Customers' perspectives on the impact of the Pathways to Work condition management programme on their health, well-being and vocational activity.

AIMS: Pathways to Work is a UK initiative aimed at supporting customers on incapacity benefits to return to work. This qualitative study complements previous evaluations of Pathways to Work by exploring customers' perceptions of the impact of the Condition Management Programme (CMP) offered to claimants with long-term health conditions. METHODS: 39 customers took part in focus groups held at the seven sites where Pathways was originally piloted. The main focus of the discussions was on perceptions of the ways in which participation had impacted on health, well-being and return to work. The discussions were audio-recorded and fully transcribed for analysis using a text analysis framework to enable the development and refinement of categories and overarching patterns in the data. RESULTS: Perceived impacts on health and well-being included a more positive outlook, social contact, changed perceptions of conditions and improvements in health. Some customers also reported an increase in their vocational activity and others felt ready to embark on new activities. Factors associated with positive outcomes included the extent and quality of contact with CMP staff and practical advice about condition management. Factors impeding positive employment outcomes related mainly to obstacles to returning to work. CONCLUSIONS: The results indicated that CMP can assist customers to learn about and manage their health conditions and increase their vocational activity, and that CMP therefore provides a promising means of enabling people with long-term health conditions to regain a fulfilling, productive life.

Employment advice in primary care: a realistic evaluation.

Every organisation in the UK is affected by mental distress and ill-health in the workforce. The first point of contact for most people with common mental health problems, such as mild to moderate anxiety or depression, is their general practitioner. The location of specialist employment advisers in GP surgeries is therefore a logical attempt to address the issue of people falling out of the workplace, through the provision of early intervention and combined vocational and psychological treatment packages. In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries in Eastern England. The aim was to help people with mental health problems gain work (Regain clients) or retain their current employment (Retain clients). In this study a realistic evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that Retain clients found most helpful were careers guidance (including psychological profiling) and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. In many cases this was supported by assistance in helping clients think through whether they wanted to consider a career change. For Regain clients the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the Retain clients than for the Regain clients. The study indicates that it could be more effective for Retain and Regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.

The role of interprofessional working in the Pathways to Work Condition Management Programmes.

Condition Management Programmes (CMPs) were established in seven pilot sites in the UK as one strand of the Incapacity Benefit Pathways to Work programme, an initiative that exemplifies interprofessional working beyond traditional healthcare boundaries. The qualitative evaluation of the pilot sites employed a realistic evaluation approach and used focus group discussions and telephone interviews to examine stakeholders' perceptions of interprofessional working and its impact on service provision and practice. Although teething problems were experienced in establishing the interprofessional working necessary for success, a shared commitment to the CMP ethos enabled these to be largely overcome. Outstanding issues raised by participants concerned the boundaries around the CMPs' new ways of working, in particular around treatment versus self-management and around the combined health and work focus of the pilots. One of the recommendations from a recent review of the health of Britain's working population was for a drive to promote the understanding of the positive relationship between health and work. The experiences of the staff involved in the CMP pilots provides a useful insight into the benefits and difficulties experienced in relation to interprofessional working between different professional groups in this area.

The expectations of families and patterns of participation in a Trailblazer Sure Start.

The aim of this case study was to evaluate the local impact of an innovative Sure Start located in the east of England. The evaluation addressed the expectations of parents/carers for themselves and their children, and the extent to which Sure Start contributed to their achievement. A distinction was made between regular users and families that did not engage with services. Methods included individual interviews, events data linkage, goal attainment scales for parents and children and group review with stakeholders. The participants were 67 local families (160 individuals), all of whom had at least one child born between August 2001 and April 2004. An exploration of the utilisation of services over time and consumer engagement with services showed that the programme became more effective at engaging families. The role of community practitioners in the early promotion of Sure Start became apparent. Certain entry points, such as a home visit by a health visitor, were associated with more contacts, and more sustained pathways through the programme. Families that were actively engaged with Sure Start identified a range of benefits, especially greater social inclusion. The expectations of families who were 'active users' of Sure Start services matched the aims of Sure Start, and were being met.