A Realist Evaluation of a Voluntary Sector Drop In Service for Veterans

Abstract: Objectives: How best to support veterans is a key question for service providers and policy makers.
The objectives of the current study were to evaluate a drop in service for veterans delivered by veterans, in terms of effectiveness and cost-utility. Design: A realist evaluation was used to evaluate the drop in service. Realist evaluations seek to understand what works for whom and in what context, and are traditionally mixed method. Methods: The realist evaluation comprised three Work Packages. Work Package 1 involved the development of the programme theory, based on stakeholder interviews, current evidence base, and organisation documentation. Work Package 2 was a retrospective study and included; a retrospective analysis of the service’s dataset of CORE outcomes, one-to-one interviews with veterans and service providers, and a survey of past and current users. Work Package 3 was a prospective study following new users for a maximum of 6 months, which included a cost utility analysis including use of the CSRI. Results: A number of interesting themes arose from the components of the service, with each element providing vital triangulation. Two types of users emerged from the findings; those who access the service for the mental health provision and those who attend to receive practical support from attending agencies. The drop in service was seen as a safe haven, and the military-like environment acted as a core mechanism for change. Comparisons with other services, particularly NHS, were favourable. Cost utility analysis found that the service is cost-effective if improvement is maintained for one year. Conclusions: VOS represents a trusted, familiar environment that meets a range of different needs. Despite this, there are areas that require consideration. Findings suggest that one size does not fit all; what works for those who present with psychological or physical need may not work for those who present with practical or social need. What might suit the former is a quieter drop in, with formal psychological assessment, risk monitoring, and where onward referral is efficient. The power of the military-like environment comes to the fore here as a mechanism. What suits the latter is a busier drop in, with no psychological assessment, and where agencies and service users can network. Of importance to this group is the efficiency of a ‘one stop shop’. What is important for both is greater privacy afforded to them while at the drop in and, arguably, a more frequent drop in.