Back on Track: Exploring ways to promote inclusion

1. Back on Track: Exploring ways to promote inclusion Pam Ringland November2011

2. Aspiration I hope that the findings of this project will raise awareness of the needs of young people with mental health needs and influence future provision and support for arelatively small, but vulnerable and disadvantaged group.

3. Jack • 20 years old • Diagnosed with schizophrenia a year ago • Chaotic lifestyle and frustrated that his hopes were not being realised • Intelligent and articulate but failed to achieve academically • Wanted to gain qualifications and get a job • Repeatedly enrolling on vocational courses at FE college • Had difficulty sticking with study and often dropped out in first term

4. First Episode Psychosis (FEP) • Knowledge, skills and qualifications are crucial for those wanting employment, therefore FE has an important role in providing hope for the future (Lay et al, 2000; Lloyd and Waghorn, 2007) • Young people recovering from FEP often struggle to: • access mainstream vocational courses & maintain their academic performance (Roy et al, 2009) • keep their jobs if already employed (Birchwood et al1992). The good news is that international studies have shown that specialist vocational support for young people with FEP can greatly improve their chances of vocational success (iFEVR, 2008).

5. Back on Track course Locally, the Back on Track course has greatly improved the chances of young people recovering from FEP maintaining their education and achieving qualifications that may improve their employability in the future. The approach has been disseminated at local, regional, national and international levels. It has inspired other EIP teams and FE colleges to work together to improve vocational outcomes for young people with FEP.

6. 50% There remains a group of young people with complex needs and barriers to achievement, like Jack, who require more help and support if they are to regain meaningful lives in the future. This has prompted the local team to look for ways to improve outcomes for the 50% of learners who are unable to progress and are therefore at risk of long term welfare dependency.

7. Frames of reference • The identification of further learning impairments does not always fit with the social model of disability. • This project uses a ‘person-centred’ approach by focusing on and identifying the support needs of individual learners. • Listening to and observing Back on Track learners has identified that cognitive impairments and ASDs have presented as obstacles to their participation and achievement in education and employment. • A literature search provided evidence to support this assumption and identified ways to assess learning needs related to the two conditions.

8. case studyActivity

9. Actions & Conclusions

10. Jack • Gaining skills and finding employment is especially difficult for young people with complex needs and hidden disabilities. • Specialist diagnostic assessments can help to identify strengths as well as support needs. • A ‘one size fits all’ model of support e.g. IPS, is unlikely to meet everyone’s needs and many young people with FEP may fall through the net. • CRT strategies can be simple and easy to deliver, such as memory prompts, or the ‘errorless learning training method’, and can be effective at improving academic performance.

11. Steve • A ‘person- centred’ approach can help individuals and others understand their difficulties and plan support. • Sensory processing difficulties are common in those with ASD and psychosis and can trigger high levels of anxiety that can impact on behaviour. • Compensatory strategies can be simple to implement and very effective at reducing anxiety levels. • Communication between health and FE staff can help to identify needs and strategies and can avoid ‘drop out’ from college.

12. John • Access to specialist assessments to identify hidden impairments is essential if we are to avoid ‘giving up’ on those whose needs we feel unable to meet. • Health and vocational staff need training to ensure that they recognise possible ‘hidden’ learning difficulties and are able to offer opportunities for assessment. • Sensory and environmental adjustments can have a positive impact on quality of life, daily function and relationships as well as academic performance.

13. Jane • Partnership working between health and vocational workers helps to ensure that vocational opportunities are tailored to the individual to maximise chances of success. • The IPS model does not suit everyone and some people need more support to help them prepare for the workplace. • OTs are well placed to assess individual’s work capabilities in relation to their mental health needs. • Learners with FEP may benefit from learning support delivered by experts by experience. • Stigma surrounding mental health issues continues to have a negative impact on employment prospects.

14. Challenges • Stigma and pessimism • In 2010, the Shaw Trust found that mental health ‘remains the last taboo... 40% of employers [still] viewed workers with mental health issues as a significant risk’ (Shaw Trust, 2010). • Risk of gaining a ‘learning difficulty’ label as well as a mental health diagnosis. • Mental health staff have been accused of ‘low expectations’ and not always listened to when advising about appropriate vocational pathways. • Lack of consistency in policies & guidelines • IPS vs vocational rehab • Mental health policy vs clinical guidelines • Disability vs vocational guidelines

15. Challenges Funding & staffing • Following the NHS efficiency savings and staff reductions, demands on remaining staff have increased. • Vocational support is often contracted to employment specialists with no ‘in depth’ mental health training • Few frontline NHS staff are trained in the use of specialist assessments to identify mental health related learning difficulties. • Cognitive assessments are time consuming to administer and score

16. Solution - The Cognitive and Sensory Needs Screening Tool ? • The tool was developed for this project & could be offered to young people who had reported difficulties with learning or were currently experiencing unexplained poor daily function. • Outcomes of the screening assessment could identify those who may benefit from specialist cognitive and / or sensory assessments. • NB Further research will be needed to validate and assess the effectiveness of the screening tool - it should be used only to inform the need for specialist assessments rather than as a diagnostic tool. • It is hoped that other EIP teams and health researchers may become involved in validatingthe tool in the future.

17. The social enterprise?

18. Localism • Local authorities are currently responsible for supporting local people to set up social enterprises to improve local services, as stated in the Localism Bill (2010) • Will this provide opportunities for the most disadvantaged, who may lack work experience or enterprise and social skills, to participate in this type of initiative?

19. Imagine if... • A not-for-profit organisation decided to start a recycling business that would benefit the environment and local community while providing work for those with difficulty accessing employment in the open market. • Jack could be supported to work in a hands-on ‘production’ role while improving his cognitive skills and gaining qualifications. • Jane could use her marketing skills and work flexibly to accommodate her mental health needs. • Individuals could work alongside experienced volunteers and have access to high quality training provided by the local FE College. • They could try out different roles to see what suited their strengths and have regular reviews to plan their career development.

20. The Way Forward? • Social enterprise may be a useful way to provide flexible employment related activities for young people with FEP that can fit with their mental health needs; • Current changes to local NHS mental health services mean that EIP staff are less able to be actively involved in developing and running vocational projects ( and collecting the evidence). • Access to business and financial expertise and a source of sustainable funding is required in order for a social enterprise initiatives to succeed. • Opportunities for Back on Track learners to engage with existing local social enterprises have been identified.

21. Recommendations

22. For local mental health services 1. Ensure evidence based models of vocational support are used and adhered to; 2. Ensure that barriers to vocational achievement, including cognitive impairments and ASD, are assessed and appropriate support needs are identified; 3. Ensure that clinicians have the knowledge and skills to assess and address any impairments that negatively impact on participation in vocational activities, including cognitive, social communication and sensory difficulties; 4. Negotiate Service Level Agreements with Further Education, training and employment providers to support and embed partnership working.

23. For mental health practitioners • Ensure services are recovery focused and include career goals and aspirations in all holistic assessments; • Screen those with complex needs and / or unexplained functional difficulties for cognitive / sensory needs; • Offer specialist assessments if appropriate; • Facilitate the development of self management skills to compensate for cognitive/ sensory difficulties and improve chances of vocational success.

24. For vocational providers • Effective liaison with health services to ensure specialist support is available to those with complex needs; • Ensure equality of opportunity in education and employment opportunities is offered to young people with FEP; • Offer opportunities to engage in learning and achieve qualifications that enhance employability, such as training in enterprise and business skills; • Provide opportunities for flexible, creative ‘hands –on’ work experiences that will help to engage those who struggle in solely mainstream environments.

25. Partnership Working • No one service will be able to meet the needs of those with complex needs • Reciprocal agreements between services may help to avoid individuals ‘falling through the gaps’ • Pooled budgets and individual learning accounts may help services and service users to meet complex support needs

26. Thank you Ideas and suggestions welcome! If you would like to comment on, or discuss this project please email me at: pam.ringland@solent.nhs.uk