWEDA helps and can be used to establish suitable performance indicators for future funded work
- Meaningful comparisons with similar services; stakeholders and funders can consider the outcomes data reported by SWEDA in relation to other similar services who report outcomes data. This aids a better understanding of how different services help people.
Paula Blight, CEO reflects on this journey:
"The report we received has been so helpful in terms of being able to quantify our impact in a language that makes sense to a whole range of stakeholders including our clients, our funders, the NHS, our trustees and other key people. We have also been able to share the results with our team which has enabled them to see the important role they are playing in supporting our clients. They can see clearly that their work has made a real, measurable difference. We are all passionate about our work with eating disorders but knowing that we are enabling change is motivating us to be better and do better if we possibly can".
We are looking forward to continuing our support for SWEDA on the next part of their journey.