FORENSIC EMPLOYABILITY PATHWAY

1. FORENSIC EMPLOYABILITY PATHWAY Catherine Totten Specialist Practitioner Occupational Therapist Cheryl McMorris Head OT Directorate of Forensic Mental Health & Learning Disabilities

2. Employability “Not everyone wants to be employed, but almost all want to “work”, that is to be engaged in some kind of valued activity that uses their skills and facilitates social inclusion.” National Social Inclusion Programme (2006) The right work in the right place, with the right tasks … and the right support gives us: • Social networks and contacts • Structure and purpose to our time • Physical & mental activity • A sense of identity • Money • Skills • Social Status • Meaning to the concept of leisure (Work Matters – Vocational Navigation for Occupational Therapy Staff, 2007)

3. Background to Pathway. The Equal Access partners in conjunction with the Scottish Executive, devised a generic employability pathway. This determined the different support systems required at each stage, to add clarity to the process of gaining or working towards employment. This employability pathway was created to help individuals from the very earliest stages of considering work through to those who have moved into work and are learning the disciplines of holding a job down and continuing to build their employability.

4. Employability & the Forensic Population. It is well recognised that those who are most likely to be out of employment include: people with no qualifications, lone parents, people with disabilities or health problems in particular, mental health problems; ex offenders and those with drug problems. (Work force Plus - an Employability Framework for Scotland, 2006) The benefits of work and employment are well evidenced, including knowledge that enabling people to gain employment reduces offending. (Lipsey, 1995) Personal and social barriers, such as confidence, mental health and substance misuse problems, and a lack of relevant skills and qualifications make gaining work or employment much harder. (Social Exclusion Unit, 2002). Issues in relation to stigma, disclosure of history of offending and mental health problems can cause additional problems for forensic patients looking to access work.

5. Forensic Employability Pathway The Forensic Directorate recognised the challenges faced by the forensic population and the fact that they often represent some of the most disadvantaged groups of people in relation to employability potential. So…. • Customised the pathway to demonstrate forensic approach to each stage, give examples of some of the activities, resources and services utilised for this journey. • A large part of the employability pathway is the collaboration with other organisations to assist in provision of a range of meaningful skills development opportunities, qualification attainment and work options, and the protocols and support that we provide to enhance these. These opportunities can provide further skill development and important alternatives for occupational choice and engagement in work tasks for those patients in the early stages of the pathway or who are unready or unable due to current situations to meet the demands of obtaining full paid employment.

6. Generic Pathway: Social Contact Social Support Sense of Structure Forensic Approach: Identification of individuals strengths and areas requiring development. Identification of any volitional issues by OT / incorporation of the remotivation process to enhance the motivation to engage in meaningful activity Development of individual’s day to day routine with regular programmed activities (wide variety of choice available) based around individuals; current volitional status, skills, functioning, interests & values, impact of environmental contexts on engagement and risk / risk management. Initial development of life skills and pre vocational training, personal and social development. All sessions are facilitated or supported by Directorate staff. External tutors or external staff are utilised as required. Examples of assessments used to inform include: Volitional Questionnaire, OPHI II, Adult literacy & numeracy, Interest checklist, Assessment of Motor & Process Skills, Model of Human Occupational Screening Tool. Stage 1 – Positive Activity

7. Forensic Stage 1 – Examples of methods of delivery On ward: Activity Areas: Individual sessions Acorn Project Open informal groups ADL Skills Basic ADL skills Adult literacy/ numeracy Patient interest groups ESOL Social Activities Gym / Physical Health Therapet Music Lessons Range from engaging volitionally challenged individuals, skill assessment, habilitation & maintenance of ADL, life skills, addressing specific issues (e.g. communication). Establish appropriate routine & structure in preparation for moving onto next stage.

8. Generic Pathway: Helping individuals to address personal circumstances, confidence building, literacy & numeracy, core skills Forensic Approach: Continued development of individuals life skills and ADL skills. Focus on confidence and skills building utilising skills of staff and external resources. Initial steps towards the community through involvement with appropriate external projects – OT as first point of liaison to the established contact person with in resources. Developing educational outcomes and working towards qualifications with supported education – linked to patient interest, strengths and future goals. Early stage supported occupational roles - providing opportunities to gain experience in the workings of groups and meetings. Examples of assessments used to support & inform include: As stage 1 and: Model of Human Occupation Screening Tool (MOHOST), Occupational Circumstances Assessment Interview & Rating Scale (OCAIRS) Stage 2 – Work Preparation Initial

9. Forensic Stage 2 – Examples of methods of delivery • Patient Councils– A council for each ward within the Directorate. • Early Occupational Roles– Patients supported to complete Occupational roles within units and receive an incentive payment. • Education – Tutor emloyed at both sites - Educational Outcomes include: PC Passport advanced, Highers in a range of subjects and non vocational courses including History, Spanish, English. • Skills development projects: utilising different mediums e.g. animation, art • World Affairs & Current Affairs: To develop adult literacy skills and abilities and provide patients with a sociable discussion forum for common interests • Newsletter Group: Supported by adult literacy tutors – next stage on from adult literacy sessions. • Charlie Reid Centre: stabilising patient and personal confidence in community setting

10. Generic Pathway: Creating a greater job focus, CV preparation, job search, volunteering, work experience ForensicApproach:Augmenting skills built on in stage 1 & 2. Patients ready for community placements for skill development –OT facilitates individualised goal setting, grading planned actions & activities for identifying strengths in relation to client’s skills, educational achievements, physical abilities, & fitness for work. Identification of work type activities and individuals ability to tolerate tasks assessed through use of activity analysis. Assessing suitable types of employment, volunteering, higher education or work experience for individual. Identification and assistance with disclosure processes. Protocols established with community resources for referral process, information exchange & continued liaison. Specified OTs as organisational contacts with all community resources. Forensic training packages and support offered to Community placements/ resources. Examples of assessments used to support & inform include: As stage 1 and 2: plus Worker Role Interview (WRI). Stage 3 – Work Preparation – Later Stages.

11. Forensic Stage 3 – Examples of methods of delivery • Directorate Patient Activity Group –Representative from patients council attend. Experience involvement and workings of groups. CV opportunity • Library Job: Supported work experience in unit – job description, application, interview and contract for patient. • Supported work experience / In patient Café volunteer posts-job description, induction, training - expected to adhere to policies e.g. sickness etc. Plans to link into SVQ in customer service when SQA accredited site. • RESTART – Skills development, vocational qualifications (potential for job access – done through joint work with OT.) • Coachouse – Skills development & potential for job experience, -art classes, gardening project and woodwork. • Colleges: Various college courses. • Community health project: Volunteering Activities include: cost price fruit and vegetables sessions, an allotment project, cookery groups and outreach work. • BTCV: Wide range of practical projects offering opportunities to gain new skills & experiences and make a positive contribution to local environment. • Volunteer Projects: Links with Volunteer Centres, wide variety of volunteering projects available – gardening to office work.

12. Generic Pathway: Supported employment, helping employees adjust to specific barriers, active support. Forensic Approach: Utilising support from outside agencies – following the social inclusion agenda as per patient need - including mental health services, mainstream services and those linked to working with ex offenders. Links are established with services, for when patients are at this stage. Joint working with external services to assist in appropriate employment, OT as point of liaison & continued support. Identification and assistance with disclosure process to protect both patients and community. When patients successful in achieving employment (supported or mainstream) we continue to offer support for both employee and employers as appropriate. Ensuring both have key contact details for any issues arising. Examples of assessments used to support & inform include: As per previous stages and Work Environment Impact Scale (WEIS). Stage 4 – In work, early recruitment

13. Forensic Stage 4 – Examples of methods of delivery • APEX: Work with offenders and young people at risk of offending to address employability needs and progress them towards employment, education, and training. • Enable: Community business aiming to provide employment opportunities. • Flourish House: Promotes recovery using clubhouse model, skills development, and supported employment opportunities as appropriate. • Volunteering Jobs: Including Salvation Army, charity shop work, Coachouse trust & leading change group. • Sympathetic / Positive Employer: Employers who actively challenge discrimination – e.g. SAMH • Wise Group: Assists those facing major barriers to employment e.g. history of offending or substance misuse, progress into employment and furthereducation.

14. Generic Pathway Monitoring & supporting employees & employers to retain jobs, support those at risk of losing jobs Forensic Approach Maintainance of contact with & support of patient to assist in job retention. Identification of further skills and qualifications development to assist with career development. OT maintains link with employer for support and to identify any barriers / issues or developments as early as possible. Helping employees idenitfy and adjust to specific barriers. Support in working through benefits available to those in employment. Stage 5 – In Work Long Term Support

15. What next? Employability is a central premise of our approach to the inequalities agenda, we continue to promote the employability framework in its wider context and application and in partnership with external agencies, whose input is crucial. • We maintain a continued commitment to employability for all our patients by: • Continue to identify the gap between what individuals want to do and what their current situation allows them to achieve and where possible helping them to bridge the gap. • Continue to source and provide a range of opportunities for skill development, vocational rehabilitation, qualification attainment and employment for patients at all stages of the employability pathway. • Continue to develop stronger working relationships with organisations, resources and services, with joint working protocols in place to ensure consistent communication and support for both service and patient. • Continue support for the patient group, services and employers in relation to safe disclosure of offending and mental health conditions. • Continue to work towards social inclusion for our patient group - utilising main stream services and employment strategies. • Annual audit and review of the NHSGGC Forensic Employability pathway.

16. References • Lipsey, M. (1995) What do we learn from 400 research studies on the effectiveness of treatment with juvenile delinquents? In: McGuire, J. (ed) What Works: Reducing Reoffending. Guidelines from research & practice. West Sussex, England: John Wiley & Sons • National Social Inclusion Programme (2006) Vocational Services for people with severe mental health problems: Commissioning Guidance. London: Department of Health • Ross, J. (2007) Occupational Therapy & Vocational Rehabilitation. John Wiley & Sons • Scottish Executive (2006) Work force Plus - an Employability Framework for Scotland. • Social Exclusion Unit (2002) Reducing Reoffending by Ex-prisoners. London: Social Inclusion Unit • The College of Occupational Therapy & National Social Inclusion Programme (2007) Work Matters – Vocational Navigation for Occupational Therapy Staff. • Waddell G., & Burton, K. ( 2006) Is Work Good for your Health & Wellbeing? London: Stationary Office

17. Contact Details Catherine Totten Specialist Practitioner Occupational Therapist Forensic Community Mental Health Team Clutha House 120 Cornwall St South Glasgow G41 1AF Tel – 0141 427 8378 Catherine.totten@ggc.scot.nhs.uk