[Show abstract][Hide abstract] ABSTRACT: Interventions (such as participatory arts projects) aimed at increasing social inclusion are increasingly in operation, as social inclusion is proving to play a key role in recovery from mental ill health and the promotion of mental wellbeing. These interventions require evaluation with a systematically developed and validated measure of social inclusion; however, a “gold-standard” measure does not yet exist. The Social Inclusion Scale (SIS) has three subscales measuring social isolation, relations and acceptance. This scale has been partially validated with arts and mental health project users, demonstrating good internal consistency. However, test-retest reliability and construct validity require assessment, along with validation in the general population. The present study aimed to validate the SIS in a sample of university students. Test-retest reliability, internal consistency, and convergent validity (one aspect of construct validity) were assessed by comparing SIS scores with scores on other measures of social inclusion and related concepts. Participants completed the measures at two time-points seven-to-14 days apart. The SIS demonstrated high internal consistency and test-retest reliability, although convergent validity was less well-established and possible reasons for this are discussed. This systematic validation of the SIS represents a further step towards the establishment of a “gold-standard” measure of social inclusion.
[Show abstract][Hide abstract] ABSTRACT: Participatory arts projects are thought to increase mental well-being and social inclusion for people with mental health difficulties. This article presents a one-year evaluation of the Open Arts studio at Hadleigh Old Fire Station (HOFS) in Essex, England, established to provide opportunities
for mental health service users to carry out art-making independently with professional support. The evaluation was a mixed-methods design, with qualitative and quantitative strands. A total of 23 studio members completed measures of mental well-being and social inclusion at baseline and follow-up,
and scores increased significantly over time. Members’ comments indicated increased social support, confidence, motivation and mental well-being, in addition to decreased social isolation. Despite small sample sizes, this evaluation provides promising evidence of gains in mental well-being
and social inclusion. The question of longer-term benefits beyond the studio placement remains to be addressed, but results add further support to the use of participatory arts in promoting mental health and well-being.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Motivational interviewing is suggested as a means to increase the success rate for people receiving employment support. This study explored employment workers' experiences of using motivational interviewing following training in the techniques.
Semistructured interviews were conducted with employment support workers after motivational interviewing training and again 9 months later. Interviews were audio-recorded and transcribed for analysis.
At first interview the majority thought motivational interviewing had potential but some described difficulty using the skills. At second interview most reported using the skills and motivational interviewing was perceived to have a positive impact.
Conclusions and implications for practice:
Employment support workers find motivational interviewing helpful to use in employment support services. Opportunities for ongoing assessment of skills appeared important for facilitating skill development. Peer supervision might mitigate the resource demands in terms of supervisors' time, while inclusion of relevant requirements in formal role documentation would provide a supportive framework.
[Show abstract][Hide abstract] ABSTRACT: Aims:
Pathways to Work is a UK initiative aimed at supporting customers on incapacity benefits to return to work. This qualitative study complements previous evaluations of Pathways to Work by exploring customers' perceptions of the impact of the Condition Management Programme (CMP) offered to claimants with long-term health conditions.
39 customers took part in focus groups held at the seven sites where Pathways was originally piloted. The main focus of the discussions was on perceptions of the ways in which participation had impacted on health, well-being and return to work. The discussions were audio-recorded and fully transcribed for analysis using a text analysis framework to enable the development and refinement of categories and overarching patterns in the data.
Perceived impacts on health and well-being included a more positive outlook, social contact, changed perceptions of conditions and improvements in health. Some customers also reported an increase in their vocational activity and others felt ready to embark on new activities. Factors associated with positive outcomes included the extent and quality of contact with CMP staff and practical advice about condition management. Factors impeding positive employment outcomes related mainly to obstacles to returning to work.
The results indicated that CMP can assist customers to learn about and manage their health conditions and increase their vocational activity, and that CMP therefore provides a promising means of enabling people with long-term health conditions to regain a fulfilling, productive life.
Perspectives in Public Health 11/2012; 132(6):277-81. DOI:10.1177/1757913911414772 · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims:
The potential for participation in creative activity to promote recovery from mental ill health is highlighted in mental health policy and guidance, alongside a perceived dearth of robust evidence of effectiveness. Open Arts has run participatory arts courses in South Essex since 2008 and a course waiting list has developed with increasing demand for places. Given the waiting list and the need to improve the evidence base for the utility of participatory arts groups in mental health, the aim of this project was to conduct a naturalistic waiting list-controlled evaluation of the 12-week courses routinely provided and to explore participants' experiences of their course. It was expected that people on the waiting list who were allocated places on a course would gain improvements in well-being and social inclusion, whereas those not allocated places would show no changes over the same time period.
Measures included the Warwick Edinburgh Mental Well-being Scale (WEMWBS) and the Social Inclusion Scale (SIS). People on the Open Arts waiting list who had been allocated a place on the courses formed an intervention group; those remaining on the waiting list were asked to complete the same measures over the same time period (forming a control group). Participants in the intervention group were asked to rate the service and were offered the opportunity to join a focus group.
Thirty-two people in the control group and 26 people in the intervention group could be included in the final analyses. There were no significant differences between the two groups on either measure at baseline. Intervention group total mean scores were significantly higher after the Open Arts course than at baseline on both the WEMWBS and SIS, but no significant differences across time were found for the control group. Of the intervention group 96% reported enjoying the course and most of those providing feedback reported gains in confidence (81%) and motivation (88%). Nineteen participants in the control group completed an Open Arts course later in the year and similar improvements between baseline and follow-up scores on the WEMWBS and SIS were then found in this group.
This service evaluation of Open Arts has provided some preliminary evidence that participatory arts groups are likely to have benefits for mental health service users in terms of improved well-being and social inclusion. The evaluation justifies a future randomised controlled trial and economic appraisal of participatory arts projects.
Perspectives in Public Health 10/2012; 133(1). DOI:10.1177/1757913912461587 · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims Little is known about how the rates and characteristics of mental health service users in unpaid work, training and study compare with those in paid employment.
Methods: From staff report and patient records, 1353 mental health service users of seven Community Mental Health Teams in two London boroughs were categorised as in paid work, unpaid vocational activity or no vocational activity. Types of work were described using Standard Occupational Classifications. The characteristics of each group were reported and associations with vocational status were explored.
Results: Of the sample, 5.5% were in paid work and 12.7% were in unpaid vocational activity, (including 5.3% in voluntary work and 8.1% in study or training). People in paid work were engaged in a broader range of occupations than those in voluntary work and most in paid work (58.5%) worked part-time. Younger age and high educational attainment characterised both groups. Having sustained previous employment was most strongly associated with being in paid work.
Conclusions: Rates of vocational activity were very low. Results did not suggest a clear clinical distinction between those in paid and unpaid activity.The motivations for and functions of unpaid work need further research.
[Show abstract][Hide abstract] ABSTRACT: Background Attitudes towards the use of outcome measures by professionals working in mental health have been shown to be variable. Occupational therapists appear to have difficulty specifying goals and measuring the outcomes of interventions. Aims To measure the outcomes of therapies offered by occupational therapists and to assess concurrent validity of the Van du Toit Model of Creative Ability (VdT MoCA) assessment. Method The Global Assessment of Functioning (GAF), VdT MoCA assessment and Canadian Occupational Performance Measure (COPM) were used. Changes in mean scores on the measures were assessed using appropriate tests. Correlations between measures were assessed using Spearman's non-parametric test. Results Mean post-therapy scores were significantly higher than pre-therapy scores on all three measures. VdT MoCA assessment scores pre- and post-therapy were highly correlated with GAF scores. The COPM outcome scores were uncorrelated with VdT MoCA assessment and GAF scores. Conclusions The results offer a promising indication that occupational therapy interventions may increase functioning and thus aid clients' recovery. The VdT MoCA assessment is promising as a measure of improvement in functioning. Further research is needed to confirm these results and to further explore issues around occupational therapists' use of outcome measures.
Journal of Mental Health 01/2012; 21(6). DOI:10.3109/09638237.2011.638000 · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Interest in the health potential of arts participation is growing in the UK, but the field lacks a robust evidence base. This article describes the evaluation of 29 introductory arts courses provided by one arts and mental health project.Methods: Formative evaluation methods comprised focus groups attended by 29 participants after four of the introductory courses. Outcomes were assessed through questionnaires measuring mental well-being and social inclusion at the beginning and end of the 29 courses.Results: Formative evaluation participants identified gains in well-being and social inclusion alongside a need to address expectations more clearly and provide more individualised learning Of course completers, 33% returned both outcomes questionnaires. Results indicated significant improvements in well-being and social inclusion. Ratings of participation were very positive and supported attribution of impacts to arts participation.Conclusions: While the results are promising, methodological issues limit the conclusions that can be drawn. Controlled designs would enable impacts to be attributed to arts participation with greater certainty and further research is also needed to assess longer-term impacts. Commissioners need to include evaluation in funding criteria and allocate resources for this in order to help increase response rates by ensuring data collection is adequately resourced.
Arts & Health 03/2011; 3(1-1):51-60. DOI:10.1080/17533015.2010.541267
[Show abstract][Hide abstract] ABSTRACT: Every organisation in the UK is affected by mental distress and ill-health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.
Health & Social Care in the Community 11/2010; 18(6):598-606. DOI:10.1111/j.1365-2524.2010.00929.x · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Condition Management Programmes (CMPs) were established in seven pilot sites in the UK as one strand of the Incapacity Benefit Pathways to Work programme, an initiative that exemplifies interprofessional working beyond traditional healthcare boundaries. The qualitative evaluation of the pilot sites employed a realistic evaluation approach and used focus group discussions and telephone interviews to examine stakeholders' perceptions of interprofessional working and its impact on service provision and practice. Although teething problems were experienced in establishing the interprofessional working necessary for success, a shared commitment to the CMP ethos enabled these to be largely overcome. Outstanding issues raised by participants concerned the boundaries around the CMPs' new ways of working, in particular around treatment versus self-management and around the combined health and work focus of the pilots. One of the recommendations from a recent review of the health of Britain's working population was for a drive to promote the understanding of the positive relationship between health and work. The experiences of the staff involved in the CMP pilots provides a useful insight into the benefits and difficulties experienced in relation to interprofessional working between different professional groups in this area.
Journal of Interprofessional Care 02/2010; 24(6):699-709. DOI:10.3109/13561821003590831 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: A 12-month study of UK supported employment providers found that 77 (54.6%) of the participants in the study remained unemployed, 32 (22.7%) got jobs and 32 (22.7%) retained the jobs they held at the outset. Aims: To explore the impact of moving into employment on service use, earnings, benefits and tax allowances claimed. Methods: Service use and frequency were measured at baseline and 12 months. Comparisons paid particular attention to the differences between people entering work and those who remained unemployed. Costs were analysed from a government perspective (excluding earnings) and a societal perspective (excluding welfare benefits and taxes). Results: People who entered work reduced their consumption of mental health services (p < 0.001). However, use of supported employment increased (p = 0.04), in contrast to falling use by people who remained unemployed (p < 0.001) and those who had been working for more than one year (p = 0.002). The increase in earnings for those entering work (p = 0.02) was not offset by a similar reduction in benefits. Conclusion: This indicates that mental health services may make savings as a result of their clients engaging in paid work. It raises questions about the optimal nature and organization of employment support for this service user group.
Journal of Mental Health 12/2009; 18(6):533-542. DOI:10.3109/09638230903111098 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this article we describe Open Arts' achievements during the project's first year of operation and present the first results from an ongoing evaluation being carried out by SE-SURG (the South Essex Service User Research Group).
Life in the Day 10/2009; 13(4). DOI:10.1108/13666282200900038
[Show abstract][Hide abstract] ABSTRACT: Background: Promoting the social inclusion of mental health service users is a UK policy priority, but the development of outcome measures in this area is at an early stage. Aim: To develop a social inclusion measure for use in a study assessing the outcomes of arts participation for people with mental health needs. Method: Concept and question development based on literature review, national and European surveys and results of a survey of arts and mental health projects. Measure piloted with 23 arts participants/service user researchers and field tested with 88 arts project participants returning questionnaires including the social inclusion measure, a measure of empowerment and the CORE mental health measure. Results: Three scales were constructed measuring social acceptance, social isolation and social relations. Internal consistency was good for the individual scales and for the measure as a whole. Correlations with empowerment and CORE scores indicate reasonable predictive power for the population. Conclusions: Tests to date indicate the measure is acceptable and measures relevant concepts with good internal consistency. Test-retest reliability and construct validity are not established and replication is required to confirm internal consistency and establish a normative profile for the population.
Journal of Mental Health 07/2009; 18(1):65-72. DOI:10.1080/09638230701677803 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The UK government is advocating the use of supported employment to help people on incapacity benefits back to work, with an emphasis on Individual Placement and Support (IPS) models. However there is little UK-based evidence on the key ingredients of effective support. Aim: To ascertain service users' views of what they found helpful about supported employment. Method: Interviews were carried out with 182 people with severe and enduring mental health problems who were actively engaged with one of the six supported employment agencies included in the study. Results: Three themes emerged: emotional support, practical assistance and a client-centred approach. Conclusion: The findings highlight the importance of the quality of support, particularly through interpersonal dynamics, which go beyond the organizational features emphasized in the IPS model. Declaration of interest: The study was financed from Higher Education European Social Fund Objective 3 resources and the six partner agencies made contributions in kind.
Journal of Mental Health 07/2009; 18(2):121-128. DOI:10.1080/09638230701879151 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the employment status of people using mental health service in Pavia, Italy; to explore their employment aspirations and perceptions of support to achieve these; and to test the feasibility of working with service users as researchers.
Face to face interviews carried out by two service user researchers with a consecutive sample of 200 service users attending the local psychiatric outpatient department using a translated version of a questionnaire developed for previous UK surveys.
A higher proportion of survey participants (42.5%) were in paid work compared to the UK, but 62.4% of those in work were dissatisfied with their employment. Amongst unemployed participants, 65.2% were interested in gaining employment but only 29.3% were receiving support to do so. Support was mainly limited to referral on to a generic disability organisation. The service user researchers carried out the survey to a high standard and reported benefits from undertaking the work.
The results indicate a need in Pavia for specialist employment support using the Individual Placement and Support approach. Further development of service user involvement in research is indicated.
[Show abstract][Hide abstract] ABSTRACT: This metadata relates to an electronic version of an article published in Arts & Health, Volume 1, Issue 1, March 2009, pages 6-35. Arts & Health: An International Journal for Research, Policy and Practice is available online at informaworldTM at http://www.informaworld.com/smpp/content~db=all~content=a909028883 This paper provides an overview of the current state of the arts and health field in England, through an examination of practice, research and policy developments. Five features of arts and health practice are identified: the scale of the sector, regional variations, mapping of arts and health initiatives, recent conferences and symposia, and the role of key agencies supporting arts and health initiatives. Eight areas of arts and health research activity are considered: retrospective qualitative evaluations, prospective evaluations with some quantitative assessments, experimental research on arts and health initiatives, economic evaluations of arts interventions, systematic reviews of arts and health research, theory development to underpin research efforts, and the establishment of dedicated arts and health research centres and research programmes. The final section considers three 2007 arts and health publications from the Department of Health and Arts Council England. There has been disappointment that the policy recommendations in these documents have not been acted upon. At the time of writing, however, there are some signs of renewed efforts to encourage national leadership from the Department of Health.
Arts & Health 03/2009; 1(1). DOI:10.1080/17533010802528017
[Show abstract][Hide abstract] ABSTRACT: In the context of UK policy to promote employment for people with disability as a means to greater social inclusion, this study investigated how people with severe mental health problems fare in existing supported employment agencies. The aim of the study was to identify factors associated with successful placement in work and to test the impact of working on psychological well-being in this group. One hundred and fifty-five users of six English agencies were followed up for 1 year (2005-2006). Information was collected about their employment status, job-seeking behaviour, perceived obstacles to work, self-esteem and hope, and the employment support received. Eighty-two per cent of those working at baseline were still in work a year later. The support agencies helped 25% of unemployed clients into work, a statistically significant increase in the proportion of clients in employment. Gaining employment was associated with improvements in financial satisfaction and self-esteem. There was a trend towards working half time. People who had been out of work longer were less likely to secure employment. No significant associations were found between getting a job and personal characteristics, the quantity of employment support given, nor the recipient's rating of the support offered. The odds of moving into work were nearly four times higher for those people who visited a job centre prior to the start of the study. Clients of specialist agencies rated their provision more highly than clients of pan-disability agencies. These results demonstrate the benefits of working for this group and support the development of employment services with an individualised, rapid placement approach, linked to job centre advice and expert mental health service input. This is consistent with the Individual Placement and Support model, and highlights in addition the importance of job centres for its implementation in England.
Health & Social Care in the Community 10/2008; 17(2):151-8. DOI:10.1111/j.1365-2524.2008.00810.x · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Participatory art projects for people with mental health needs typically claim outcomes such as improvements in confidence, self-esteem, social participation and mental health. However, such claims have rarely been subjected to robust outcome research. This paper reports outcomes from a survey of 44 female and 18 male new art project participants attending 22 art projects in England, carried out as part of a national evaluation. Outcomes were quantified through self-completed questionnaires on first entry to the project, during January to March of 2006, and 6 months later. The questionnaires included three measures: empowerment, mental health [Clinical Outcomes in Routine Evaluation (CORE)] and social inclusion. Paired t-tests were used to compare overall change, and mixed model repeated measures analysis of variance to compare subgroups, including age, gender, educational level, mental health and level of participation. Results showed significant improvements in empowerment (P = 0.01), mental health (P = 0.03) and social inclusion (P = 0.01). Participants with higher CORE scores, no new stress in their lives and positive impressions of the impact of arts on their life benefited most over all three measures. Positive impressions of the impact of arts were significantly associated with improvement on all three measures, but the largest effect was for empowerment (P = 0.002) rather than mental health or social inclusion. This study suggests that arts participation positively benefits people with mental health difficulties. Arts participation increased levels of empowerment and had potential to impact on mental health and social inclusion.
Health & Social Care in the Community 06/2008; 16(6):638-48. DOI:10.1111/j.1365-2524.2008.00789.x · 1.15 Impact Factor