Connecting People Intervention

Connecting People Intervention www.connectingpeoplestudy.net

Policy context • Social Exclusion Unit report on mental health (2004) • Initiated current direction towards social inclusion in mental health services • Importance of community participation and strong networks • Policy implementation led by National Social Inclusion Programme, headed by Prof David Morris

Policy context • The Big Society (2010) • Give communities more power • Encourage people to take an active role in their communities • Transfer power from central to local government • Support co-ops, mutuals, charities and social enterprises • Publish government data

Policy context • Mental health strategy (2011) • More people will have good mental health • More people with mental health problems will recover • More people with mental health problems will have good physical health • More people will have a positive experience of care and support • Fewer people will suffer avoidable harm • Fewer people will experience stigma and discrimination

Policy context • RSA Connected Communities (2010) • An example of an initiative which links policy agendas • Investigates how services can mobilise networks to support people • Explores how solutions can be co-produced external to services • Connecting People Intervention is the inverse – facilitating services to be more outward-facing

Theoretical context Economic capital: Resources that can be used to produce financial gains (Marx, 1867) Cultural capital: Information resources and socially valued assets, e.g. knowledge of the arts, music or literature (Bourdieu, 1997) Human capital: Qualifications, training and work experience (Becker 1964) Social capital: Sum of resources (actual or potential) that accrue to a person or group from access to a network of relationships or membership in a group (Bourdieu, 1997) Community capital: Combination of capitals within a defined area or community, required to help people fulfil their potential (Hancock, 2001) Erotic capital: Beauty, sex appeal, charm, liveliness, presentation (Hakim, 2010)

Theoretical context • 1. Provision of information • about the most effective interventions or health behaviours • about job opportunities or other ways of enhancing socio-economic position and quality of life • 2. Additive effect of resources • power and authority of network members may add to an individual’s power and social status to effect exposure and vulnerability to health risks • neo-material gains of network resources • 3. Social credentials • direct intervention of network members in health care • 4. Maintenance of subjective social status • Network resources could mitigate against loss of personal resources. Shared resources maintain identification with a social group

Empirical context Wealth, power and status of network members can benefit other individuals in that network (Lin 2001) Informal social networks are influential in helping unemployed people find work (Perri 6 1997) Social capital helps reemployment (Sprengers et al 1988) and has an effect on income (Boxman et al 1991) Social capital is positively associated with current occupational status (Flap & Volker 2001) Social capital can lead to greater occupational prestige, income and political influence when mobilised (Lin & Erickson 2008)

Empirical context

Empirical context There is a cross-sectional inverse association between trust and common mental disorders (de Silva et al 2005); and between access to social capital and depression (Webber & Huxley 2007; Song & Lin 2009) Social capital is associated with improvements in quality of life, though insecure attachment styles pose a barrier to people with depression accessing their social capital (Webber 2011) High levels of trust lower the risk of depression (Fujiwara & Kawachi 2008) Low workplace social capital increases the risk of depression (Kouvonen et al 2008)

Empirical context • Incidence of schizophrenia in ethnic minorities is related to percentage of ethnic minorities in the area (Boydell et al 2001) • In areas 28-60% ethnic minorities = 2.4 • In areas 13-28% ethnic minorities = 3.6 • In areas 8-12% ethnic minorities = 4.4 • Ethnic density effect in schizophrenia has been confirmed in a study using smaller areas (Schofield 2010) • Cumulative social disadvantage is associated with increased risk of psychosis in Black Caribbean men (Morgan 2008) • Social hostility or racism can’t explain excess of psychosis in Black Caribbean men in comparison with Asian men. • Is social capital a buffer to adversity and has a protective role in terms of mental health?

Practice context • NICE Guidelines for Schizophrenia (2009) social interventions: • family interventions • social skills training • vocational rehabilitation • (nothing about connecting people or engaging with local communities)

Social intervention development Implementation • Incidence and prevalence • Explanatory knowledge • Practice knowledge • Local knowledge Effectiveness testing Efficacy testing Intervention design Modelling Epidemiology (Adapted from Fraser 2003)

Method • Combinative ethnography of social care practice • Semi-structured interviews, observations of practice and focus groups • Exploratory, not evaluative • Setting: • 1. NHS mental health services (mental health professionals and support time & recovery workers in early intervention in psychosis teams, social inclusion and recovery services) • 2. Housing support (supported housing & floating support workers) • 3. Third sector (social enterprises, voluntary organisations) • Sample • 150 workers, service users, managers, commissioners

Method • Ethnography phase 1 • Researcher interviews, observes, and holds focus groups with agency workers, service users and carers to discuss the practice of enhancing service user social participation • Ethnography phase 2: • New questions emerging from phase 1 was the focus of phase 2 through further discussion and conceptualisation of practice • Changes in service users from phrase 1 were reflected • Delphi Consultation • Intervention model was developed and revised in liaison with project’s advisory group and a wider group of stakeholders (incorporating service users, carers, practitioners and researchers)

Method • Systematic Reviews (x3) • Aims: to systematically identify, and evaluate the quality, of the research literature on health and social care interventions that promote the social participation and well-being of adults with a learning disability or mental health problem • adults with a learning disability • adults with a mental health problem • older adults (+65) with a functional mental health problem • EPPI Centre Methodology • Data synthesis and quality appraisal grouped by study design to capture quantitative and qualitative results • Inter-rater reliability at each stage

Method • Fidelity measure development • Fidelity measurement is required to answer question: how do you know that the intervention made a difference and not something else? • The Connecting People Intervention Fidelity Scale (CPIFS) will measure variation in fidelity to the intervention model at an individual level (to capture expected variation in practice at the individual worker level) • Inherently complex due to personalised nature of interventions; main focus will be on fidelity to intervention model • Items refined in Delphi Consultation; psychometric properties evaluated in pilot study

Method • Quasi-experimental study to pilot intervention • Intervention model adapted for use with adults with learning disabilities and older adults with mental health problems • Scoping study identifies about 15 agencies who are willing and able to implement intervention in the three social care user groups • 3-day intervention training provided to each agency • 240 new referrals are interviewed at baseline and 12-month follow-up • Outcomes being measured: • Social participation (SCOPE, Huxley et al 2012) • Well-being (WEMWBS, Tennant et al 2007) • Access to social capital (RG-UK, Webber & Huxley 2007)

Method • Quasi-experimental study to pilot intervention • Potential confounding factors: • Socio-demographics • Attachment style (RQ, Bartholomew & Horowitz 1991) • Life events (RLEQ, Norbeck 1984) • Hypothesis: Higher fidelity to CPI will be associated with improved outcomes • Economic evaluation: • Service use (CSRI, Beecham et al 2001) • EQ-5D (EuroQOL 1990) • ICECAP-A (Al-Janabi & Coast 2009) • Process evaluation will involve qualitative interviews with service users, workers and managers

Partnership Equality Worker Individual Developing ideas, goals, and confidence and working to attain and expand on these Shared processes Developing skills, relationships and resources with this individual and for the future Social Network Knowledge Development Social Network Development Potential Barriers Potential Barriers Agency

Partnership Equality Confidence Flexibility Lived experience Openness Hope Trust Worker Empathy “Can-do” attitude Natural networker Individual Ownership Enthusiasm Individual can leave and re-enter the intervention at any point of the cycle as desired/required Physical environment Community resources Help accessing the service Building relationships Exposure to new ideas Introduction to new people and activities Fostering trust Identifying opportunities Network assessment Objective development Inspiration Facilitation Meeting expectations Orientation/signposting Skill recognition Feedback Engaging with local community Development of skills and interests Developing own networks and resources Development of social confidence Adapting to new ideas Building currency Social Network Knowledge Development Utilising contacts Social Network Development Physical health Lack of local knowledge Cultural/ diversity factors Attitude: self Complicated external lives Barriers Barriers Stigma Extra Support Reassessment Advice Seeking Self awareness Lack of information Lack of resources e.g. time, funding Attitude: self/ organisation Poor processes/ bureaucracy ‘Bad’ social capital Access to service Agency Modelling of good practice Skill sharing Community engagement Local knowledge

The Practice Guidance

Thank you Please do not hesitate to contact us for further information. www.connectingpeoplestudy.net martin.webber@york.ac.uk https://www.facebook.com/pages/Connecting-People-Study/224658480937124

Connecting People Intervention