The Tabor Group, a provider of residential and community-based addiction treatments in Ireland, has conducted and published the results of an external evaluation of their services.1 The Tabor Group comprises three residential units: Tabor Lodge (primary treatment centre), Fellowship House (secondary treatment centre for males) and Renewal (secondary treatment centre for females) using the Minnesota Model, as well as supported accommodation in the community. In 2017, some 213 patients were admitted to their residential unit, Tabor Lodge, for treatment as well as providing structured support for their families.

Aims/objectives and methodology

The evaluation was commissioned with the aim of assessing the effect of Tabor treatment programmes across all their facilities and to provide an independent examination of the efficacy of these programmes and the ‘goodness of fit’ of the treatment model.

The evaluation comprised both desk-based research and primary data collection. The desk-based research involved an analysis of their annual reports from the period 2013–2017. The data collection was performed in two ways: there was a qualitative data component, involving interviews and focus groups, and a quantitative data component carried out through online anonymous submissions. The data collection took place from September 2017 to June 2018.

In total, there were 58 submissions for the evaluation. This included 34 individual interviews, 7 focus group participants, and 17 individual written submissions.

Results

Desk-based analysis results

The results of the desk analysis were compiled from annual reports from 2013 to 2017 and were intended to demonstrate the similarities and differences between the three services in the Tabor Group. Treatment figures were also examined in comparison with national and European treatment numbers. Trends in demographics, referrals, service utilisation, and presentation of complex needs across the three services were compiled to examine similarities and differences between the three different services.

Qualitative results

The qualitative results combined both the results from the individual interviews and the focus groups. The qualitative analysis asked three questions across a range of service users, family members, and staff/board members. These questions were: 

• What works?
• What does not work?
• What changes would you like to see happen within Tabor Group? 

The responses to these questions were quite varied, as they were taken from significantly different viewpoints; however, certain themes and responses repeatedly emerged.

Service users were mostly satisfied with their interaction with the Tabor Group services, noting that the aftercare provided was good. However, there was a mixed response when asked about the model of treatment, often stating that it was very confrontational. The majority also felt that the 28-day treatment programme was not long enough. Another issue identified was a break in the continuum of care from the residential unit to the other two services. Clients felt that this was a vulnerable period in the treatment and not helpful.

Family members were extremely satisfied with the support services provided, stating that the services provided were comprehensive and of great value. However, a recurring issue for family members was the financial barrier to treatment.

Staff responses to the interviews/surveys indicated that perhaps they were undervalued as part of the wider organisation. They also felt that the administration elements are particularly time-consuming and therefore impacted on their clinical time. Staff felt that the Tabor Group has a particularly good reputation; however, they had concerns that the three components of the Tabor Group are seen as separate services, rather than a collective organisation.

Recommendations

As a result of the external evaluation, particular issues/areas have been identified. A number of recommendations have been suggested for consideration, particularly in the following areas: 

• Strategic management and governance: Some of these issues include the advice that the board should provide leadership for the direction of the organisation. The senior management team could be restructured to improve equality between the three groups. There is a need to improve the communication that financial assistance is available through the Health Service Executive, as well as developing a communication strategy.
• Staffing issues: The findings of the evaluation report should be communicated to staff in a series of meetings to discuss results. Staff members should have a review of their training needs and the clinical director should follow up that annual staff appraisals are conducted.
• Programme issues: As a number of clients raised concerns about the confrontational counselling practice, known as the ‘hot seat’, and that research has shown that it is associated with a higher dropout and relapse rate, this practice should be discontinued. The 28-day limit for Tabor Lodge should be reviewed on a case-by-case basis, to extend this limit where needed. Trauma-informed care could also be incorporated into the core treatment model. Also, a seamless progression from primary care to secondary care needs to be developed in order to become the norm.