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Sharing what works in the UK


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Experiences and challenges from UK policy and practice

Originally uploaded on 28 May 2010.

Published in: Health & Medicine
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Sharing what works in the UK

  1. 1. Sharing what works Experiences and challenges from UK policy and practice Helen Lockett Associate Director, Employment Programme
  2. 2. Presentation <ul><li>Barriers to implementation – systems/macro level </li></ul><ul><li>Barriers to implementation – micro level </li></ul><ul><li>Our ‘Centre’s of Excellence’ programme of systematic implementation across England </li></ul>
  3. 3. A reminder of the evidence from Gary Bond, Phd <ul><li>“ Only about 5% of people with severe mental illness get the services they want. </li></ul><ul><li>The chance of consumers getting a job is at least twice as high if they receive evidence-based Supported Employment (SE) services. </li></ul><ul><li>After ten years, nearly half of the people in the studies who received SE services were still working. </li></ul><ul><li>Consumers who were employed had better control of symptoms and higher self-esteem. </li></ul><ul><li>Research shows that SE is effective not only in the United States but also in Canada, Europe, Japan, Australia, and Hong Kong. </li></ul><ul><li>SE is effective with many different cultural groups. </li></ul>
  4. 4. Barriers to implementation (systems/macro level) <ul><li>Government Policy? </li></ul><ul><li>Welfare system? </li></ul><ul><li>Separation of mental health and employment services? </li></ul>
  5. 5. Policy ‘Desert’ 1999 <ul><ul><li>Where we’ve come from </li></ul></ul><ul><ul><li>National Service Framework for Mental Health, 1999 </li></ul></ul>
  6. 6. 10 years on ‘Wave’ of Policy <ul><ul><li>Cross-government mental health and Public Service Agreements (HM Treasury, 2007) </li></ul></ul><ul><ul><li>Health, work and well-being (Cross-government department) </li></ul></ul><ul><ul><li>Commissioning Framework for Health and Well-being (DH, 2007) </li></ul></ul><ul><ul><li>Reaching Out: An action plan on social exclusion (SEU, 2006) </li></ul></ul><ul><ul><li>Our Health, Our care, Our say: a new direction for community services (DH 2006) </li></ul></ul><ul><ul><li>Vocational services for people with mental health problems: Commissioning guidance (DH 2006) </li></ul></ul><ul><ul><li>Disability Discrimination Act 1995 (amended 2005) </li></ul></ul><ul><ul><li>Mental Health and Social Exclusion (SEU, 2004) </li></ul></ul>Mental health and employment near top of our political agenda
  7. 7. Cross Government Policy Explosion! <ul><li>National Strategy for Mental Health and Employment </li></ul><ul><li>New Horizons: 10 year mental health strategy </li></ul><ul><li>The Perkins Review </li></ul><ul><li>Work, Recovery, Inclusion </li></ul><ul><li>Launched together: 7 December </li></ul>
  8. 8. Headlines <ul><li>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 </li></ul><ul><li>EBSE should be available across primary and secondary mental health services </li></ul><ul><li>Employment integral to treatment and a key part of recovery orientated approach </li></ul><ul><li>Consistent measurement across Health and Employment Agencies </li></ul><ul><li>Public sector leading by example </li></ul>
  9. 9. Welfare Benefits Reform <ul><li>Greater emphasis on ‘capacity’ and what people can do </li></ul><ul><li>Change from Incapacity Benefit to Employment Support Allowance </li></ul><ul><li>Move to ‘contracting out’ employment services, through a prime contractor model </li></ul><ul><li>Major review of Disability Employment Schemes </li></ul><ul><li>Increase in Access to Work funding and targeted support to people with mental health problems </li></ul>
  10. 10. Mental Health & Employment Services <ul><li>Different worlds: </li></ul><ul><li>Separate departments and funding </li></ul><ul><li>Different definitions </li></ul><ul><li>Different geographical locations </li></ul><ul><li>Different philosophies </li></ul><ul><li>Different providers </li></ul>Health Employment
  11. 11. In summary <ul><li>Now have supportive, evidence-informed policy framework </li></ul><ul><li>Culture of welfare reform good direction; but concerns that some funding mechanisms actively promote poor practices and exclusion </li></ul><ul><li>Separation of health and employment needs to be addressed at strategic and operational levels as part of successful implementation of EBSE </li></ul>
  12. 12. Challenges (micro-level) <ul><li>People don’t know about the evidence base </li></ul><ul><li>People know about it but don’t believe it </li></ul><ul><li>Most frequently in practice: </li></ul><ul><ul><li>Health and employment services aren’t integrated </li></ul></ul><ul><ul><li>Intensity, continuity and individualised nature of support need to be strengthened </li></ul></ul><ul><ul><li>Financial planning is not provided </li></ul></ul>
  13. 13. Integration - key ingredient <ul><ul><li>People with mental health problems can require extended periods of mental health care which needs to be coordinated with any vocational services provided </li></ul></ul><ul><ul><li>Employment services can facilitate engagement in mental health treatment and care </li></ul></ul><ul><ul><li>Employment outcomes can demonstrate the effectiveness of a recovery orientated mental health service </li></ul></ul><ul><ul><li>Discharge plans can be linked to real world milestones such as stable housing and employment. </li></ul></ul>
  14. 14. Advantages <ul><li>More efficient use of existing resources; knowledge and expertise flow to both sectors </li></ul><ul><li>Health staff implement a recognised evidence-based practice; benefit from seeing more individual recovery and develop new skills and expertise </li></ul><ul><li>Employment specialists can facilitate re-access to mental health services if needed </li></ul><ul><li>Early intervention, forensic services, substance use and acute care teams can participate </li></ul><ul><li>Employment specialist can assist clients most in need of this assistance and build more expertise compared to those in segregated services. </li></ul>
  15. 15. Sainsbury Centre Centre’s of Excellence Programme <ul><li>Information </li></ul><ul><li>Resources for a range of stakeholders including: </li></ul><ul><li>Tools for commissioner’s (purchasers) </li></ul><ul><li>Establishing EBSE centres of excellence </li></ul>
  16. 16. Series of Information Papers <ul><li>Doing what works </li></ul><ul><li>Summary of IPS and the evidence base </li></ul>
  17. 17. Measuring what matters <ul><li>A set of Key Performance Indicators for supported employment services: </li></ul><ul><ul><li>Context indicators </li></ul></ul><ul><ul><li>Input indicators </li></ul></ul><ul><ul><li>Process indicators </li></ul></ul><ul><ul><li>Outcome indicators </li></ul></ul>
  18. 18. Commissioning what works <ul><li>Cost effectiveness and value for money </li></ul><ul><li>EBSE costs certainly costs no more than traditional vocational services, and probably costs less </li></ul><ul><li>Long term savings to health </li></ul>
  19. 19. About Time <ul><li>Changing investment </li></ul><ul><li>A step-by-step guide to undertake and manage change to transform traditional ‘day and vocational’ services </li></ul><ul><li>Includes on-line tools to: </li></ul><ul><ul><li>Involve service users in change process </li></ul></ul><ul><ul><li>Develop evidence-based contracts </li></ul></ul><ul><ul><li>Assess needs in your local area </li></ul></ul>
  20. 20. Establishing EBSE Centres of Excellence <ul><li>Tender process to select local mental health and employment partnerships; led mainly by NHS Trusts </li></ul><ul><li>9 Partners: 5 full, 4 emerging; agreed outcome measures </li></ul><ul><li>Undertaking regular fidelity reviews and action planning </li></ul><ul><li>Modelling the process of effective systematic implementation (based on the US Dartmouth – Johnson and Johnson Programme) </li></ul><ul><li>Leadership collaborative to Dartmouth US (Jan 2010) </li></ul>
  21. 21. Key features for successful implementation <ul><li>Recruitment, training and supervision </li></ul><ul><li>Organisational commitment </li></ul><ul><li>Outcome and process measurement </li></ul><ul><li>Learning networks </li></ul>
  22. 22. Training and Supervision <ul><li>Getting the right people in posts </li></ul><ul><li>Providing initial training – then on-going ‘field mentoring’ </li></ul><ul><li>One full-time supervisor to no more than 10 employment consultants </li></ul><ul><li>One ‘State’ Trainer to 3 or 4 supervisors initially to reach high fidelity in all teams </li></ul>
  23. 23. Organisational commitment <ul><li>Commitment to the goals and principles of EBSE </li></ul><ul><li>Coherent strategy for funding including ceasing funding ineffective services </li></ul><ul><li>Recovery-oriented mental health services </li></ul><ul><li>Inspiring leadership (local and strategic level) </li></ul><ul><li>Ability to make structural organisational change where necessary </li></ul><ul><li>Continuing education and training in IPS (practical understanding of the evidence base) </li></ul>
  24. 24. Measurement <ul><li>Input, processes, context, as well as outcomes </li></ul><ul><li>Agree a common indicators set consistent with local purchasing requirements and national policies </li></ul><ul><li>Collection of good quality data requires time and effort </li></ul><ul><li>Set regular returns (monthly) </li></ul><ul><li>Use computer systems where possible </li></ul><ul><li>Feedback reports </li></ul>
  25. 25. Learning networks <ul><li>Communities of practice – encourage collaboration and mutual support </li></ul><ul><li>Regular meetings </li></ul><ul><li>Reciprocal visits </li></ul><ul><li>Celebrations </li></ul>
  26. 26. Conclusions <ul><li>Implementing EBSE is not difficult </li></ul><ul><li>Strong evidence base and clear quality criteria (fidelity scale) </li></ul><ul><li>EBSE is cost effective against alternatives </li></ul><ul><li>Is cost neutral if we stop funding ineffective alternatives and will bring long-term savings to health services </li></ul><ul><li>Requires training, but training as an ongoing learning/mentoring process </li></ul><ul><li>Requires good management and leadership </li></ul><ul><li>Sharing information about process and outcomes is a central driver for change </li></ul>
  27. 27. Thank you Helen Lockett [email_address]