Social and Communities Opportunities Profile SCOPE v1 Peter Huxley PhD King s College London Institute of Psychiatry S

1. Social and Communities Opportunities Profile SCOPE v1 Peter Huxley PhD King�s College London Institute of Psychiatry Social Care Workforce Research Unit

2. SCOPE v1 Social inclusion � �the extent to which people are able to participate fully in the institutions of society� � by choice Quality of life domains � Subjective and objective Work � open employment Housing � independent living, suitable accommodation Finances � high income, maximum benefit Family relationships � level of contact Social relationships � choice of friends Leisure activity � community participation Safety � not at risk Physical and mental health � access to care, met need It is important to recognise that the participation involved in social inclusion is by choice. No-one should be forced to participate in things that they do not wish to. Many examples spring to mind, like voting and line dancing. We have looked at inclusion using QoL measures � these tap into what users/consumers feel are the most important areas of their lives, - the areas in which they wish to see improvement, or to maintain the status quo, and the areas which they think services ought to adopt as outcome indicators. The QoL domains that reflect aspects of social inclusion are: Work, where open employment is the choice of many consumers, or something meaningful to do during the day Housing � where independent living and suitable accommodation are the goals Finances where either improving ones lot or accessing entitlements are usually the objectives Family � where one wants to be able to choose who to see and how often Social relationships � one wants to be able to choose ones own friends Leisure � what wants to choose the level of participation in community activities Safety � one wants to live in as safe a community as one can And in terms of health care one wants access to it when one needs it, and if possible to have ones needs met. As one commentator said, where service users are making extensive use of service provision, the quality of that provision is itself an important aspect of inclusion, and as we have seen, Commins defines the welfare and state support system as one of the key systems of inclusion. Subjective appraisal of the NHS, does therefore qualify as an aspect of inclusion; however, this is not out main area of interest, and there are many other people (eg Picker Inst) who are employed by the NHS to look at its quality from the user perspective. It is important to recognise that the participation involved in social inclusion is by choice. No-one should be forced to participate in things that they do not wish to. Many examples spring to mind, like voting and line dancing. We have looked at inclusion using QoL measures � these tap into what users/consumers feel are the most important areas of their lives, - the areas in which they wish to see improvement, or to maintain the status quo, and the areas which they think services ought to adopt as outcome indicators. The QoL domains that reflect aspects of social inclusion are: Work, where open employment is the choice of many consumers, or something meaningful to do during the day Housing � where independent living and suitable accommodation are the goals Finances where either improving ones lot or accessing entitlements are usually the objectives Family � where one wants to be able to choose who to see and how often Social relationships � one wants to be able to choose ones own friends Leisure � what wants to choose the level of participation in community activities Safety � one wants to live in as safe a community as one can And in terms of health care one wants access to it when one needs it, and if possible to have ones needs met. As one commentator said, where service users are making extensive use of service provision, the quality of that provision is itself an important aspect of inclusion, and as we have seen, Commins defines the welfare and state support system as one of the key systems of inclusion. Subjective appraisal of the NHS, does therefore qualify as an aspect of inclusion; however, this is not out main area of interest, and there are many other people (eg Picker Inst) who are employed by the NHS to look at its quality from the user perspective.

3. SCOPE v1 Aspects of social inclusion NOT covered in SCOPE Empowerment and psychological aspects (self-esteem, mastery) Information and consultation about care Participation in design and review of services delivered to self and others Users employed in the service The NIMHE social inclusion resource pack includes proformas for reviewing services in terms of their inclusive activity in most of these life domains and include these suggestions for the measurement of social inclusion in relation to service access. To what extent do services aim to produce empowerment, and to what extent do service users participate in the design and delivery of services. I don�t plan to look at these areas in any detail in this presentation today, since others are covering/have covered these areas. I am more concerned to day with the second area in the NIMHE SIRP�..The NIMHE social inclusion resource pack includes proformas for reviewing services in terms of their inclusive activity in most of these life domains and include these suggestions for the measurement of social inclusion in relation to service access. To what extent do services aim to produce empowerment, and to what extent do service users participate in the design and delivery of services. I don�t plan to look at these areas in any detail in this presentation today, since others are covering/have covered these areas. I am more concerned to day with the second area in the NIMHE SIRP�..

4. SCOPE v1 Why use objective social indicators? [Objective - independently verifiable] Valued social goals Compare with the general population (locality comparisons control for available opportunity structures) Demonstrate inclusion of groups Change in rates over time Reflecting altered opportunity structures Assess service performance Support funding arguments While we can clearly use subjective indicators like these I have shown you to measure the outcomes for service users, subjective indicators alone are very rarely accepted as adequate evidence. To cut a long story short, in general it seems to be the case that both subjective and objective indicators are desirable. Objective indicators here means independently verifiable; that is the source could be someone other than the person themselves, but in our work we trust the judgement of the individual and use self-reported information. This is exactly the same technique used in all national social surveys pertaining to inclusion, such as the Labour Force Survey, and all ONS data collection, and the SE unit report on mental health. Such surveys are used to make judgements about the �state of society� and about things such as social inclusion and the nature and extent of social capital. My argument here, is that we can use the findings of these surveys against which to judge the status of groups of people with mental health problems and the success of services in delivering the social inclusion agenda. So, objective indicators can be used to demonstrate inclusion, to show increasing or decreasing inclusion over time, to show the extent to which socially valued goals (such as independence) are achieved. We can compare the levels of integration (or inclusion) with those in the general population and we can compare service performance in the extent to which integration or inclusion are achieved. Performance in these terms can be used a a powerful aide in seeking continued or improved resources. While we can clearly use subjective indicators like these I have shown you to measure the outcomes for service users, subjective indicators alone are very rarely accepted as adequate evidence. To cut a long story short, in general it seems to be the case that both subjective and objective indicators are desirable. Objective indicators here means independently verifiable; that is the source could be someone other than the person themselves, but in our work we trust the judgement of the individual and use self-reported information. This is exactly the same technique used in all national social surveys pertaining to inclusion, such as the Labour Force Survey, and all ONS data collection, and the SE unit report on mental health. Such surveys are used to make judgements about the �state of society� and about things such as social inclusion and the nature and extent of social capital. My argument here, is that we can use the findings of these surveys against which to judge the status of groups of people with mental health problems and the success of services in delivering the social inclusion agenda. So, objective indicators can be used to demonstrate inclusion, to show increasing or decreasing inclusion over time, to show the extent to which socially valued goals (such as independence) are achieved. We can compare the levels of integration (or inclusion) with those in the general population and we can compare service performance in the extent to which integration or inclusion are achieved. Performance in these terms can be used a a powerful aide in seeking continued or improved resources.

5. SCOPE v1 Issues Existing investment in data sets Re-inventing the wheel Multiple surveys Of course this is easier said than done, and there are a number of issues to deal with in attempting this approach. There is quite a list, but I don�t believe this should stop us trying. Obviously, in a diverse society there are different norms and values, and these somehow have to be incorporated into our efforts to measure inclusion. In the development of the QuiLL, a QoL measure for older people, we included a large number of Asian respondents, and found that, given a free choice, they found the existing life domains worked for them, and they could not add any new ones. I should add that in the development of the quill a �spiritual� or �religious� domain emerged from older white UK citizens as well; this domain did not emerge in the adults of working age QoL instruments. It does show however, that religion and spirituality are important to some people and not others. There are clearly also age and gender differences, issues around the way questions are asked, appropriateness for people with disabilities, and technical issues such as coding � unless responses are coded in the same way comparisons may become impossible. Obviously, in many life domains, what the person wants to achieve may not be �normative� in the statistical sense. This goes back to the choice issue mentioned earlier, and it raises the question of the relationship between individual goals and valued roles. However, many of the social surveys can be disaggregated by these subgroups so that what an individual wants to achieve in terms of inclusion or integration is close to their cultural norm. In other words one can compare like with like. Of course this is easier said than done, and there are a number of issues to deal with in attempting this approach. There is quite a list, but I don�t believe this should stop us trying. Obviously, in a diverse society there are different norms and values, and these somehow have to be incorporated into our efforts to measure inclusion. In the development of the QuiLL, a QoL measure for older people, we included a large number of Asian respondents, and found that, given a free choice, they found the existing life domains worked for them, and they could not add any new ones. I should add that in the development of the quill a �spiritual� or �religious� domain emerged from older white UK citizens as well; this domain did not emerge in the adults of working age QoL instruments. It does show however, that religion and spirituality are important to some people and not others. There are clearly also age and gender differences, issues around the way questions are asked, appropriateness for people with disabilities, and technical issues such as coding � unless responses are coded in the same way comparisons may become impossible. Obviously, in many life domains, what the person wants to achieve may not be �normative� in the statistical sense. This goes back to the choice issue mentioned earlier, and it raises the question of the relationship between individual goals and valued roles. However, many of the social surveys can be disaggregated by these subgroups so that what an individual wants to achieve in terms of inclusion or integration is close to their cultural norm. In other words one can compare like with like.

6. SCOPE v1Sources General Household Survey GHS Social Capital Module British Crime Survey Home Office Citizenship Survey Labour Force Survey British Social Attitudes Survey British Household Panel Study inc Living in Wales/Scotland Health Survey for England Psychiatric Morbidity Survey National Adult Learning Survey Census These are some of the surveys one can use. They are routinely up-dated and so need to be re visited for the most current figures. Much of the content is not relevant, and much is too detailed. The questions from each survey is usually accessible through the Question Bank (ref) and the data itself accessible (if you have a huge memory on the computer) through the UK data archive to registered users. A list of sources and their coverage is in the NIMHE social inclusion resource pack. I am continuing work on this idea, and I am prepared to work with services who want to operate any part of what they do in this way � from Kings College � addresses attached.These are some of the surveys one can use. They are routinely up-dated and so need to be re visited for the most current figures. Much of the content is not relevant, and much is too detailed. The questions from each survey is usually accessible through the Question Bank (ref) and the data itself accessible (if you have a huge memory on the computer) through the UK data archive to registered users. A list of sources and their coverage is in the NIMHE social inclusion resource pack. I am continuing work on this idea, and I am prepared to work with services who want to operate any part of what they do in this way � from Kings College � addresses attached.

7. SCOPE v1

8. SCOPE v1 Issues (continued) Clarity of instructions Cognitive appraisal/follow-up probing Mode of application (self / interview) Missing data, incomplete data sets Gender, ethnicity, rurality Personal goals are more idiosyncratic Often low prevalence of participation Group profile vs individuals

9. SCOPE v1 Issues (continued) Therefore�. We need to influence the national or mega-surveys to include the exact data and questions we need, together with sensible and sensitive identifiers, such as locality, gender, age etc. Or buy into them�???? But only one-off

10. SCOPE v1 Question design and harmonisation Income question In search of an income question for the 2001 Census Debbie Collins and Amanda White (ONS Social Survey Division)(1996?) Conclusions 1. The sources of income question is acceptable to the public. 2. A question on amount of income has the potential to affect response to the whole Census as some people find the topic of income intrusive and unacceptable. 3. The individual income question is less intrusive than the household income question, particularly in households containing unrelated adults.

11. SCOPE v1 Question design and harmonisation Social capital � the full or main set which takes around 20 minutes to complete and the core question set which takes about 5 minutes to complete. The question set was run on the General Household Survey in Great Britain in 2004/05. It is also being adopted on other household surveys within the UK, including the Citizenship Survey and the Survey of English Housing. The GHS 2004 data will be analysed � probably in early 2006 when the data become available � to describe the national picture of social capital and provide a baseline for comparisons into the future and against local studies.

12. SCOPE v1 Question design and harmonisation The efforts to achieve standardisation are already underway. For example the European Union Survey of Income and Living Conditions has included indicators of social participation, such as contact with relatives and friends, and informal volunteering. While there was some debate over the appropriate phrasing, a version of these questions will be included when the questionnaire is adopted. It will be some years before the data will be obtained, when we will have an opportunity to be able to make the first comparisons. However, this is a useful experience and can help inform our further efforts to achieve comparability.

13. SCOPE v1 Question design and harmonisation Modelling work is currently underway using the Family Resources Survey to produce estimates of caring � both giving and receiving care. We hope to include these estimates on our web site showing neighbourhood statistics across the UK.

14. SCOPE v1 � civic participation � the propensity to vote, to take action on local or national issues � social networks and support � such as contact with friends and relatives � social participation � involvement in groups and voluntary activities � reciprocity and trust � which include giving and receiving favours, as well as trusting other people and institutions such as the government and the police � views about the area � although not strictly a measure of social capital, it is required for the analysis and interpretation of the social capital measures, and includes satisfaction with living in the area, problems in the area. Penny Babb ONS 2005

15. SCOPE v1

16. SCOPE v1Suggested targets for the SI Programme (selected examples)

17. SCOPE v1Achieving NVQ2 or equivalentNational figure = 70% Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.

18. SCOPE v1In �adult learning� National figure = 76% For those in work or not, the proportion in adult learning, which is of considerable relevance to people with mental health problems who may have been out of the workforce for many years, the figure is huge � 76% (in the past 3 years). The Welsh figure is in the last year, Powys reaching the national average but Blaenau Gwent again being the lowest.For those in work or not, the proportion in adult learning, which is of considerable relevance to people with mental health problems who may have been out of the workforce for many years, the figure is huge � 76% (in the past 3 years). The Welsh figure is in the last year, Powys reaching the national average but Blaenau Gwent again being the lowest.

19. SCOPE v1Social and leisure activities Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.

20. SCOPE v1Care work Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.Achieving qualifications tells a similar story, with chances of achieving NVQ2 more than the national average in Ceredigion, but a bit more than half in Blaenau Gwent.

21. SCOPE v1

22. SCOPE v1Participation Political parties 1.4 Trade unions (including student unions) 3.8 Environmental groups 1.9 Parent-teacher association or school association 6.2 Tenants' or residents' group or neighbourhood watch 4.8 Education, arts, music or singing group (including evening classes) 11.8 Religious group or church organisation 10.6 Charity, voluntary or community group 9.7 Group for elderly or older people (eg lunch club) 1.3 Youth group (eg scouts, guides, youth club) 4.6 Women's institute or Townswomen's Guild or Women's group 1.0 Social club (including working men's club, Rotary club) 6.5 Sports club, gym, exercise or dance group 35.7 Other group or organisation 8.3 None 38.9 If you are looking at community participation, then here is the code list for participation used in the General Household Survey. If you are looking at community participation, then here is the code list for participation used in the General Household Survey.

23. SCOPE v1 Participation: 100 service users compared to the local population feel leisure opportunities are restricted (cf 64) 83 want a more active social life (cf 62) 47 want to participate more fully in family activities (cf 28) 56 not a member of community groups ( cf 47) Satisfaction with leisure activity 3.7 (cf 4.3) (p<0.001) And here is an example, based on South Manchester, of how this information might inform service providers. Say the service is provided to 100 service users, then the number who want to improve their leisure activity is about 80%, however, in the local population 62% want an improvement. So the service will be doing well if it reduces the proportion to this level, and even better if it goes beyond it. The same can be said of membership of community groups. The level is 56 in the service and 47 in the population. Subjective well being in this domain is lower than in the local population and so helping people to feel better about their leisure activity also could be used as an indicator of improved social inclusion. And here is an example, based on South Manchester, of how this information might inform service providers. Say the service is provided to 100 service users, then the number who want to improve their leisure activity is about 80%, however, in the local population 62% want an improvement. So the service will be doing well if it reduces the proportion to this level, and even better if it goes beyond it. The same can be said of membership of community groups. The level is 56 in the service and 47 in the population. Subjective well being in this domain is lower than in the local population and so helping people to feel better about their leisure activity also could be used as an indicator of improved social inclusion.

24. SCOPE v1 Service users in South Manchester compared to the local population 5% employed compared to�.. 61% Average working week 24 hours compared to.. 38 hours 53% seen a friend in the last week compared to�. 80% 57% have a close friend compared to ��95% 16% contact with relatives less than monthly�.3% Here is a summary of some of the findings regarding the objective inclusion problems among the South Manchester population. These figure come from the UK700 case management trial, and the Urban Regeneration study. Here is a summary of some of the findings regarding the objective inclusion problems among the South Manchester population. These figure come from the UK700 case management trial, and the Urban Regeneration study.

25. SCOPE v1