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Recovery, Resilience and Self-Management Strategy September 2015 1

Cambridgeshire and Peterborough NHS Foundation Trus t

Building Recovery, Resilience and Self Management: our Strategy for the next five years to 2020

Forward from the Board Recovery, Resilience and Sel f-Management Champion

To go into the final version

Introduction

1. This document is presented at a time of great change within the Trust. Five years ago the Trust was a pioneer of Recovery and one of the first NHS organisations to establish peer support workers. The challenge today is not only to update the old, but to extend the Strategy to encompass the new services that became part of the Trust in April 2015 by harnessing the concept of “resilience” as an adjunct to “recovery”.

2. Other changes reflected in this Strategy are a coming of age of the Recovery College: the need to put this onto a sustainable footing, the role of Carers, pathways to volunteering and employment, and wellbeing.

3. The Trust is a partnership organisation providing services on behalf of our two

Councils under section 75 agreements. The language may be different, but the underlying concepts are the same and that is why this Strategy is also situated within the priorities and plans of our local authority partners.

Safeguarding

Right S

kills, Right P

eople

The Transforming Lives ModelHelp To Help Yourself

Accessible, friendly, quick, information, advice, a dvocacy, support to carers and families, universal services to the

whole community, prevention, early identification a nd early intervention

Help When You Need ItImmediate short-term help, time limited, reablement ,

rehabilitation, intense support to help regain independence, minimal delays, no presumption about long term support, goal-focused, integrated support

On-going Support for Those Who Need ItSelf-directed, personal budget based,

choice and control, highly individualised, integrated support, strengths based


4. All of this means that this Strategy could be described as a “hub” with spokes that connect to other strategies of the Board including: Carers (in development), Employment (to be developed with Commissioners), Working with the Third Sector (a CQUIN) Volunteering Strategy, and Spirituality.

5. Finally Recovery has been one of the most powerful “culture carriers” within the

Trust over the last 5 years and this Strategy has the potential to be the culture carrier for the new expanded mental health and community services organisation. In recognition of this, the current work on renewing the Trust’s Vision and Values, includes consideration of the issues raised here.

Background

The Trust Strategic Plans 6. The Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) mission is

‘to offer people the best help to do the best for themselves’ (CPFT 2 and 5 year Strategic Plan Nov 2014). This means that we strive to ensure that people can stay in the driving seat of their lives whilst receiving our services. We also aim to exceed peoples’ expectations by making every interaction with us count. We value and trust our staff and support them in their development. We aim to inspire people who receive our services, their loved ones and staff and be inspired by them and to provide excellence in everything that we do.

7. We aim to give those people who receive our services the best possible chance to live a full and happy life, and aim to support them to thrive beyond any limitations ensuing from condition or circumstance. Central to achieving this ambition are the concepts of Recovery, Resilience, Self-Management and Integration, which are also enshrined in the Trust strategic plan:

‘We will adopt the principle, in all our services, of empowering patients to achieve independence and the best possible life chances, removing dependence and giving them and their families (in the case of children) control over their care.

8. We will work closely with providers, along pathways, to deliver integrated, person centred care and support to local people, close to their homes, principally in non-institutional settings. We will integrate with key partners to improve efficiency and effectiveness and simplify access’. (CPFT 2 and 5 year Strategic Plan Nov 2014).

9. This Strategy seeks to add the idea of “resilience”. UnitingCare Partnership (UCP) 10. From 1st April 2015, Community Services for Older People and Adults with Long

Term Conditions transferred into the Trust as part of the UCP with Cambridge University Hospitals Trust. These services expand the Trust’s portfolio from being a provider of predominantly (but not exclusively) Mental Health Services. These


services provide assessment, diagnosis, and treatment and also support to individuals living with a range of long term, often debilitating conditions.

11. As the Trust becomes a provider of a broad range of community services, careful consideration will be given to the concepts of Recovery, Resilience and Self-Management and their application more broadly than within a mental health context. In terms of mental health, Recovery is taken to broadly be concerned with the development of services based on hope, a sense of control, choice, autonomy and personal growth for people in receipt of those services. It is clear that these concepts equally apply to other areas of health. In these broader health contexts Recovery is articulated as building resilience, and emphasis on self-management and the notion of the Expert Patient. This also fits within the overarching context of the Care Act with its emphasis on building community resilience, prevention and re-ablement.

12. This begs the question as to whether a strategy that is based solely on the notion

of “recovery” can resonate and gain the same purchase within the new services as it has within mental health. The challenge therefore is not to loose or dilute the recovery ethos but to expand or add to it to envelope the new services. For this reason it is proposed to re-badge the Strategy as “Building Recovery, Resilience and Self-Management”.

Recovery, Resilience and Self-Management – a mixtur e of the old and the new Recovery 13. The term “recovery”, with the rise of IMROC (Implementing Recovery through

Organisational Change), has become almost a trade name embedded within mental health and within much recent UK mental health policy. It builds on older concepts of rehabilitation and promoting independence

14. The literature is rich with definitions of Recovery. The CPFT website says that “Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms (Scottish Recovery Network 2009). Recovery is not about ‘getting rid of problems. It is about seeing people beyond their problems”. (Julie Repper and Rachel Perkins 2002)


15. The above are quotes from attendees at the Recovery College. The box below is a definition commonly quoted from Royal College of Psychiatrists’ literature: Recovery is “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness”. (Anthony, 1993 quoted in Recovery is for All SLAM 2010)

Reablement and Wellbeing 16. A more recent term used in local authorities is “Reablement” whereby targeted

services are provided with the express purpose of helping people to recover from a specific illness or event ( typically a fall) and then the service is withdrawn when the individual is deemed to have sufficiently recovered. Often there is a standard time attached to how long a Reablement service can be provided for. This comes with a notion of “throughput” (Peter Beresford 2015)1 which some commentators up to now have not seen as appropriate within the field of mental health.

1 Article “From Recovery to reclaiming madness” in Clinical Psychology Forum Special Issue Recovery April 2015

“What does recovery mean to me? It means being able to make my own decisions, having my voice heard, accessing the support I feel I need, when I need it and believing that I can live a life that I feel proud of” (RCE Student)

“Recovery is remembering who you are and using all your strengths to be all you were meant to be”

“Recovery to me is being able to do the things I used to be able to do, to get out of bed, to get to work, to enjoy my hobbies and interests and to love and be loved in return”


17. However with new duties under the Care Act 2014 to promote wellbeing (see below), this is leading to a renewed interest in the concept of reablement in mental health and our two local authority partners have asked the Trust to develop reablement services. In Peterborough this is to develop a dedicated Reablement Team. The approach in Cambridgeshire is different, based on introducing Reablement practices into two of the existing teams on a pilot basis (Huntingdon and Fens initially).

18. This fits well with recent new funding from the CCG for “recovery coaches” who

will be able to support reablement approaches and support individuals out of services and provide quick re-access if required.

Definition of Wellbeing

Wellbeing” is a broad concept, and it is described as relating to the following areas in particular:

• personal dignity (including treatment of the individual with respect);

• physical and mental health and emotional wellbeing;

• protection from abuse and neglect;

• control by the individual over day-to-day life (including over care and support provided and the way it is provided);

• participation in work, education, training or recreation;

• social and economic wellbeing;

• domestic, family and personal relationships;

• suitability of living accommodation;

• the individual’s contribution to society.

The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering “wellbeing” in the round

Official Care ACT 2014 Guidance, DoH 2015)

Resilience – a partner to Recovery 19. Google resilience, or resilience and mental health, or resilience and wellbeing,

and thousands of websites come back: the literature on resilience is large. Some examples of resilience, picked randomly, are cut and pasted with the web references in Appendix 3 of this paper to illustrate the power of this concept.

Factors that contribute to resilience include:


Close relationships with family and friends A positive view of yourself and confidence in your strengths and abilities The ability to manage strong feelings and impulses Good problem-solving and communication skills Feeling in control Seeking help and resources Seeing yourself as resilient (rather than as a victim) Coping with stress in healthy ways and avoiding harmful coping strategies, such as substance abuse Helping others Finding positive meaning in your life despite difficult or traumatic events

http://www.pbs.org/thisemotionallife/topic/resilience/what-resilience

20. Key points to note are: • The use of “resilience” across all ages i.e. across the life course which

matches our portfolio of activity; • The read across to mental health; • The commonality underlying the principles of recovery and the list of factors

that contribute to resilience; and • Resilience can be applied at different levels: individual, community and

economic resilience. This reads across to the plans below to strengthen pathways to employment, and to the Wellbeing Services being developed under the banner of UCP that are based on harnessing social capital within local communities.

• The importance of developing “personal resilience” within our staff – for example around the concepts of home: work life balance.

21. Self-Management comprises a portfolio of tools and techniques to support

people to manage their own physical and mental health. It requires a fundamental transformation of the ‘patient’ / ‘care giver’ relationship towards a collaborative partnership. In this way it has considerable resonance with the concept of Recovery in Mental Health.

22. For the above reasons it is proposed that the Strategy be reframed to be the Building Recover, Resilience and Self-Management St rategy.

23. The CPFT website contains our “Recovery Pledge” taken in January 2010:

This pledge was our 2010 commitment to working in p artnership with service users to: • Carry hope together • Believe change is possible • Work hard to understand experiences and build on strengths • Provide access and information to enable individual decisions and choices


• Share control and responsibility with individuals, but only when this is helpful to them

24. It is proposed that this statement be updated by a small focus group drawn from across all services in keeping with the full range of services within the Trust.

The Story so Far Achievements 25. This builds on the strong progress that has already been made by CPFT in the

pursuance of a Recovery orientation across its services. This progress is evident across a number of service streams and departments and includes: • development of Peer Support Worker roles • delivery of cohorts of training towards this Nationally and UK accredited

qualification • inception of Recovery College East • PROMISE project which involve a number of initiatives which have

o significantly improved the experience of people in adult inpatient services

o empowered staff to make small but significant changes to their own practice.

• Training, delivered by HR colleagues through the Recovery College, for people with a lived experience to sit on interview panels in CPFT

• Feedback from people with a lived experience using a variety of methods including IPad based surveys, focus groups

• Development of Daisy Change Women’s Institute which provides an opportunity for women with a lived experience to re-frame themselves as women first and members second and take part in everyday activities and educational opportunities. This also enables them to move away from illness saturated environments and which provides a link to local WIs in the area

• Board Champion appointed (see appendix 2)

26. It is impossible to represent here the entire breadth and wealth of the developments towards Recovery that are going on across the Trust. There is more detail in the recently published biennial report for the period Jan 2013 to Jan 2015 for the Recovery College East.

Challenges and Opportunities This strategy seeks to address the following challenges within an ongoing wider environment of austerity and reduced funding generally.

Our challenges include:


• Embedding recovery and resilience within our organisational DNA and as referred to above, we are now an organisation that is no longer predominantly a provider of mental health services. This is also an opportunity to use this Strategy as the “glue” within the organisational development strategy.

• Identifying, supporting and embedding the initiates that have come across with the community health services (for example health coaches and the “Breathe Easy” service within COPD)

• Taking the Recovery College East to the next stage – should the College be at arms length from the Trust, and if so what governance positions it best to attract funding from sources other than health and social care

• Developing the capacity within and the offer of the Recovery College East to meet a greater and widening demand – for instance from Carers

• Bringing the Recovery College East to Fens – consider a base in Wisbech or a peripatetic service offer within this part of the County where travel without a car is very difficult

• Growing and making the most of our relationships with the vibrant independent sector within Cambridgeshire and Peterborough, especially the rich culture of volunteering.

• Opening up jobs within the Trust and (including its commissioned services) to peer workers and to permanent roles.

• Encouraging staff to engage more with the Recovery College.

Five Year Strategy

27. Our objectives fall under the following headings: • Embedding the culture of Recovery and Resilience throughout the organisation • Walking our own walk – CPFT as an exemplary employer • Improving people’s life chances – health, employment, education • Changing the way we approach risk and supporting staff to work differently • Financial sustainability of Recovery College East • Implementing Recovery through Organisational Change (ImROC) – applying the

10 key organisational challenges identified by IMROC as fundamentals for change.

Embedding the culture of Recovery, Resilience and S elf-Management throughout the organisation 28. Over the life of the previous strategy considerable progress has been made in a

number of areas in relation to the development of a culture of Recovery across the Trust but like all such initiatives the drive to embed this has to be a continuous rather than continuing process if Recovery, Resilience and Self-Management are to become everybody’s business and firmly established throughout the organisational DNA. This must span the entire organisation from


the Board to the front line, administrative functions and across all services, teams and departments. Recovery, Resilience and Self-Management orientated practices will need to be explained and articulated in a way that is appropriate for individual teams and departments and to ensure that everyone understands how Recovery applies to their service or department and what is demanded of their own practice.

29. This also requires different approaches for different services which means that one overarching plan will no longer, if it ever did, fit the wide range of services provided by the Trust. For example there are a number of the community health staff moving into CPFT are trained as health coaches and this is an example of a service that might be grown and taken from community health services and embedded into mental health services.

30. We need to consider how we understand and map over the recovery orientated

practice from our new UnitingCare Partnership (UCP) older person’s services, learning disability and specialist services.

31. The concept of building resilience in Children’s Services is well established and

learning might be taken from these services across the rest of the Trust. Principles from Person-centred Dementia Care (Tom Kitwood) have been mapped against the principles underpinning Recovery. The diagram below is the famous Kitwood 2 “dementia flower” used now over the last 25 years within dementia care services.

2 T Kitwood (1997) Dementia Reconsidered


Comparable Principles in Recovery -orientated practice and person -centred care

Recovery (CSIP, RCPsych & SCIE, 2007; Sainsbury Centre for Mental Health, 2008)

Person -Centred Care (Kitwood, 1997, McCormack, 2004; Brooker, 2007)

Recovery is fundamentally about a set of values related to human living applied to the pursuit of health and wellness

A value base that asserts the absolute value of all human lives regardless of age or cognitive ability

The helping relationship between clinicians and patients moves away from being expert/patient to being ‘coaches’ or ‘partners’ on a journey of discovery

The need to move beyond a focus on technical competence and to engage in authentic humanistic caring practices that embrace all forms of knowing and acting, in order to promote choice and partnership in care decision-making

Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying roles in society

People with dementia need an enriched environment which both compensates for their impairment and fosters opportunities for personal growth

People do not recover in isolation. Family and other supporters are often crucial to Recovery and should be included as partners wherever possible

Recognises that all human life, including that of people with dementia, is grounded in relationships

Recovery approaches give positive value to cultural, religious, sexual and other forms of diversity as resources and supports for wellbeing and identity

An individualised approach – valuing uniqueness. Accepting differences in culture, gender, temperament, lifestyle, outlook, beliefs, values, commitments, taste and interests

Walking our own walk – CPFT as an exemplary employe r 32. Building on the more generic section above regarding improving peoples’ life

chances, as a large NHS employer CPFT is ideally placed to lead by example as an exemplary employer. There are a number of frameworks we can use to help us achieve this: such as further developing the Mindful Employer initiatives or adopting another framework such as the “Wearing 2 Hats” initiative, ensuring we are an organisation that actively seeks to employ people with lived experience.

33. The following is recommended: • To continue to host ‘Time to Change’ initiatives ensuring we are challenging

the stigma of mental health within the wider community. • To proactively support staff in the organisation who are also experiencing

mental health challenges.


Improving people’s life chances – wellbeing, employ ment, education 34. Central to the concept of Recovery is the challenge to service providers to

maximise opportunities for people to build lives beyond illness. This involves ensuring that service providers contribute positively to peoples’ sense of identity as citizens and focus on them in the context of their whole lives, not defining people by illness or deficit. This means mental health services being ‘on tap not on top’ in people’s lives (Repper and Perkins 2003).

35. The Recovery College is key in delivering the aspiration of “improving people’s

life chances”. The Recovery College would like to widen its curriculum to incorporate expert patient self management courses, and to increase the focus on building resilience and wellbeing.

36. This is also about situating the Recovery College within a pathway towards

employment that makes it easier for service users. This may include both volunteering and employment opportunities acknowledging the rich network of employers and volunteering support organisations across Cambridgeshire and Peterborough with whom the Trust is developing closer working relationships.

37. But volunteering is not just about pathways to employment. For an older person,

no longer in paid employment, it may be about social engagement and activity that builds their resilience and supports their wellbeing.

Changing the way we approach risk and supporting st aff to work differently 38. A recovery orientation and the building of individual resilience within the context

of service provision, is largely agreed to be concerned with the development of delivery based on hope, a sense of control, choice, autonomy and personal growth for people receiving services.

39. It is also agreed that, in order for staff to work within this framework, organisational commitment to supporting them in their efforts to do so is also key. Traditional risk management is usually concerned with danger avoidance, restrictions, containment, protection and control. Our challenge is to reconcile these tensions and to find a way to support people appropriately in their recovery journeys and to support staff in their attempts to do so (Boardman and Roberts 2014).

40. There are two main strands to this challenging goal. The Trust-wide articulation of

a recovery and resilience orientated attitude towards risk and the policy framework to underpin this and some subject specific initiatives including the No Force First project.

41. This is acknowledged to be difficult. The implementation of personalisation under

the Putting People First Concordat (2007) has led local authorities to develop


positive risk taking policies and procedures so that they can step back and relinquish control over the lives of people with life long conditions and disabilities. Examples include the choices of individuals who may not wish to settle in one place, choices about food, and about the hours that people choose to live.

42. There is also a read across to the new adult safeguarding provisions of the Care

Act 2014 which lower the threshold for safeguarding. It might be thought that a widening of safeguarding would increase risk averse behaviour. However, paradoxically, knowing that this framework in place might actually assist clinicians to feel more confident in their approach to risk.

Financial sustainability of Recovery College East 43. CPFT is rightly very proud of this innovative and ground-breaking work carried

out at Recovery College East since its inception.

44. However, a victim of its own success, the College has out grown its funding base, and the College is at a watershed in terms of its future direction. A vital strand of the Recovery and Resilience Strategy therefore needs to focus on ensuring that the Recovery College is sustainable into the future and can continue to thrive and develop in more diverse areas.

45. We are proud of the reputation of our Recovery College and the developments

around our partnership working. We have recently secured funding from the Skills Agency to pilot courses around transition and change in partnership with the City College in Peterborough. Additionally, the CCG have asked the Recovery College to host a number of recovery coach posts to support people who are struggling with being discharged from mental health services.

Implementing Recovery through Organisational Change (IMROC) 46. CPFT became an IMROC demonstration site in the inaugural year of IMROC’s

inception in 2010. This demonstrated that CPFT had provided evidence that they had made significant progress towards the development of a Recovery orientation. It also meant that CPFT had made a commitment to support other organisations in their own journeys as well as receive support from the IMROC team and members to further CPFT’s own journey.

47. IMROC coined the ten key organisational challenges that we have adapted over

time and are now familiar with from our development work over the intervening five years:

1. Changing the nature of day-to-day interactions and the quality of people’s

experience 2. Establishing a ‘Recovery Education Centre’ to drive the programmes

forward and


3. Delivering comprehensive user-led education and training programmes 4. Ensuring organisational commitment, creating the ‘culture’. The

importance of leadership 5. Increasing personalisation and choice 6. Changing the way we approach risk assessment and management 7. Co-production as a founding principal 8. Transforming the workforce 9. Supporting staff in their recovery journey 10. Increasing opportunities for building a life ‘beyond illness’

48. Note that a brief review of what has been achieved under each of these headings

is Appendix 1

49. This Strategy is an opportunity to take stock of progress made so far in all the key areas and to consider the strategic direction and priorities over the five coming years. This has been co-produced with a number of stakeholders including people with a lived experience, carers, staff, Governors and Board members. This is summarised in the tables in Appendix I below.

Next Steps 50. The next steps for the Recovery, Resilience and Self-Management Strategy will

include: • A period of discussion of the ideas in this document across the Trust and

partners, (recommended to finish end of October) • The production of a detailed action plan to include dates and lead

responsibilities that will come through the Quality, Safety, and Governance Committee for sign off.

• Ensure that the action plans are built into the annual CPFT Business planning cycle

• Develop and implement an internal and external communication plan


APPENDIX I

The IMROC 10 Organisational Challenges What would good look like?

Achievements so far

Action Plan

Outcome measures

1. Changing the nature of day -to-day interactions and the quality of people’s experi ence • Every significant encounter by

every member of staff would reflect the principles of recovery and resilience and promote these values – increasing self-control (‘agency’), increasing opportunities for life ‘beyond illness’, and validating hope.

• Each interaction would acknowledge non-professional expertise and attempt to redress power imbalances.

• The quality of staff/user interactions would be central to staff supervision and appraisal and reflected in any documentation.

• People would be routinely asked to feedback on their day to day experience of staff.

• People with a lived experience would be involved

• People with a lived experience are involved in some recruitment panels

• Some policies reflect a Recovery orientation

• The PROMISE project is making considerable impact through No Force First initiatives

• Specialist Services have taken steps to improve their physical environments (Children’s Tier 4 services, Eating Disorder team, Liaison Psychiatry, Learning Disability Services and Forensic team)

• Specialist Directorate held a successful recovery away day to explore ways to make their services more recovery orientated and have utilised the team recovery implementation plan (TRIP)

• To work proactively with commissioners and external stakeholders on the Recovery and Resilience agenda

• Build Recovery expectations into all personal development plans through the appraisal process

• To develop a robust process of Recovery and Resilience orientated supervision and leadership including staff development plans and appraisals

• To introduce Health Passports • To develop a mechanism for

Benchmarking e.g. Team Recovery (and Resilience) Implementation Plan (TRIP) or the adaptation / creation of another tool

• To review from time to time the ‘Patient Story’ Trust Board Agenda item to ensure that it reflects and models a Recovery and Resilience orientation

• To consider the role of Carers in

• Surveys of user and carer perceptions of their experience in relation to Recovery and Resilience principles

• Supervision and appraisal systems reflect a Recovery and Resilience orientation

• Recruitment policy requires all panels to involve people with a lived experience

• Piloting the use of the INSPIRE tool as a way to elicit feedback on recovery orientation within individual practitioners. i.e. Arts Therapies


in all aspects of staff selection.

• All policies are designed to facilitate a recovery and resilience orientation.

• People receiving services would take an active part in making changes to Trust environments

to create recovery action plans in each team.

Recovery o Providing carers with education

about Recovery and Resilience o Involving carers in the Recovery

College courses (as facilitators and students)

o Sensible and sensitive approaches to confidentiality

o Introduction and roll out of the Triangle of Care

o Carer’s assessments o Support for carers

2. and 3. Establishing a ‘Recovery Education Centre’ delivering comprehensive, peer led, co -produced 3 education and training programmes • A Recovery College based

on principles of lived experience and co-production

• Delivery of Recovery orientated courses based on what people find helpful and including Peer Support Worker training and accreditation

• Course available to people receiving services, their families, carers and staff

• Links to Further and Higher

• Recovery College established in 2012

• Two hubs established by 2013

• Co-production is the founding principle on which the College is built

• 8 Cohorts of Peer Support Workers graduated by end of 2015

• Peer support workers on work experience supporting the Recovery College

• To employ a commercial business / development worker via CPFT Charitable funds, for one year, to develop and business strategy and to explore funding opportunities including:

• Internal and external funding opportunities

• Registering the Recovery College as a Charity

• Accessing National Lottery funding • Opportunities to second assistance /

sponsorship from commercial

• We measure and then try to increase the number of staff who attend Recovery College courses. (see challenge 4)

• CPFT clinical teams offer some support / resources to the Recovery College

• Internal funding provides a Deputy Recovery Manager and at least two PSW posts within the College.

3 Co-production has been defined as a “relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have

vital contributions to make in order to improve quality of life for people and communities” (Slay & Stephens 2013 quoted in Clinical Psychology Forum April 2015)


Education and other learning opportunities.

• More than 90% of staff would have attended at least one course per year at the Recovery College or equivalent.

• There is a continuous programme of evaluation and audit to measure the impact of the college.

• Closer alignment between traditional learning and development courses and opportunities and the Recovery College.

• A wide range of opportunities are available throughout the Trust for co-produced education, not just through the Recovery College.

• There is a well established route into employment.

• Ensuring the Recovery College is applicable to all service areas ( older persons teams, learning disabilities, specialist and children’s services)

• More than 630 students accessed the College over 2012-2015

• Overwhelmingly positive feedback from students (96-100% of students would recommend the College to family, friends and loved ones).

• Peer Employment Training is now delivered through the college and now has a UK accreditation (Open College Network) as well as the US accreditation.

• The Recovery College attracts National and International visitors.

organisations to Recovery College East

• To pursue increased internal funding to provide sustainable posts to support the current team

• To explore the possibility of the Department of Work and Pensions providing funding to support ‘return to work’ courses e.g. Curriculum Vitae writing

• To develop relationships with mainstream Higher Education and Further Education Colleges

• To explore relationships with Anglia Ruskin University School of Health and Social Care and Business School

• To work with pathway teams to ensure recovery education and co-production is built into the Affective and Psychosis Disorder pathway protocols

• Learning Disability services and the recovery college will be co-producing courses together

• Links with external Education, business and voluntary organisations are established providing two way opportunities eg external student placements in the College and RCE student experience in business

• Business and Marketing post recruited to

• Sustainable funding established

• All group interventions are delivered within a model of Recovery Education, ultimately aiming for full co-production and co-delivery


4. Ensuring organisational commitment, creating the ‘culture’. The i mportance of Leadership

• There is strong leadership from the Trust Board to set the organisational Recovery and Resilience agenda, drive this forward and model the philosophy.

• A Non Executive Director is identified as the champion and advocate for Recovery and Resilience at Board level.

• Recovery and Resilience values are embedded in every operational policy, management process including recruitment, supervision, appraisal and audit.

• All key internal ‘pathways’ including referral systems, assessments, CPA, discharge planning, etc. are organised so as to reflect a recovery and resilience orientation.

• All service transformation would ensure that outputs reflect the organisational commitment to Recovery and Resilience principles e.g. Resilience Impact

• Recovery and resilience enshrined in broad terms in the Trust Strategy.

• Non Executive Director appointed as Recovery Champion.

• Executive Director of Service Integration holding the Executive Lead for Recovery and Resilience.

• Specialist Services have led the way in terms of using the Team Recovery Implementation Plans (TRIP) and have started to develop recovery orientated services.

• Some directors and Governors have attended a Recovery College course.

• The Board to provide a clear sense of direction of travel and commitment to the Recovery and Resilience agenda including a review of policy and the introduction of Impact Assessments.

• The Board to explicitly set goals and standards e.g. o co-production as a founding

principle o we increase the number of staff

attending recovery college courses each year)

o Peer Support Worker training is delivered every year through the Recovery College.

•••• To commit to having 1 PSW in every clinical team by 2017 and 2 in every team by 2019

•••• We identify ways of measuring the number of staff with lived experience in the workforce and then try to increase this number

• The Board sets a clear expectation that middle and senior manager will ‘step up’ and lead from the front and implements this.

• Provision of ‘Training the Trainers’ courses to support the ‘stepping up’ of middle and senior managers.

• A clear steer from Trust Board regarding the direction of travel for Recovery and Resilience and the expectations of the organisation

• Policies and procedures demonstrate a Recovery and Resilience orientation

• Experts by experience involved as a standard in all service design and transformation

• Impact Assessments used • Benchmarking of practice

is achieved to identify areas for improvement and celebration across the Trust.

• Recovery orientated objective within staff’s appraisals


Assessments. • All teams utilise Recovery and

Resilience orientated benchmarking as a way of measuring progress.

• The Board and Governors sign up for Recovery College courses.

5: Increasing personalisation and choice

• There is a clear emphasis on ‘life goals’ as opposed to symptom treatment goals in practice and prompted by all documentation.

• Care plans are owned by the individual using a process of co-production

• Co-produced, collaborative Crisis Plan/Advance Statements would be routinely used to support people to retain control even in the most difficult times.

• Adults Safeguarding systems incorporate the requirements of “Making Safeguarding Personal”

• Shared Decision Making Project in collaboration with Anglia Ruskin University culminating in a Conference March 2014.

• Shared Decision Making is a theme in the majority of courses delivered in the Recovery College.

• Hearing Voices Conference, in collaboration with Anglia Ruskin University, for sharing opportunities and ideas for complementary and non-medical alternatives for people who hear voices January 2015.

• Draft collaborative crisis plan has been co-produced by people receiving services and staff, ready to roll out in

•••• To reduced the reliance on medication and increased choice and alternatives to medication and shared decision making in medication.

•••• Enabling people to understand and make informed choices about the health risks associated with mental health and other treatments and any resulting side effects.

•••• To increase the take up of cash direct payments by eligible service uses and carers from current levels to a target to be set.

•••• The introduction and roll out of Personal Health budgets.

•••• To continue and roll out the work already started on collaborative crisis planning / advance statements.

•••• Work with both safeguarding Adults Boards to implement Making Safeguarding Personal

• Documentation including care plans place emphasis on life goals

• Progress towards agreed targets for all personal budgets and direct payments

• Published information is available to assist service users to make informed choices about treatment and support options

• Co-produced, collaborative Crisis Plan/Advance Statements are routinely used to support people to retain control even in the most difficult times.

• All adults (with relevant capacity) about whom a


stage two. • Development of a co-

produced tool to support goal setting around social inclusion

• Development of a goal setting programme within Personality Disorder pathway

• Development of a framework within Rio to capture and monitor goal attainment from care plan outcomes regarding vocation and Activities of Daily Living

• Adult Safeguarding documentation redesigned to capture the desired outcomes of adults at risk

safeguarding concern is raised identify their desired outcomes.

6. Changing the way we approach risk assessment and management • The organisation supports

open, transparent, honest, risk assessments, supports staff to adopt this way of

•••• The PROMISE project has captured people’s imagination and provided a framework for a number of

•••• To re consider the Trust’s attitude and approach towards risk

•••• Implementation of the DOH guidance ‘Best Practice for Managing Risk’

• Staff have received training in the application of recovery and resilience principles to risk


working. • The organisation values

‘positive’ risk taking and a willingness to examine and learn from incidents and support staff, rather than ‘blame’ them if adverse events occur. This is been made explicit to staff by the Board and is reflected in action.

• The organisation is prepared to grapple with the tension between its duty of care to provide safe services while promoting a positive approach to risk assessment and management.

• Collaborative initiatives based on the principles of No Force First are encouraged and captured within the PROMISE local project

• Recovery orientated risk assessment means consideration of and value given to recovery risks such as social exclusion, unemployment, etc.

initiatives which are positively impacting on attitudes to risk.

•••• Work is underway to co- produce a collaborative crisis plan / advance statement which is designed to change the way we respond to risk and crisis situations.

•••• Risk / Suicide courses are in the process of being co-produced between Learning and Development, Psychology, Recovery College, Peers and partner agencies to complement the formal training that already occurs.

•••• The implementation of the PROMISE project, actively exploring the ‘No force first’ agenda.

•••• To develop sensible and sensitive approaches to confidentiality

•••• To articulate what ‘good’ would look like if CPFT approached risk differently

Subject specific initiatives •••• To implement and roll out Health

Coaching building on the earlier work in Community Health Services

•••• To develop truly personalised approaches

•••• For co-production and shared decision-making to underpin all services

•••• To amalgamate the Learning and Development prospectus and the RCE prospectus starting with the Risk Module

•••• To further develop the PROMISE project o To introduce No Harm objectives

for everyone (and to translate this for people whose roles are not directly linked to service users)

o To formally commit to the elimination of physical and psychological trauma caused by services

o To formally commit to the

assessment and management and this is built into all inductions.

• Risk assessment and management procedures (e.g. CPA) contain a clear expectation that service users will be routinely involved in these processes and this is systematically audited;

• Training in the use of ‘Joint Wellbeing Plans’ has been delivered and these have been incorporated into routine practice;

• The organisation routinely examines serious and untoward incident reports with a view to ‘learning the lessons’ rather than apportioning blame;

• Risk management policies reflect a shift towards supporting positive risk taking, while ensuring appropriate corporate governance and adherence to safe practice and regulatory requirements.


elimination of control and restraint

7. Co-production as a founding principle • A move away from

‘involvement’ as a concept to full co-production in all aspects of service delivery, transformation and service design.

• All training is co-produced across the organisation.

• Co-produced team Recovery Implementation plans are commonplace throughout the Trust

• Recovery College East is firmly founded on the principle of co-production and co-delivery.

• Co-production is more evident within the Learning and Development portfolio.

• People with lived experience are routinely involved in transformations and service re-design.

• The Recovery College has quickly become a centre for involvement both in CPFT and externally.

• TRIP assessment day for the Intensive Support Team for service users, carers and families

• The Trust Board to adopt as a principle that co-production is central to all aspects of service delivery, transformation and service design.

• The language of co-production will be used consistently in written documentation.

• To gather evidence that this is being implemented.

• Learning and Development and the Recovery College work closer together to ensure co-production is high on the Trusts agenda.

• The Trust Board adopt as a principle that co-production is central to all aspects of service delivery, transformation and service design and research.

• The language of co-production is used consistently in written documentation.

• Evidence that this is being implemented. E.g. to monitor and audit involvement in change projects

8: Transforming the workforce

• The value of a lived experience within the entire workforce is articulated explicitly

• Peer Workers make up at least 25 % of the workforce and 50% of the workforce are

•••• Recruitment processes explicitly states that CPFT invites and welcomes candidates with a lived experience

•••• Peer Support Workers have been employed in teams and

•••• To commit to the training and employment of future cohorts of Peer Support Workers

•••• To commit to 25% of the workforce being made up of PSWs by 2017.

•••• To commit to having 1 PSW in every clinical team by 2017 and 2 in every

• All recruitment explicitly invites and welcomes candidates with a lived experience.

• Vacancy control process considers all un registered vacancies for conversion


made up of staff with lived experience in other roles.

• All vacancies for un registered staff would be considered for conversion to a PSW role.

• Clear arrangements for supervision and professional leadership for PSWs are in place.

• All recruitment clearly states that CPFT values and welcomes applications from people with a lived experience.

• The Trust actively supports the Mindful Employer status.

• Support for staff with a lived experience in the organisation.

• The role of lived experience within all professional groups being recognised, valued and strengthened and structural mechanisms to be developed further with professional leads

on the wards since 2010 •••• Some Peer Support Workers

have gone onto more senior roles and some are undertaking their Nurse training.

•••• Some key roles have specifically required someone with a lived experience.

•••• Requirement for all PSWs to have individual supervision and appraisals and to attend Peer Professional days bi-monthly (requirement to attend 4 out of the 6 professional forums every year). Support for those managing PSW’ s

team by 2019 •••• To ensure that all recruitment clearly

states that CPFT values and welcomes applications from people with a lived experience.

•••• Further research and evaluation to understand the impact of peer support workers.

to a PSW role. • Clear arrangements for

supervision for PSWs are in place and evaluated.

• Recovery built into staff goals, personal development and appraisals

9. Supporting staff in their recovery journey

• Staff do not fear stigma or •••• Human Resources take the • CPFT has already been awarded • Anonymous staff


prejudice from colleagues or managers in the workplace if they reveal their own lived experience.

• Staff are encouraged and supported to share their own lived experience if they feel they would like to and it would be helpful to the person they are working alongside.

• The organisation has in place comprehensive provisions to optimise staff health and to constructively address issues (e.g. augmented occupational health services).

• The personal qualities and prior experience of staff are explicitly stated during recruitment

• The Recovery College provides support to all people including staff without prejudice.

• Staff would be happy to receive services from CPFT if they needed to access inpatient or community support.

• Dashboard developed to

lead in the Health and Wellbeing agenda for staff

•••• More staff are sharing their lived experience in the workplace, although we acknowledge we would like this to be more.

•••• The ‘Road to Recovery’ book was co-produced in 2014 celebrating the recovery stories of both CPFT staff and people receiving services.

Mindful Employer status and this could be used more effectively and its potential amplified

• Identifying ways to capture the number of staff with lived experience applying for and who are subsequently employed by the Trust

• To then increase the number of staff in all roles in the organisation with lived experience (50% of staff are people with lived experience) .

• Improved support for staff with a lived experience and the introduction of Health Passports

• Implementation of ‘Time to Change’ initiatives to challenge stigma

• The introduction of robust reflective supervision process

• Developing a strategic approach to Involvement across CPFT (Partnerships Strategy 2013-2016)

•••• To provide support for staff in the organisation with their own lived experience.

•••• Staff feel supported to talk about their own lived experience in the organisation

• Implementation of the Payment of Service Users Policy 2015

• Working with GPs to increase their

satisfaction surveys, with evidence that results are acted upon

• Recruitment practices positively reflect the value of lived experience among staff;

• The Trust retains and exploits its status as a Mindful Employer.

• Wearing Two Hats support forum is officially launched to develop ways of supporting staff who also have their own mental health challenges.

• Protocols / policies are reviewed and established to support staff who may need to access services from CPFT.

• Employing an OT within Occupational Health supporting staff to return to work quicker and more effectively.

• Employing a Recovery Lead within HR to ensure we are implementing policies and procedures


ensure the Trust is able to report on employment of people with mental health challenges. .

• To have an OT lead within Occupational Health and a Recovery Lead in HR both supporting staff and managers within the organisation

understanding of Recovery and Resilience principles

• Implementation of the Care Act Dashboard developed to ensure the Trust is able to report on employment of people with mental health challenges.

that reflect a recovery and resilience orientation and support staff with their health and wellbeing.

10. Increasing opportunities for building a life ‘ beyond illness’ • There is a particular emphasis

on the importance of paid employment and IPS workers would operate in all teams.

• Recognition that community and social engagement is paramount (employment is not an option for all)

• Health promotion and wellbeing is accessible across all cultures.

• There are a range of effective partnerships with external organisations to support individuals in building a life for themselves independent of formal mental health services.

• CPFT and people receiving

•••• People with a lived experience have a range of opportunities in CPFT to develop further skills around peer employment and tutoring at the Recovery College.

•••• CPFT have tried to develop a range of effective partnerships with external organisations to support individuals in building a life for themselves independent of formal mental health services.

•••• A number of successful ‘Time to Change’ initiatives have

• To spread Health Coaching across the Trust

• To introduce Health Passports • To develop explicit pathways to

employment/education that bring together the new funding for “recovery coaches” from the CCG with “Reablement initiatives” working with our two local authority partners.

• To implement more ‘Time to Change’ initiatives to challenge stigma

• To underpin all services with co-production and shared decision-making

• To develop opportunities for volunteering and accessing leisure pursuits

• Employment specialists trained to deliver Individual Placement and Support (IPS) in each team

• The organisation routinely audits the effectiveness of discharge plans to sustain recovery

• Identifying ways to capture levels of satisfaction of service users with the delivery and outcomes of services. Identifying ways of capturing date on the employment of people with lived experience


services are playing an active part in the wider community to help challenge stigma through campaigns such a Time to Change’.

• To have a broader concept of health and recovery to include physical health and resilience

• An understanding of the importance of and role of education, training and employment within people’s recovery, including children’s and young peoples services

• To ensure that people are always asked about their vocational goals and needs at the earliest possible opportunity

• People’s vocational achievements are captured at regular intervals to show positive change

• Volunteering – route to employment and Wellbeing for Older People

taken place over the years to challenge the stigma of mental health in the wider community.

•••• Recovery principles are embedded in the new clinical and service model for Arts Therapies

•••• Vocation is embedded in the community pathway protocols and the JD and PS for OTs within Adult mental health

•••• Mental Health OTs have identified vocation as a priority area for OT resource and expertise and are developing local mechanisms to deliver and capture this

•••• Mental Health OTs consider vocational needs and goals as part of routine OT practice through use of MoHO

•••• Mental Health OTs capture vocational achievement through use of standardised, evidence based MoHO assessments (repeated measures)

•••• Mental Health OTs have and

• To amplify the link between the Recovery and Spirituality Strategies and the Recovery and Volunteering Strategies

• To consider the introduction of animals as therapy as appropriate

• To build relationships with other social care departments including housing

• Increased proportion of people receiving services reporting that they have achieved their personal recovery goals.

• Continuing improvement on the ASCOF employment measures

• Appropriate involvement and effective input within education, health and care plans ( EHC ) for children and young people (SEND reforms).

• OTs are able to demonstrate positive change in relation to vocation using the Model of Human Occupation (MoHO) tools

• HoNOS scores show change as a result of OT intervention (prioritisation project)

• People are asked about their vocational goals and needs upon entry to the service and at regular intervals

• Increased proportion of


are engaging in ongoing CPD and training around vocation, which has include IPS training from Miles Rinaldi

•••• Use of the Occupational Self Assessment (OSA) by OT to capture goals and change – underpins the Personality disorder goal programme

•••• OT have attended training on Recovery through Activity and are implementing (eg older people)

people receiving services reporting and demonstrating achievements of personal recovery goals through changes within care plan


APPENDIX 2

Role of Recovery Champion – Jo Lucas 1. To champion the ethos of Recovery in Mental Healt h

• as a way of thinking about and framing services within the Board and with staff and partners in the role of NED

• promotion of the Recovery College to the Board and external partners, attending their events etc

• To work with the Board in extending and adapting this concept to the other services that will be in the Trust from 1st April 2015

Actions:

• to host a workshop on recovery later on in the year to embed more into the Board

• visit other RCs eg the Harrow campus of CNWL's RC which is in partnership with Westminster University

2. Promotion of the values of social care and deve lopments

• giving visibility to social care at the Board • prompting the inclusion of social care in the relevant papers that come through

the Board (workforce plans, business planning etc) • Be visible to social care staff eg through the Social Care Forums – as an

emissary from the Trust Board 3. Carers

• to be Trust Board lead on this area of work (Strategy to be refreshed and updated in 15-16)

• To work with Governors in this area of work (a key priority for Governors) • To develop the linkages between Recovery for service users and support for

Carers 4. Social Enterprise Café at Fulbourn project

• To provide support and challenge as the lead NED to the Senior Chaplain and the project team for the establishment of this facility on the Fulbourn Hospital site. t

February 2015


APPENDIX 3

What is resilience?

Resilience is the capacity to withstand stress and catastrophe. Psychologists have long recognized the capabilities of humans to adapt and overcome risk and adversity. Individuals and communities are able to rebuild their lives even after devastating tragedies. Being resilient doesn’t mean going through life without experiencing stress and pain. People feel grief, sadness, and a range of other emotions after adversity and loss. The road to resilience lies in working through the emotions and effects of stress and painful events. Resilience is also not something that you’re either born with or not. Resilience develops as people grow up and gain better thinking and self-management skills and more knowledge. Resilience also comes from supportive relationships with parents, peers and others, as well as cultural beliefs and traditions that help people cope with the inevitable bumps in life. Resilience is found in a variety of behaviors, thoughts, and actions that can be learned and developed across the life span. Factors that contribute to resilience include:

• Close relationships with family and friends • A positive view of yourself and confidence in your strengths and abilities • The ability to manage strong feelings and impulses • Good problem-solving and communication skills • Feeling in control • Seeking help and resources • Seeing yourself as resilient (rather than as a victim) • Coping with stress in healthy ways and avoiding harmful coping strategies, such as

substance abuse • Helping others • Finding positive meaning in your life despite difficult or traumatic events

http://www.pbs.org/thisemotionallife/topic/resilien ce/what-resilience


Arch Project What is resilience?

Resilience is a key factor in protecting and promoting good mental health. It is the quality of being able to deal with the ups and downs of life, and is based on self esteem.

We look into many different factors that affect resilience:

• secure early attachments

• confidence of being loved and valued by one’s family and friends

• clear sense of self-identity (personal, cultural and spiritual)

• sense of self-efficacy (being able to make decisions and act independently)

• confidence to set goals and attempt to achieve them.

Based on these, the project uses 6 domains to work with to try and build people’s resilience:

(Brigid Daniel & Sally Wassell – Assessing & Promoting Resilience in Vulnerable Children)

http://www.barnardos.org.uk/arch/arch_what_is_resilience.htm

the transforming lives model€¦ · ‘we will adopt the principle, in all our services, of...

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