Lucy Goodwin & Nicky Thomas (Occupational Therapists)

1. Welfare to Work Convention 30th June, 2011Developing and Sustaining a Healthy Workforce & Delivering Employment Outcomes Through Health Related Group Work Lucy Goodwin & Nicky Thomas (Occupational Therapists)

2. Aims of Session • To cover the following themes: • Into work and staying there: what works? • Delivering fairness: Opportunities for all

3. History of the Condition Management Programme (CMP) • Green Paper (published November 2002) set out a strategy for enabling people with health conditions to move into and remain in work • Department for Work and Pensions (2003) Pathways to Work: Helping People into Employment, The Governments response and Action Plan D.W.P. London • 2.7 million people receiving Incapacity Benefit (IB) in May 2002 • The duration on IB was increasing – averaged 9 years compared to 3 years in 1985 • Once people have been on IB for 1 year, their chances of returning to work diminish significantly

4. To promote self care and use of self help techniques Explore and overcome barriers to recovery Assist customers to achieve a work life balance Reinforce the health benefits of work (Waddell & Burton 2006) N.B Medical treatment and diagnosis not offered Aims of the CMP

5. Fatigue Depression Reduced Self Esteem Low Motivation Chronic Pain Long term health impacts Social Exclusion Anxiety / Fear Debt Low Confidence Stigma

6. Education and advice Groups and 1:1 Community Delivery Solutions focused Partnership with JCP CMP Signposting Motivational Interviewing Approaches CBT based interventions Increased quality of life Increased social inclusion

7. Evaluation • An evaluation of CMP revealed successful outcomes in relation to • Return to work/training and education • Volunteering • Re-engagement with the community • Positive customer experience

8. Research Question • ‘To what extent do CMPs enable customers to manage their health conditions & move closer to work/education/training?’ • Dr Carly Reagon and Chris Vincent

9. Data Collection • N=244 (122 non-responses) • Qualitative interviews with customers (N=15) & staff (N=12) • Customers represent broad range of ages, but cluster in 36-55 yr bracket • Primary health conditions: Mental health & musculoskeletal • Quantitative data collection over 12 months: SF36v2, GSES, HADS plus demographic data

10. Short Form 36 Outcome Measure • Health-related quality of life measure • Produces two scores: • Physical Component Summary (PCS) • Mental Component Summary (MCS) • A score of between 45 and 55 is deemed the norm for the general population

11. Changes in SF36v2 Component Scores (%)

12. The Hospital Anxiety and Depression Scale • Provides scores of Generalised Anxiety & Depression • Interpreted as: • Normal (0 - 7) • Mild (8 - 10) • Moderate (11 - 14) • Severe (15 - 21)

13. HADS Depression Scores Pre/Post CMP (%)

14. HADS Anxiety Scores Pre/Post CMP (%) normal mild moderate severe normal mild moderate severe

15. General Self Efficacy Outcome Measure • Self belief to cope with life demands • Produces a score of between 10 & 40 • A score of 29 is deemed the average score for the general healthy population

16. GSES Scores 30 20 Mean 10 0 GSES Pre Score GSES Post Score

17. Work Outcomes

18. Work Outcomes • During the 2009/10 operational year 250 clients completed the Pathways to Work CMP. Of those, 112 (45%) reported positive work related outcomes: • Paid employment 62 (25%) • Voluntary work 25 (10%) • Training/education courses 25 (10%) • A further 23 (9%) clients were referred or signposted to other services/organisations which is considered to be a positive outcome as a result of accessing the CMP

19. Qualitative Analysis • Main Themes – CMP staff • The bio-psycho-social approach meets the complex needs of CMP customers • Work and unemployment linked to personal identity and social inclusion • Link between being out of work and deteriorating mental health • Personal motivation related to successful outcomes • Therapeutic relationship dependant on collaborative working, openness and honesty, and professional behaviours

20. “Our programme is entirely tailored to individual • needs, it is not standardised. it is clinician led which means that the clinician has the skills and professional competence to [act upon] what the individuals are telling them.” (M1:298-301) • “we don’t work from an expert model, the clients are the experts and we have the skills, so we work with them” (OT2 415-416)

21. Qualitative Analysis • Main Themes – Customers • Association between CMP and Job Centre plus created anxiety for some: • “[The Job Centre] just want people off their books…I’d like to be off their books but you can’t magically say you haven’t got pain, get a job.” (C7:33-35)

22. Main Themes –Customers cont’d • Health practitioners seen as prime facilitators of change. • Benefits of seeing the same health practitioner throughout • Intervention plans tailored to suit their needs • “It’s helped me to deal with my physical problems and I emphasise that: my particular physical problems, because mine are not the same as anyone else’s.” • (C15: 407-409)

23. Common Themes • Benefits of CMP • Education about health condition/s • Learning to manage health condition • Learning to manage pain • Social interaction with other participants • Increased confidence & self esteem • Being listened to by healthcare practitioner • Referral/signposting to other services • Increasing activity & routine

24. Common Themes • Referrals from employers/early intervention: • “If I had been picked up earlier by my employer and gone through [the CMP then] I would not have become ill. It would have been caught and sorted earlier.”(C2:250-5) • Renewed sense of hope: • Physiological & psychological problems often co-exist • “On the last session [at the CMP] I was a different person, a totally different person … I felt positive for the first time in years … I [was] more like the person I wanted to be, not the person I was when I became ill. I don’t want to be that person again.” (C2:159-165)

25. Benefits of Group work • Provided a structured day in the week • Interactive media –opportunity for group discussion • Building confidence through Social interaction • Solutions focused approach • Venue choice e.g. raising awareness of local services • Focus on exploring and overcoming barriers to returning to work • Previous customers talk about their experience of the course

26. Added Value and UnintendedConsequences • Use of non clinical venues • Job Centre plus funding benefits • 3 month gym pass • Equipment to deliver courses • Staff training i.e motivational interviewing, solution focus, transactional analysis, mindfulness

27. Sustainability • Raising Political Awareness/Support • Customer stories ( influenced ABMU Executive Team) • Argued the case for cost effectiveness • Demonstrable outcomes • NHS Award for ‘Working Seamlessly Across Organisations’ • Publications in local media, professional magazines & research journal

28. The Future • NHS Staff Health & Well-being Agenda • Well-being through Work • Developing NHS Pain Management Programme • Developing Chronic Fatigue Programme • Providing services to local private & voluntary sector • Work Programme

29. Debate: Opportunities & Challenges • Further service development to ensure fit for purpose • Explore use of telephone support & e-resources to deliver health interventions • Involvement of participants in delivery • ‘ DOES HEALTH RELATED SUPPORT HAVE TO BE DELIVERED BY HEALTHCARE PROFESSIONALS’

30. Contact Details • Nicky Thomas and Lucy Goodwin - Occupational Therapists • Condition Management Programme, • ABMU Health Board, • Britannic House, • Llandarcy SA10 6JQ. • Telephone: 01792 326568 • Email: • nicky.thomas2@wales.nhs.uk • lucy.goodwin@wales.nhs.uk

31. References • Department for Work and Pensions (2002) Pathways to Work: Helping People into Employment • Department for Work and Pensions (2003) Pathways to Work: Helping People into Employment, The Governments response and Action Plan D.W.P. London • Reagon, C & Vincent C (2010) An Evaluation of Three NHS-led Condition Management programmes in Wales Cardiff: Cardiff University • Waddell, G & Burton, A.K. (2006) Is Work Good for Your Health and Well-being? London: TSO