Valued Solutions’ Quality Impact Audit 2013 of Groundwork West Midlands programmes

Valued Solutions’ Quality Impact Audit 2013 of Groundworks West Midlands' programmes

Groundwork West Midlands Quality Impact Audit What is Valued Solutions?

The Pod aims to embrace talent and support both entrepreneurialism and co-production. Valued Solutions is the consultancy and training trading arm of the Pod. It is run on co-production principles so brings together, and draws upon, the knowledge and skills of both people with lived experience of severe and enduring mental ill health and practitioners in the Pod team.

Valued Solutions creates an opportunity for the Pod to build the capacity of both people referred to the Pod and the communities we connect with. All the income generated through Valued Solutions is invested back in to this enterprise enabling more people to be trained as trainers and “peer” consultants.

The outline project brief Groundwork West Midlands secured “Supporting Change” funding from ECOMINDS to enable them to look at how they plan, market and deliver their projects and to assess how accessible they are to people with mental ill health. Two projects were chosen for consideration, Cook and Eat Well and Back to my Roots. Valued Solutions has engaged in 3 areas of the evaluation; the first was a Focus Group. A report from this focus group has already been published by Groundwork West Midlands.

This report is the product of the second piece of work which was a more detailed audit and evaluation of how successful Groundwork West Midlands have been at both engaging and sustaining the engagement of people that may not have used mental health services but feel their mental health is vulnerable and people that are

currently, or have been, supported by secondary mental health services. Valued Solutions have also made some recommendations based on their findings.

Finally Valued Solutions facilitated a Snap Shot training session for the Groundwork West Midlands team. In the original schedule this training was planned to take place as a consequence of the audit findings but because of delays in securing data, it preceded it. The feedback from Groundwork West Midlands’ staff members was that this was very helpful and gave a real insight into the issues surrounding mental ill health. It is hoped that this training will encourage Groundwork West Midlands to address some of the issues and recommendations contained within this report.

The contextual landscape Groundwork West Midlands states that they work towards a vision of:

A society of sustainable communities, which are vibrant, healthy and safe, which respect the local and global environment and where individuals and enterprise prosper. Creating those sustainable communities means developing initiatives, which cut across economics, social issues and the environment. Our work is diverse, but all of it helps to achieve our vision.

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Mental Health and Social Isolation

This vision appears to dovetail with the recommendations of the No health without mental health cross government report which states:

The mental health and resilience of individuals, families and communities is fundamental to building a fair and free society which protects people’s human and civil rights. This can only be achieved if we can all work together in partnerships. We know that being in control of our own lives, good relationships; purposeful activities and participation in our communities improve our mental health

Cook and Eat Well Recent evidence suggests that good nutrition is essential for our mental health and that a number of mental health conditions may be influenced by dietary factors, see: http://www.mentalhealth.org.uk/content/assets/PDF/ publications/healthy_eating_depression.pdf http://www.mentalhealth.org.uk/help-information/ mental-health-a-z/D/diet/

Back to my Roots Research published by Thrive showed that nearly one in three disabled people (31%) believe that gardening has ongoing health benefits, while almost one in five (19%) report that it has helped them through a period of mental or physical ill-health, see:

Social relationships and support are important for everybody’s mental well being. Research strongly supports the proposition that for those recovering from mental illness, reconnection with society promotes recovery and decreases the chance of relapse.

Nationally, approximately 2.87% of the population have a severe and enduring mental illness; this represents some 1.82 Million people. Of these 1.3 Million use secondary mental health services and 520,000 primary services only.

If these figures are used as a representation for Coventry’s 316,960 citizens then some 9,096 people could be assumed to have a severe and enduring mental illness across the city.

84% of people living with severe and enduring mental ill health report that they feel lonely and isolated compared to 29% in the general population.

‘Social connections include engaging with friends and peers, maintaining employment and economic wellbeing, undertaking education, art, hobbies, and other activities, physical exercise, leisure and recreation and social relationships. Engagement in society encapsulates the principles of having a sense of purpose and agency, feeling safe and secure, being free from violence or threat of violence, and having hope for the future’ (View from the Peak).

Research has shown that people with a serious mental illness are more likely to have smaller social networks spanning 5 to 13 relationships compared to the general public’s average of 25. It is essential therefore that those relationships are maintained and where possible expanded if social inclusion is to be achieved.

http://www.independent.co.uk/life-style/health-andfamilies/health-news/gps-devise-new-treatment-tobeat-depression-its-called-gardening-7584583.html http://www.carryongardening.org.uk/files/documents/ Gardening%20for%20mental%20wellbeing%20 FINAL%20artwork.pdf

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Universal Services Universal Services are commonly defined as: Community facilities and services available to everyone within their community such as transport, leisure, education, housing and access to information and advice (JIP, 2011) The diagram below illustrates the transition of need from the ordinary to the complex. This is then cross referenced to the type, level and nature of interventions to address them. It can be seen that there are different qualities and attributes to addressing these, leading to different intensities of engagement from a range of different agencies.

Programmes such as Cook and Eat Well and Back to my Roots should address the green zone i.e. the General Population but it is recognised that this will involve those with more complex needs that are also being addressed by others.

People with complex needs have a plethora of other desired outcomes in common with the rest of the population and as such ought to be connected to universal services at large.

Engaging people from hard to reach groups with such services can be challenging because unlike commissioned services, where there may be an obligation or a degree of coercion to attend, any programme must be attractive and align with a person’s individual aspirations.

The Intervention Continuum

Š Valued solutions @ The Pod

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Consulting approach Defining the parameters Initially Groundwork West Midlands asked Valued Solutions to evaluate two discrete programmes; these would fit into the pale green area on the Intervention Continuum above since they both had eligibility criteria targeting people with mental ill health. After much debate it was agreed that the projects identified for this equality/quality impact audit should both be community orientated and universal because they would be more indicative of the general accessibility of Groundwork West Midlands programmes to this group. Those chosen for evaluation were therefore: • Not discrete - by this we mean not a closed or bespoke group working exclusively with people known to mental health services.

Valued Solutions elected to use Survey Monkey for the following reasons: • Objectivity • Anonymity • Reach • Time constraints

Constraints and concerns: • The data set provided did not include emails and telephone numbers were in some cases incorrect.

• A significant number of those contacted were children who had engaged or their parents.

• Not referral based - by this we mean open to all with the understanding it could be targeted to reach people within a defined geographical area.

Because of a low response rate to emails and the difficulties detailed above, Valued Solutions agreed to conduct the survey via telephone, in the first instance for beneficiaries.

Information provision

The anticipated challenges of this approach were:

A full information set was requested to support this quality audit, unfortunately much of this was not immediately available and in some cases not supplied at all. This has impacted on the approach taken and the associated timescales. In future projects it is recommended that such information is always readily available to support either internal or external auditing at any time.

The approach adopted to facilitate contact was: • Developing 3 questionnaires for each project, 1 for beneficiaries, 1 for professional stakeholders, and 1 for project workers.

• Securing approval for the questionnaires from Groundwork West Midlands Community Leader (People).

• Telephone calls could only be made in core business hours so will have impacted on the diversity of respondents e.g. would not reach people in work or education • Telephone interviews can feel pressurising and there is a risk of bias (subjectivity). To manage this risk the person making the call was given a script to ensure that everyone secured the same understanding of the rationale for the activity.

It also became apparent that professionals, including some in the Groundwork West Midlands project team were not completing the email survey either. This was a real concern as everybody uses email as part of their work, again we had to resort to telephone calls.

• Agreeing sample size.

• Collecting data via Survey Monkey.

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Summary findings from the survey

Resultant data set

Using key themes from the surveys Valued Solutions have clustered the findings under the following headings:

Due to the vast amount of data collected it is not possible to represent all of the data within the written report. Access to the full and specific data for each set of stakeholders and programmes can be found and analysed via the web links at the end of this report. We have included visuals of what we believe is the most relevant data.

For other significant data we have signposted this below.

• Marketing • Engaging • Programme Structure • Mental Health • Learner Autonomy • Community Connection • Programme Feedback • Wellbeing

Cook and Eat Well – beneficiaries Sample Size 33/205

Marketing: • The pie chart above illustrates that word of mouth and promotional material were the most impactful methods of attracting people to the programme.

Engaging: • Only 3% of the beneficiaries felt that the programme workers did not try to understand what was important to a person although 39% thought it was irrelevant.

• Individual responses can be found by referring to the detailed results of Q1 by following the corresponding web link at the end of this report.

Programme Structure: • 79% of people attended a series of workshops and 21% one off events. This makes the dataset relevant when considering sustained engagement.

• 100% of those respondents who felt it was relevant believed that the programme would be flexible to people’s needs. This is an excellent result.

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Mental Health: • 15% surveyed accessed secondary mental health services; this is 8 times the national average. We are aware that strong connections were forged with Willow View Acute Day Hospital but are unable to identify if these people were from Willow View or the community at large. If the majority are from Willow View there is a risk that the results are unrepresentative

• The bar chart above illustrates that) in both cases only 12% of people felt barriers surrounding gender and formality of delivery could be overcome, both of which are understandable for an open access programme which is standard in its format.

• Responses established that 94% of people felt no more attention should be given to

and also that the programme may have been positioned as a part of a pseudo mental health service.

• 37% asked would not want to or feel able to discuss their mental health with a project worker. The distinction to be remembered here is ‘want’, this does not necessarily mean that the worker was unapproachable it may well be that the person would choose to withhold this information anyway.

mental wellbeing; the question here is how much consideration had been given anyway.

• It was established that 82% of the respondents would recommend the programme to someone who had mental ill health, this is an excellent result, so long as each group is representative of society and not simply a mental health group.

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Learner autonomy:

Community connection:

• 21% of the sample attended alone. Research suggests that 84% of people with Mental ill health expressed that they felt lonely and isolated compared to 29% in the general population.

From this one might conclude that the programme could have been more successful at reaching such people.

• 37% of those surveyed believed that the mix of people on the course did not represent the make up of the community across the city. This is to be expected because the programme was to a large extent run locally where there are different demographics in different areas of the city.

• 57% of people attended with family members (mainly children). This is unsurprising based on the programme aims.

• 42% of the participants reported that they made new friends. This is an outstanding achievement. It would add value to know what the experience of those who had previously felt isolated was.

Programme feedback

• Only 12% questioned felt that there was room for improvement in the programme; another excellent result.

• The pie chart above illustrates a high level of satisfaction with all key areas of the programme.

• It is clear that the project met its core objective in the eyes of the participants. It is interesting to note that 10% of people expressed making friends as an important outcome.

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Cook and Eat Well - Professional Stakeholders Sample size 6/9

Engaging • 67% of the stakeholders said that they were made aware of Groundwork West Midlands’ equality statement; ideally this should be 100%.

• The above pie chart illustrates that 83% of those surveyed said that equality considerations were a part of the programme operation.

Mental Health • 83% of people believed that increased consideration should be given to people with mental ill health. This is a key statistic and one to be seriously considered for future programmes.

• None of the stakeholders reported being asked by Groundwork West Midlands how they could engage people with mental ill health. Another key statistic, if the programme wants to access more of this hard to reach group.

• Only 20% of those who responded believed that thought was given to people with Mental Ill Health in the project design. This is not necessarily a bad thing because the programme is not targeted specifically at people with mental ill health.

Well being • 33% asked believed that the impact on beneficiaries’ well being surrounded integration, cohesion and a reduction in isolation. This is consistent with the 42% of beneficiaries reporting that they made new friends.

• The responses suggest that there is little consistency in the extent to which the programme did or did not impact on a person’s mental well being.

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Cook and Eat Well - Project Team Members Sample size 2/3

Engaging • 1 in 2 thought that consideration had been given to engaging people with Mental Ill Health; this should be thought about in light of the 83% of Project Stakeholders who felt more consideration should have been given.

• 1 in 2 believed that there was an opportunity for a meeting with a project worker before signing up.

Since 80% of the people surveyed attended a series of workshops, this could have been more explicit.

Mental Health • A score of 4/5 was scored for reaching people with mental ill health. The 15% with severe and enduring mental ill health, taking into account the sample size represents 5 people. It is believed that these may have been a cohort from the Willow

View day hospital, if so this questions how successful the project was at reaching those in the community at large.

• Both respondents stated that they had not had any mental health training. Did these people miss the Snap Shot training?

• Both felt able to discuss any mental health issues and believed that Groundwork West Midlands would be supportive.

• Both believed that consideration had been given ‘somewhat’ to people with severe and enduring mental ill health in the project design and delivery. Should this have been more?

The aim should be to make the programme as easy to access for all. To achieve this account should be taken of the difficulties of some groups to access the programme but then to make the delivery accommodate, but to be free of any bias towards any particular group.

Back to my Roots - beneficiaries Sample size 5/7

Marketing:

Engaging:

• The above chart and the detailed responses indicated that, despite using the internet and promotional material to find out information about the programme, all of the beneficiaries reported that they were signposted to the opportunity by agencies i.e. Job Centre Plus, the Pod and others.

• 60% of the participants felt that they had had the opportunity to discuss any concerns with the programme worker prior to signing up.

• It appears from the dataset that some people had a dual role of beneficiary and supporter/volunteer.

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Programme structure:

Learner autonomy:

• 80% of people felt the programme was flexible to their needs

• 67% of people attended with a support worker.

This suggests that the programme was not as universally attended as it might be.

Mental Health: • 80% of participants felt able to discuss any Mental Health Issues with the project worker.

• 20% of participants access secondary mental health services. This is 10 times national average. This however represents 6 people all of who may have joined as a group from the Willow View day hospital.

• 40% of people felt more attention should have been given to mental health.

Community connection: • 80% of the participants reported that they had made new friends; being such a small group with potentially common issues this is not that surprising.

• 80% of the people felt the mix of participants was representative of the city’s community; this is questionable based on the high percentage of people who had a support worker.

• 100% of those surveyed would recommend the programme to someone they knew who had mental illness.

Programme feedback

• The graph above demonstrates that the participants believed that the course was very well designed and delivered.

• 80% of people expressed how much they valued meeting new people.

• 80% of the participants could not specify any areas for improvement of the programme.

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Back to my Roots - Professional Stakeholders Sample size 6/6

Marketing:

Mental Health:

• Please refer to the results of Q1 via the web link at the end of the report.

• 83% of professional stakeholders stated that more consideration should be given to engaging people with mental ill health.

Engaging: • 67% of the partners were not aware of Groundwork West Midlands’ equality statement; this really should be 100%.

• The above pie chart demonstrates that only 33% of the respondents felt that a great deal of consideration was given to equality in the operational activities. This should be higher if the programme is to be universally accessible.

• 84% of those surveyed said that Groundwork West Midlands had asked them how they could engage with people with Mental Ill Health.

This is encouraging.

• 100% of those people who were signposted had mental ill health.

• 67% stated that Mental Health was considered as part of the design and delivery of the programme.

• Everyone struggled to identify how the programme could be improved for people with mental ill health despite as stated above believing more consideration should be given.

Well being: • Everyone felt it would have a positive impact on well being.

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Back to my Roots - project team members Sample size 2/2

Marketing:

Mental Health:

• The highest priority was given to promotional material where, as can be seen from the beneficiaries’ responses, no one cited this as how they found out about the programme.

• One of the team was offered mental health training prior to recent Groundwork West Midlands’ Snap Shot training.

Engaging: • 100% of the project workers said that there was an opportunity for people to talk to them before the programme started whereas, only 60% of the beneficiaries said that they were aware that they could get set aside time with the project worker.

Due to the small group sizes one would expect this to be more.

• There was a 50/50 split between ‘a great deal’ and ‘some’ in terms of understanding what is important to a person who participates in the programme.

• It is apparent that the team had developed a solid relationship with professional stakeholders which encouraged signposting.

• The team scored themselves as having a 3.5 out of 5 success rating in reaching people with mental ill health.

• 100% of the team felt able to discuss their own Mental Health at work.

• 100% of the team did not try to establish the relationship between people who attended together. This is as it should be if people are to be treated equally.

• One of the team reported that they discussed the participation of people with mental ill health in their supervision.

Programme structure: • Both team members said that only ‘some’ consideration was given to people with mental ill health in the programme design and delivery.

• Transport was cited as a potential barrier to accommodating people with mental ill health.

This is not surprising due to the limited number of sites the programme was run from.

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Recommendations: In addition to the specific observations and recommendations made above, it is suggested that the following be considered:

Human Resource: • The balance or weighting of expertise detailed in the job specifications needs to be looked at with regards to inter-personal versus operational competencies. The specifications do not adequately reflect a commitment to equalities as there is no evidence that lived experience is valued as much as a vocational/professional qualification.

Marketing: • Website – Groundwork West Midlands’ Equalities statement and Equality Impact Assessment need to be more readily accessible.

• Publicity – see detailed recommendations made by the focus group. In future, there is a need to involve target beneficiary group in the design and development of any marketing material.

• The survey findings supported national research which indicates that people with severe and enduring mental ill health have a smaller network of supporting relationships than the general population. It is therefore important that Groundwork West Midlands includes in their marketing message the element of friendship and community connectivity engendered by their programmes.

• Groundwork West Midlands needs to ensure that the disabling impacts of mental ill health on a person is given the same consideration and concern as those for a person with physical or sensorial impairment or learning disabilities.

• If equality is to be at the heart of all that Groundwork West Midlands do it is essential that whenever working with partners they are exposed to and buy into the Groundwork West Midlands Equality Statement.

Quality Assurance: • The Groundwork West Midlands’ team needs to be “evaluation ready” at all times and see it as a positive. They also need to be clear with beneficiaries and professional stakeholders that external agents may be commissioned to complete evaluations.

• For ease of evaluation, email addresses should be collected as well as telephone numbers.

Organisational Intent: • Groundwork West Midlands’ vision places a powerful emphasis on both environment and sustainability. Although these are very important it needs to be considered if there is adequate focus on their commitment to enhancing the development of emotional intelligence and resilience in both participants and employees.

Organisational Culture: • Mental Health needs to become an ordinary part of conversations at Groundwork West Midlands in no way a subject of discomfort. The inclusion of all members of society in their programmes should be a key objective.

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Conclusion Through the provision of these two programmes Groundwork West Midlands has strengthened and enriched the offer of universal opportunities available to people in Coventry. Both programmes have influenced people’s mental health recovery journey, whilst also developing the capacity and resilience of people that have had no contact with mental health services thus supporting the public health and preventative agendas.

To remain truly universal Groundwork West Midlands’ programmes need to reach and reflect whole communities. Access to universal services can engender both individual and community wellbeing and stimulate opportunities for a cross fertilisation of interest and experience; by doing so they develop the capacity and resilience of both individuals and communities. The value of such universal services or opportunities is that personal disclosure of mental health status is not required; the focus should not be on mental health itself rather, making things feel ordinary to all thereby not ‘categorising’ anyone. The emphasis should be on making sure all programmes are equally accessible to all and that any barriers to any particular marginalised group are reduced. The risk of any service focussing on any one particular group is that the majority may in turn be excluded, to some degree, thereby preventing it from being a universal service. To manage this dichotomy a project worker must have a high degree of emotional intelligence and resilience.

This can be fostered in a number of ways, none more powerful than having lived experience of mental ill health or working alongside someone who does.

By commissioning people with lived experience of mental ill health to evaluate these two programmes, Groundwork West Midlands has demonstrated their commitment to continuously improving the accessibility of their universal service offering.

To conclude, the Valued Solutions team are encouraged by the evidence that Groundwork West Midlands has given considerable thought to the engagement of people with mental ill health with these programmes and that this has to a great extent been successful.

Web Links to full dataset: Cook and Eat Well Beneficiaries: https://www.surveymonkey.com/sr.aspx?sm=eMedJZbqqHBPCEIE KOwnnPuiJ79JbQLfHfhRNV2szpQ_3d Cook and Eat Well Professional Stakeholders: https://www.surveymonkey.com/sr.aspx?sm=Ns750 NheNeSGTDL1VDnWDYeO4RdhxnvCUl7T3diDM1U_3d Cook and Eat Well Project Team: https://www.surveymonkey.com/sr.aspx?sm=XCnevqAG1te0sq7oA qkhku3YwrnxvJ_2b_2bPEI7Xa6o5W4_3d Back to my Roots Beneficiaries: https://www.surveymonkey.com/sr.aspx?sm=4RVXLVPvU4U5z5eQF dOCieudu2tPfsnA_2f7RZf8O2OHQ_3d Back to my Roots Professional Stakeholders: https://www.surveymonkey.com/sr.aspx?sm=kx4Rzsg 3zuM_2bnsZzAj_2fZaZN8fo8uxC8ZxJzbA1nGgA0_3d Back to my Roots Project Team: https://www.surveymonkey.com/sr.aspx?sm=kx4Rzsg3zuM_2bnsZz Aj_2fZaZN8fo8uxC8ZxJzbA1nGgA0_3d

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