let's get engaged! event - additional notes issuess get engaged feedback.pdf · 2012-10-11 ·...

Additional Notes

Let's get engaged! Event - Additional Notes

issues

Have not been asked to sit on interview panel since having been in

hospital. Used intimidatory / against her when being restaraint.

No support for people C/S/A J/S/A

Performance - too much time spent on targets

Caseloads - must do work versus therapy / help deliver

MH engaging with SS

Too much medication prescribed - YesEngagement needs to be meaningful not just tick box exercise. SU ans

Carer need to be centre of everything we do

Actions

PALS to investigate (Laura)

Reduce levels of management

Keep inputus going

Increase number of clinical staff

More staff engagement

Seeing what's changed - evidence of important outcomes

Know how Sus and Carers need to be involved

Need support systems in place

Employ Sus with experimental experience

Peer support to be involved in policies from Q perspectiveSpecial and secure CUSP - Carers and SU and public - ask number of

questions - how are they supported - team leader

360 degree feed back - does everyone do this?NAME DELETED hasn't had reply from NAME DELETED SU and

carer being involved

Questionaires Returned by post

Q1 Ten years as employee

Q1 Grass roots worker. Not involved in any decision making at higher level

It is a Trust that is going through an extreme amount of change. That

the change has not necessarily been well planned nor executed. That

many services are particularly // and unable to perform these roles

due to not having the structure and support nor staff numbers to do so.

Q1 As community psychiatric nurse / Care co-ordinator

Q1 My work is all on BME (Black and Minority Ethnic connection)

Q1 Community engagement

Q1 Training – Orgs + AWP

Q1 Stratergise – senior meetings – changes etc

Q1 Sharing info of SU/Carer/Community with BME

Q1 Data analysis

Additional Notes

I have worked for AWP for over 3 years prior to that I had joint clients

with AWP.

Q1 An event at Brookland Hall

Q1 Staff Nurse CPN

Very little because meetings are regularly re-arranged or cancelled at

the last minute.

A few years ago I remember there being public meetings where

contentious issues were brought up and they were addressed in a

reasonable and fair way. Service users were very frightened about

changes and because it was addressed in an open honest way their

fears were lessened.

Don’t (as a whole organisation AWP is very low in its priority in this

area BME) individuals may make the effort but unfortunately has no

strategic value.

Q2 Endless questionnaires, little result

I think individual workers do their best. However for example many

people / service users are unaware that there is no longer an Assertive

Outreach team and therefore no capacity for an assertive outreach

service.

Q2 Lacking consultation

Offer opportunities for people to pass on their views i.e. Forums and

surveys.

Q2 Staff and public

Staff try to get back to service users / callers. There seems to be good

communications between the team and admin staff.

SU / carers – some good liaison / signposting works, good

communication in local areas (i.e. words to community)

We do engage as a degree with service users. Our staff are really

struggling with implementing so many current changes.

Better sharing between different areas e.g. community / crisis teams in

Swindon with inpatient teams in Bristol; CJIT and SDAS services and

Mental Health teams. Difficulties now with sharing info between AWP

I think duty should try and take calls from GPs if they ring in because

GPs have very busy schedules and are very difficult to get hold of.

I think going around to service users and carer groups to discuss

views. Offering incentives for people to complete surveys / come to

events. Make them more exciting. In the past people have given

opinions and have not felt that they have been heard – could do with

improving all of the above.

Q3 Listening and sharing information, certainly involvement

Really listening rather than efforts to give appearance of listening. Not

so punitive re mistakes made.

Additional Notes

Representatives need to have a forum to feedback to other SUsers

and the Rep needs to take issues forward from members. Maybe there

should be a term of office as User Rep so that others get to go to

meetings (this is not personal to me, I have heard someone else say

they would like to be more involved).

Service users have been asking for more talking therapies for several

years. We have not employed more staff in talking therapies roles, in

fact we have lost people and we are not facilitating skilled band 6

workers in talking therapy skills to do these role. We need to recognise

this and take significant steps.

Sharing info – changes, care pathways, how to access, entitlement to

resources, true updates. Making effective change from listening – not

tokenistic.

Transparency management could admit that there is no longer an

Assertive Outreach Service although the Trust continues to reserve

monies for one.

Act upon requests, be inclusive, explain why something cannot be

done if not able to. No need to brush it off – Be innovative – not the

same strategy – heads making same strategy comments. Push the

boundaries, pilot stuff, and autonomy to a degree to staff. Listen and

acknowledge this document.

Actually listen to clients / carers / staff views and show how these have

been taken into account.

Be able to demonstrate how people can express their views, have

them heard and change be made.

Better linking with other teams / services – more engagement to build

better working relationships.

Q4 Demographic evaluations and appropriate recourses

Holding open meetings and maybe some closed if there are service

users who would feel too vunerable to be in an open situation. Listen

to feedback from SUsers on the services available.

Q4 improve their moods! ?

Q4 Interventions / therapies

It could do what it says it is doing. Clear policies that are adhered to

rather than managerial decisions being made on hearsay.

Q4 Less admin paperwork

Lifting email restrictions between relevant services or ensuring that

everyone automatically has an nhs.net account linked to outlook.

Q4 More involvement with GP / P.C

Q4 More psychology input

Additional Notes

My experience of MH services is from many years ago, but everyone

assumes that because I have a physical disability that automatically

and mentally I’m OK. I have joined the Wellbeing Project and would

like it financially supported as an integrated part of MH services

because it is so helpful. I feel much supported and some others would

benefit from it too.

Q4 Offer incentives for coming / completing things

Possibly giving service users’ cups of tea or snacks while they wait for

appointments might

Q4 Recognise the client group you’re working with

Stamped addressed envelopes for replies would be helpful for those

who are on a limited budget.

Q4 Think about service users? Think about staff? Less stress?

Q4 Think about the venues you are using for events.

13.08.12 Smead (DEH)

Let's get engaged! Event - 13/08/2012 - Southmead Hospital

issues

No one to listen out of hours

staff to listen to patients

Balance of power running one way

Signposting staff how they can inform Su and carers how to get involved

Not enough joined up working

Need to use volunteers more creatively and empower them

Equal consideration to involvement

helpline / listening line or crsis line

Equal & Equitable method to involvement which is open, clear and well known to all listed on

database

Actions

Meet in the midde

One AWP SU forum that can be accessed by all

Act on the NSUN recommendations ASAP

Use SU to help train student staff

More integrated working e.g. different teams/specialisities sharing premises

Team brief on how staff can help to access SU and carer engagement in AWP - signposting

Any additional posts to service users and carer steering committee please advertise widely

Workshop outcomes - table 1

Q3. Very poor staff engagement

Questionnaires (SU and carer) have been successful in giving feedback to teams which in turn

resulted in having information leaflets about diagnosis available by the door

Q3. each SBU does engagement differently with various success rates

Q3. Information is a big issue (accessing info and getting info)

Not being listened to as a staff member when ideas are being brought forward to improve

things

Q4. Advertising of the Let's get Engaged events should be improved

AWP did not stick to its own engagement strategy i.e. Communications re. new service user

and carer steering group did not to out to all people on the involvement database. Who

decided on membership for this group?

Q4. Opennes and transparancy is key

Make the existing of the involvement database clearer on Ourspace for staff. And explain to

staff how they can get service users and carers on the involvement database

Q2. CQC questionnaires are good

Q2. Introduction of the friends and family promoter score is good

Q4. Improve communications and look at alternative methods like SMS and do more by email

Q3. AWP needs to be aware

Q3. the US / THEM attitude needs changing

Q4. Using volunteers more. Make volunteers feel more included

13.08.12 Smead (DEH)

Go out and about and give information on mental health and local mental health services

available to local people (education) in public places (malls etc.)

use Peer support more in the community and in patient settings - but how? By using different

methods and reaching out

Q4. AWP needs to link in better with local authorities and social services

Q4. AWP needs to stop being defensive

Q4. Streetwise workers

? Keep to self

? Do not know

Q4. Better optoins for feedback

Q4. More joint working - SU's, 32rd sector & AWP

Q4. Education = SU's, carers, AWP, schools, police

Q4. Make aware service users involved in interviews

Q3 Used to have better involvement across all MH services

Q4. Crisis Line (now gone)

Q4. Listening and sharing information

Q2. Public health team Involvement with primary care & Sus

Q3. Each service has its own forum structure - JOIN UP!

Q4. AWP to display what is good practice in each service

Q4. GP mental health leads for CCGs to be more involved

Q4. Engage with local groups for local services

Q4. Improve education - Police, schools GPs

Q4. Listen to SU and carers needs - local

Q4. Improve communications at local level - ref. services

Q4. Joined AWP & 3rd sector services / support each other

Open Pathway top-bottom, bottom-top. NHS, Central government, local gov, PCT, MH units,

community MH teams, Sus, carers and families

Q4. AWP to speak out for SU's and carers

15.08.12 Devizes

Let's get engaged! Event - 15/08/2012 - Green Lane Hospital

issues

More consistency needed amongst staff techniques

136 section; Police treatment not appropriatePoor sharing of information - constantly being asked about past

trauma by every new staff member

Methods of complaining other than PALS

Crisis team - don't feel like they were listening

Inpatient: no one to talk to you - all the staff in the officeDecision making should be transparent and quick. Is AWP top-

heavy?

Response time Out of Hours

Actions

Inpatient: staff need to spend more time with service usersMore education about methods of complaints - who is in the chain of

command

Use the checklist

Session 1Workshop outcomes - table 1

Q1. None - first time today. Informal friendship support for years

Q1. Service user for 20 years - sectioned at one point

Q1. Staff member

Q1. Partnership Organisation

Q1. used CMHT & crisis teams

Q1. used Inpatient services

Q1. used SDAS

Q1. carer

Q2. This meeting

Q2. Communication with FT members

Communication with family/friends and public about services and

changes in service should be improved

Q3. Make people aware of ways of feeding back

Staff have information/ideas from various sources re.

improvements/feedback but don’t know what to do with this

information to inform and implement any changes/improvements.

They don’t know how to channel this informatin/ideas up or down.

Execs and Non-execs to attend events like these to hear stories first

hand and action on it.

15.08.12 Devizes

Staff does not make service users and carers aware of support

groups that they can use. And who they can contact in the Trust to

get more engaged/involved.

Staff need to tell service users about possible care planning

complaints

Opportunity for service users to change their nurse/CPN if they want

Q3. Wider engagement with staff who directly engae with service users

Telliing service users / carers / staff what action they have taken

when there is a complaint

Ask Service Users who might be the best person to fillin care plan +

advice on how much to involve other areas e.g. housing Dept.

Q4. Execs to "back to the floor" on a monthly basis

Q4. Introduce Peer support workers

Inform people that they can feedback anonymously through PALS

and that this does not impact on their care

Q4. Support / Training with wider community i.e. Police

Q1. Carers groups

Q1. Training - delivering

Q1. PEEP, interviews, discussion panels

Q1. Recovery star

Q1. Shift for carers as well as sus

Q1. Working in partnership, collaboration

Q1. Working with families - embedded

Q1. Engaging with individuals

Q1. Nurse consultant posts e.g. carers

Q2 Holistic approach

Lottery for what you can get - when call at 3am want someone to

speak with me (not answerphone)

Engaging with people who don’t want to engage - staff find this

difficult

Q3 MH not often cured

Q3 A lot of listening not a lot of actions

Q3 NHS stop focusing on targets and allow quality conversations

Q4. Can we learn from what's working well?

Quality indicators need to be service user and carer focused / staff

care team. (Some previous targets worked against service quality)

When things go wrong, complaints made, need right people involved

to resolve. More discussion

15.08.12 Devizes

Important for sus and carers to be completely included within the

care 'team'.

Local recovery college type courses to include service users / carers

and staff

Many excellent staff but some who struggle to engage. E.g. 50%

attendance at carer's training. This leads to lack of consistency.

Check list / reminders for staff e.g. to contact the carer every month

(see the "check list manifesto")

Care coordinators email address to be given to service users and

carers

Q4. Improvements to partnerships

Q4. More support during carers respite

Q4. Joint approach; invite service users with their carers

Q3 Assertive Outreach - where are they, who are they?

Q2 PALS works well

Q3 Rude CPNs - Abrupt

Q2 Value of Readers Panel - positive

Q1 Quality Accounts

Q1 Board Meetings - Listening but difficult to get resolutions

Q4 More involvement with GPs - drug difficulties

Q4 Samaritans involvement

Q3 Face to Face involvement CPN/Parent

Q3 Carer Assessments

Q2 Carers involvement improvements

Q1 Staff supervision

Q3 OOH Crisis Team fail because of history. Pushed by lack of time

Q2 Complaints dealt with earlier - the sooner the better

Q4 Better communications

Q4 Communications geared to younger generation

Q4 Back to basics

Q3 Improved Listening

Q4 Crisis telephone number

Q4 rationing

Q4 Help reduce stigma

Q4 Offer better respite care

Q4 Red Gables Trowbridge

Q4 Crisis houses in Swindon

Q4 Split funding MIND - AWP

Alabaré - what involvement?

Support

Discharge - what planning?

Q3 Lack of weekend surgeries

15.08.12 Devizes

Q.O.F. figures

GP hours / weekends

Q4 Out of hours service

GPs appointments

Q4 Psychiatric nurses, CPNs in practices

Q4 Psychiatric social workers

Q4 Supervision / traning continue

Q4 managers more involved

Q4 process for engaging all levels

Q4 training for non execs

Q2 observer role 'service users' at interviews

NHS Choice'

Q3 Views asked but no feedback received

Q4 Carer pack - needs to be available as paper version

Information - no one stop shop. Neurological handbook - excellent

example

Q4 Cancer service information in a package available

Opportunity to speak to manager at meetings - feedback to user

groups - suddenly stopped

Stigma of using services and having hospital separate from Acute

hospitals (i.e. Green Lane)

Sus don’t like holding events like Lets get Engaged in hospital

location

Could there be a central telephone for local people if they want to

report something? (i.e. neighbours from Green Lane who can they

call if a possible service user wandering the estate in a confused

state?

Q4 GROW newsletter - good newsletter to advertise events

Q4 AWP + SU groups lets be proactive and plan for MH Week event

Q4 Information should be short, informative and easy to understand

Q1 SU's took part in SBU meetings

Q1 None - that's why I am here

Carers are not seen as "full support" and are not part of the care of

It all depends on consultant/individual if communicatoins with

su/caerrs is good or not. There is no consistency.

Q3. Has confidentiality / secrecy gone too far?

Q3 As carer, how do you find out what are confidentiality issues?

The way the trust works is very segmented. Different ways of working

in different areas of the trust all depending on individuals

Set up meetings again with SU and repos and operational staff (Area

managers) (i.e. like the meetings that used to happen with Peter) To

speak with nanagers of their area/services.

15.08.12 Devizes

educate staff (like reception and telephonists) in customer service

and how to deal with difficult calls.

Q4 Introduce mystery shoppers

AWP could produce information about services, what people can

expecyt and how processes work.

Q4 Set up a crisis phone number and man it 24 hrs p.d. 365 d.p.y.

03.09.12 Salisbury

Let's get engaged! Event - 03/09/2012 - Fountain Way Hospital

issues

Actions

Q1. Interview panels

Q2. PALS

Q2. Veterans service

Q3. Translating performance into involvement

Q3. We need to get peoples experience

Greater SU and carer involvement for PICU & L3 (Feels chaotic -

related to change process)

Q3. More use of volunteers - peer mentoring

Q3. Work more with 3rd parties

Q3. Access to services - what number to call in a crisis and expectations

Q4 Keeping Ourspace up to date

Q4 Better communication regarding redesign and staff movement. Chaotic

Q4 Clearer crisis pathway - P.C.L. - needs to be integrated.

Q4 Educating GP's information regarding community teams - redesign

Q4 Clear strategy and structure clearly communicated.

Q4 Lack of signposting and ways of reporting need for improvements.

Q4 Needs to state what it provides and what it can't

Q4 Assign people to carry out good ideas and thus make them happen.

Q4 Try and change the attitude of the carers services.

Q1. Feel like I've walked into another planet

Q1. Saw psychiatrist once a month and just given pills

Q1. Things get missed - react to crisis

Q1. Inconsistent care co-ordination.

Q1. AWP needs to know what it's responsibilities are

Q1. Carers - liaise with CPN's

Q1. Needs advocacy

Q1. Time is money but we need to take time to know people.

Q1. Not about numbers it's about need

Q1. Needs consistency, stability and continuity

Q1. Support drops away when doing well.

Q1. Not looked at as people, not holistic

Q1. Person centred - more focus needed

Q1. People get desperate

03.09.12 Salisbury

Q2. Lots of meetings

Q2. Introduce peer mentors - SDAS only

Q2. Carers assessments

Q2. Meet performance targets - statutory

Q2. Dedicated and hardworking staff group - Salisbury

Communication - good ideas not actioned in a timely manner - care

pathway process and crisis card

Q3. Drop-in crisis house

Q3. Taking action to implement good ideas.

Encourage people into jobs that are worthy of their education and

qualifications.

05.09.12 Swindon (SWC)

Let's get engaged! Event - 05/09/2012 - Sandalwood Courtissues

Actions

SU - Intimate knowledge of the system. Very good care then in 1996 - but now

community service lacking now Schizophrenia but well on meds.

SU - Jenner House unresponsive / not listening to needs - no consultation - very

frustrated - anonymous - faceless. Redesign has resulted in confusion and non-

involvement of SU's. Lack of communication - Care Pathway not integrated - SU in

limbo. First point of contact at Chatworth house lacking/poor and sickness and holiday

cover not adequate.

Carer - Early Intervention Team was very successful. Constant change of staff. Care in

medication - delivery and lack of contact - i.e. not handing direct to SU. Reassurance

and confidence in doctors and nurses.

Ex Forces need more support from knowledgeable staff - need more specialist support -

diagnosis has been taking 12 years+

Q1. Acknowledgement of other health issues i.e. wheelchair users.

Q2. EIT - was good

Q2. New website is good

Q2. Willingness to improve

Q2. Carers groups and forums - Swindon - others?

Q2. Swindon local Acute Care forums - information flow in & out

Q2. WWLF and Nursing Group

Q3/4 Listening to SU's and Carers and acting upon.

Q3/4 Developing a better understanding of multiple disabilities.

Q3/4 Need ex-servicemen SU and Carer groups set up

Q3/4 Monitoring of medication

Q3/4 Continuity of CPN's, doctors and care workers

Q3/4 Proper handover of patients and SU's from one medic / care worker

Q3/4 ID badges in hospitals

Q3/4 Communication / introductions / advise what's happening and what's going to happen.

Q3/4 More engagement / listening opportunities

Q3/4 More multi-disciplinary engagement

Q3/4 Train GP's

Q1. Gaps in service - transparency

Q1. Stigma of diagnosis e.g.. Aspergers

Q1. Alcohol/substance misuse - MH access barriers

Q1. Access to different types of support difficult

Q1. Assessment process judgemental / stereotype

Q1. Misdiagnosis re trauma

Discharged care due to better periods of mood - No support when feeling low anymore -

closed access to MH support after 1 month - was not made aware of this

Q1. Employed - positive work with CPN's

Q1. No 1-2-1 support in hospital - 5wks to support session

Q1. Difficult for 2nd opinion of diagnosis

Q1. Lack of crisis intervention

Q1. Floating support

Q1. Awareness

Q1. Early diagnosis of OCD - assistance with managing diagnosis

Q1. Frequent change of CPN - difficult when forming relationships

Q1. Children to adult service

Q1. Not being believed

Q1. Empathy

Q1. More skill based enhancing schemes

Active SU involvement with Swindon - Various groups / networks - ACF / CCF /

Recruitment

Q2. SU involvement exists

Q2. Changes to improve Applewood environment

Q2. Have seen changes happen as a result of steering group

Q2. Steering group - representation of service users - balance between both SU and staff

Q3. More awareness of support services available.

More multi-disciplinary working - can cross over services - access more support from

service than one - e.g. D substance / MH

Q3. Don't penalise re negative behaviours - balanced approach

Q3. Training in self awareness

Q3. Peer support

Q3. Be more engaging with patients / SU

Q3. More services available when in crisis

Q3. improvement on services from things such as Aspergers

Q3. Listen to experiences of patient

Q3. Less change of CPN

Q3. Improve communication

Q3. Ongoing support after crisis

Q3. Creative with support - more than just medication

Q3. Not enough services - accessibility - Gaps in services Veteran's, Aspergers

Q4 Simplicity - access to services

Q4 Being aware of the Plan/Pathway when engaged with service

Q4 Posta available to people who have similar experiences

Q4 Educating people how services work

Q4 Changes made in Sandalwood - Now is a space for non-smokers to go to.

Q4 Open minded

Q4 Peer support

Session 2

Q1. Service User

Q1. Readers panel

Q1. PEAT

Q1. Interviews

Q1. Meetings

Q2. Listened to our views - changes implemented

Q2. Views can differ

Q2. Garden facilities now improved

Q2. Inclusive - opportunity to help others inside and outside AWP

Q3. Lots of doors and gates - in and through the service.

Q3. Getting people to venues - transport

Q3. Size of Trust - is big good?

Q3. Aspergers and LD

Q3. Localism and intergration

Q3. Covering prisons - MH teams input.

Q3. Better use of space

Q3. Mapping of services

Q3. Travel distance between sites and locations

Q3. Training induction for staff

Q3. Constantly evolving / changing

Q3. Venues - Fry's too far out

Q3. How to get back into the system.

Q4. Manageable case load

Q4. Resource book - update directory of services

Q4. 715000 - Debbie Andrews developing - staff XX?

Q4. Clarity on what's available and for how long

Q4. Sign posting to what's available for support out of hospital

Q4. Get to all GPs in the area - they will be buying services in future.

Q4. Dr.Maysees - Kingswood surgery GP MH interest

Q4. Lots of unknown - Staff, SU, Carers, Hot Potato Teams, Crisis Teams

Q4. Lots of temp staff

Q4. Medical staff - lack of medical cover.

Q4. 1 doctor with permanent post

Q4. Agency staff - lack of continuity

Q4. To greater case load

Q4. Discharge and after care

Q4. GPs not aware of policies and procedures for how to access AWP services

Q4. Doesn't feel like a partnership - revolving door - LA/NHS

Q4. More streetwise workers.

Q4. Peer support workers - need more.

Q4. Work as a collaborative team.

Q4. Reduces stigma

Q4. Choice between meeting targets v giving a good service - quality.

06.09.12 Bath (HL)

Let's get engaged! Event - 06/09/2012 - Hillview Lodgeissues

Gap between voluntary sector and clinical

Relationships with MH voluntary organisations

Clinical information is often in clinical jargon - jargon free

Actions

Attend staff meeting - share experiences of what AWP do. Sharing of information.

(Counselling course off the record)

Text people reminders

Customer service training

Mapping of services. Find out if you are on AWP website if not ask to be linked

MH org to link to AWP

Tailor information to suit individual needs. Involving SU to how their information is

shared

Negative due to my role - hearing what goes wrong as part of everyday work. Single

experience - sometimes the same issue for lots of people. Shared with PALS /

Complaints team to escalate in AWP.

Q1. They get addressed / resolved monitored

Q1. Little understanding of what AWP do and my organisation

Q1. Gap between voluntary sector and clinical

Q1. Particularly transition between children and adults 16-25 years

There are opportunities - e.g.. Membership, staff recruitment, Readers panel,

discussion panels

Q2 Need to promote more

Q2 Stigma

Q2 Gina Smith has started a course for carers to share experiences

Q2 PALS excellent, do what they say they will do

Q3 AWP to go into GP surgeries and provide training.

Q3 GP staff show no empathy

Q3 Link - Speed dating - GPs / SU & Carers

Q3 Acronyms means nothing - make it simple

Q3 Summary care records - How is this working in BANES?

Q3 Communication - Promising to call people back and don't

Q3 Not turning up for appointments

Q3 Being late

Q3 Not returning or replying to emails

Q3 Staff seem stretched - admin so can't keep visits

Q3 Relationships with MH voluntary organisations

06.09.12 Bath (HL)

Q3 Clinical information is often in clinical jargon - jargon free

Q1. FT Member & MH Nurse

Q1. Courses for SU & Carer

Worked at MIN identified need for Liaison Nurse carried out a survey - linked to

A.Harrison and created post for MIN

Q2 Today's event

Q2 Stands at festivals

Q2 Stigma - MH time for change - Stephen Fry

Q2 Trying to change

Q2 Passionate staff

Q3 Include telephone number in email communication

Q3 Carer support - Alzheimer's

Q3 Own experience of MH should be promoted for staff

Q3 Negative views of AWP

Employing S.U & Carers - e.g.. Peer support workers (paid employee) Needs full

support

Q4 Computer access for all - help SU and Carers get connected

Q4 Health matters needed in library - Melksham

Q4 Promote good things - how many people we've helped - accessibility

10.09.12 Bristol (BC)

Let's get engaged! Event - 10/09/2012 - Blackberry Centreissues

Q1 Inpatient - Volunteering, Community meeting, PEEP meeting and Acute Care Forum

SU Carer - negative experience was the motivator to volunteering and a positive view of

AWPQ1 SU - Steering Group, strong voices - direct feedback to management

Service Manager - i.e. NAME DELETED visiting, NAME DELETED visiting, professional

and helpful. Being invited to AWP events i.e.. £150,000 of funding lost due to funding

being tied to AWPQ2 Engagement between AWP and local charitiesQ2 Outstanding attendance of SU+Carers at this eventQ2 AWP is doing well by providing this opportunity for everyone's voices to be heard.

BME - CDW AWP - rethink spiritual conferences - Doing really well. Foundation Trust

events.Q3 Difficult to hear about eventsQ3 Sustainable community links - have these links been made to support.

Rethink: South Gloucester rethink closed so the members set up free group - would like

some support & training to maintain the group. AWP support by getting up to 4 more

members(companionship) AWP could support by signposting to services/training. AWP to

visit/speak to group.

Advertise involvement opportunities e.g. posters at GP services and booklet of all MH

services AWP/Charities.Q4 Book of acronyms.Q4 AWP should say what it is doing well! (eg.BME)

Q4 Feedback outcomes of SU & Carer involvement to those with an interest and accessible.Q4 Exit interviews for SU & CQ4 Be transparentQ4 Access to courses and trainingQ4 SU & C lead groupsQ4 Peer Group lead / Named contact - single point of contact.

d/ch info booklet and feedback sheet plus support at the time of discharge - Outcomes -

feedback to SU & carer'sQ4 Annual quality account - everyone needs to be aware.

Q1 EmployeeQ1 CarerQ1 Service UserQ1 Groups with interest in MHQ1 Associate TrainerQ1 AdvocateQ1 ProjectsQ1 Supporting people with staying in work and getting back to work.Q1 Service User Involvement - Jargon means different things to different peopleQ2 Good membership base

Q2 PALS/Complaints teamQ2 Board Meeting / TransparencyQ2 Listening from board membersQ2 Service re-design - staff adaptable to change.Q3 Accessing services when needed

Q3 Idiot Guide needed to services - How system work, reality of the situation/expectationsQ3 Peer support - mentoring when new to the system?Q3 Focus on radicalised not enough on lived experience - Talked aboutQ3 Gap between CAMHS service and adult - stability and continuity lost.

Lottery of where you live - Different services accessible in different parts of the Trust -

creates gapsQ3 Feedback/consultation need as to be used and results sharedQ3 Give PALS right to fire. Higher profile in organisation.Q3 Build on what works well.Q3 Referral process - Action - Standards - set charterQ3 Management of power relationships in pshcy - Ch empowermentQ4 3 years being involved

Gap - accessing employment support when living in different areas e.g.. South Glos

cannot access Bristol

Normalise MH - not just within MH services but within community settings, community

publications, buildings etc. - Just look at Olympics and Paralympics coverage

Specialist Employment Services - Lack of advisors within job centre. Enabling SU's with

MH diagnosis, support in gaining and retention of jobs. Reasonable adjustments etc.

Service Providers - Too protectionist over their own budgets and service users. Should be

partnership and collaborative working with 'Su + Carers' at heart of servicesNAME DELETED

Q1 SU encouraged by CPN - CPN pivotal role in involvementQ1 Involved in websiteQ1 Involved in community care forumsQ1 Medical Director interviewQ1 RethinkQ1 Foundation Trust member - can put themselves forward to be a governorQ1 Investigating and managing complaintsQ2 Involvement with and by CPN is excellent

Q2 Local GP - understanding of mental health and communication with community servicesQ2 Good communication in some areasQ2 Steering groups / engagement eventsQ3 Keep improving on areas we are already doing well inQ3 Greater involvement from S Users/Carers in clinical areas

Q3 How to make events/meetings comfortable for carers - i.e. not stigmatising/flag waving

S Users and Carers not at the heart of the organisation -= involved in decision making

(mentoring training) more clinical engagement.Q3 Top management should have more faith in skills of others

Not enough S Users/ ex S Users work within AWP - ? Risk / finance / fear / lack of

exposureQ4 Employ service user with experienceQ4 Understand what risk means to individual usersQ4 Take all the feedback from all the engagement eventsQ4 SU's involvement in policies/ways of workingQ4 Renew of the defensive jigsaw

Organisation needs to work out what it is there to do - lack of clinical focus from Jenner

HouseQ4 Are we asking the right questionsQ4 How do we engage with those people who aren't in the right place to engage?Q4 Will the centre change - is there a willingnessQ4 Local areas two the initiativeQ4 Trusting staff who have experienceQ4 Service users expectationsQ4 SU and Carers need to sit in to MDT (CPA) reviewQ4 Assumption - people all have their own transportQ4 Gaps - Groups in local areasQ4 SU's who don't want to engage in their care - no insight - unwellQ4 Manufactured (bad) publicityQ4 Stigma MH 'visible illness'

10.09.12 Bath (WR)

Let's get engaged! Event - 10/09/2012 - Bath NHS Houseissues

Q1 Carers Forum

Q1 Events (FT, Carer)

Q1 Hillview meetings + Rethink + Acute Care Forum + Local levels

Q1 Staff

Q1 SU + Carer Engagement Steering Groups

Q1 Visit Acute Care Units - create reports and present to Commissioners

Q1 PALS drop-ins

Q1 Informal' contacts, talking to teams directly. Relationships 3rd party/staff

Q2 Asking for feedback e.g. setting up events

Q2 Providing information

Q2 Collating information e.g.RIO

Q2 Attend Carer Groups

Q2 Respond to general queries

Q3 More feedback - good and bad

Q3 More continuity - particularly involving Psychiatrists

Q3 Have freedom of views and opinions from staff

Q3 Less red tape and regulations and too much pressure of work on trained individuals

Q3 Have involvement with AWP and mental health charities

Q3 RIO excellent but needs simplifying for certain circumstances

Q3 When people visit in another area and information is repeated all over again

It is important to have co-ordination with other local NHS Authorities - money is

always involved - not always for the best.

Q3 Shared information should be used and not just quoted

Q3 Carers assessment about a SU without the SU being present.

Q4 more staff continuity - stop moving staff around so much.

Q4 More targeted information

Q4 Streamline RIO and ensure staff properly trained

Q4 Share the positive stories - good publicity - positive engagement stories

Q4 Improve links with 3rd sector organisations

Q4 Produce clear map of AWP and it's services

Improve partnership working with NHS organisations - particularly those providing

services to our service users.

Q4 See 3rd sector as potential 'service champions'

Q4 Support for Carers of SU's who don't or won't engage with AWP

Q4 PCLS - ensure it can provide advice / support to GPs

Session 2

10.09.12 Bath (WR)

Q1 Worked for AWP

Q1 Staff survey

Q1 F.T. Member

Q1 Service re-design

Q1 Introduced through Carers Centre

Q1 F.T.Meetings (Service User)

Q1 Emails to all staff from Chair AWP

Q1 Web Twitter

Q1 Emails to F.T. members (Newsletter)

Comprehensive - Lots of info available at meetings. Informative - got the message

across

Q2 More engaged since new executive sends staff emails - well pitched

Q2 Inspiration from other Service User's stories at meetings

Q2 Very welcoming and friendly

Website looks better - gives readers more confidence in the service - well put

together

Q2 Internal training - involving Service Users is greater than it has been

Q2 Interviews involving Service Users is greater than it has been

Q2 PALS responses

Communicate and engage better in the acute inpatient settings rather than

community settings

Q3 More emails - to improve contact between leaders etc (Top - down communication)

Service Users find it hard to communicate with all areas (phone & email) with the

exception of PALS

Q3 Carers assessment - no response - no record of report delivered

Q3 Increasing formal involvement between staff and service users.

Q3 Make greater use of the web page i.e. direct users to it.

Q3 Carer surveys findings should be sent automatically to carer.

Q3 Getting the word of AWP out to the public. How to do it?

Q4 Look at how psychological therapies are offered by region

Q4 Encourage L & D to liaise with 3rd sector organisations over student placements.

Q4 Resurrect Community Care Forums

Q4 Greater use of Social Media for communication

Make greater use of website in patient treatment e.g. have resources available

online to support therapies.

If people access website for resources, you can also seek their views and

experiences.

Q4 Advertising local services

13.09.12 Swindon (VC)

Let's get engaged! Event - 13/09/2012 - Victoria Centreissues

CCG's are not involving SU in their engagement. KH to pass equalities

contact on to AG. So that SU can be involved. SU are kept away from the

public spend figures SU would be aghast.Actions

When raising concern with PALS. CPN and pschy were not happy that I had

taken my concern to PALS.

I had tried to resolve the issue with the CPN and other clinical staff - "had a

clean record until you went to PALS".

It was hard to have the same relationship with the clinicians after I had been

to PALS

Some of the things we had agreed would be in my care plan were included

but never happened. I had to fight for these things to happen and it felt like I

was a trouble causer.

Q1 I like the statement "person centred care" and really hope that this happens.

I have had a bad experience with my phys but I was advised to ring through

and complain. I rang the receptionist and with 4 days I had a new phys.

Q2 Holding the Let's Get Engaged Event

Helpful to have conversations with these members of staff who were

working directly in the service. (Jane Salman, Peter Hollingsworth) who

engaged in a respectful and meaningful way, taking issues directly back into

their service and take action.

There was a mis-match between the crisis team and crisis line and by

having conversations with the right people in the Trust who could tell and

explain why there was a mis-match.

Everyone loved the metal health response team/line - it felt it was working

well so not sure why it was removed.

We should consider "How much reduction in suffering" - this should be a

value added measure.

There seems to be a lot of management in AWP and lots of people that are

employed to check quality and performance targets.

Q2 Hard to get to speak to the commissioners

Experience based design is something that we are doing well - you get to

learn about people's experience in a meaningful way rather than just data

and figures.

Need to replicate mentors for peers like they do in BDAS "peer mentor

volunteers"

Staff have to be aware of when is the right time to get feedback. Then you

said we did (or couldn't do because….) is helpful to show that we are taking

action.

Q2 An apathy about questionnaires and feed back.

Q3 It's important that mental health doesn't get left out of the CCG.

Q3 Do we think that mental health will be overlooked.

Q4 Victoria Centre toilets issues water dripping

Q1 Work on an OT for the Trust in older adults (LLL)

Forget-me-not centre involves service users for meetings, interviews, radio

and conferences etc

Q3 Listen to praise from feedback.Making sure all voices are being listened to and that people can make a

difference.

Make sharing information easier to access to older adults.

Q4 OT specific - More groups available to older adults and carer support group

More staff to help facilitate the groups

SU experience - Difficulties / communication - not listening - awaitlist of

treatment. Need access to service and closer communications / liaison with

GP and 3rd Sector Agencies

People are unique - need to be treated as unique and individual. Labelled

and treated as a label.

Workshops and Events - Educating and make people ware. Need to be

ongoing and local. Information from workshops and events needs to be

acted upon.

Q3 Working to gether - GPs - 3rd Sector Agencies

What can we give you? - Unhelpful questions - Raising awareness.

General customer service - returning calls, not turning up for appts

Respect and honesty.Minority groups - Engagement and Involvement needs to improve with these

groups.

Engagement with commissionaires

Q4 Continuity of care - CPNs and staff

Stability in service needed - staff undermined - pass on frustration.

Decisions need to be made with consultation

Cultural change needed whereby staff treat SU's with respect.

Q1 Frustrating for staff driven by charges, sense of conflict.

Q1 Electronic systems clunky.

Q1 Time might be spent more valuably Top - down

Q1 Hope for the future

Q1 SU and Rep - Hope for the future. Felt involved with commissioning.

Q1 Chaos with change - still catching up with change.

Q1 Not engaged as time went by - fragmental

Q1 SUNS

Q1 FT Membership

Q2 SUNS is good

Q2 In-service training for staff is excellent

Q2 Realising things needed to change - accept criticism

Q2 Good PALS and complaints system - Praise

Q3 One size fits all doesn't work

Q3 Escaping clinical boundaries and a prescribing point of view

Staff often late - actually too big a caseload, no time for lunch or reading

notes.

Q3 Lack of transparency

Q3 Early intervention - prevention is better than cure

Q3 Reduce management levels - increase frontline staff

Q3 Not enough money

Q3 Unrealistic time scales - bounce back

Q3 Mapping of services - Lack of understanding for SU before they

became SU. Lack of understanding of role of SU, Carer + peer support

mentor roles.

Q4 Peer support mentoring

Q4 Forum for SU's.

Q4 Streetwise workers.

Q4 More effective system for engagement and representation.

Q4 Less medication - more therapy.

Q4 Be honest and genuine.

Q4 Hope for the future

Q4 Working in partnership to develop services.

Meetings ACF Swindon Carers. Involved with caring for husband going to

appointments been involved 15 years. Commissioner meeting with AWP

services. 2nd services not working together. Psychology service. Chatsworth

House doors are every heavy. (Consultants doors). Also very noisy.

People are taking more notice of carers. Not all carers feel they can be

involved. Could be fearful of dealing with professionals. Carers needed

carers leave. The person they are for? Support needed to attend meetings.

|Physical and mental together. Information needed - Feels like a risk say

going on holiday. Funding / practical issues. Who do you speak to? Who is

appropriate to speak to? Too many assumptions made and all sides taken

into account. Carers often not identified due to the reduction of / or level of

services provided. Carers are not always aware of their rights. Carers are

the experts and should be given that importance. Process of care plan is

good. Crisis teams don't respond well to calls, need relief / a hand.

Sharing more information between physical and mental health. More

involvement with GPs. Letters not being forwarded (5 letters). Possible

reaction to redirection - can we record on RIO and other systems.

Communication about medication to all areas. The ease of which

prescriptions are prescribed and have available to all. Concern over medical

problems being caused by MH drugs. Would the help be available in

different areas?!

Q4 Communication needs improving.Point of contact between groups and AWP (Carers help group) Links

needed to progress group (Swindon Carers) - small sub-group. A lot of

things have improved.

18.09.12 Bristol (CRH)

Let's get engaged! Event - 18/09/2012 - Callington Road Hospitalissues

Training for Sus to develop skills and confidence - mentoring from

work person not treatment person

Shorter events for older carers

October event at a difficult venue for public transport

Induction not accessible for volunteers take it around local areas

Geography - estate problem - Get a bus and get out there

Logistics for older carers

Difficult for Carers - Timings of events - start too early - finish too late

Actions

Plan events with this in mind

More small events to feedback findings of Oct event for those that

can't attend

Q1 Interview panels

Q1 Spoke at the Trust FT event in WSM

Q1 Nominated on the staff wards

Q1 Service user group at Colsley Fare (pleased to hear CF still exists)

Q1 Art exhibition at Colsley Fare

Q2 Having service users and carers involved in the interview panel

Having access to service users and carers and being able to

communicate with these groups to share information and listen.

Q2 Young carers DVDs - this is really helpful

Q2 Link with the Vassell Centre

Have AWP and other agencies able to run joint events /

consultations so that there is a joint care pathway.

Q3 Improve liaison with GPs not just in services where IAPT /Lift is.

Vary the locality / timing of the events so that SU and carers can

attend

How do you keep mental health and managers informed about Trust

business (changes / activities)

Improve the preparation and support the Sus receive in preparation

for panel. So that the transition into society / home is successful -

(many SU's become transient and lose their way)

Q3 Improve contact with support groups for transition

Why are most therapies Art & Craft based? - not all those who are

mentally ill like Arts / Creative writing

Some issues with AWP staff attitudes towards Su and Carer training.

Not valued despite being experts by experience (not seen as equal

adults)

AWP need to incorporate SU and Carer training into mainstream

business

Look at the estates v geographical patch. AWP has services in

buildings which are inaccessible and often not in the geographical

patch which they are commissioned for.

Community mental health bus to travel around both rural and urban

areas - including schools / university / shopping's to challenge

stigma.

Stop holding inductions at just Jenner House. It isolates those

people who want to volunteer or work for the Trust from doing so.

Everyone can tell you where your nearest acute hospital or A&E is

but few people can tell you where the nearest Mental Health walk-in

or service is that you can immediately access.

(SU suggestion) Trust to have AWP outreach services in all parts of

society

To hold coffee mornings, support groups where you can go to keep

in touch with mental health services, but you're not receiving a

therapy or service, but you would be able to have a MH worker

recognise that you would need more support and put you in touch

with MH services rather that you get to crisis point.

When you have been an inpatient for a long time you have regular

contact every morning, noon and night (including making you get up,

take meds, eat dinner and have communication with people)

Then you are released / discharged back home or into society and

all this stops. You are then isolated, often then having other

demands like childcare and this adds stress and isolation can lead to

a relapse.

Q4 We used to explain the O.T. was how to stuff pink felt bunnies !

Founder member of patients council 1995 at Barnes working with

Service development worker - still founder member - fades then re-

ignites periodically

Q1 Foundation Trust Member, volunteer and local resident with interest.

Bristol survivors network - redesign interview - chaired wy????

Training - co-production

Staff worker and support ex-service user to work as a volunteer and

also take on roles through responsiveness engagement.

Q1 Design training

Service user involvement worker - Jess Wright and volunteer co-

ordinator Paul - not enough of them, and don't promote the enough.

Q2 L + D + PALS have right attitude

Spotting opportunities to spread the message - Our Voice , Nursing

Conference.

Recovery implementation group looking at pathway peer support

worker.

Concept of recovery college - good starting point but need to go

further - access to specific training and apply for substantive post.

Q3 Attitude and stigma. Them and us - it works both ways

Q3 Systems don't help e.g. clusters, diagnosis, labels.

Q3 Media doesn't help.

Q3 Fear and ignorance

Q3 Not enough local involvement workers, want Bristol one.

Q3 Look at job descriptions.

It's everybody's' business to spot the opportunity to work together

alongside hand in hand - CAN DO!!

Generic + are specific + project specific. Draw up with service users,

carers, collaboration.

Q4 If people are willing to offer services AWP need to make it happen.

Reduce barriers - some infrastructures are too hard and not

supportive.

Q4 People have lots of skills and should be re-numerated accordingly

Q4 I am more than a service user / staff member see me first!

Q4 Separate work mentor and let staff do this! Support, Nurture

Q4 Our Voice - send to service user groups.

Feedback - re co-production event. It's hard for carers to attend a full

days event, and that Fry's is not accessible if you don't have a car.

. Are Foundation Trust members invited to the co-production event?

Need to consider how the information / feedback from the Let's Get

Engaged / Co-production events are communicated to those who do

not have access to computers / and email.

Q1 Acute forum - Callington Road

Q1 Peer mentors training and introduced in SDAS

Q1 In SDAS appointment was offered to carers.

What service? - authoritarian, bound by criteria, (policy, procedure,)

tolerant, mismatch in CMHT staff. Transfer to central team was

difficult - no consistency / continuity with CPNs. Knowledge - lack

(but not generic but with specific area.)

Q2 Not being listened to. Crisis team too busy.

Complaining doesn't do anything. Solution is not happening. Process

is long, time is wasted, snotty letter.

Not being listened to (carer). No care when carers need it. Service in

chaos in Bristol.

Q2 Support worker issues - hand over / changes

If CPN is ill, appointment is cancelled, rather than "Bank" worker to

fill gap.

Q2 Be human, flexible - how are you today?

Volunteer, get support, training found myself. Training of dual

diagnosis - training given good.

As worker you get what you put in. Support and supervision is

available.

Q2 Public image exercise.

Q3 Allow staff to do their job

Carer support lacking in Bristol. AWP staff invited but then does not

turn up.

Q3 Carers Assessment is fiasco

Q3 Services to be there before something happens.

Q3 Early intervention

Q3 AWP not listening to Carers / Sus

Q3 AWP less resources but bigger caseload so Sus see AWP less

Q3 Work in partnership with Bristol PCT, Council

Q3 More events - not tick box

Q4 Work closer with GPs, police and social workers

Q4 Better communication

Q4 Think outside the box - on high street

Q4 MH walk in centres in big towns

Q4 Radio

Q4 TV, newspaper

Q4 Branding

19.09.12 N Som (Coast)

Let's get engaged! Event - 19/09/2012 - Coast Resource Centre

issues

Mis information hence his diagnosis and judgement

When Integrated services come into force, how will you make sure you get your

fair share of funding?

Lack of continuity - psychiatrist - word nurse - 1.stCare plan was in place, worked well then changed and everything stopped. No

further support available for either SU and Carer

Issues between primary and secondary care

Actions

Caseload weighting measure

Admin backup to minimise loss of worker time

Ring fenced time to deliver care plans / therapy

Improve communications by using technology

Interface between partsEspecially for the 1st home visit. Leave details of person making visit, their unit,

their manager, when and how they will next be contacted.

Q1 Interview panels

Q1 Organic conference

Q1 Sit on recovery and implementation group

Q1 Train staff for AWP

Q1 Got to forums

Q1 Community meeting on Juniper Ward

Q1 Family therapist - Adult mental health in children's centre - "Think family worker"

Q2 Training enjoyable and useful

Q2 Learning and development

Q2 Recent engagement meetings - feedback of outcomes / actions please.

Q2 Service user involvement - especially on wards

Q2 Staff passionate about care delivery - setting up peer mentors a great idea

Q3 Haven't been asked to go on an interview panel since being in hospital

Q3 Being in hospital has been used against her (discrimination)

Q3 Sometimes meetings/forums can be short following a talk.

Q3 RIO has negative impact? Reduces face to face time.

Q3 More communication - difficulty getting help when needed

Q3 Less Sus per CPN - caseload weighting tool / measure

Q3 More clinical support (resource)

Q3 Intensive support team do not react quickly enough

Q3 Negative feedback to involving with MH services

Adult MH and social care working together. Social care don't understand my

mental illness. No contact with care co-ordinator.

Q3 Training issues. Stigma holding

Q3 Both agencies signed up to Think Family working but it's not happening.

Q3 Collaborative working is the way forward.

Clear description of services able to be offered and if unable to offer direct to

appropriate services.

Q4 Joint meetings to clarify needs across agency / clients concern / child

Q4 Time to change / rethink campaigns.

Q4 Link with colleges

Q4 Roll out MH first aid.

AWP being a mindful employer: evidence of this please. Uncaring sickness

policy

Discuss interview panel experience to be discussed with PALS

Ask service users etc why they do not attend (feedback)

Can ex service user be contacted fro feedback / experience.

AWP staff to me more informed to let service user know.Demarcated agreed time to develop care plans + deliver therapy - aided by

admin inputting data to computers

Staff member x number of hours each week to deliver therapy

Interface between many different agencies and how difficult that can be - red

Could do better at processes. It is not necessarily the staff who are not doing

their jobs, rather the systems that we are within.

Q2 AWP has a lot of bad press and have worked hard to remedy this

Carers form was handed out immediately when wife was admitted. Wasn't

unhelpful but it was abit woolly and wasn't really sure what to fill in.

Juniper ward staff are committed but are totally pressurised and it's amazing how

they keep their equilibrium.

Q2 Sending the information on bus / train routes to this event was really helpful.

Integrated services are working well in Hereford / Torbay where you ring one

central number for (Health Services / Social Services)

Do not interpret non medical terminology (having fidgets) to a medical term

(agitation) and it was among diagnosis/action

Improve the information provided to the service user - including any acronyms,

words, what AWP does some of the basics as it sometimes feels like we are

starting on chapter 2 or 3

Q3 Improve communication between services

Q3 Improve the knowledge of mental capacity in general / acute hospital

Improve GP knowledge about AWP and MH services, communicate changes in

services which affect SU's and carers to those who are affected.

Some SU's and carers would like a 2nd opinion and find it hard and time

consuming to get one.

Staff feel very under resourced, there are inconsistencies in approach and often

where there is a discrepancy the pschyiatrist takes the decision despite the

nurses knowing the SU well because they spend the most time with them.

NMC code of conduct about managing the ward and health safety and risk, yet to

get additional staff ward managers have to spend much time ringing someone at

home (on call manager) who gives authorisation. More trust in the nurses who

are working the wards and can make those decisions.

Q3 Increase the knowledge of real time surveys

Q3 Staff need to be informed about the involvement database

Q3 We do not spend enough time with the service users

Q3 No continuity for SU with their pschysoratrist

Comment box on the wall so Sus and carers can capture ideas and suggestions

as they occur rather than wait until the monthly survey comes round. Also when

aided to complete the survey (by a staff member) you might get a bias view

point.

Can volunteers help with feeding Sus who need help, like they do on the acute

wards?

Have a method for staff to complete file notes electronically whilst in the

community on visits not after 4 or 5 visits. On that day and then have to

remember all that information at the end of the day.

Be explicit with Sus that they may not always have the same care giver - but the

Trust can mitigate the impact these changes have on the Sus by ensuring that

key information is passed over and the SU/Carer have lots of contact.

let's get engaged! event - additional notes issuess get engaged feedback.pdf · 2012-10-11 ·...

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