Easington Locality (now part of North

Durham Adult Services)

The EPIC Project one year on

Jean Wiggins

Margaret Brett

Demographics

•Rural Locality with 20 electoral wards when district on Easington

•Population(2001 census) 96,600

•% of BME Population 1.2.%

•% of White British Population 98.8%

Profile•One of the most deprived area of the country

•high expected level of prevalence of mental health illness compared to the national average (33.28%)

•Social conditions likely to be linked with mental ill health

•Recognised as the least diverse place in the country

•Had an Easington PCT and Easington LIT until reconfiguration

•Mental Health services provided to adults and older people by Tees, Esk and Wear Valley NHS Foundation Trust & North Tyne & Wear NHS Trust

Wingate

Haswell

Hutton Henry

Murton East

Blackhalls

Easington Village

Shotton

Thornley

Wheatley Hill

Park

Seaham

Easington Colliery

Dawdon

Murton West

South Hetton

Passfield

Deaf Hill

South

Eden Hill

Horden North

Horden South

Dene House

Deneside

Howletch

Acre Rigg

High Colliery

Map 1. Electoral wards in Easington PCT

Easington District

Rural Complexities

• Dispersed Individuals – Isolation• Low BME population• Micro Cultures – Town, Villages, Individuals• Accessibility• None or little local community & voluntary

organisations though increased investment over last year has improved this

EPIC Project Plan

1 Build on previous work carried out…..• Cultural Sensitivity Audit – LIT

• BME Themed Review (Autumn Assessment 2004)

• David Bennett Audit & Recommendations

2 Utilise the pathway experiences…….• Experience of a patients journey through services using

(case study examples)

We identified that• Because of the small percentage of Chinese people in

our population we did not know how to make access to our services easier and once accessed, Staff needed to be aware of cultural and language issues in order that the persons journey to recovery was smooth and effective

• We agreed we needed to focus on two areas using a collaborative methodology ,

a) Chinese Community engagement to enhance the

pathways into care for the Chinese Community

b) An individual case study

Project Aims & Outcomes

Aims Developing an understanding

(cultural & mental health needs of the Chinese community)

Creating and Sustaining Partnerships

Mental Health Promotion

Outcomes Increased Satisfaction with

services

Less fear of services among the Chinese Community

More BME service users reaching self – reported states of recovery

Access Pathway

• Four main areas to the Pathway

• Website

• Directory of Services for the Chinese Population

• Cultural Awareness Training

• Staff Directory of Resources

WEBSITE

• Website developed by Ambient Creative services that includes information both in Cantonese and English regarding the following:

Addresses and links to specialist Chinese Mental health services and Local community groups

Access to the local service directoryInformation regarding our services Review of literature and links to Chinese mental health

information www.cmh-easington.org.uk

• Developed a leaflet to promote the website

Outcomes

• Expected Outcomes

• Monitoring the number of ‘HITS’ the Website receives

• Create a Column for people to review the site

• At the point of access to services monitor where the referrer received information in relation to our services and determine its usefulness

• One year on • Completed waiting to

go live • Ongoing development

to broaden the scope to include other BME communities within the region

• Provisions for yearly update agreed

DIRECTORY OF SERVICES

• Directory of Easington services Translated in Chinese and distributed to the Chinese population via GP practices and local businesses in the area

• Distributed with a letter and request to complete questionnaire or agree to an interview as part of the project.

• Utilised Chinese researcher to interview volunteers or assist with questionnaire

• Researcher engaged in activities i.e. support proof read, provide advice etc

Outcomes

Expected Outcomes • Follow up visit to GP Practices

and local businesses for feedback of its usefulness

• Log of directories used as a resource

• Promotion of directory via posters etc.

• At point of access to services monitor if services accessed by the use of the directory

• Comparison of Statistical data from previous years

One year on• Minimal data re its usefulness

collected.• Very poor response to

questionnaire• Sow Fong Cole has

interviewed 2 Chinese people • No Chinese patients referred

to services

CULTURAL AWARENESS TRAINING

• Questionnaire to all staff in local mental health services to establish baseline

Excellent response-50 returned in 1st Phase. Phase 2-wider distribution

• Thematic Analysis of questionnaire– Lack of knowledge by staff about– Population figures– Culture-understanding of mental illness/work ethic– Language and how to access interpreter/information

• Focus GroupGroup of 10 staff from each service who completed questionnaire

In depth discussion about needs of staff and knowledge required

Analysed for themes

• Training session Initial training for 25 single point of access staff on themes identified in focus group

Follow up sessions as an ongoing process .

Outcomes

Expected Outcomes • Evaluation of training course

• Questionnaire revisited to establish new knowledge

• Single point of access service monitored through ‘a walker of services’

• User / Carer Satisfaction survey

One year On• Majority of staff received

training

• 70% staff improvement in knowledge from previous

• Access team now established for whole Durham

• No Data available from BME community with responses to Satisfaction survey

STAFF DIRECTORY OF RESOURCES

• Information on interpreting services and Community Groups readily available at single point of access.

• Researcher continues to contribute to the development to include the wider BME community of the resource directory for staff.

• Staff also involved in the update and development of directory

Outcomes

Expected Outcomes • Evaluation through

the use of staff questionnaires

• User/Carer satisfaction with services

One Year on • Data reflects 0 BME

referral to Easington services

Co Audit One year on

• Through the new ways of working and Strategic aims of the organisation there has been significant changes in the way services are delivered within Easington

• The Race Impact assessment cannot be replicated to show further improvement within the previous existing services as they no longer exist in previous format.

• Demographic data collected through Performance management systems within the organisation

• Data collected in relation to the Patient questionnaire on discharge for January 08

Race Equality Impact Assessment

• This REIA had been completed collectively for all the services in Easington Managed by the Mental Health Trust, reflecting both a retrospective and current position.

• It looked at basic demographics, assessment, referral and treatment stages.

• It covered a registered population of 98,600

Service /functions within the REIA

• At the last stage improvements noted showed

Now looking at information available regarding our services in relation to referral, assessment

and treatment

Looking at different methods of delivery of this information

Routine information and monitoringDo you receive information about the ethnic makeup, age gender etc?Do you currently monitor the service/function by ethnicity/age/gender

disability etc?

• RETROSPECTIVE• Not routinely

information although Trust and Social services collects data

• Census in residential unit

• Not routinely monitored in services

• CURRENT• Yes services now

looking at ethnic make up and breakdown

• Agreement to role out Co Audit tool

• Yes now monitoring services

Referral StageHow are people referred to the service?

Could the methods used have an adverse impact on people from different racial groups?

• RETROSPECTIVE• Variable referral process

dependent on service criteria

• Includes open access• Referral by Primary

Health care Practitioner

• CURRENT• Single point of access

now in operation for all services

• Working on the development of a resource file and website

Referral ImpactCould the methods used have an adverse impact on people from

different racial groups?

• RETROSPECTIVE• We do not routinely

consider gender related issues

• Assume English as first language due to small BME Population

• Not routine to ask questions in relation to these issues although is good practice

• CURRENT

• Started to look at issues through the resource pack been developed

• Front line staff have attended Cultural Awareness training

Negative Impact EvidenceCould the methods used have an adverse impact on people from

different racial groups?

• RETROSPECTIVE

• Referral procedures and criteria

• Documentation• All correspondence in English• Delayed referral response if

not English speaking

• CURRENT

• Single point of access • Service directory now available

in all languages• Directory in Chinese being

delivered to GP practices

Assessment StageHow are people assessed to use the function/service or receive

treatment?

• RETROSPECTIVE

• Differing assessment processes

• Screening clinic• More rigid for crisis referrals• Joint assessment tool• Further assessment following

referrals• Some limited data collection

around Ethnicity and communication issues

• CURRENT

• Standardised assessment process.

• Prior to assessment cultural needs are assessed i.e. do they need an interpreter, or chaperone

• Flexibility to venue/time i.e. own home (more user friendly)

Negative ImpactCould the methods used have an adverse impact on people from

different racial groups?

• RETROSPECTIVE

• Similar to the referral stage

• CURRENT

• Yes it could have an adverse impact however we have improved our response to Cultural and Religious needs etc during the assessment process

Negative Impact Evidence continued

• Screening clinic reviewed to offer more flexibility i.e. appointments, Chaperone etc

• Resource directory for staff currently being developed

• Training in Cultural awareness • New ways of working offering

specialists and assessments in a variety of settings, earlier appointments for treatments and treatment options (no the traditional out patient role)

Treatment StageHow when and where is your services or treatment provided?

• RETROSPECTIVE

• Services provided in a variety of settings

• Home and office appointments • Urgent care centre• Creativity in engaging as

required and based on need i.e. Assertive Outreach

• CURRENT

• Remains Unchanged

Project outcomes v actual outcomes

• Developing an understanding (cultural & mental health needs of the Chinese community)

• Creating and Sustaining Partnerships

• Mental Health Promotion

• Positive feedback from staff re-training

• Established links with other agencies i.e Stockton International Centre/Middlesbrough Chinese association

• Mental Service Directory located in identified GP practices

• Cultural needs are identified at single point of access

• Model applied to similar demographic areas

Challenges & Solutions during project

Challenges• Been able to keep the

pathway on a micro level • Engaging the local

Chinese community• Project staff having the

knowledge and skills to move things forward

Solutions Support from the EPIC

team Clarity and focus on what

we are able to achieve in the pathway

Greater understanding in how we are taking the pathway forward

Challenges & Solutions during project

Solutions continued Enlisting the help of

other community resources (interpreter Researcher)

Dedicated Community development worker

Continual support Engagement for all

the project members

Some awareness training before commencement of the project

Agreeing at the outset the focus on the pathway

AFTER PROJECT

Challenges • Team disbanded due to

key organisational changes

• To keep the project as a priority within change management processes.

• Engagement with local Chinese community

• Deadlines to project

delayed• Absence of strategic lead

both at Local and EPIC project level

Key Learning Points

• Difficulty in defining project aims

• ‘small is beautiful’• Use of a local

manager• Lack of appreciation

in relation to the impact of cultural differences

• Self managed team approach (high levels of commitment from team members)

• Support required from the ‘decision makers’ outside of the core team

• Designated time out

One year on

• Consolidated progress, monitored and evaluated outcomes and never gave up

• Rolled out cultural awareness training amongst staff

• Applying model to other BME communities (including website)

• Applying model to other service areas through service re design

• Expanding research work to other minority groups through community staff involvement within teams

• Community Development worker linked to the project aims