sharing what works in the uk
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Experiences and challenges from UK policy and practice Originally uploaded on 28 May 2010.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!
1. National Strategy for Mental Health and Employment
2. New Horizons: 10 year mental health strategy
3. The Perkins Review4. 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 workEBSE should be available across primary and secondary mental health servicesEmployment integral to treatment and a key part of recovery orientated approachConsistent measurement across Health and Employment AgenciesPublic 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 frameworkCulture of welfare reform good direction; but concerns that some funding mechanisms actively promote poor practices and exclusionSeparation 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 basePeople know about it but don’t believe itMost frequently in practice:
Health and employment services aren’t integratedIntensity, continuity and individualised nature of support need to be strengthenedFinancial 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 careEmployment outcomes can demonstrate the effectiveness of a recovery orientated mental health serviceDischarge 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 CentreCentre’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 indicatorsInput indicatorsProcess indicatorsOutcome indicators
Commissioning what works
Cost effectiveness and value for moneyEBSE costs certainly costs no more than traditional vocational services, and probably costs lessLong 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 supervisionOrganisational commitmentOutcome and process measurementLearning 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 policiesCollection of good quality data requires time and effortSet regular returns (monthly)Use computer systems where possibleFeedback reports
Learning networks
Communities of practice – encourage collaboration and mutual supportRegular meetingsReciprocal visitsCelebrations
Conclusions
Implementing EBSE is not difficultStrong evidence base and clear quality criteria (fidelity scale)EBSE is cost effective against alternativesIs cost neutral if we stop funding ineffective alternatives and will bring long-term savings to health servicesRequires training, but training as an ongoing learning/mentoring processRequires good management and leadershipSharing information about process and outcomes is a central driver for change
Thank you
Helen [email protected]/employment