1 Version 4.0
Connecting People Intervention
Practice Guidance
2
Contents
3— 6— 10– 13— 19— 25— 31— 37— 38—
Introduction The model Case studies The agency The practice The individual The worker Conclusion Additional resources
3
Welcome to the Connecting People Intervention Practice Guidance! Introduction This manual has been developed in response to a need to have practice guidance on effective ways to connect vulnerable people to others in their local community.
Social connections are good for you! Research has found that social networks help you to find work1, live longer2 and to improve your mental health3 and quality of life3.
Connecting people has been identified as one of ‘five ways to wellbeing’.4 There is evidence that having good social connections is important for your well being and helping you to get on and get ahead with your life. However, there is little guidance available for health and social care workers about a complete process that will help isolated people connect more effectively with others.
This guidance is aimed at both teams and individual practitioners. Whole teams need to be able to support the ways of working described here to facilitate individual practice. However, each team member needs to be familiar with the intervention model so that their practice can be shaped accordingly. The practice guidance provides the ‘what’ - explaining how the intervention works. The training that accompanies this manual provides the ‘how’ for workers who will be using this intervention to help the individuals that they work with as effectively as possible. Training will include familiarisation with the model, development of necessary skills to implement it, and ongoing support from the research team behind the intervention as well as other agencies using the model. 1. Lin, N. & Erickson, B. (Eds.) (2008) Social capital. An international research program, Oxford, Oxford University Press. 2. Holt-Lunstad, J., Smith, T. B. & Layton, J. B. (2010) Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7 (7), e1000316. 3. Webber, M., Huxley, P. & Harris, T. (2011) Social capital and the course of depression: Six-month prospective cohort study. Journal of Affective Disorders, 129, 149-157. 4 Five ways to wellbeing: http://neweconomics.org/projects/five-ways-well-being
4
About the Connecting People Intervention The Connecting People Intervention is the result of a two-year study of practice5 in six health and social care agencies (see box below). In this study we explored how workers help to connect people with others, either directly or indirectly. We found that connections were primarily made with others within Research was conducted in these agencies. the same agency, but there Extracts from interviews, field notes and reflections are were some examples of included in the guide to add perspective to the model. good practice in connecting people beyond the agency BlueSCI, Trafford they were involved in. Hestia, London, and Kingston RISE, Kingston SHARP, Lambeth Start Again Project, Birmingham The aim of the Connecting STEP, Somerset People Intervention is to W. Kent EIS, Kent help workers in supporting service recipients to connect with people beyond A big thank you to all of those who took part! health or social care agencies. These may be neighbours or people living locally. They may be people interested in the same hobby, sport or leisure pursuit. They may even be family or friends with whom the individual has lost contact....there are many possibilities.
Based on ideas from social capital theory (see box on the next page), the Connecting People Intervention aims to enhance the diversity of individuals’ social networks. It is not prescriptive about the size or quality of networks. It is up to individuals to decide how many people they want or need to be in contact with. However, it aims to ensure that people know others outside of health and social care services in addition to those within them. Sometimes workers may need to act on behalf of their clients to them to move forwards. These new links and the resulting increase in social capital are achieved through a dynamic series of processes involving both the worker and the individual. The Connecting People Intervention model is not a traditional linear process of a worker doing something for or with the individual and an outcome occurring as a result of this. 5 Connecting People study page: http://connectingpeoplestudy.net/
5 The Connecting People Intervention Social Capital: model has been developed from our Social capital refers to the potential benestudy of existing good practice. We fits which accrue from social relationships have taken the best bits from several between people . organisations and combined them with Co-production: principles such as co-production (see Both service users and service providers box). Many of its elements will theredevelop and provide the service together. fore be familiar to many people. Its Social participation: distinctive approach comes in drawing Leaving the house to engage with a social together all these different compoactivity with other people nents of practice into one place to create a unique and dynamic model that is grounded in lived experience. The language has been kept simple and friendly throughout this Practice Guidance, in order to ensure that it remains accessible and engaging to as wide a cross-section of people as possible. We hope that the intervention will benefit individuals accessing services, but that it will also help workers with their practice, and agencies with a more cost-effective way of working.
How the Intervention Works Due to the dynamic nature of the intervention, there is no set method to achieving success. The following pages show each stage of the process, but these can be modified to suit the needs and time available of the worker-individual partnership. Similarly, the intervention does not specify exactly what the individual and worker should do within this process as it is up to them to co-produce the activities. We do however anticipate that new social connections may be made at any point in this process. We do not wish to encourage the individual to become dependent on the worker. At the core of the intervention is the trusting, equal relationship that is built up to form the base for the individual to achieve their own independence. The individual is just as responsible as the worker for the success of the intervention process. In turn the worker needs to be sure to really learn from the individual to ascertain what exactly they want to get out of the process. Over the page is a diagram of how the intervention works for your reference. A more comprehensive version can be found on the A3 pullout included with this Practice Guidance.
6
The Model You could annotate this page with any groups, local organisations or other elements specific to your agency and make the model more relevant to your own practice
Partn Worker
Developing skills, relationships and resources with this individual and for the future Enhanced social network knowledge
Equ
Sha proce
Potential Barriers
Age
7
nership
uality
Individual
ared esses
Developing ideas, goals, and confidence and working to attain and expand on these
ency
Potential Barriers
Enhanced social network
8
The model explained The aim of the Connecting People Intervention is to rotate the green and blue wheels seen in the model. These represent cycles of discovery for both the worker and individual, which result in the development of new social connections and social networks. At the heart of the intervention process is the equal, positive partnership between the individual and the worker. The symmetry of the model demonstrates this important aspect of the intervention, and every effort should be made to maintain as much equality and balance as possible, despite barriers such as social workers being responsible for the funding of their clients.
Social Network Mapping
The worker and the individual start by having a conversation as to exactly how they want this relationship to work. They then map out the individual’s existing social network. They may do this by ranking the people in the individual’s life in concentric circles extending outwards from the individual and those closest to them in the ‘inner circle’ (see image). Then, both worker and individual discuss and write down their own strengths or assets. These may be their interests; things which they/other people think they are good at; or their unique qualities. They will draw on these assets throughout the process of the Connecting People Intervention. Finally, the worker supports the individual to explore their life goals and to discuss what they would like to achieve. In individuals with higher support needs, these processes may need to be led quite actively by the worker—for example through trial and reaction, or respectful guessing. The individual needs to be encouraged to think beyond what the service could provide and to consider new opportunities which they had previously not thought possible. Together, the worker and individual select a goal, or a series of goals, to work towards. The processes of mapping social networks, exploring assets, and talking about goals aid the formation of the relationship and the task of bringing the individual to the point where they are ready to move forward.
9 However, before the wheels can start to spin, the worker and individual both need to be prepared to work together, to engage in new situations, and to meet new people. The shared development of objectives and activities is depicted at the centre of the model because it represents the co-produced activities. The way that the green and blue wheels overlap further illustrates this partnership. They are interlocked to represent the fluidity of the process and the uncertainty about when, or if, new social connections are made, as well as the interdependence that worker and individual share in order to continue moving forward. The individual’s journey (represented by the blue circle on the right) is the focus of the intervention process. In achieving his or her goals, the individual is, for example, exposed to new ideas; introduced to new people and activities; and supported to develop skills, interests and social confidence. The green circle on the left represents the worker’s journey, and is of equal importance to that of the individual. Along the way, the worker may develop self awareness and self confidence, along with the desired end product of an improvement in their knowledge of social networks available to the individuals that they work with. The worker also needs to look out for barriers which may prevent the individual’s blue wheel from rotating. These work in the opposite direction to the intervention cycle and can pose considerable challenges for some individuals. These barriers will present the worker with a number of challenges, and helping the individual to overcome them is likely to be the most time-consuming element of their work. They may also need to provide extra support and reassessment for the individual. Additionally, they may face barriers themselves which could need to be faced in order to develop their own networks, and form an effective partnership. The worker-individual partnership described here takes place in the context of a supportive agency, which is shown at the bottom of the model to illustrate its crucial, underpinning nature. An agency needs to encourage their workers to form new ideas and ways of doing things, and share the principles of the Connecting People intervention. A positive physical environment is also important, as well as good methods of sharing knowledge that prevent reliance on a particular staff member for information. If all of these processes occur to some extent, the model shows the outputs of ‘social network development’ for the individual, and ‘social network knowledge development’ for the worker. This – as has already been emphasised – can occur at any time during the process, and will do so to different extents in each situation. The intervention aims to create new links for the individual beyond any health or social care services which they may be receiving, and is seen as successful if this occurs at any level.
Case Studies 10 Here are some case studies showing the model in action across a range of client
When I first met Greg he was very nervous as he perceived our service to be the ‘judges’ of whether or not he could keep his Personal Budget. It was important to make him feel at ease straight away by being friendly, having a bit of banter with him about the football (I’m a United fan and they’d just won against City), and above all being very open about the process. I could tell he was a man who got confused by the paperwork (don’t we all!) so whereas with some clients I go through the forms bit by bit, with Greg we just spoke and I filled things in after our session. I get a lot of clients through the door as the nature of our service means we see a lot of people once every few months, so I always keep a record for myself of what we spoke about To work effectively I have to have really strong knowledge of all of the available services out there – and constantly be looking for new ideas of where someone could go, where they could try out. Here at our base we have a big table full of leaflets, fliers, and all sorts of information about different schemes in the area, which helps with inspiration if you are a bit stuck. With Greg it was relatively easy as he was keen to become more active so a gym referral was the obvious choice. Then beyond that I remembered a local running club that I had heard good things about so after chatting with them about being supportive of Greg, put him in touch with them too. Because I don’t see him very often we try and set clear goals each time that he can then manage with the help of other people. This last session, we decided that he should go for a commitment goal as Greg has had problems attending something regularly due to his depression. We spoke with the gym and Greg decided to attend a regular kick-boxing class there, committing to attend every week. Greg also wanted a tangible target, so I investigated and with the help of the running club found a 5km run that Greg is going to enter in three months time. Greg has good insight into his condition and knows that exercise and keeping busy helps stop his low mood, whereas sitting in the resource centre does not help. It is all about having solid goals to keep him moving forwards in the direction that he wants to go.
When Deloris first came to the service she had recently lost her husband. She was coping reasonably well but several months after the loss her sadness had not improved and seemed to be getting worse. At the time that I met Deloris she was clinically depressed but seeking change in her life. Deloris has two daughters who live in London and Birmingham with their families. They visit on occasion and have expressed concern over Deloris’ situation but are unfortunately unable to be involved on a daily or weekly basis. Through our initial assessment and building a relationship of trust, I could tell that her depression stemmed very much from her loneliness and isolation. At aged 72 and living in a rural area, her husband and the couple friends they had together were her main source of social contact for many years. Although mobility was not an issue, she has deteriorating sight and is therefore unable to drive. When Hugh passed she found it difficult to leave the house and connect with others. Because she was motivated to recover from the depression we initially worked on exploring her interests (past and present) and setting achievable goals for getting out of the house and connecting with others. Many of the other service users I work with have mobility issues, making it increasingly difficult to leave home and get connected to others. Aside from her inability to drive, she is still able to get out of the house. She can walk to the local shop but the buses to larger towns only run once per day. Together we decided to look for activities in the area that Deloris could get to on the bus, and set goals initially to leave the house twice per week. I was able to take her to some activities but wanted to be sure these were opportunities to meet new people so that she could continue getting involved without me.
When Jack first approached us, he wasn’t doing much and was outwardly angry and frustrated. He was bullied at school and had no friends and said it was because he was “different”. He had no self-esteem and was even alienating his family. We needed to put Jack at ease straight away because he was visibly upset about the state of his life, we thought the best way to tackle Jack’s issues was to identify some opportunities for him to develop his own networks. At first we tried to build a relationship by simply talking to Jack openly. We wanted to find out what he enjoyed doing and discovered that football was a passion for Jack. Someone I knew was already part of the local football team, so I utilised this contact and this person became a buddy for Jack and took him along to a football session. This proved to be a meaningful place for Jack to be and his confidence grew, not only that but others started to see the assets in Jack. He has made friends and has discovered he is a good leader and teacher so has been looking into becoming a coach. This success has led to Jack seeking out more opportunities to become involved in the local community, and a new idea that Jack identified was going to a reading group. To begin with, we weren’t sure what reading groups were available that Jack would be able to get to easily, so we contacted the library who knew of one that had just started a couple of months before. At first the leader of group seemed reluctant about Jack attending and seemed to have incorrect perceptions of what he would be like, however after talking with them and agreeing to go with Jack to the first session, the leader agreed and when they had spent some time with Jack, their attitude changed completely and they could see the great potential in Jack and were inspired by him. Attending this group enables Jack to be included in a totally different environment to the football club and we can see that it is turning out to be marvellous for his mental capacity and has led to all sorts of people realizing that he isn’t “different” at all!
11
groups and services. Each is seen from both the worker and the individual perspective Worker and individual, NHS assessment team, mental health
I was really not looking forward to meeting Vish because I had heard from friends in the mental health system that as soon as you stop getting a full time care coordinator, your support and your benefits start to stop too. Vish was nice though, he had some similar interests to me and I didn’t feel as scared about what this meeting meant after a few minutes in the room with him. He was really reassuring about it all and didn’t sit behind a desk with loads of official documents and stuff, it just felt like we were having a chat about what I liked to do and what I wanted to be doing in the future. He reassured me that I wouldn’t have my Personal Budget stopped as long as I needed it, and that if it did happen it would be because I was doing other things that didn’t require one any more. I had never thought of it that way before. It was weird because even though I sort of knew that I wanted to do more exercise, Vish helped me work out what exactly I could be doing and put it into small bites of tasks. I had been sitting in a mental health resource centre not really doing much up until recently when my Personal Budget was up for review, and I think that had maybe made things worse. I had been quite worried about just going to the gym as I feel pretty unhealthy compared to how I used to be before I got ill, so when Vish told me that he knew the people at the gym, and that the staff there were really supportive I felt a lot better. He also told me about the local running club and put me in touch with them. I’ve been going once a week to that since our session, and feeling a lot fitter. Its really nice to go somewhere where the point of the activity is just to run – its not some medical thing where everyone talks about their illness and stuff. After we spoke about the running club, we decided ‘no time like the present’ so spent the remainder of the time visiting the local gym and getting the induction form filled in. I know that Vish only has a bit of time with me so it felt good that he could come and do that. I am not seeing him again until our next session which is a few months, but the goals that we have set are keeping me busy – I have a 5km run quite soon which I am trying to get a PB in! He wants to know how I do so I will email him after it. All in all, Vish has provided me with all the support he can, and has linked me in with people that can help me get back on track and that have the time to spend with me, and all doing activities that I am actually interested in.
Worker and individual, community NHS team, older adult mental health
From the beginning I really enjoyed my time with Kay. She came round to see me every week or so and we’d have a cuppa and start chatting. I never felt like she was just testing me, or asking too many questions. You know how some support workers are, they seem to be ticking boxes rather than getting to know a person. I never felt that way with Kay. She was friendly and never pretended to have lived through my experience. She let me share details about my life and I felt that she understood, without necessarily having lived it herself. We started talking about my hobbies and interests and sometimes I don’t feel like I have many at all. But she helped me to think back about what Hugh and I used to do together. He was a farmer and was quite involved with the union of farmers in the county. When they met together, I would go and see the wives, but hadn’t been since he passed away. I wasn’t so sure that I could go back to this group without Hugh. Kay suggested we go together. Her brother is also a farmer in the area and we decided to go to the meeting together for a few times so that she could introduce me to a few people. Well the first time I was really nervous. I hadn’t been out to see people much recently and I didn’t know how others would react to my being there. Also, I worried that people wouldn’t be the right age. Sometimes I feel that I have nothing in common with people from the younger generation but those in my age group have many more health problems than I do. It’s all they talk about sometimes! But at the first meeting I recognised a few people and was happy to have Kay there with me. It took a few meetings before I felt ready to go on my own but I’ve met one woman who lost her husband too and we’re now able to go to the meetings together. Next week we’re planning to go to the travelling cinema that comes to the area once per week. I’m still seeing Kay regularly but with meeting new people I feel less anxious about leaving the house.
Worker and individual, third sector resource centre, learning disabilities I was so annoyed when my family said they didn’t know how to be around me anymore, and I should “go see someone”. I thought they wanted to get rid of me so was really scared when I first went to meet Eric but when he explained that I could meet with him whenever I wanted to I felt much more relaxed. I felt I could speak with him really easily because he was so relaxed and friendly, that first meeting all we did was chat about what I liked doing! Looking back I just think how lucky I was to get the chance to meet him, and all the other people who worked there! I love my buddy! He helped me so much when I was feeling like I had nothing to live for. He found out that I like to play football every day and have found that I’m even good enough to teach other people. I took a football book to my book group and everyone loved it! I feel so excited to be sharing my love for football with lots of different people. It feels good to be able to know more about something than other people! I’m reading a book about a farm now which is totally new to me but I’m actually enjoying it, my friend from the reading group told me to read it, I’m glad I listened to her! My Dad says I have grown up a lot and I’ve started to feel a lot closer to my family lately. I love waking up in the morning and getting excited for what the day might bring.
12
In short The agency in which this practice occurs needs to be supportive to the outward-facing nature of the intervention and embedded in its local community to ensure that connections can be facilitated. (see page 13) The intervention process itself begins with a discussion about the individual’s strengths, assets and interests. S/he is supported to develop his or her own goals which the worker will support them to achieve. (see page 19) The individual needs to be supported to overcome barriers which they may face in the process of achieving their goals. Workers may need some assistance from their teams with this. (see page 25) The worker needs to be open to expanding their network of contacts which may be needed to be drawn upon to assist the individual. (see page 31)
How to use this manual This manual does not provide step-by-step guidance on how to help people to make new social connections. As we have discovered in the Connecting People Study, there is no one way to do this. How this process will work will vary from individual to individual. Instead, this manual provides a framework for practice which should assist workers to adapt flexibly to the strengths, needs and desires of the individuals they are working with. For more practical suggestions on how to use the model, we will be running training sessions for workers alongside this manual.
Feedback We are seeking feedback on this guidance and wish to ensure that it is fit for purpose. If there are aspects which you wish to discuss with us, please let us know. Our contact details can be found at the back of this guide, along with links to useful resources and more.
We hope that you find this manual useful to your work.
13
The agency The influence of the agency is depicted in orange on the diagram. As you can see, it underpins the entire intervention, and is an integral factor in both the shared processes of the model as well as providing support for the worker and for the individual. Without a supportive agency, it is unlikely that the processes depicted will occur. There are a number of features characteristic of a supportive agency, including modelling of good practice, skill sharing, community engagement and good local knowledge. These aspects create the security necessary to allow the workers within it to do their jobs well, and the individuals accessing their service to feel confident enough to make progress. An organisation also needs to know its limitations and its barriers, and the ‘can do attitude’ of its workers needs to be echoed to try and overcome any issues. Workers need to know that they can use their initiative and try new things whilst being supported by their agency, in order for ideas to prosper. In addition to this, the agency can provide a physical environment which facilitates social connections and can provide useful connections with community resources which individual workers may not have. Shared knowledge of the local and wider communities and a thorough understanding of the intervention model held by the agency can prevent interventions failing when workers leave. Comprehensive handover procedures in this event are also necessary, as individuals may have built up a strong relationship with their worker rather than with the agency as a whole. These factors can also help to reduce reliance on individual workers who may be the only ones to hold connections within the local community. The environment in which the agency works is also key—support from other local organisations, and funding bodies is very helpful when an agency is trying to complete this sort of work. If there is competition between organisations due to funding or another issue, jealous or unhelpful attitudes may appear that can impact negatively on the agency’s work.
14
The Agency: explained These three factors are key to assist the worker and the individual to start moving forward with the intervention: Physical Environment This will obviously vary according to facilities available. However, it needs to be as inclusive as possible. Creating a non statutory ethos is key to engaging individuals who do not identify well with typical NHS settings. For example, no sharps cupboards, don’t lock equipment away, encourage service users to assume front line positions e.g. answering phone, working on a reception.
Partn Worker
Community resources An agency should aim to link in with other local resources in order to help an individual feel less segregated and more grounded when accessing their service—this will increase the likelihood of attendance.
Help accessing the service The agency can play a key role in encouraging an individual to attend a service: Creating a welcoming environment e.g. a café; Not forcing paperwork on an individual as soon as they start attending.
Equ
Physical e Communi Help accessi
Developing skills, relationships and resources with this individual and for the future Enhanced social network knowledge
Potential Barriers
Ag Modelling of good practice
Skill sharing
15
The underlying ethos of the agency has to support the whole intervention process Modelling of Good Practice It is helpful for an agency to set an example from the top down for all of its staff. Barriers and boundaries need to be clearly set out within policy to allow staff to feel confident in sharing and being a real ‘person’ to the individuals that they work with.
Skill sharing An agency should not keep its skills and resources private. Sharing knowledge is really key —whether this be a skilled staff member going and helping other community organisations, or being happy to share policies and procedures. By keeping an open mind and creating a sharing ethos, the agency is opening up more opportunities for itself.
nership
uality
Individual
environment ity resources ing the service
Developing ideas, goals, and confidence and working to attain and expand on these
Community engagement Agencies should invite community members and groups in wherever possible. This reduces the stigma of mental health services. It is great if they can utilise mainstream community resources wherever appropriate.
Potential Barriers
gency Community engagement
Local knowledge
Enhanced social network
Local knowledge There should be a database of local knowledge within the agency. Although staff will build up their own connections the agency should collaborate with staff to produce a record of useful links that can be passed on to other workers. Agencies should also be familiar with relevant facilities in the wider area.
16
The Agency: case studies Physical Environment My first impressions were of a very light and airy place, the standard of the art on the walls was amazing, and no one was sitting at a loose end. Even those who were at the computers were conversing whilst they looked on the internet. The place had quite a buzz to it….the café set up meant that nervous individuals could just have a cup of tea without feeling that they had to engage further... -field notes, researcher
“The whole building has a buzz about it, a good feeling. I always go away, even if I felt miserable when I had come, I always go away feeling good. Because you come here and you can sit down and realise that your problems are not that bad and everyone has their own problems. And everyone who comes here has problems and that’s why they come here but they don’t bring it out here “ -extract from interview, service user
Partn Worker
Community resources The agency ‘s football groups link with a local college and the FA. The chance of being scouted encourages individuals to attend the groups, play the matches, and engage with the other beneficial services offered by the agency. - reflections, researcher
Help accessing the service “That’s where I learned – if people ever wanted to come here and they didn’t actually want to (travel), I’d go and meet them and come down with them” - extract from interview, volunteer
Equ
Physical e Communi Help accessi
Developing skills, relationships and resources with this individual and for the future Enhanced social network knowledge
Potential Barriers
Ag Modelling of good practice
Skill sharing
Modelling of Good Practice 17 Ethos training from the outset means that new starters in the organisation –whether these be staff or volunteers - are aware of how the agency is run and how they fit into this ethos - reflections, researcher “we built this metaphor which was its this lovely picture of a table with all the stuff we deliver on top of it, but underneath it is all the procedures like you can’t see them, in a big chest and its sort of locked up so you don’t see any of it... “ -extract from interview, co-director
Skill sharing The agency sent policies and contacts through to another local organization, who had lottery funding to set up but are now struggling to sustain the service. They see it as leading from the front, and passing on knowledge is one way to continue being a success Individual and your ethos/philosophy being shared - field notes, researcher
nership
uality
environment ity resources ing the service
Skill sharing There is a culture that everyone wants to learn a little of everyone else’s role. This will allow knowledge to be shared beyond a single person holding everything (and thus avoid the issue of it all being dependent on one member of the team). - field notes, researcher
Developing ideas, goals, Community engagementand “we’ve linked up confidence with LOCOG, which is the Lonworking don Organisingand Committee for the Olympic Games...they provide volunteering roles within to attain and the Olympics. So expand we’ve been able to throw some on of our guys down that route. theseAnd then it’s down
to them really to take it on” - extract from interview withEnhanced two staff
Potential Barriers
social network
gency Community engagement
Local knowledge
Local knowledge—displayed at centre within the 5 ways to wellbeing framework
18
More information taken from the participating organisations
The importance of the environment external to the agency is highlighted in this quote from a Commissioner: “I think we’ve been more supportive, a lot more supportive and hands on possibly than other commissioners might be in other areas and I do think that’s helpful ...“ And commissioners have the overview of how the organisation compares to others: “They represent a belief in dynamism and proactivity in pursuit of outcomes - whether these be organisational, community wide or for individuals”
Interactive website at BlueSCI allows for individuals to keep up to date
19
The practice The practice refers to the active process that occurs within the intervention. The intervention model is a very dynamic process with lots of potential for change and modification. It is not simply instructions to follow which will result in a particular outcome occurring. We have used two interlocking circles to represent the fluidity of the process and the uncertainty about when, or if, social network development will occur. There is room for experimentation within this practice—it is intended just to provide a framework to work from. The shared components of the model are represented in purple, and are located at the very heart of the model. They consist of: The partnership: the relationship built between the worker and the individual is key to the success of the intervention. It must be an equal relationship where both parties feel able to comment and change as necessary. The partnership should be discussed openly from the start, and the conversation conducted on a level playing field. Other factors key to the partnership include confidence, flexibility, lived experience, openness, hope and trust. Although there will be differences between partnerships, it is clear that this needs to be built over time. First impressions are critical and a consistency needs to be there in order to allow an individual accessing the service to open up to a staff member in their own time. Shared development of objectives and activities (represented by the square in the middle): This is the crucial part of the model as it represents the co-produced activities. When the worker and individual meet for the first time in the context of this model, they discuss the life goals of the individual and they develop a realistic strategy together to help him or her achieve this. The activities may be in the context of what the agency provides or it may be additional to that. Some underpinning elements of these activities may include network (and asset) assessment; objective development; inspiration; facilitation; meeting expectations; orientation; sign-posting; skill recognition and feedback.
20
The Practice: explained The partnership: EQUALITY: This is really key—the worker must be on the same level as the individual. This needs to be achieved through mutual respect—just as important from the worker as from the individual. There is no reason that the worker cannot take on board comments or suggestions from the individual to aid their own work, or their wider lives. Similarly, workers can use examples from their own lives to help the individual that they work with, where appropriate. Sessions should be conducted at a location and time chosen by the pair.
Flexibility: The partnership can be very flexible, and not bound by paperwork. If an organization feels that they need paperwork to document meetings and the process, then it works best for this to be minimal and interactive—both worker and individual should play a part in filling it in. Anything above and beyond this should be completed by the worker after the session.
Lived experience: Some service users say that the best workers are those who have been through a similar experience to themselves. Whilst this is not always feasible/appropriate, workers can make an effort to understand aspects of their clients’ lives—from listening to them talk, to going away and researching a client’s interest to fuel conversation the next time.
Partn
Equ
Worker
Developing skills, relationships and resources with this individual and for the future
Con Flex Lived e Ope H T
Network Objective d Insp Facil Meeting e Orientation Skill re Fee
Sha proc
Trust:
Enhanced This is really important to the individual social —a worker will build the trust and renetwork spect of their client by ensuring that they are not late to meetings, and keepknowledge ing in good contact with them about arrangements.
Ag
21
The shared processes: Network Assessment: This is a shared process. It can be formal—network mapping; e.g. “draw me three circles, list who is in the inner circle and closest to you”, or less formal e.g. a discussion about who is important in your life and why.
Inspiration: Ideally this will come from the individual—their dreams and aspirations. Open questions could promote ideas and discussion, or tools such as an activity timetable used to pick something new to try. Motivational interviewing can also be used at this point to identify how best an individual can move forward.
nership
uality
nfidence xibility experience enness Hope Trust
assessment development piration litation expectations n/signposting ecognition edback
ared cesses
Individual Facilitation: Some individuals may just need help determining how they want to move forward, and they can achieve the rest. However many who may be more anxious will need help taking the first step. Aiding with the setting up of meetings or introductions to a new activity goes a long way to overcome nerves. the willingness to work flexibly and accompany the client to new activities until they feel comfortable. Using the stages of belonging to understand at what level an individual needs a worker to help with can be a useful tool.
Developing ideas, goals, Skill recognition/orientation/signposting: and All of these require the worker to constantly think outside of the box and see as confidence many opportunities as possible for their client. They need to use their resources, and working networks and experiences to help the individual find the best available new opporto attain and tunities. Matching individuals according to a shared interest can work wonders, expandcare on should be taken when doing this. Individuals need to fill valued roles although these within the community rather than remaining outsiders
Enhanced social Feedback: This needs to be a two-way street with the worker network helping the individual to reflect on how they
are progressing, possibly using written notes to gauge progress. The individual will also be able to comment on the worker’s performance. This can be achieved if the relationship is very equal face to face, but a good structure for making comments, complaints and suggestions is also pretty crucial within the agency. Good questions to ask both yourself and to the individual include “am I gency asking the right questions?”, “How will we know this is helpful?”, and “Is this a helpful conversation?”. This allows constant monitoring of how effective the practice is proving to be.
22
The Practice: case studies Equality “Office staff and admin staff would come and get involved, so you’ve got this real mix of people. And you had no idea who was a patient, who was staff, who was a visitor, who was a volunteer. It was completely about the activity and engagement” -extract from interview, director of service
Partn
Equ Flexibility “We met initially each week at a coffee shop or somewhere where it just felt like we were having a chat—it never felt like we were going through questions or filling out forms. After a while we used to meet less and left often—the decrease in intervals was always something I felt comfortable with though” - extract from interview, individual
Objective Development Worker “They are not coming to be pressured, ‘what are you going to do with your life’, you know and so what we try and do with the service is make it very much user led, so they come along….we don’t say after 4 weeks, ‘you are going to do this,’...we monitor their progress so you know, after 4 weeks our health advisor would be having those conversations with them, and finding out what it is they are trying to do” -extract from interview, worker Developing
skills, relationships and resources with this individual and for the future
Con Flex Lived e Ope H T
Network Objective d Insp Facil Meeting e Orientation Skill re Fee
Sha
Skill recognition proc “I think (there is) something around reconceptualising a service user: if you reconceptualise what your relationship with your service provider is into one where you’re giving something back, then actually that’s a more empowering position to be in and it values the fact that actuEnhanced ally everyone who comes into our services has Feedback social “It (support session feedback) was brilliant because i something to give...we now have two staff in the s.u. involvement team who are service users network tion...it kind of contextualised what you’d done and too...one we’re encouraging to do more train-knowledgemonth: ‘we discussed that you were going to go and ing...she’s a very very good trainer and and you were going to give up smoking’, and things speaker...so we are trying to build her skills things going on in there which you didn’t realise but around that”. -extract from interview, worker
Ag
nership
uality
nfidence xibility experience enness Hope Trust
assessment development piration litation expectations n/signposting ecognition edback
ared cesses
23 Equality “We’re heavily in control in a sense and then we’re trying to empower them to take control at the end of our contact with them, that that’s changed and that they’ve become in control. It’s what we’re aiming for” - extract from interview, worker “I chip in, tidy up, setting up the flat, you know, putting on the cot linen...” - extract from interview, worker
Openness and objective development ““look, we’re going to establish a partnership here… I’ll provide as much guidance as I can, as much support as I can, but the duty work, you have to do it. Because this is your life. This is not about me, this is about you.” So usually, I use that kind of approach…I always say to them, “look, I don’t have any kind of clinical training, so we’re not going to talk medication, we’re not going to talk Individual symptoms, and things like that. What we are going to talk is what you need, what you want, and where you want to be.” - extract from interview, worker
Developing ideas, goals, and confidence and working to attain and expand on these
it was a summary of your conversawhat you’d achieved over the last d see this, you were going to do that, like that you know….there’s a lot of you were going forward all the time” -extract from interview, individual
gency
Network Assessment “in that handbook now we’re asking each manager to build a resource—like a community resource and we’ve got two blank pages basically for that with all of the different resources in the community that people can access” Extract from interview, worker
Facilitation Due to a semi-paralysis down his left-hand side, he could no longer carry his equipment Enhanced and therefore had had to stop fishing. The social agency put him in touch with someone else network who was interested in fishing, who wanted a companion to do this with. The pair now go fishing together regularly, and the gentleman has reported an lift in his mood as a result of attending the service. Field notes, researcher
24
More information taken from the participating organisations The process of empowering the individual is a tricky one: there is a balance between mollycoddling them and risking relapse if a worker pushes too hard. It is also important to keep the process moving forward, rather than finding a state where the individual feels comfortable with their level of empowerment and sticking there for too long. “If you focus on the process and making sure the process is empowering, making sure that the values that we would like to bring into the relationship are actually brought in and evidenced into the day to day interactions with people then the outcomes that we would like i.e. people feeling confident to go out and do different things meet other people engaging with the one to one work but also engaging with the wider activities happen naturally. Because its only through process that people change, its only through the moment to moment interaction with someone that someone can feel better”. -extract from interview, worker
Matchmaking—a good or bad idea? Workers who find two individuals with similar interests often want to link the pair up. This would result in an increase in social capital for both. However, company policy often prohibits this due to confidentiality issues and risk levels. A worker should discuss with other staff before making a link. “You’d love to be like a matchmaking agency and be able to go, “oh my god, I know this person,” but I mean I think that’s kind of, their place to do that. And that’s where they gain those skills, getting their confidence up to have those conversations with people to know it’s going to be alright”. - extract from interview, worker I meet them both individually and we do the same things. They want to go to the same town, they want to go to the same computer game shop. And that gets me thinking, “I don’t need to do this with you, you could do this together.” But obviously, you know, confidentiality and their own issues...it’s very difficult. …. potentially, they could be really good friends. But, you can’t force people to be - extract from interview, worker friends and...it’s a bit of a political mine field…”
25
The individual In order for the intervention process to work effectively, there is the prerequisite that the individual needs to have some enthusiasm for engaging in this process and ownership of it. In other words they need to have a wish to change. A level of enthusiasm can be encouraged/inspired by a skilled worker, but for the process to work in the long term the individual has to take responsibility for themselves, and must have a desire to do this. This is often a major challenge, especially when individuals suffer with high levels of anxiety…in other words there are cases where an individual may want to change but does not have the confidence to start on the journey. A worker must be sympathetic and flexible to allow the individual to choose to start the process and move forward in their own time. A worker also needs to listen to how large or small a goal the individual wants to set—they may see a small amount of social networking as sufficient for their wellbeing. An individual’s journey is represented by the blue circle on the right of the model. This is the focus of the intervention process as it is where the social network development is expected to occur. We expect it to involve the individual being exposed to new ideas; being introduced to new people and activities; the development of skills and interests; development of social confidence; and building currency (both personal and social). We have deliberately omitted any details about what the individual and worker might do within this process as it is up to them to co-produce the activities. We believe that social network development may occur at any point as a by-product of the process. Barriers to social network development (represented by the smaller circle to the right of the model) work in the opposite direction to the intervention cycle and can pose considerable challenges for some individuals. These may include stigma; cultural factors; physical health problems; complicated external lives; poor attitudes of self and the organisation providing the context for the intervention; ‘bad’ social capital; lack of information; or poor access to services. These barriers present the worker with a number of challenges, and are likely to be the most time-consuming element of their work.
26
The Individual: explained The worker and agency must help the individual to help themselves move forward:
The individual’s journey As stated in the introduction to this section, the processes occurring here are unique to each worker-individual pairing, and need to be flexible and dynamic to the situation. The crucial idea to keep in mind is that this is not a linear process. Individuals move as part of a cycle. Their own attitudes and experiences mixed with the impact of the opportunities around them, the worker’s efforts, and the agency create a different experience for each person. Some may move around the stages of the cycle more quickly than others, and some may skip stages. A worker needs to expect the unexpected, as results may Partn occur earlier or later than were preconceived, and opportunities need to be seized as they come up. Equ Social network development and the building of social capital is the end goal of the process, but this may occur Worker as a by-product of any one of the stages on the model. An individual may move through the cycle and build their social network up but still want more support – in which case the cycle could start again with new opportunities being identified.
Barriers Stigma: By grounding the service within the wider community, and linking individuals by a common activity rather than illness, the stigma of a ‘separate mental health service’ reduces. Self-stigma can also be reduced by encouraging the individual to attend large-scale organisational events, as there are likely to meet people that they can relate to. This is seen as a key issue by workers and individuals alike, and is really important to tackle effectively. Developing Physical health: Workers need to be sensitive to physical health issues when suggesting activities, and ensure skills, that they are inclusive to allow the individual to take part fully. Sha relationships Complicated external lives: Although family etc should be included where appropriate in the process, the and resources proce individual should keep ownership of the process and prioritise their journey as something that they will do with this ‘for themselves’. Attitude of self/of organisation: Staff working with an individual withindividual a self-limiting andattitude should encourage them to take very small steps forwards, for example attending justfor one appointment the future or making just one phone-call. The agency should strive to support people to move on rather than be an overly nurturing, protective place. Enhanced
social network knowledge
Potential Barriers continued: ‘Bad’ social capital: If an individual’s network is impacting negatively on them they should be encouraged to seek Barriers alternatives. Access to service: Workers should accompany individuals where necessary. If a service is geographically governe knowledge of similar services nearby is important. Age Lack of information: The service must be promoted clearly in a variety of different locations. The inclusion/exclus criteria must be evident (e.g. an age restriction or a referral from CMHT needed). Cultural factors: Individuals from tightly knit cultures may be less likely to access mainstream services and allowa must be made for these groups.
27 The stages of the process A worker needs to be able to gauge at what stage the individual is in the process in order to judge when and how to move forward. Generally, increased personal confidence, an increased attitude of ownership towards a task etc, and a more forward looking attitude are signs that an individual is comfortable at a stage and that it may be time to move forward. Body language and a change in the support that they ask for are other hints that can be monitored to determine this.
nership
uality
Individual Ownership Enthusiasm
Catalysing ideas Introduction to new people and activities Development of skills and interests
ared esses
k out
ed,
ency sion
ances
Individual can leave and re-enter the intervention at any point of the cycle as desired/required
Freedom to leave and return The individual should be encouraged to engage with the intervention process—through the positive consequences that they begin to witness, the reinforcement of the new confidence and experiences that they begin to experience. However, the individual should never be forced or contracted to spend a minimum number of weeks on the intervention. Please note that the intervention process is different to attending the service as a whole. People can still access the service without feeling they must continue with the intervention. They may re-enter the intervention at a different stage to where they left it.
Development of social confidence Building currency Access to service Stigma Lack of information ‘Bad’ social capital
Potential Barriers
Attitude: self/ organisation
Diversity factors
Physical health Complicated external lives
Enhanced social network
Moving on Where protocol allows, it is best that an individual never feels that they cannot re-access the intervention, or the service within which it occurs. The best results of people moving on seem to come from organisations where individuals see an open door that they can re-enter as necessary. This seems to allow people to have the confidence to try new things, acting as the back up that they need, until they no longer think about it.
28
The Individual: case studies .
Barriers “If someone had difficulty…it would be about sitting down and working through it and what it was that there were barriers that make it difficult for them to get to the group. Is there anything that we could put in place that would make it easier for them to do that? Is there somebody else that they might want to come with them? That might make that easier? Would they perhaps want to come for part of the groups…” -extract from interview, worker
Initiating the process “...people come into this sort of situation for the first time they’re testing it because that’s exactly what I used to do, you put your foot in the door and take it back out again. Maybe a couple of months down the line they’ll put 2 feet in the door and try. You’ve got to remember a lot of these people have been shells for years and years and years—they don’t trust anybody, it’s hard to really sort of like to befriend all at once so you’ve got to take a short of gradual you know process cause Partn you can frighten people away just as easily”. Equ -extract from interview, service user volunteer
Bad social capital “Because even though I’ve got friends to hang around with, some of them are not very good friends. Some of them drink, (do) drugs, and even though I drink the odd time, but, they do drugs and you know, it’s just sort of like, they’re wrong ones, do you know what I mean? And I want to hang around with decent people who want to get their life in track and not destroy their life”. -extract from interview, individual
Attitude of self/organisation “One part of it is fear cause they tell you “ok you’re Enhanced better now”, and you got some idiot telling you you’re social better because you’ve ticked all the boxes and you’ve gone through your programme and there are people network still in therapy and they look a lot worse knowledge than you cause you seem to be ok then you’re ok”. - extract from interview, service user volunteer “Because sometimes individuals don’t want to engage, that’s a decision they’ve made, they’re not ready” -extract from interview, worker
Worker
Building currency/social network develop “People swap contact details and decide t socially with each other and make contact Facebook. But they’ve got a shared exper start with. And it just develops”. - extract from in
“I’ll say, “well I don’t know the answer to t what we could try is Googling this?” so it’s Developing like, you’re sharing, you have social capita skills, whole ability to think and research and co Sha relationships You’re almost modelling it.” and resources - extract from interview, worker proce
with this individual and for the future
Potential Barriers
Age
Exposure 29 to new ideas “It’s giving them ideas, new ideas that they might not have thought of before I think really. So I throw a lot of things out that might not necessarily apply to them. But generally they’ll find something that’s interesting and think...” -extract from interview, worker “...well, straight away, they said, “are you interested in the activities.” And as far as I, I wasn’t interested, I was like, “nah, I’ll just use the team for the doctors, just to go and talk.” But then later on...I used the services, the activities...I’ve been playing football for two years with them now”. - extract from interview, individual “I see the, the exposure to new ideas as being a joint thing as well because I’m constantly being exposed to new ideas from my clients that make me question quite a few things. Have I got that? Am I clear in my mind when I think about that? So I do find that working with people is kind of a thought provoking kind of process. So it’s not introducing clients to new ideas. They’re introducing us to new ideas. And so that’s a fifty-fifty kind of split up” - extract from interview, worker
nership
uality
Individual Ownership Enthusiasm
pment to go out t on rience to
nterview, worker this but s almost al... That onnect. ared
Individual can leave and re-enter the intervention at any point of the cycle as desired/required
Catalysing ideas Introduction to new people and activities Development of skills and interests Development of social confidence
esses
ency
Development of skills and interests “I don’t think it matters if you’re only doing one thing a week but the one thing you week you’re doing is so fantastic that you can go home, if it’s an art class and be painting and doing a lot of stuff on your own” -extract from interview, individual
Building currency Access to service Stigma Lack of information ‘Bad’ social capital
Potential Barriers
Attitude: self/ organisation
Diversity factors
Physical health Complicated external lives
Leave and re-enter the cycle She doesn’t see herself as having stopped interacting with the service altogether, as she still goes back from time to time and would like to volunteer in the future —field notes, researcher
Enhanced social network
Development of social confidence “...what we talk about is, not piling lots and lots of activities into, into your week. But having regular exposure, so having an hour a day, go to the gym or even four hours a week, go to the gym. Just constantly go and then sooner or later, you become acclimated to the environment and you become a lot more confident in that environment and then you can expand those experiences”. - extract from interview, individual
30
More information taken from participating organisations Below are some extracts of interviews showing the individuals’ perspectives of the process “Yes the organisation did help me to move on, but not in an obvious way, in other words I did not feel pressurised to stop attending. The idea of going to university to study to degree level was something I had thought about in the past, but never really thought I would do this. At a group session I mentioned this but was not going to do anything about it, until (my worker) encouraged me to do something about it, and I applied to college and was accepted onto an access course. On the first morning (my worker) met me at the college to reassure me that I was able to take this route. II went on to complete the course, and was accepted on to a History BA (hons) course, which I completed earlier this year and gained a 2:1 If it was not for (the organisation) I doubt very much I would have gone into higher education”.
“I’ve come through the hospital and hostel, I’ve been through prison. And I’m nearly getting my own place, on my feet. And once I do get that, I want to be looking at education, you know, part time education, preferably evenings. Something, I’m going to enjoy doing something that I have a future in”.
“everyone’s got assets: when you’re ill and particularly when you’ve got mental health problems you forget about them and they’ve got to be coaxed out”.
“Well I find that she’s (the worker) quite clever, she’s quite good at analysing and making me think and understand the way I think about things, like problems...like going out, she, she’s been getting me to think about what it is that I don’t like about it. And she taught me to understand that even though I don’t feel like doing some of it. If I do, then I’ll benefit from it”.
31
The worker Just as the individual must be enthusiastic and have the desire to move forward, there are also pre-requisites of the worker in order to ensure that the intervention is as successful as possible. An empathic worker, who understands the factors that impact on the individual will find the best way to work around these problems. The worker should hold a can-do attitude and be driven to see the possibilities in situations—be this forming new relationships, learning new things or exploiting existing contacts ...they need to be a natural networker, or to be able to link individuals with others who are. They should also see the value of an individual’s existing network—others may know useful things that are invaluable to the individual’s progress. Workers need to think creatively to help an individual to think of new ideas. If an individual cannot find inspiration, a worker can help them to be inspired. This can be aided by the worker letting their personality shine through in their job—agencies should know workers’ interests and allow them to be resourceful people in their own right, rather than simply facilitators to link the individuals accessing the service to other contacts. The worker’s journey is as important in the intervention process as the individual’s. This assumes that the worker will need to develop their own social network knowledge in order to support the individual on their journey. Workers will need to build relationships; foster trust; identify opportunities; engage with the local community of the individual; develop their own networks and resources; adapt to new ideas; and utilise their contacts in the process of supporting the individual they are working with. At any point, they may need to provide extra support or reassess their involvement with the individual, whilst the individual may seek advice from the worker. Along the way, the worker may also face barriers, including a lack of local knowledge, poor systems, a lack of resources, and most importantly an unhelpful attitude. These need to be addressed to allow their own development of social network knowledge, as well as an effective partnership with the individual to be created. The worker should never do something for the individual, instead they should help them to do it for themselves.
32
The Worker: explained Fostering trust To build trust, the reliability and punctuality are really important at key work sessions. They could also try to remember or note down key details to ask about the next session, which encourages feelings of trust within the individual: that the worker really is interested, and really does care what they think and say. Trust goes beyond this, however, and takes time to build up with an individual. The way that a worker acts as an individual gets to know them will be the biggest tool to build (or to not build) trust—individuals need to know a worker means what they say. Identifying Opportunities It is useful to be constantly on the look out for new opportunities in the local area, through both information given out by their agency and also their own research. They must be dynamic and use their imagination to think creatively about finding new opportunities. If they come across something of interest, they should share with their wider team to allow this knowledge to be effectively utilized.
Engaging with local community Creating bonds with the community allows the individual who the worker is helping to easily pass from mental health specific services into the mainstream. If the worker has contacts in the local area, this transition is aided...for example a college admissions tutor will be more sympathetic towards a new admission. Additionally, having these eyes and ears in the local area provides a more comprehensive knowledge of potential opportunities for the future. Knowledge of relevant facilities further afield will help the individual to branch out more to follow a special interest. It is important to remember that a swimming pool or cinema is somewhere that an individual goes with a friend, not to make a friend
Enhanced social network Barriers Of all of these barriers, the attitude—of staff, agencies and other knowledge organisations—has been cited as the hardest to overcome. Good working relationships within and outside of the organisation can help this. Breaking larger barriers into smaller, more manageable problems with single solutions can also aid workers with overcoming barriers.
Building re Positivity a Different w viduals. Th Using hum ment whe one anoth Sharing so ground; Sharing yo Simply sm individual
Partn Worker Worker Empathy
Equ
“Can-do” attitude Natural networker
Building relationships Identifying opportunities
Fostering trust
Engaging with local community Developing own networks and resources
Sha proc
Adapting to new ideas Utilising contacts
Lack of local knowledge
Attitudes
Potential Barriers Poor processes/ bureaucracy
Lack of resources e.g. time, funding
Extra Support
E Reassessment T r n t Agcm s
33
elationships: and optimism from the outset is invaluable.. workers gave different ideas for engaging indihese included: mour to create a bond and creating an environere there was a free reign to take the mick out of her; ome information about yourself to find common
our own experiences of mental health; miling and using open body language to make the feel as comfortable as possible.
nership
uality
ared cesses
Individual
Developing own networks and resources This can often be a by-product of the research completed to find opportunities for the individual. These new opportunities should be recorded rather than forgotten about, and again shared with the agency as a whole if appropriate. If the worker has a particular area of interest then they may take time to build up knowledge of this, as it will improve their own skill set and allow them to potentially be more useful to an individual in the future.
Adapting to new ideas A dynamic agency will change frequently and the worker needs to be enthusiastic about this rather than see it as a hassle. If the individual changes their ideas, it should be taken as a positive thing as they are taking ownership of their recovery journey. If the change feels like a step back then a discussion should be held about what makes this new idea attractive.
Developing ideas, goals, and Utilising contacts A worker must have the confidence, and be supported by their agency, to use the contacts and confidence resources that and they working have built up in order to help the individual to progress. A file of numbers and email addresses builtand up by the agency will simply go stale and connections will fade if they to attain are never used. expand on Workers could consider using their personal contacts if the contact could provide something spethese company policies and boundaries should be taken into considcific for an individual. However, eration when doing this.
Enhanced social network
Extra support and reassessment Potential The path to recovery is not a smooth one and individuals may progress substantially before encountering an issue, or Barriers relapsing. To help this, the worker can monitor the individual in a sensitive fashion to allow for extra support where necessary. This may come in the form of meeting them more frequently, or re-attending a group with them until their confidence is built up once again. Conversely, if the individual is leading a relatively independent lifestyle then calls or text messages can be less intrusive than a structured, regular meeting. Over time as the individual becomes gency more integrated with their new social networks, the role of the worker should become less important. Accurate assessment of when and how to drop back and allow the individual to ‘go it alone’ is crucial.
34
The Worker: case studies Building relationships “I will, kind of, smile, encourage them, because really, it is not that easy, not very easy for any human being, when you have someone, that you don’t know, before, coming into your life...I have at the back of my mind, my conversation is giving them that assurance”. - extract from interview, worker “I try to make the individual laugh—I cultivate an atmosphere of humour in my sessions...sometimes people are laughing at me but they are laughing together at a common cause, and this makes them bond” - extract from conversation, volunteer
Fostering Trust “So for us to make that attachment stronger, we have to keep to the time...if you promise to do anything for them, be sure you keep to it. If there’s any changes, you inform them immediately…If I’m going on annual leave, I will let them know, I will inform them when I’m going, when I’m coming back and any other contact number, office number if they need to talk to somebody...we put all those plans in place” - extract from interview, worker
The empathic worker “I think what you’re doing is that you’re understanding people, what it’s like for people, other people to, in terms of social interaction, what it’s like for other people when they might lack the confidence to go out and meet other people. “ - extract from interview, individual
Partn Worker Worker Empathy
Equ
“Can-do” attitude Natural networker
Building relationships Identifying opportunities
Fostering trust
Engaging with local community Developing own networks and resources
Sha proc
Adapting to new ideas Utilising contacts
Identifying Opportunities “I guess if someone wants to work in a gallery, what Enhanced about an arts suppliers or what about WH Smith? Or social what about a library, which have links to kind of the arts network and stuff like that. What about theatre?...Its just trying to think creatively...if someone’s interested in art,knowledge thinking about all the arts and, those kinds of places. It could be music shops and it could be the cinema. And then through talking about these things: “oh actually I would quite like to work there.” - extract from interview, worker
Lack of local knowledge
Attitudes
Potential Barriers
Lack of resources e.g. time, funding
Extra Support Reassessment
Poor processes/ bureaucracy
Ag
35 Engaging with local community “...We went along to a really wicked café...Really cool, it’s all black walls inside and they use it like, it’s like a mini-gallery in there so local artists display their stuff there. But they also have a club on a Sunday at two o’clock, where local artists can meet up together and just sort of meet socially or whatever. So I just said, “well you could go along to that if you wanted. If you felt anxious or whatever, I could always come along for the first time”, and help facilitate some conversations or introductions or whatever “. - extract from interview, worker
Developing own networks and resources “So it is knowing what’s out there, building relationships with perhaps other peonershipple who run that scheme or whatever it offer. You know, uality is, knowing what they Individual knowing how appropriate it is for our clients. And that sort of knowledge takes quite a while to build up. The first year I knew nothing...now I’ve got quite a detailed map in my head”. - extract from interview, worker
Adapting to new ideas The agency is always changing and workers’ job titles alter every few months. Workers seem to take this as a positive thing though, and feel it ensures that their roles remain fresh and vibrant. It doesn’t let them sit still and they seem to thrive from this atmosphere, and in acting like this help the individuals they work with to thrive too. - reflections, researcher
Developing own networks and resources/utilising contacts “...You talk to colleagues, you talk to other people that work in the area, either in the health field, the mental health field forDeveloping people that would be helpful or you go to other resource centres and local serideas, goals, vices like, you know, your leisure centre, or you find out where some activities are available and if there’s any schemes or events, and it’s, you putting in the effort to build your own knowledge”. - extract from interview, worker confidence
ared cesses
and working to attain and expand on Extra support/reassessment these
“(I) try and work out with them exactly what it was that was stopping getting them from whatever they needed and was it Enhanced a very particular thing like, I don’t know, they were intimisocial dated by being in that spacePotential or felt uncomfortable. And try to network work with them to overcome Barriers that hurdle. I think that’s the approach that I make. Because often it’s very specific things that hold people back and you can make them aware of them. And also, I’ve prepared to do it with them, like I wouldn’t mind going with someone to the Jobcentre…” gency - extract from interview, worker
Fostering trust and creating a secure attachment are important in building the relationship
36
More information taken from participating organisations Below are some extracts from interviews with workers, showing their perspectives of the process “I had a young man who was thinking about going to college. I have, contacts, people I know, who work at the college, either in the careers advice or they’ve got a mental health worker there. And I was able to take him down...I’m aware that colleges are quite scary places for young people. They’re full of bright young things, so we in one of the holidays and just had a look around the college. And went for coffee in the cafeteria the following week, and we met with one of the careers advice workers...we went in the evening when they were working and saw them in a quiet room...And sort of a gradual, overcoming the stress of being in a college by introduction, then meeting the form teacher. He (my client) gave permission (to) the teacher of the course, to disclose information about himself to them so that they could be aware of what support he might need. So working out a care package with them. And the tutor had somebody else on the course he knew, who would be quite a good contact. So they buddied up...the tutor helped the student find somebody he could go to the courses with. To me, the problem wasn’t to do with this underlying psychotic problem or whatever. It’s the lack of confidence that people have in returning to their life. College is a very scary place at the best of times. They’re very lively and noisy or whatever. So it’s like any kind of anxiety issue. The more you know about the risk and what’s going on, the less you worry about it”
“I’ve got a client that I’m working with who’s really into films and computer games. I personally have no interest in computer games, I don’t own any computer console. Never played one and wouldn’t particularly want to. But he wants to talk about it but I don’t have the knowledge base to be able to really respond. I had to spend some time looking up games and kind of trying to grasp what the object is so that I can actually get into a conversation about it…. He did know that I was winging it and that my knowledge isn’t that great. But he appreciated that I was trying. And then what he did was explain to me, “this game involves this,” and explain it to me. And actually, we’d have a conversation. He just initiated the conversation and helped me to feel confident enough to get into the conversation about computer games”.
“there was a young girl who had, well fixed delusion disorder, but we were around the same age at the time and she was really keen to go out and do some sporting activities. She was really sporty, fit. And she really wanted to go and do a dance class at the local gym, sports centre. And so, I went with her for the first four sessions because she said that she was too anxious to go on her own. So I actually met her there, went with her and because I quite enjoy doing that thing, it was easy for me”
37
Conclusion We hope that this guide has been an interesting and informative read for you. It highlights the flexibility of the intervention process, and the importance of a worker thinking creatively and putting their own stamp on their practice. You may well already be doing a lot of these things in your day to day work—in that case keep it up and try and add other aspects of the model into your sessions as well. The experiences and viewpoints of the six agencies that we have worked with were integral to the development of the manual, so we would like to thank them immensely for all of their help and support with the development of the process. However, this manual is still a work in progress. We would greatly value any feedback, on how to make it work better for you and your organisation.
What next? Whereas the guide has explained how the intervention works, the training section that will follow looks to add the ‘how’ to the ‘what’ - to train you on what it is that you need to do in order to achieve these results. Comments from our training sessions regarding the intervention model: “It is a good tool to use in identifying the barriers that people have to overcome ….. used with service users to help them understand my role, and the complexity of the situation/ systems that we all live in, especially as service users internalise a lot of their problems” “It is a visual piece, they can view their situation, especially when finding it difficult to work in an abstract way” “I take the framework with me when I meet with service users in order to guide discussion. It helps me to reflect on how I work and to explore creative and alternative approaches”
38
Additional resources These pages provide you with links to more information, websites, and general information surrounding the Connecting People Intervention. Your first port of call should be the study website at www.connectingpeoplestudy.net Here you can find the links below and many more, discussion boards, and useful materials in the dedicated ’Practice Guidance’ area.
Useful Links: www.grapevinecovandwarks.org - Helping people with learning disabilities move on with their lives www.motivationalinterview.org - website with lots of resources on MI techniques www.ndti.org.uk - concerned with social inclusion, resources on network mapping www.neweconomics.org - pioneers of the ‘five ways to wellbeing’ www.nesta.org.uk - charitable organisation completing research into social capital www.thersa.org - organisation that researches, designs and tests new social models www.socialcapitalresearch.com - website dedicated to research in the area
39
Agency Websites: BlueSCI: www.bluesci.org.uk Hestia: www.hestia.org Kingston RISE: www.kingstonrise.org SHARP: http://www.slam.nhs.uk/service-finder/service-details.aspx? su=SU0058&currentPage=0 STEP: http://www.sompar.nhs.uk/pdf/Psychosis-%20STEP.pdf Start Again Project: http://www.start-again.co.uk/ W. Kent EIS: http://www.kmpt.nhs.uk/West-Kent-Team.htm
Photo Credits: Cover photo—W. Kent EIS Page 2 picnic—Kingston RISE Page 2 singing—BlueSCI Page 4 people—Start Again Project Page 8 network mapping—Connecting People team Page 17 notice boards—researcher at BlueSCI Page 18 meeting—Kingston RISE Page 24 stepping stones—Kingston RISE Page 30 mountain top—W. Kent EIS Page 35 hilltop—Kingston RISE Page 37 go-karting— W. Kent EIS Page 39 singing—BlueSCI Thank you!
The Connecting People Study The research which informed this practice guidance was conducted by Martin Webber, Hannah Reidy and David Ansari with funding from the NIHR School for Social Care Research. The views expressed in this guidance are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS. The Connecting People Intervention is now being piloted in 18 health and social care agencies across England in a large pilot study funded by the NIHR School for Social Care Research. This study is being led by Martin Webber at the University of York and David Morris at the University of Central Lancashire. More information about the Connecting People study and updated versions of this guidance can be found on the study's website: www.connectingpeoplestudy.net.
40
This guidance arose from independent research funded by the NIHR School for Social Care Research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS.
In association with: