Transcript Newham Talking Therapies - Healthcare Conferences UK

Newham Primary Psychological
Services
Neelam Dosanjh
Head of Service
Monton Jienpetivate
Deputy Head
Newham’s Model
Newham Profile
Population
- 308, 800
- High transient population
- 4th most deprived borough in London
Diversity
- Young population - 60% aged between 25 and 45
- 70% are from different ethnic backgrounds, 130 languages
Employment
- Approximately 10% are unemployed double London’s average, no change post 2012
- Second highest in benefit claims
- 60% of ESA claimants report having mental health issues
Health Inequalities
Service Profile
• Extended IAPT with specialist provision for LTC and
MUS, Peri- Natal MH, Eating Disorders, Trauma
• Stepped Care Model – 0 to step 4a
• 7000 Referrals per year
• Approx. 5000 into treatment
• Therapy choice is a priority but can’t always deliver
due to capacity - CBT, DIT, IPT, Systemic, Integrative
• Sub contract to Third sector for counselling, a service
for DV and welfare and employment
Drivers
• Mental ill-health is prevalent in the working age population and is
associated with high economic and social costs to individuals and
society at large.
• Improving the wellbeing of people with mental health problems and
helping them find and sustained employment remains a challenge to
health and employment services alike.
• Unemployment and being out of work are seen as key drivers behind
mental ill-health (Pevalin and Goldberg, 2003; Paul and Moser, 2009).
Employability and returning to work helps to improve mental
wellbeing (Paul and Moser, 2009; McManus et al., 2012.
Profile of Service Users accessing
Employment Service
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Length of depression and anxiety – 2 to 5 years
Social isolation and exclusion
Poor motivation and self esteem – extrinsically driven
Low educational attainment
Workless-ness in the family
Co – morbidities – substance misuse, poverty, safeguarding
issues, poor social stability (welfare), physical ill health
Integrated Model
Barriers:
• To employment for people with mental health problems is the stigma and
discrimination (Centre for Mental Health, 2013)
• Is the ‘benefit-trap’ when benefits create stronger incentives to remain in the
system rather than return to work ( Lelliott et al., 2008)
Integrated Provision:
• The integrated employment service within Newham IAPT offers opportunities
to overcome these barriers
Cultural shift :
• Therapists to assist the engagement
• SUs – suspicious, disengagement
Integrated Model - Benefits
• Provides social stability to better engage with the therapeutic
process
• Ease of access for Service Users
• Learning , having a shared language and tailoring service
provision
• Improves the Service User’s overall experience of care,
engagement, quality, retention in employment and provides a
longitudinal approach to improved well being
Integrated Model - Benefits
• Collaboration and close working ensures
wellbeing goals are aligned and realistic
employment and
• Employment service has excellent links with national and local
employers and employer support services such as Access to Work
• The in work support provided by the employment service ensures
early intervention for Service Users who are in work, and need
additional mental health support to successfully retain their job.
Work of employment advisors
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Forming relationships with Service Users
Assessing literacy and skills
Employment steps - identifying competencies
Coaching on motivation and confidence building
Job searches – matching competencies
Assisting with CV writing and application forms
Preparing for interviews
Employer engagement
Liaising with educational and welfare agencies
Data for a year period- July 2013 to July
2014
Number of people referred for employment support
Number of people moving off sick pay and benefits
Total number moving from unemployment to paid work ( 15
self employment )
Number moving from unemployment to part time or full time
student
Number retaining full time work
Number retaining part time work
517
218
100%
42%
40
8%
99
124
36
19%
24%
7%
IAPT Employment Initiative
• Newham IAPT and local partnership
• Letwin pilot project: Newham IAPT engagement
IAPT Employment Initiative: existing
partnership
• Local initiatives between Newham IAPT and Work
Programmes set up in 2012
• Initial meeting with all local main providers
• CDG and A4e signed up
IAPT Employment Initiative: Existing
partnership
Planning and pre-referral stage
• Establishing relationships with advisors and fostering
engagement
– Training provided by IAPT
– Ongoing contact, consultation, follow-up and engagement
• Pathway mapping and Referral and infrastructure
configuration
• Evaluation: Joined by UCL Partners
IAPT Employment Initiative: Existing
partnership
Success
• Relationship
• Commitment from staff
from both sides
• Support and accessibility
of IAPT staff to advisors
• Advisors increased
confidence in their role
and engagement with
customers
Challenges
• Learning each other’s
“language” and system
• Governance, information
sharing and data sharing
• Keeping on the task, and
maintaining enthusiasm
Letwin Pilot Project: Aims
“The purpose of the pilot is to test the impact on
benefit off-flows of a client receiving support from the
NHS (provided by IAPT). The focus will be Employment
and Support Allowance (ESA) claimants in the Work
Related Activity Group (WRAG) who report a common
mental health condition that may impact on their
ability to job search. These claimants will be engaged
with the Work Programme.”
Letwin Pilot Project: Scope
“Advisers to address job search and employment
and establish if progress may be restricted by a
common Mental Health Condition – advisers are
not expected (nor should attempt to) to
diagnose mental health conditions, but to
identify where it impacts on Job search activities
and employment and refer those who consent
to the support.”
Letwin Pilot Project: Scope
• One thousand claimants
• Eight providers across the course of four
months from September 14.
• The referrals will be voluntary and no
sanctions can be applied for non-participation.
Both existing claimants and new claimants of
ESA.
Letwin Pilot Project: Newham IAPT
engagement
• Preparation stage
– Being “introduced” to selected partners – Seetec
and CDG (Shaw Trust)
– Process mapping, information sheets, data
sharing, referral form and process
– Weekly conference call/ feedback with the pilot
team
Letwin Pilot Project: Newham IAPT
engagement
• Local implementation
– Active engagement “at the top” - Three-way meeting –
IAPT, Primes and the project team
– Negotiating a model, establishing contact points and
referral route with management
– Establishing and maintaining relationships
 Information session with advisors
 One-to-one, team consultation
 Maintaining contact
– In-house communication, configuring IAPTus, referral
pathway, tracking and engaging booking and clinical staff
Letwin Pilot Project: Newham IAPT
engagement
• Two models
• A dedicated advisor as a link person
– Meeting with local manager and the advisor to clarify aim of the
project, criteria and secure commitment
– Individual meeting with the advisor to help identify appropriate
referrals
– Regular contact
• All advisors make referrals
– A half-day information session, including “refreshers” session of
previous training and referral route
– Establish referral handling, feedback and information sharing
– Regular contact via dedicated team leader and individually
about outcomes of referrals
31 Referrals received Dec 14 – Jan 15
Current SUs
of IAPT = 3
(10%)
New SUs,
18, 58%
Previous
SUs of IAPT=
10
(32%)
Initial engagement outcomes
Not contactable
=8
(26%)
Successful
engagement to
assessment = 20
(64%)
Unable to
process = 3
(10%)
Current status
53% made it through to assessment completion;
47% dropped out at booking and pre-assessment
In therapy = 20%
In Assm’t = 20%
Refer on = 13%
Assm’t = 13%
Pre-assn’t = 34%
IAPT Employment Initiative: Letwin Pilot
Project
• Learning points
– Engagement and relationship is the key.
– Commitment from the top is vital.
– Be adaptive and understand our partners’ organisation needs
and pressure, e.g. avoid training at the end of the month,
multiple sessions as needed to ensure enough advisors on the
ground to keep the business open.
– Keep it simple. Advisors are busy and have a high caseload.
– If plan A does not work, have a plan B in place.
– Communication of outcomes – no-one would like to refer to a
“black hole”.
– Ensure a robust and referral handling and tracking system.
– Engage and communicate with your own staff – clinical and
booking team.
Neelam Dosanjh
[email protected]
Monton Jienpetivate
[email protected]
0208 536 2161
[email protected]