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JUNE 2022
ISSUE 2
© NUS SOCIAL SERVICE RESEARCH CENTRE. ALL RIGHTS RESERVED.
SNIPPET
CUTTING-EDGE APPLIED RESEARCH
IN THIS ISSUE
Editor’s Note
by Dr. Rosaleen Ow
The Design and Development of Interventions: An Application to an After-school
Program by CampusImpact for Disadvantaged Families in Singapore
by Karen Lee Yih Chee and Dr. Gerard Chung
Keywords: Logic model, intervention, after-school care, evaluation, Singapore
Research Skills & Implementation Research for Social Services Mentoring
Programmes: Project Abstracts
by SSR Research Mentoring Programme participants
Upcoming SSR Events
June 2022 Issue 2 | 2
EDITOR’S NOTE
by Dr. Rosaleen Ow (Reviewing Editor)
Practice research is an important aspect of social service provision and delivery worthy of a deeper focus. The two articles in
this second issue of Snippet 2022 showcase two major contributions of Social Service Research Centre to the efforts in
capacity building of practice research in the social services.
The first article by Karen Lee and Gerard Chung argues for a shift in paradigm from evaluation research to intervention
research where the design and development of interventions comes forth in our thinking of social interventions. The authors
present the application of program theory, problem theory, and the logic model from the Intervention Research Model to
highlight the creative processes in intervention development and the internal logic of an intervention. It outlines the
theoretical concepts behind the model and illustrates the translation of the theory behind the model to practice intervention.
It is a ‘must read’ for practitioners, researchers and policy makers engaged in understanding the difference in the process of
evaluation and intervention research
The second article is a collection of research abstracts from practitioner-led research projects conducted under the SSR
‘Research Skills and Implementation for Social Services Mentoring Programmes’ and shared in the Snippet for the first time.
The collection of research abstracts identifies the various social needs in the community that had been given attention in
service provision and research under the SSR mentoring programme. It is also a platform for sharing ideas among social
service agencies about how future social needs in the community can, through practice research, gain more clarity and how
these needs can be met and possibly funded in different ways. Obtaining practice research data is important for planning
and evaluating the efficacy of an intervention programme. SSR provides opportunities to partner with agencies to do this in a
systematic manner that will also lead to capacity building among practitioners in the future. The second run of the research
mentoring programme will begin in August 2022. Remember to sign up for it!
Hope you will find time to run through the Snippet 2022 Issue 2 and enjoy the read.
June 2022 Issue 2 | 3
The Design and Development of Interventions: An Application to an
After-school Program by CampusImpact for Disadvantaged Families
in Singapore
by Karen Lee Yih Chee, Research Executive, CampusImpact
and Dr. Gerard Chung, Research Fellow, NUS Social Service Research Centre
Keywords: Logic model, intervention, after-school care, evaluation, Singapore
Introduction
This article explains why a shift in paradigm from evaluation research to intervention research is useful for social service
practitioners in Singapore. We suggest the use of program theory, problem theory, and the logic model from the Intervention
Research Model to describe the internal logic of an intervention. We then demonstrate its use by applying it to an innovative
after-school care program StudyBuddy from the CampusImpact social service agency in Yishun.
Evaluation research as a part of Intervention research
The design and development of social interventions is “bread-and-butter” work in the social service sector. When I (Gerard)
was a social worker at Fei Yue Family Service Centre, my team designed and developed a group-work intervention to
provide informational and emotional support to women who experienced spousal abuse at home and their children who
witnessed the violence. We evaluated the intervention on some outcomes to assess if the intervention was effective. While
the evaluative process is key, the design and development of interventions also entail a creative process. This creative
process consists of the formulation of the program and revision of the intervention. In our family violence intervention, we
developed detailed session-by-session outlines that comprehensively described what and how specific intervention
strategies will be implemented to support these women and their children. A logic model for the intervention was also laid
out to explain the processes that produced the outcomes in our intervention.
The point here is this: evaluation is only a component of a broader process that includes formulation of the program and
revision of the intervention (creative process). Together, this creative and the evaluative processes often result in two
products: a detailed description of the new intervention or program as well as an evaluation of the effectiveness of that
program. Evaluation research is part of a broader and elaborated process of designing and developing an intervention for
use in the community. This elaborated process is intervention research. Evaluation focuses on assessing the processes and
outcomes related to an existing intervention, service or program. The design and development of an intervention is what
distinguishes intervention research from evaluation research (Fraser et al., 2009; Fraser & Galinsky, 2010).
But first, what are interventions?
Interventions are purposively implemented change strategies. In the social service sector, social interventions often are
intended to reduce social problems (e.g., family violence, peer bullying) or health-related issues (e.g., mental health,
June 2022 Issue 2 | 4
suicide). As purposeful or intentional actions, interventions can operate at individual, family, organizational (e.g., school-wide
interventions to prevent bullying), community, or national level. Interventions could be designed as a single-action strategy
(e.g., e-counseling, parenting support group) or as a cluster of actions (e.g., an early childhood home-visitation program
providing parenting support, child development education, financial assistance, and counseling).
Interventions target risk processes
What do interventions target for change? A key target of interventions is the risk processes. Social interventions are
designed to interrupt the risk processes that are hypothesized and supported by evidence to lead to the social or health
problems. For instance, during the Circuit-Breaker in Singapore, I found that parenting stress was a risk factor for increased
harsh parenting behaviors among a sample of Singaporean parents (Chung, Lanier, et al., 2020). Interventions such as
community support groups or individual-level skills training (e.g., stress management or parenting coaching) could be logical
change strategies targeted at these parents’ stress or skills levels that can interrupt the risk sequela. Interventions can also
(and often do) mitigate the effects of risk by strengthening protective factors (e.g. parenting programs often increases
parents’ self-efficacy which is a protective factor).
Underlying any intervention should be a logical sequence between risk and change strategies
If interventions are purposively implemented change strategies, then the internal logic of an intervention can be assessed as
the extent to which malleable risk factors are matched to change strategies of adequate strength or intensity to produce the
desired positive outcomes (or reduction of negative outcomes). Specifically, the design of an intervention often involves
delineating a problem theory in which potentially malleable risk factors are identified (e.g., insufficient knowledge of age-
appropriate parenting disciplinary methods). Then in specifying the program theory, we match these risk factors—also called
mediators—with change strategies, such as the provision of parenting skills coaching. The logic model, which is familiar to
most social service practitioners in Singapore, can be a useful tool to connect these links between risk factors and change
strategy\ies that underlie the internal logic of a social intervention.
Intervention research model: 5 steps in designing and developing
Evaluation research is limited in helping us to consider other key issues related to the design and development of
interventions. These issues include developing program theory, specifying program content, creating treatment manuals,
validation of measurement tools, pilot testing, identifying mediators and moderators of treatment effects, implementing as
well as disseminating program materials. Another problem is that evaluation research is often associated with quantitative
research methods though the process of optimizing an intervention and its components can include a full range of tools that
should not preclude qualitative methods. A focus on intervention research can help to overcome these limitations.
Intervention research has been defined by Fraser et. al. (2009) as the “process of creating the elements of an intervention
and refining those elements in a series of studies” (p. 28). The authors (all social work researchers) presented a 5-step
model of intervention research that lays out the core activities in designing and developing social interventions (Figure 1).
The model is useful for the social service sector in Singapore because many of these core activities are often done by the
social service professionals here in developing and disseminating interventions. The risk and protective factor framework
(Jenson & Fraser, 2011), familiar to social service practitioners, also provides a useful framework to design an intervention
and to adapt it for new settings and populations.
June 2022 Issue 2 | 5
Figure 1: Steps in Intervention Research
Step 1:
Develop problem & program theories
Develop problem theory of risk, promotive, protective factors
Develop program theory of malleable mediators
Identify intervention level, setting, and agent(s)
Develop theory of change and logic model
Step 2:
Design program materials and measures
Develop first draft and submit for expert review
Specify essential program elements and fidelity criteria
Pilot program and measures (i.e., outcome and fidelity measures)
Expand content to address training and implementation
Step 3:
Refine & confirm in efficacy tests
Maintain high control and test intervention components
Estimate effect sizes and test for moderation and mediation
Develop rules for adaptation based on moderation and mediation
tests, community values and needs, other issues
Step 4:
Test effectiveness in practice settings
Test intervention under scale conditions in multiple sites
Estimate effects under ITT
Estimate effects on efficacy subsets
Step 5:
Disseminate program findings & materials
Publish findings
Publish program materials
Develop training materials and certification
Note. Steps in intervention research. From “Steps in Intervention Research: Designing and Developing Social Programs” by
Fraser et al., 2010, Research on Social Work Practice, 20(5), p. 463.
Problem theory, program theory, and logic model
Unlike other models, the 5-step model of intervention research places greater emphasis on the use of problem theory and
the program theory in the first step of identifying the problem and designing the intervention. We recommend that the
June 2022 Issue 2 | 6
problem theory and program theory be two key conceptualizations that social service practitioners in Singapore use to
design and develop their interventions.
Problem theory refers to understanding the psychosocial processes that leads to the development of the social problems or
health issues. This includes defining the problem, understanding the prevalence of the problem in the community and the
mechanisms that produce or suppresses the problem (i.e., risk or protective factors). Often, these mechanisms are
combinations of risk and protective factors at the different ecological levels (individuals, families, organizations, community).
These mechanisms are key because they form the targets for change in the program theory.
The program theory should then clearly articulate a logical link between the problem theory — typically the risk and
protective factors — and program content and components. The program theory does this by specifying and matching
intervention methods to a range of proximal and distal outcomes. The key idea here is that the program theory should
explicate and explain the causal logic of an intervention and describe how the intervention activities are expected to produce
the outcomes desired through the targeting of mediators (risk factors) as well as moderators of the treatment effects (Chung,
Ansong, et al., 2020).
One useful tool that can be used to express both problem theory and the program theory is the logic model. The logic model
specifies an intervention process in terms of core program elements (i.e., objectives, inputs, activities, outputs, and
outcomes). The advantage of logic models lies in planning and evaluation. From a planning perspective, specifying the logic
model helps managers to delineate the program inputs and to make resource planning, such as the resources needed to
train the staff or to conduct the activities. From an evaluation perspective, clearing describing the intervention logic also
guides the focus of the evaluation and the selection of measures to assess the effects of the intervention.
A shift in paradigm to an intervention research model and the use of problem theory, program theory, and the logic model
can be beneficial for the social service sector in Singapore. The rest of this paper shows how CampusImpact, a social
service agency in Yishun, uses a logic model to develop their intervention and to plan an outcome evaluation of their
signature after-school care program, Study Buddy.
Background of StudyBuddy
The StudyBuddy (SB) program serves disadvantaged children and families mainly residing in Yishun. SB was established as
an after-school program that seeks to improve the accessibility of after-school care and enrichment activities amongst
families of low income and disadvantaged (e.g., single parent households) backgrounds.
The SB program provides academic supervision (e.g., homework completion) and enrichment opportunities (e.g., activities
promoting social-emotional learning) in a routine and structured manner to children aged 7 to 14 (primary one to secondary
two). At present, approximately 40% of SB enrolment are referred by school counsellors and family service centres for after-
school support. Such children are often from latchkey families (home alone after school) or might require more adult
supervision to support their needs (i.e., learning, emotional, behavioural, character development).
The Importance of After-school Care for Disadvantaged Families
It is known that education inequality remains a problem in Singapore (Chiong, 2019; Teng, 2018) and children from
disadvantaged backgrounds are not enrolled into educational services that they are most likely to benefit from (Magnuson,
June 2022 Issue 2 | 7
2010). In improving the affordability and accessibility to after-school learning and enrichment opportunities within the Yishun
geographical area, important needs of families from low-income and disadvantaged backgrounds are addressed.
The affordability and accessibility for after-school care is a likely concern for families residing in Yishun. According to the
2015 Singapore General Household Survey
1
the income demographic in Yishun is 8 times less than affluent
neighbourhoods (e.g., Bukit Timah). In terms of important non-economic indicators, Yishun has two times the proportion of
people (4.8 per cent) who are divorced or separated compared to residents in Bukit Panjang (2.42 per cent)
2
.
With a need in Yishun for affordable social services to support the disadvantaged (i.e., low income, single parent) families,
the provision of childcare as a type of intervention is reiterated. This is because, when the parent/parents are at work (and/or
are working long hours), the number of latchkey children have increased significantly. The effects on children of having both
parents or single parents in paid employment have increased the likelihood of children needing to attend childcare (Zhang,
2015). The need for childcare is also shared by those unemployed. The Ministry of Social and Family Development
3
found
that 27.6% of unemployed respondents cited family-related responsibilities (housework/childcare etc) as their main reason
for not actively looking for a job. Of which, women aged 30 to 39 years old formed the largest proportion of those who cited
childcare as the main reason for not working (38.9%). Therefore, the need for SB as an intervention is justified at uplifting
disadvantaged families in Yishun.
There are two important benefits of after-school care in meeting the needs of these families. Firstly, families need more
support for their children’s education. Such disadvantaged families are at risk of helplessness, particularly with Singapore’s
‘parentocracy’ (Ong, 2014) where wealthier parents can draw on their comparative advantages in social and cultural capital
to help children move ahead. For children of low-income families, the inability to afford educational services increases the
weight of responsibility for educational progress which in turn affects family wellbeing. This need for more learning support
reflects the educational inequalities prevalent in Singapore. Lim & Kwek (2006) found that one third of the recipients of the
Public Service Commission scholarship come from households earning less than S$10,000/month with a mere 7% coming
from households earning less than S$2000. Secondly, these disadvantaged families need support for other holistic
developmental opportunities. With a desire for ‘education’ to be more than about academic results; these disadvantaged
families also value the social, emotional and higher-order thinking competencies that formal education could develop
(Chiong, 2019).
Therefore, it may well be the case that the provision of good quality childcare and family support can contribute to the
financial stability and harmony of the families. This may have in turn contributed in some way to the maintenance of school
progress in Singapore (Sharpe, 1994). With a focus of providing holistic support for these children of disadvantaged
backgrounds, SB is therefore an important intervention that addresses the needs of such families residing in Yishun.
Problem Theory
After identifying the problem of educational and enrichment inequalities amongst children and youths from disadvantaged
backgrounds, a problem theory was constructed to identify which risk factors faced by such families that SB hopes to
reduce. These risk factors are hypothesised to contribute to poorer outcomes in child development. For example, a
1
https://www.singstat.gov.sg/publications/ghs/ghs2015content
2
https://ipscommons.sg/inequality-has-a-geographic-dimension-between-and-within-neighbourhoods-in-singapore/
3
https://www.msf.gov.sg/research-and-data/Research-and-Data-Series/Documents/Family%20and%20Work%20Report.pdf
June 2022 Issue 2 | 8
systematic review conducted by Huaqing (2013) showed that parental stress is found to predict challenging behaviours in
children.
The risk factors outlined in the problem theory in Figure 2 are derived from clinical experience supported with evidence on
the risk factors affecting the children and youths of disadvantaged backgrounds. Children from disadvantaged backgrounds
are exposed to multiple risks, and interrelationships among these risk factors influence a child’s development (Huaqing Qi,
2003). As such, these factors were systematically conceptualised using the Bronfenbrenner ecological systems theory
(Bronfenbrenner, 1989) to better understand the contexts of change SB operates within a child’s ecosystem. Using the
problem theory, specific risk factors targeted in the SB program are shown to reside primarily within the individuals
themselves. Assuming interactions exist between the ecological systems (Bronfenbrenner, 1989), families and schools are
likely to benefit indirectly from SB when they in turn are enabled to benefit from the students’ holistic developmental
outcomes. To complement this ripple effect, CampusImpact also works closely with schools and families for casework
outside of its SB program if applicable.
Figure 2: Problem Theory for StudyBuddy
The Problem Theory for StudyBuddy
The problem theory is a key tool in this intervention research for multiple reasons. Firstly, it contextualises the role that SB
plays in each child’s ecological system. Next, it also frames the significance of its intervention activities (i.e., academic
supervision, enrichment activities) to strengthen the protective factors in the students’ environment (e.g., academic
competence after homework completion to reduce the risks of poor academic achievement). Finally, it shows why the
primary aims of SB are to support their students’ learning, behavioural, socio-emotional and character development.
June 2022 Issue 2 | 9
Program Theory
The next phase in the intervention research is outlining how activities in SB are linked to reducing the risk factors identified
and targeted in the problem theory. The development of a program theory with a logic model was used to conceptualise the
important intervention activities in SB, and how it should be delivered to achieve SB’s primary program aims.
The logic model for SB is outlined in Figure 3. The model seeks to explain the mechanisms in SB that produce its positive
outcomes and allows for a consideration of various design and development factors affecting these outcomes. This concise
representation of how the SB program works to achieve its aims enables a logical identification of process and outcome
factors to be further evaluated in intervention research.
As illustrated, the model provides a logical map of how the activities
4
carried out in SB can lead to its intended primary and
secondary outcomes for its beneficiaries. It outlines key assumptions
5
and enablers
6
that are necessary for the change
processes leading to its outcomes, along with contextual factors
7
and potential confounds that might influence these change
processes. For example, in improving self-esteem (intermediate outcome), socially desirable behaviour and sense of
belonging (final goal), the implementation of a reward system (activity) with teachers using descriptive and immediate praise
effectively (enablers) to acknowledge positive behaviours from all students (assumptions) is required for this change process
to work in SB.
4
The things that an organisation or project does or the way it chooses to deliver a project day-to-day.
5
The underlying beliefs about how a project will work, the people involved and the context.
6
Conditions or factors that need to be present or absent to allow an organisation or project’s work to succeed.
7
The context in which your organisation and its beneficiaries operate.
June 2022 Issue 2 | 10
Figure 3: Logic Model for Study Buddy
June 2022 Issue 2 | 11
Conceptualising the Logic Model
The logic model for SB was conceptualised using clinical experience and research supporting the change processes
outlined in Figure 3. It is important to ensure that the logic model is applicable to the real-life service implementation of SB.
This is done by first identifying intervention activities carried out in the program that result in realistic intermediate and long-
term outcomes for students attending SB. Next, enablers and assumptions were identified based on CampusImpact’s
training programs that ensure the quality implementation of SB. Finally, gathering consistent feedback from service
practitioners ensures the transferability of the logic model into clinical work.
Overview
Specific to this paper, the problem and program theories are used to inform an ongoing process and outcome evaluation for
SB. In process evaluation, important change processes in the logic model were identified to test the fidelity and quality of
executing such processes in the SB program. For example, with reference to Figure 3, to understand the quality of academic
supervision (activity) in improving academic improvement and motivation for learning (final goal), a qualitative and
quantitative questionnaire can be administered to investigate quality of teaching (enablers; i.e. teachers giving clear
instruction, rehearsal and feedback) and the effectiveness of current training programs to equip teachers with relevant skills
(assumptions; i.e. being able to engage a child academically) to enable effective program implementation.
The prospective findings from the process evaluation elaborate on the findings from the outcome evaluation for SB. For
example, the data on the quality and fidelity in academic supervision provides further elaboration on the outcomes in
academic motivation in SB students across time. Taken together, the process and outcome evaluation provide a holistic
overview of the implementation and effectiveness of SB. Using such tools in intervention research, recommendations for
program implementation to improve its outcomes can be outlined.
In conclusion, the problem and program theory are useful for many reasons. Firstly, it elevates program reporting as it can
be used by CampusImpact to understand what the program is about. Next, it allows CampusImpact to present the
importance of SB in a concise and clear manner to external stakeholders for better funding, evaluation and intervention
support. Finally, it provides a framework to identify key processes and outcomes for intervention research to review and
improve the effectiveness of SB. Together, applying a problem and program theory to understand the design and outcomes
of social interventions can spearhead improvements in the delivery and effectiveness of such interventions in the social
service sector.
June 2022 Issue 2 | 12
References
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Chiong, C. 2019. What do Low-Income Families Think about Singapore’s Education Policy?. A Publication of the Research
& Planning Department, 39.
Chung, G., Ansong, D., Brevard, K. C., & Chen, D.-G. (2020). Identifying treatment moderators of a trauma-informed
parenting intervention with children in foster care: Using model-based recursive partitioning. Child Abuse & Neglect.
https://doi.org/10.31219/osf.io/aqxer
Chung, G., Lanier, P., & Wong, P. Y. J. (2020). Mediating Effects of Parental Stress on Harsh Parenting and Parent-Child
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https://doi.org/10.1007/s10896-020-00200-1
Dowsett, C. J., Huston, A. C., Imes, A. E., & Gennetian, L. (2008). Structural and process features in three types of child
care for children from high and low income families. Early childhood research quarterly, 23(1), 69-93.
Durlak, J. A., Weissberg, R. P., & Pachan, M. (2010). A meta-analysis of after-school programs that seek to promote
personal and social skills in children and adolescents. American journal of community psychology, 45(3), 294-309.
Fraser, M. W., & Galinsky, M. J. (2010). Steps in Intervention Research: Designing and Developing Social Programs.
Research on Social Work Practice, 20(5), 459–466. https://doi.org/10.1177/1049731509358424
Fraser, M. W., Richman, J. M., Galinsky, M. J., & Day, S. H. (2009). Intervention Research: Developing Social Programs.
Oxford University Press.
Glendinning, E., Smith, C. J., & Md Kadir, M. M. (2015). Single-parent families in Singapore: Understanding the challenges
of finances, housing and time poverty.
Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and
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literature. Topics in early childhood special education, 23(4), 188-216.
Jenson, J. M., & Fraser, M. W. (2011). A Risk and Resilience Framework for Child, Youth, and Family Policy. In J. M.
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Kremer, K. P., Maynard, B. R., Polanin, J. R., Vaughn, M. G., & Sarteschi, C. M. (2015). Effects of after-school programs
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Lauer, P. A., Akiba, M., Wilkerson, S. B., Apthorp, H. S., Snow, D., & Martin-Glenn, M. L. (2006). Out-of-school time
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Lester, A. M., Chow, J. C., & Melton, T. N. (2020). Quality is critical for meaningful synthesis of afterschool program effects:
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June 2022 Issue 2 | 14
Research Skills & Implementation Research for Social Services
Mentoring Programmes: Project Abstracts
9 participants from SSAs attended our mentoring programs for the Research Skills and Implementation Research workshop
in January 2022. These are the abstracts from their practice-based research projects.
List of abstract titles
Suicide Attempters’ Perception of Support Group Intervention: A Qualitative Study
Based on the Theory of Planned Behaviour
Chiang Xing Ling, Lynn (Samaritans of Singapore)
16
Evaluation of the Collaborative Assessment and Management of Suicidality Framework
(CAMS) in Crisis Counselling: A Mixed Methods Study
Leong Yee Teng, Janice (Samaritans of Singapore)
16
What’s Behind the Clutter? An Exploratory Study on Social Work Professionals’
Management of Hoarding Cases in Montfort Care
Lim Jia Min (Montfort Care)
17
How Nature Walks Promote the Emotional Health of Children/Youth with Autism and
their Families
Sim Jia En (National Youth Council)
18
Study Buddy After-School Programme: A Process and Outcome Evaluation Study
Lee Yih Chee, Karen (CampusImpact)
18
Finding Suitable Business Models for Small NPO in Singapore
Toh Jia Min
19
Effectiveness of Safe and Strong Families - Reunification (SSF-R)
Ek Xin Rong (Chen Su Lan Methodist Children's Home)
19
June 2022 Issue 2 | 15
Using Cluster Analysis to Identify Family Needs Profiles of Children Staying in
Residential Care: Insights for Reunification Work
Chen Wenwei (Chen Su Lan Methodist Children's Home)
20
Implementation Study of Peer Support Leader Training for Migrant Workers
Paul Justin, Yongzheng (HealthServe)
21
June 2022 Issue 2 | 16
Suicide Attempters’ Perception of Support Group Intervention: A Qualitative
Study Based on the Theory of Planned Behaviour
Chiang Xing Ling, Lynn (Samaritans of Singapore)
Suicide has been a prevalent problem in Singapore. With suicide attempters being at a higher risk of completing suicide, a
multi-pronged approach to suicide prevention that includes a focus on intervention among suicide attempters is critical.
Beyond individual counselling and therapy, a relatively new intervention format is support groups for suicide attempters. As
Samaritans of Singapore (SOS) will be starting a new support group for suicide attempters, this qualitative study explores
factors that influence a suicide attempter’s help-seeking behaviour and perception towards support group as an intervention.
Drawing on the theory of planned behaviour (TPB), interviews (n=3) were conducted using convenient sampling with SOS’s
counselling clients within 3 weeks. Interviews were transcribed and thematic analysis was used to identify themes that were
organised corresponding to the 3 factors of TPB: attitude towards behaviour (ATB), subjective norm (SN)), and perceived
behavioural control (PBC).
The analysis yielded 15 categories under the 3 TPB factors. Some salient categories include alleviation of symptoms,
psychological safety, and social connections under ATB, friends and family under SN, and accessibility and availability of
services under PBC.
In conclusion, participants’ beliefs in the importance and usefulness of help-seeking and support groups were important
motivating factors to reach out despite the low support they have from family and friends. However, as friends and family are
the first level of support participants usually turn to, it is still important to raise awareness and mental health literacy to
reduce delays in initial help-seeking behaviour and allow early intervention. The findings also have implications for social
service agencies to relook at ways they spread awareness of their services and programmes, and accessibility of
information on website and social media pages. As sample size is small, a more in-depth study will be required to further
verify the results of these findings.
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Evaluation of the Collaborative Assessment and Management of Suicidality
Framework (CAMS) in Crisis Counselling: A Mixed Methods Study
Leong Yee Teng, Janice (Samaritans of Singapore)
With increasing focus on suicide-specific interventions, the collaborative assessment and management of suicidality (CAMS)
framework emerges as a leading evidence-based framework for treating suicidality. The present study aims to explore
counsellors’ perceptions and experiences with CAMS’s current state of adoption in crisis counselling, and better understand
the factors that influence adoption. A secondary aim is to determine the effectiveness of CAMS on reducing suicidality.
Purposive sampling was used to recruit crisis counsellors who utilise CAMS (n=4). Two focus group discussions were
conducted over one month. Thematic analysis was used to analyse the qualitative data in-depth. To address the secondary
aim, descriptive analysis and independent paired samples T-tests were used to analyse self-reported measures of the initial
and outcome CAMS Suicide Status Forms (SSF) completed by past clients (n=8).
June 2022 Issue 2 | 17
Thematic analysis yielded 14 categories and 3 themes: (1) Perceived Strengths of CAMS, (2) Challenges faced with CAMS
and (3) Factors that influence the adoption of CAMS. Some salient categories include the strengths of the philosophical
approach of CAMS, challenges navigating cultural nuances and the need for organisational and sectoral support. The
quantitative analysis suggest that clients reported a significant improvement in scores in 4 factors that measure suicidality
(emotional pain, stress, hopelessness, self-hate), but not agitation.
Counsellors recognise CAMS’ value as a structured evidence-based tool, with its unique underlying philosophy of care and
collaboration. Cultural adaptation and allowing flexibility in the use of the framework is recognised as important. Beyond
theoretical understanding, counsellors need more context-specific training and supervision to build competency and
confidence in applying CAMS in regular practice. Based on preliminary findings, CAMS shows promise as a viable
framework to guide practice in Singapore. Recognising the study’s constraints with the small sample size, further
investigation is required to determine CAMS’ effectiveness in our local context.
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What’s Behind the Clutter? An Exploratory Study on Social Work
Professionals’ Management of Hoarding Cases in Montfort Care
Lim Jia Min (Montfort Care)
Hoarding disorder is characterised by excessive acquisition of, and persistent difficulty in discarding possessions regardless
of its actual value. Social Work Professionals (SWPs) are usually involved in direct work with persons with hoarding
behaviour in the community. However, there is no established literature documenting effective social work interventions. A
survey of SWPs in Montfort Care (MFC) found that decluttering took place in 60% of the cases. Amongst these, 94.4% had
recurrent hoarding after decluttering. This study examines (1) SWPs’ rationale for decluttering and the (2) types of hoarding
interventions and its effectiveness. This study also hopes to (3) generate internal hoarding management guidelines for
SWPs in MFC.
Ten SWPs with eight months to 12 years of experience participated in a three-hour focus group discussion (FGD) held
virtually via Zoom. The FGD was facilitated by a senior social worker to understand SWPs’ rationale for decluttering, the
effectiveness and barriers of hoarding interventions in MFC. A short survey administered during the FGD evaluated two
proposed hoarding interventions. The session was transcribed and analysed using inductive thematic analysis.
The results showed that decluttering arises from concerns of safety and health risk of people living in a cluttered home,
pressure from stakeholders and SWPs' lack of knowledge of alternative interventions. Rapport building, service linkage and
communication with stakeholders were identified as common interventions used. Common challenges faced include the
client’s lack of insight and lack of clear inter-agency protocols for hoarding management. SWPs hoped that future work can
focus on preventive work, stronger collaborations between stakeholders and more hoarding-related training. SWPs preferred
intervention 1 (categorisation, decision-making; exposure and habituation to discarding; cognitive restructuring) over
intervention 2 (group and individual treatment).
In conclusion, the challenges SWPs face in hoarding management are similar to those reported in the literature. Further
research to evaluate hoarding management by SWPs in Singapore is important to necessitate timely and cost-effective
intervention. The current study also has implications on legislation and national efforts to curb hoarding behaviour.
June 2022 Issue 2 | 18
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How Nature Walks Promote the Emotional Health of Children/Youth with
Autism and their Families
Sim Jia En (National Youth Council)
Parents of children with autism tend to experience a higher level of stress and a greater risk of mental health distress. Their
children, as compared to the neurotypical, have higher emotional and behavioural needs. As nature walks have been proven
to promote physiological health-related outcomes for the general population, this study seeks to examine the emotional
health benefits of nature walks for both children/youth with autism and their caregiver(s).
Four families, comprising five caregivers, three children and one youth, aged 5 to 17, with varying levels of needs
participated in 2-hour nature walks over two consecutive Saturdays. Caregivers completed four weekly self-administered e-
questionnaires which inquired on them and their child’s overall mood, sleep hours and number of sleep disturbances.
Caregivers also reported their individual stress levels, number of emotional meltdowns their child experienced and the time
taken to regulate them. Additionally, an e-survey was completed after each walk to report on their overall mood and
experience. One caregiver was also interviewed to further examine observable changes for her and her child.
Overall moods of the children/youth and caregivers saw an immediate improvement after one or both of the nature walks. All
four children/youth had 1 to 3-point improvement and all five caregivers experienced 1 to 5-point improvement and 2 to 4-
point decrease in stress levels. Two children and their caregivers experienced an increase in sleep hours and reduction in
sleep disturbances in a week. From the interview results, the walks provided a sense of safety and belonging and improved
the child’s emotional regulation.
In conclusion, nature walks provide some emotional benefits for families with children/youth with autism. A study of at least
two months with randomised controlled trial would better determine the emotional benefits. Future studies could engage
behavioural therapists to observe changes and explore the impacts of organised and self-directed nature walks.
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Study Buddy After-School Programme: A Process and Outcome Evaluation
Study
Lee Yih Chee, Karen (CampusImpact)
CampusImpact is a social service agency that conducts Study Buddy (SB), an affordable after-school programme for
children from disadvantaged families. Study Buddy mainly provides homework supervision and enrichment opportunities to
develop their students' holistic growth and well-being. At present, there has been an absence of any process or outcome
evaluation research conducted on Study Buddy. Such research is integral to generate insights to the effectiveness of SB
and enhance the continuation and extension of this programme.
This research presentation aims to evaluate the process of planning and designing a process and outcome evaluation
research on Study Buddy.
June 2022 Issue 2 | 19
The research questions to be investigated are: What are the key processes in planning (i.e., formulating a problem and
process theory) and designing (i.e., methodology design for children) a process and outcome evaluation study? What are
some key considerations and challenges in planning applied research? What are some key considerations and challenges in
designing applied research for children aged 6 to 12?
A longitudinal process and outcome evaluation research framework is being outlined. Potential recommendations for future
research and limitations for the present study will be discussed.
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Finding Suitable Business Models for Small NPO in Singapore
Toh Jia Min
There is no guarantee that non-profit organisations (NPO) can always secure sponsorships to keep its operations going. As
such, it is important for these organisations to self-sustain financially through innovative means. However, there are few
studies on well-established business models for small NPOs. This study aims to explore ways in which Changing Minds, a
small volunteer-run NPO that was established in Singapore 1 year ago can improve its business model to enhance its
financial sustainability.
A discussion with the CEO of Changing Minds and another small NPO was initiated to understand its current business
models and the various ways to enhance its financial stability. SWOT analysis was used to further analyse current and
proposed business models for Changing Minds.
From the discussion, it was found that value creation is a top priority for small NPOs like Changing Minds. In the short term,
small NPOs may have to organise free events to attract participants to return for upcoming events and enhance the value of
the organisation. It is only when the value of the NPO is visible, then people will be more willing to pay for the services
offered or even invest in the NPO. An expansion plan with meaningful activities is required to attract manpower to work on
both short and long-term goals. With these inputs from the discussions, a focus group discussion (FGD) guide was created
to assess the acceptability, appropriateness and feasibility of the three proposed business models.
With inputs from the discussions, a FGD guide has been created. The FGD will be conducted with volunteers and staff of
Changing Minds within the next 3 months to identify the most acceptable, appropriate, and feasible business model for
Changing Minds to adopt in the near term.
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Effectiveness of Safe and Strong Families - Reunification (SSF-R)
Ek Xin Rong (Chen Su Lan Methodist Children's Home)
Every year from 2011 to 2020 in Singapore, an average of 1073 children reside in an out-of-home care (OOHC) setting,
either in residential institutions or foster care, due to child welfare concerns. The Safe and Strong Family – Reunification
(SSF-R) programme intervenes with caregivers and children to return OOHC children safely back to the care of their families
in a timely manner. This study examined the effectiveness of the SSF-R programme by using administrative data to compare
June 2022 Issue 2 | 20
outcomes between the treatment group (SSF-R) and a treatment-as-usual comparison group to find 1) group differences in
the length of children’s total out-of-home stay duration, and 2) changes in children’s well- being at point of reunification.
Administrative data from a team that runs the SSF-R programme; including the Family Strengths and Needs Assessment
(FSNA) tool, and a residential institution; including Child and Adolescent Needs and Strengths (CANS) tool, were used to
examine a sample of 109 children (treatment = 59, control = 50). Using a quasi-experimental design, appropriate linear
regression models were used to control for potential confounding variables (e.g., child age and sex) to estimate the
programme’s effectiveness.
Controlling for child age and gender, children in the SSF-R group experienced significantly lesser months (M = 24 months)
than the children in the comparison group. No significant group differences in the well-being of the children were found.
Based on this study, SSF-R is effective in reunifying children with their families in a shorter period of time. Further studies
will be needed to explain the lack of significant changes between treatment and control group in terms of the children’s well-
being needs. A longitudinal study looking into the sustainability of discharging the children from the child welfare system
might also bring about more meaningful discussions on the effectiveness of the treatment in place.
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Using Cluster Analysis to Identify Family Needs Profiles of Children Staying in
Residential Care: Insights for Reunification Work
Chen Wenwei (Chen Su Lan Methodist Children's Home)
Reunification is a priority for children who are in out-of-home care (OOHC) due to child welfare issues such as child abuse or
neglect. Hence, being able to understand the needs and profiles of families leading to children entering OOHC would allow
for better family engagement in the planning for services and interventions as preparation for the reunification process.
The long-term caregivers of a sample of 63 residents staying in Chen Su Lan Methodist Children’s Home in Singapore
between 2016 to 2021 were analysed using ratings from the Child and Adolescent Strengths and Needs (CANS) tool. K-
means cluster analysis was performed using three family and caregiver-related factors.
A three-clusters model was determined as optimal and the model differentiated the families based on their levels of needs
relating to social resources, family stress and family relationships: (a) the “disadvantaged” family group had moderate needs
in accessing social resources but lower needs in family stress and relationships than the other groups, (b) the “tense”
family group characterised by high family stress and poor family relationships, and (c) the “isolated” family group defined by
limited social resources and high family stress. Subsequent multiple linear regressions found that child maltreatment was
significantly less likely to occur in the “disadvantaged” family group as compared to the “tense” and “isolated” family groups.
Significant differences were also observed between the family groups relating to type of maltreatment and length of stay.
These findings suggest that family stress and family relationships could be significant contributing factors towards child
maltreatment among children who are in residential care, which would highlight the need for interventions to be targeted at
strengthening family relationships and equipping family members with healthy coping skills during the process of returning
children.
June 2022 Issue 2 | 21
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Implementation Study of Peer Support Leader Training for Migrant Workers
Paul Justin, Yongzheng (HealthServe)
As part of the national effort to improve the mental well-being of migrant workers, the Peer Support Leader (PSL) training
was developed to help migrant workers community leaders acquire basic mental health skills and become first responders to
distressed workers in the community. At the pilot stages of implementation, there is a need to develop programme content
that is appropriate and adaptable to the different cultures and languages. In addition, there is a need to ensure some level of
consistency in the delivery across the different facilitators.
This implementation research seeks (1) to refine the theory of change for the PLS training and (2) to assess the
implementation, focusing on dosage, adaptation and fidelity. Findings can possibly contribute towards building a framework
for the auditing of PSL training, in terms of its content and delivery, for future runs. This presentation will reflect on the
research process: (1) Conducting research with migrant workers, given the cultural and linguistic diversity and (2)
Incorporating research into operational work on the ground.
June 2022 Issue 2 | 22
The Snippet Team
Check out other Snippet publications here!
Editorial Team
Review Editor: Dr. Rosaleen Ow
Executive Editor: Dr. Gerard Chung
Editorial Assistants: Nurul Fadiah Johari and Sandy Chen
Questions for us? Want to write for us?
Contact us at:
NUS Social Service Research Centre
Faculty of Arts and Social Science
National University of Singapore
The Shaw Foundation Building, Block AS7,
Level 3, 5 Arts Link,
Singapore 117570
Email: ssr@nus.edu.sg
Phone: 6601-5019
Website: https://fass.nus.edu.sg/ssr/
Upcoming SSR Events
SSR Training:
Research Skills for Social Services Mentoring Programme, 1 August to 1 November 2022
Critical Discourse Analysis for Social Services, 13-14 September 2022
Participatory Research for Social Services, 1 July 2022
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