• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Sharing what works in the UK
 

Sharing what works in the UK

on

  • 1,027 views

Experiences and challenges from UK policy and practice

Experiences and challenges from UK policy and practice

Originally uploaded on 28 May 2010.

Statistics

Views

Total Views
1,027
Views on SlideShare
529
Embed Views
498

Actions

Likes
0
Downloads
6
Comments
0

2 Embeds 498

http://www.centreformentalhealth.org.uk 493
http://translate.googleusercontent.com 5

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Sainsbury Centre for Mental Health – what we do Employment Programme Priorities Work with health professionals, health services and providers of specialist employment support Work with employers to improve the capacity of the workplace to employ and retain people who have experienced mental ill health Work on ways of meeting the employment needs of people with mental health problems within the criminal justice system
  • Don’t we have a duty to implement this knowledge base? Analogy - overwhelming evidence that seat belts prevent road fatalities, we ensure we have legislation to implement the evidence; we know what works – why are we not putting this knowledge into practice as a matter of routine?
  • Employment’ appears only 20 times in the 153 page document The written care plan for an individual should include: ‘action needed for employment, education or training or another occupation’ The carer’s plan should include: action needed to secure advice on income, housing, educational and employment matters
  • Framework for implementation; we need to make this work
  • Government policy in the UK is largely informed by the evidence base Supports the direction of travel Now provides a strong framework for action / implementation Health – should measure employment status and vice versa
  • Majority of claimants will be required to participate in some sort of work-related activity Supportive, good change in emphasis but concerns that Government funded generic employment services will always exclude/marginalise people with mhps, particularly as funding mechanisms promote creaming and actively go against the evidence base. Therefore responsibility, although joint between DH and DWP, needs to lie with Health.
  • or ‘specialist mental health services’ e.g. in-patient care, crisis resolution, assertive outreach, early intervention teams, community mental health teams (CMHTs) etc Increasing emphasis on early intervention, job retention, recovery orientated mental health services – e.g. employment advisors in GP surgeries and CMHTs – commitment there, but not necessarily in widespread practice A national survey of mental health service clients in the UK found that 50% wanted help with finding paid work but were not receiving it (Healthcare Commission, 2006).
  • Acknowledge Geoff Waghorn
  • Acknowledge Geoff Waghorn
  • A set of Key Performance Indicators for employment services: Context indicators Input indicators Process indicators Outcome indicators
  • We want to demonstrate that it is possible to establish high fidelity (and hence high performing) EBSE services in a range of service configurations, partnerships, urban/rural conditions, different regional labour markets
  • What we are already learning and seeing from our own experience and the increasing literature now being published on implementation from across the world – US, AUS, NZ etc
  • Ensure reports are easy to understand

Sharing what works in the UK Sharing what works in the UK Presentation Transcript

  • Sharing what works Experiences and challenges from UK policy and practice Helen Lockett Associate Director, Employment Programme
  • Presentation
    • Barriers to implementation – systems/macro level
    • Barriers to implementation – micro level
    • Our ‘Centre’s of Excellence’ programme of systematic implementation across England
  • A reminder of the evidence from Gary Bond, Phd
    • “ Only about 5% of people with severe mental illness get the services they want.
    • The chance of consumers getting a job is at least twice as high if they receive evidence-based Supported Employment (SE) services.
    • After ten years, nearly half of the people in the studies who received SE services were still working.
    • Consumers who were employed had better control of symptoms and higher self-esteem.
    • Research shows that SE is effective not only in the United States but also in Canada, Europe, Japan, Australia, and Hong Kong.
    • SE is effective with many different cultural groups.
  • Barriers to implementation (systems/macro level)
    • Government Policy?
    • Welfare system?
    • Separation of mental health and employment services?
  • Policy ‘Desert’ 1999
      • Where we’ve come from
      • National Service Framework for Mental Health, 1999
  • 10 years on ‘Wave’ of Policy
      • Cross-government mental health and Public Service Agreements (HM Treasury, 2007)
      • Health, work and well-being (Cross-government department)
      • Commissioning Framework for Health and Well-being (DH, 2007)
      • Reaching Out: An action plan on social exclusion (SEU, 2006)
      • Our Health, Our care, Our say: a new direction for community services (DH 2006)
      • Vocational services for people with mental health problems: Commissioning guidance (DH 2006)
      • Disability Discrimination Act 1995 (amended 2005)
      • Mental Health and Social Exclusion (SEU, 2004)
    Mental health and employment near top of our political agenda
  • Cross Government Policy Explosion!
    • National Strategy for Mental Health and Employment
    • New Horizons: 10 year mental health strategy
    • The Perkins Review
    • Work, Recovery, Inclusion
    • Launched together: 7 December
  • Headlines
    • Public health approach – whole spectrum i.e. early identification and support from workplaces; addressing sickness certification process; evidence-based services for people out of work
    • EBSE should be available across primary and secondary mental health services
    • Employment integral to treatment and a key part of recovery orientated approach
    • Consistent measurement across Health and Employment Agencies
    • Public sector leading by example
  • Welfare Benefits Reform
    • Greater emphasis on ‘capacity’ and what people can do
    • Change from Incapacity Benefit to Employment Support Allowance
    • Move to ‘contracting out’ employment services, through a prime contractor model
    • Major review of Disability Employment Schemes
    • Increase in Access to Work funding and targeted support to people with mental health problems
  • Mental Health & Employment Services
    • Different worlds:
    • Separate departments and funding
    • Different definitions
    • Different geographical locations
    • Different philosophies
    • Different providers
    Health Employment
  • In summary
    • Now have supportive, evidence-informed policy framework
    • Culture of welfare reform good direction; but concerns that some funding mechanisms actively promote poor practices and exclusion
    • Separation of health and employment needs to be addressed at strategic and operational levels as part of successful implementation of EBSE
  • Challenges (micro-level)
    • People don’t know about the evidence base
    • People know about it but don’t believe it
    • Most frequently in practice:
      • Health and employment services aren’t integrated
      • Intensity, continuity and individualised nature of support need to be strengthened
      • Financial planning is not provided
  • Integration - key ingredient
      • People with mental health problems can require extended periods of mental health care which needs to be coordinated with any vocational services provided
      • Employment services can facilitate engagement in mental health treatment and care
      • Employment outcomes can demonstrate the effectiveness of a recovery orientated mental health service
      • Discharge plans can be linked to real world milestones such as stable housing and employment.
  • Advantages
    • More efficient use of existing resources; knowledge and expertise flow to both sectors
    • Health staff implement a recognised evidence-based practice; benefit from seeing more individual recovery and develop new skills and expertise
    • Employment specialists can facilitate re-access to mental health services if needed
    • Early intervention, forensic services, substance use and acute care teams can participate
    • Employment specialist can assist clients most in need of this assistance and build more expertise compared to those in segregated services.
  • Sainsbury Centre Centre’s of Excellence Programme
    • Information
    • Resources for a range of stakeholders including:
    • Tools for commissioner’s (purchasers)
    • Establishing EBSE centres of excellence
  • Series of Information Papers
    • Doing what works
    • Summary of IPS and the evidence base
  • Measuring what matters
    • A set of Key Performance Indicators for supported employment services:
      • Context indicators
      • Input indicators
      • Process indicators
      • Outcome indicators
  • Commissioning what works
    • Cost effectiveness and value for money
    • EBSE costs certainly costs no more than traditional vocational services, and probably costs less
    • Long term savings to health
  • About Time
    • Changing investment
    • A step-by-step guide to undertake and manage change to transform traditional ‘day and vocational’ services
    • Includes on-line tools to:
      • Involve service users in change process
      • Develop evidence-based contracts
      • Assess needs in your local area
  • Establishing EBSE Centres of Excellence
    • Tender process to select local mental health and employment partnerships; led mainly by NHS Trusts
    • 9 Partners: 5 full, 4 emerging; agreed outcome measures
    • Undertaking regular fidelity reviews and action planning
    • Modelling the process of effective systematic implementation (based on the US Dartmouth – Johnson and Johnson Programme)
    • Leadership collaborative to Dartmouth US (Jan 2010)
  • Key features for successful implementation
    • Recruitment, training and supervision
    • Organisational commitment
    • Outcome and process measurement
    • Learning networks
  • Training and Supervision
    • Getting the right people in posts
    • Providing initial training – then on-going ‘field mentoring’
    • One full-time supervisor to no more than 10 employment consultants
    • One ‘State’ Trainer to 3 or 4 supervisors initially to reach high fidelity in all teams
  • Organisational commitment
    • Commitment to the goals and principles of EBSE
    • Coherent strategy for funding including ceasing funding ineffective services
    • Recovery-oriented mental health services
    • Inspiring leadership (local and strategic level)
    • Ability to make structural organisational change where necessary
    • Continuing education and training in IPS (practical understanding of the evidence base)
  • Measurement
    • Input, processes, context, as well as outcomes
    • Agree a common indicators set consistent with local purchasing requirements and national policies
    • Collection of good quality data requires time and effort
    • Set regular returns (monthly)
    • Use computer systems where possible
    • Feedback reports
  • Learning networks
    • Communities of practice – encourage collaboration and mutual support
    • Regular meetings
    • Reciprocal visits
    • Celebrations
  • Conclusions
    • Implementing EBSE is not difficult
    • Strong evidence base and clear quality criteria (fidelity scale)
    • EBSE is cost effective against alternatives
    • Is cost neutral if we stop funding ineffective alternatives and will bring long-term savings to health services
    • Requires training, but training as an ongoing learning/mentoring process
    • Requires good management and leadership
    • Sharing information about process and outcomes is a central driver for change
  • Thank you Helen Lockett [email_address] www.scmh.org.uk/employment