The Intensive Client Support (ICS) trial is a three year randomised control trial. It focuses on improving off-benefit outcomes for two cohorts of clients – Early Entrants (aged 18-29) and Entrenched Beneficiaries (aged 30-39 years) – who entered the welfare system as youth and who are currently receiving Jobseeker Support with full-time work obligations. On the trial, clients receive support from ICSMs who provide a more intensive service than traditional case management, through, for example, smaller caseloads and a holistic approach.
MSD commissioned this evaluation to inform the continuous improvement of ICS service by answering the following questions:
- How well has the scaled-up service been implemented?
- What operational difference has the Navigator role made in being able to provide outside services for clients? What difference has the Navigator made in terms of client experience and ‘staircasing’ (i.e. progressive steps towards goals)?
- How has the ICS service contributed to clients ‘staircasing’ towards work and benefit independence/reduction (e.g. wellbeing, life skills and employment skills)? What is the client experience, what challenges do they face and what factors contribute to client success, particularly for Māori clients?
- What is the difference, if any, between clients on the Jobseeker Support – Work Ready benefit vs. Jobseeker Support – Health Conditions and Disability benefit? In terms of providing case management, client experience and/or client outcomes?
- Based on the current service offered by ICS-X trial, what could be added, expanded or changed that would be most beneficial?
- How have the process issues raised in previous evaluations been addressed? Have any new issues arisen?
This qualitative evaluation at 12 months includes a process review and client case stories. It is part of the wider ICS-X trial evaluation, which includes qualitative and quantitative evaluations at 12, 24 and 36-months. It builds on qualitative evaluations of the original ICS trial as described above. Table 1 below provides an overview of what is in and out of scope for this piece of work.
In August 2017, MSD commissioned Gravitas Research and Strategy to collect qualitative data for the 24-month stage evaluation, using a case-study approach with clients, to assess how the trial has contributed to client outcomes of ‘stair-casing’ towards goals and work.
Data was collected through face to face in-depth interviews with 26 clients and all six of the current Intensive Client Support Managers across the five service sites (Manurewa, Naenae, Porirua, Invercargill and Rotorua x 2) and via review of client engagement documentation.
This qualitative 12-month evaluation builds on earlier evaluations of the original ICS trial with the aim of providing information to continue fine-tuning the ICS service. It is part of a wider programme of qualitative and quantitative evaluations at 12, 24 and 36-months.
This report describes findings from in-depth interviews with:
- 100 clients who received ICS service: 59 in-person and 41 by phone
- 15 ICSMs and 12 Service Centre Managers (SCMs) at 12 sites
- Nine Navigators
- Five MSD national office project team members.
Qualitative findings collected for this 24-month evaluation of the Intensive Client Support trial indicate that it is effective in contributing to client outcomes of stair-casing, sustainable employment and benefit reduction. However, as with any social service intervention, the degree to which it is effective varies between individuals and is dependent on each client’s unique set of circumstances, past experiences, challenges, and barriers to employment.
It appears that clients who have come onto the ICS trial and are close to being work-ready, both in terms of their skills, training and/or experience, and in terms of their attitude, outlook and personal wellbeing, are able to achieve an off-benefit outcome relatively quickly. For other clients, who come to the service with more entrenched, complex barriers, the ICS service is less likely to result in an off-benefit outcome in the short term. However, this is not to say that the service is less effective for these clients. Many clients for whom employment may be a long-term, rather than short or medium term, goal, achieve outcomes from engagement from the ICS service that provide an essential stable, sustainable foundation of health and wellbeing from which employment-related skills can be established. This means that, once they do become work ready, these clients are more likely to achieve more sustainable employment.
Given that client selection for the ICS trial is data driven and that those with less complex barriers are likely to move off the service and into employment sooner, it is likely that caseloads for ICSMs will become increasingly complex and challenging over time. The ICSM-client relationship underpins the success of the service and it is therefore critical that ICSMs selected for the role possess the necessary range of skills and personal attributes to be able to effectively meet the needs of this client group.
The findings of the evaluation support the continued development of intensive case management for clients with complex needs. The ICS service creates the conditions for ICSMs to build effective relationships with clients through lower caseloads and having clients working with a single ICSM. Effective relationships enabled clients to share their challenges with their case managers and for case managers to respond.
Underpinning the effectiveness of the ICSMs is a need for case managers to demonstrate empathy, a non-judgemental approach, and have the skills to build relationships with clients with multiple challenges.
Risks to the ICS service that need to be mitigated include:
- Ensuring that ICSMs continue to have ring-fenced time to focus on the role, as some ICSMs were still participating in Work and Income business-as-usual (BAU) in addition to their ICS service roles.
- Workloads of 60 seemed to make good use of ICSM time while allowing sufficient time for client-facing work. Increased workloads have the potential to limit the effectiveness of intensive case management.