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Integration of Social Care Staff in Community Mental Health Teams

Integration of Social Care Staff in Community Mental Health Teams. Professor Peter Huxley 4 th National Social Work CPD Conference Institute of Psychiatry, 14 th September 2010. RESEARCH QUESTIONS What determines the social care composition of CMHTs?

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Integration of Social Care Staff in Community Mental Health Teams

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  1. Integration of Social Care Staff in Community Mental Health Teams Professor Peter Huxley 4th National Social Work CPD Conference Institute of Psychiatry, 14th September 2010

  2. RESEARCH QUESTIONS • What determines the social care composition of CMHTs? • Does team culture and climate vary by composition? • Are service users experiences effected by team climate and culture and composition

  3. THREE PHASES • PHASE 1 - National survey of MH trusts – reasons for team composition • PHASE 2 - Four location study of culture and climate in teams • PHASE 3 - Two locations impact on user experience

  4. RESEARCH QUESTION 1 • What determines the social care composition of teams?

  5. Data were collected from 42 out of 79 Trusts (response rate 53.2%). • 381 Community Mental Health Teams (CMHTs). • Managers provided details of: • the numbers, sizes and composition of community teams • Reasons for CMHT composition, drivers of planned changes, reasons for social care component

  6. CMHT

  7. Assertive Outreach Teams

  8. Early Intervention Teams

  9. Crisis Resolution Teams

  10. Team membership and composition, in terms of total staffing and social work and social care numbers is largely unrelated to the rationale given by managers. • Despite more than 15 years of policy guidance relating to the mental health workforce (and increasing staff numbers over the same period) team staffing and composition was not associated with guidance or demand.  

  11. Financial resources emerged as having some influence on team staffing and composition. • Smaller Trusts appear to struggle to populate policy prescribed specialist teams and were more likely to have to consider redeploying CMHT staff for this purpose. • Supply, historical and resource factors have an undue influence on the composition of CMHTs compared to need and demand factors.

  12. UK Mental Health Services Social Care Services MHSW Health and SocialCare Integration

  13. Social Care Services Mental Health Services MHSW Health and Social Care Integration

  14. RESEARCH QUESTION 2 • Does team culture and climate vary by composition?

  15. Phase 2 four location study of culture and climate in teams • Workforce dynamics questionnaire (Susan Nancarrow) • Karasek job content questionnaire

  16. 42 TEAMS • 300 WDQ RESPONSES

  17. Inter-professional working and role overlap in the whole sample

  18. Inter-professional working and role overlap by location

  19. Inter-professional working and role overlap by professional group

  20. Proportion of sample with no overlapping role Psychiatrist n=30 (11.9%) Psychologist n=27 (10.3%) GP n=98 (38.1%) CPN n=15 (5.7%) Other nurse n=85 (35.0%) OT n=23 (9.0%) Social Worker n=12 (4.7%) ASW n=37 (14.4%) Support Worker n=22 (9.0%)

  21. INTEGRATION

  22. TEAMWORKING

  23. QUALITY OF CARE

  24. JOB SATISFACTION

  25. INTENT TO LEAVE EMPLOYER

  26. RESEARCH QUESTION 3 • Are service users experiences effected by team climate and culture and composition

  27. PHASE 3 TWO LOCATIONS IMPACT OF CULTURE AND CLIMATE ON USER EXPERIENCE

  28. 41 SERVICE USER INTERVIEWS • CUES • MANSA • SUQ

  29. Relationship between worker and user views WORKER (WDQ)USER (CUES) TEAMWORK AVAILABLE CHOICE QUALITY OF CARE NURSE COMPETENT & KNOWLEDGABLE SOCIAL WORKER LISTENED UNDERSTOOD SUPPORT WORKER LISTENED UNDERSTOOD TRAINING/CAREER NEEDS MET SOCIAL WORKER LISTENED UNDERSTOOD SOCIAL WORKER COMPETENT KNOWLEDGABLE SUPPORT WORKER LISTENED UNDERSTOOD SUPPORT WORKER COMPETENT AND KNOWLEDGABLE OVERALL JOB SATISFACTION AVAILABLE CHOICE SATISFACTION WITH CHOICE INTEGRATION NOTHING

  30. Conclusions • Variable proportions of social care per team from 0% to 65%,88% (lower in new teams) • Narrow conception of social care being integrated • Regressions – new teams more integrated than CMHTs

  31. Conclusions continued • Regressions – integration makes no contribution to teamwork, to quality of care, job satisfaction or intention to leave • Social workers are more likely to want to leave

  32. Conclusions Continued • Culture and climate can be shown to be related to user outcomes • But integration is not • Composition is also unrelated (as tested here with CUES or MANSA or SUQ but n is small) • Integration is not a useful construct for implementing the New Horizons agenda, personalisation may be preferable.

  33. Acknowledgements • SDO Funding Acknowledgement:This project was funded by the National Institute for Health Research Service Delivery and Organisation programme (SDO114). • Department of Health Disclaimer:The views and opinions expressed are those of the author and do not necessarily reflect those of the NIHR SDO programme or the Department of Health.

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