Getting Employment Specialists established within clinical teams

Lynne Miller, Vocational Services Manager, CNWL

Katherine Dawson, Vocational Team Leader Brent

Introduction:

Introduction to CNWL

Setting up vocational services from scratch – where to you start!

Keys to successful implementation of IPS and UEP

Integration - an Employment Specialist’s Perspective

Feedback from service users, clinical teams

Monitoring/Recovery stories

Introduction to CNWL:

5 Mental health boroughs – Westminster, Brent, Kensington and Chelsea, Harrow and Hillingdon

7 Addictions boroughs – Westminster, K&C, Hammersmith and Fulham, Brent, Hillingdon, Hounslow and Ealing.

Vocational Services Manager, 4 Vocational Team Leaders (16 ES)

Now delivering IPS in a range of teams including CMHTs, EIPT, Addictions and Forensic Services

The road to evidence based services:

Start with a User Employment Programme: Getting your own house in order within the Trust/partner agencies.

Success of UEP was an important factor in adoption of IPS within CNWL.

Two elements – direct access to paid posts within the Trust, and time limited work placements as a step towards paid work

Getting started - UEP:

Selling the vision to key people – top down, top up

Gaining commitment from CEO, Directors, HR, Occupational Health

Staffing / partnerships

Employment Charter / Launch

Encouraging other providers to develop a similar commitment eg LA

IPS – getting started:

VSM – selling the vision – evidence base

Sponsorship from Snr Management

Implementation plan

Working in an opportunistic way

Start small, communicate successes

Keys to success:

ROLES:

CMHT Mgr/Snr Practitioner– shared vision/clear expectations

OT Role

Joint supervision/joint induction/joint meetings

Consultants

Team presentation – emphasis around it being a team model

ES role in selling the idea that anyone can work with the right support.

Keys to success : ES – recruiting the right staff

ES is clear about their role/purpose

Someone who is not afraid of employer engagement

Fidelity to IPS: Focus on service user strengths/ early job seeking/ job development / effective in work support / MDT approach

Staff supervision/training/local leadership

Effective monitoring and evaluation

Communicating successes

Integration: an ES/Voc Team Leader Perspective

Into the CMHT

Building trust within the team

Integration within Vocational Services

Training staff

Advisory groups

Effective Supervision

Job clubs

Challenges:

Not recruiting the right ES

Lack of a multi-disciplinary approach – person seen as an add on

Team chemistry

Lack of commitment from team mgt or low expectations around what an ES can achieve

Confusion over performance mgt issues

Common IPS fidelity issues:

Zero exclusion

Early job seeking

Lack of employer engagement

Lack of a Team approach

Not providing effective in work support hence the job retention rate is low

ES is not confident about supporting service users to manage personal information, hence employer engagement is limited

Monitoring:

Clear monthly and bi-annual monitoring systems in place

Making sure ES are part of integrated files

Use of recovery stories

Fidelity Reviews

Feedback from clinical teams:

Clinical teams have identified that having an effective ES immediately raises the profile of employment

Raises expectations – especially when they can see results

The clinical team are more aware of local employment resources

ES can assist in engaging service users with the team.

Feedback from service users:

“ My name is R.M. I am 44, and have had schizophrenia and a physical illness for over 21 years. I have been to the Job Centre many times over the years, but they did not seem interested in helping me. Staff at my community mental health team put me in contact with their Employment Specialist.

After a few sessions with the ES she invited me to the job club every Friday between 3-5pm. I quickly became motivated and eager to look for a job. They explained to me how to draw up a CV and write correct application forms. Within months I had an interview with B&Q but didn’t get the job. Then I had an interview with Homebase but didn’t get the job! The ES suggested some pointers and we did more interview practice and I got a job – 14hrs a week at B&Q. I couldn’t have done this without the constant support from the ES, she kept motivating me even when I felt low after not getting the first two jobs. I considered taking a break but she encouraged me to keep trying. I know have my dream job.

Results:

UEP – since it started in Sept 05, 200 people have accessed the programme, 168 placements have taken place, 80 people have gone into jobs, 30 into educ, and 11 into volunteering.

When IPS was first introduced within an Early Intervention Team. In Yr 1 80% of those referred were inactive. Within 9 months 77% were involved in paid employment or education. Year 2 37 people accessed the service of which 1 was in employment (78% were unoccupied) and none were in education. By the end of the year 15 were in paid work and 8 were in education.

In Brent in first 10 months of this financial year – 2.5 posts (one of has been in post just 10 months), 125 people accessed the service 35 have been supported into paid work and 25 into education.

Conclusion

Support from Snr and local Management to move the agenda forward and free resources.

Joint work with OTs

Leadership/Support for ES / Ensuring high fidelity to the model

Getting the monitoring and evaluation right

Increasing access to external partnerships to increase capacity

Fidelity reviews and a culture of continuous improvement

For Further information

Lynne.Miller@nsh.net

Katherine.Dawson@nhs.net