1. health and fitness

FORENSIC EMPLOYABILITY
PATHWAY
Catherine Totten
Specialist Practitioner
Occupational Therapist
Cheryl McMorris
Head OT
Directorate of Forensic Mental Health
& Learning Disabilities
Employability
“Not
everyone wants to be employed, but almost all want to “work”, that is to
be engaged in some kind of valued activity that uses their skills and
facilitates social inclusion.” National Social Inclusion Programme (2006)
The right work in the right place, with the right tasks … and the right support
gives us:
 Social networks and contacts
 Structure and purpose to our time
 Physical & mental activity
 A sense of identity
 Money
 Skills
 Social Status
 Meaning to the concept of leisure
(Work Matters – Vocational Navigation for Occupational Therapy Staff, 2007)
Background to Pathway.
The Equal Access partners in conjunction with the
Scottish Executive, devised a generic employability
pathway. This determined the different support
systems required at each stage, to add clarity to the
process of gaining or working towards employment.
This employability pathway was created to help
individuals from the very earliest stages of
considering work through to those who have moved
into work and are learning the disciplines of holding
a job down and continuing to build their
employability.
Employability & the Forensic
Population.
It is well recognised that those who are most likely to be out of
employment include: people with no qualifications, lone parents,
people with disabilities or health problems in particular, mental health
problems; ex offenders and those with drug problems. (Work force
Plus - an Employability Framework for Scotland, 2006)
The benefits of work and employment are well evidenced, including
knowledge that enabling people to gain employment reduces
offending. (Lipsey, 1995)
Personal and social barriers, such as confidence, mental health and
substance misuse problems, and a lack of relevant skills and
qualifications make gaining work or employment much harder.
(Social Exclusion Unit, 2002).
Issues in relation to stigma, disclosure of history of offending and
mental health problems can cause additional problems for forensic
patients looking to access work.
Forensic Employability Pathway
The Forensic Directorate recognised the challenges faced by the
forensic population and the fact that they often represent some of
the most disadvantaged groups of people in relation to
employability potential. So….
 Customised the pathway to demonstrate forensic approach to
each stage, give examples of some of the activities, resources and
services utilised for this journey.
 A large part of the employability pathway is the collaboration with
other organisations to assist in provision of a range of meaningful
skills development opportunities, qualification attainment and work
options, and the protocols and support that we provide to enhance
these. These opportunities can provide further skill development
and important alternatives for occupational choice and
engagement in work tasks for those patients in the early stages of
the pathway or who are unready or unable due to current
situations to meet the demands of obtaining full paid employment.
Stage 1 – Positive Activity
Generic Pathway:
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Social Contact
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Social Support
 Sense of
Structure
Forensic Approach:
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Identification of individuals strengths and areas requiring development.
Identification of any volitional issues by OT / incorporation of the
remotivation process to enhance the motivation to engage in meaningful
activity
Development of individual’s day to day routine with regular programmed
activities (wide variety of choice available) based around individuals;
current volitional status, skills, functioning, interests & values, impact of
environmental contexts on engagement and risk / risk management.
Initial development of life skills and pre vocational training, personal and
social development.
All sessions are facilitated or supported by Directorate staff. External
tutors or external staff are utilised as required.
Examples of assessments used to inform include:
Volitional Questionnaire, OPHI II, Adult literacy & numeracy, Interest
checklist, Assessment of Motor & Process Skills, Model of Human
Occupational Screening Tool.
Forensic Stage 1 – Examples of
methods of delivery
On ward:
Activity Areas:
Individual sessions
Open informal groups
Basic ADL skills
Patient interest groups
Social Activities
Therapet
Acorn Project
ADL Skills
Adult literacy/ numeracy
ESOL
Gym / Physical Health
Music Lessons
Range from engaging volitionally challenged individuals, skill
assessment, habilitation & maintenance of ADL, life skills,
addressing specific issues (e.g. communication). Establish
appropriate routine & structure in preparation for moving onto next
stage.
Stage 2 – Work Preparation Initial
Generic Pathway:
Forensic Approach:
Helping individuals to
address personal
circumstances,
confidence building,
literacy & numeracy,
core skills
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Continued development of individuals life skills and ADL skills.
Focus on confidence and skills building utilising skills of staff
and external resources. Initial steps towards the community
through involvement with appropriate external projects – OT as
first point of liaison to the established contact person with in
resources.
Developing educational outcomes and working towards
qualifications with supported education – linked to patient
interest, strengths and future goals.
Early stage supported occupational roles - providing
opportunities to gain experience in the workings of groups and
meetings.
Examples of assessments used to support & inform
include:
As stage 1 and: Model of Human Occupation Screening Tool
(MOHOST), Occupational Circumstances Assessment
Interview & Rating Scale (OCAIRS)
Forensic Stage 2 – Examples of
methods of delivery
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Patient Councils– A council for each ward within the Directorate.
Early Occupational Roles– Patients supported to complete
Occupational roles within units and receive an incentive payment.
Education – Tutor emloyed at both sites - Educational Outcomes
include: PC Passport advanced, Highers in a range of subjects and
non vocational courses including History, Spanish, English.
Skills development projects: utilising different mediums e.g.
animation, art
World Affairs & Current Affairs: To develop adult literacy skills and
abilities and provide patients with a sociable discussion forum for
common interests
Newsletter Group: Supported by adult literacy tutors – next stage on
from adult literacy sessions.
Charlie Reid Centre: stabilising patient and personal confidence in
community setting
Stage 3 – Work Preparation – Later
Stages.
Generic Pathway:
Forensic Approach:Augmenting skills built on in stage 1 & 2.
Creating a greater job
focus, CV preparation,
job search,
volunteering, work
experience
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Patients ready for community placements for skill development –
OT facilitates individualised goal setting, grading planned actions &
activities for identifying strengths in relation to client’s skills,
educational achievements, physical abilities, & fitness for work.
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Identification of work type activities and individuals ability to tolerate
tasks assessed through use of activity analysis.
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Assessing suitable types of employment, volunteering, higher
education or work experience for individual.
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Identification and assistance with disclosure processes.
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Protocols established with community resources for referral
process, information exchange & continued liaison. Specified OTs
as organisational contacts with all community resources. Forensic
training packages and support offered to Community placements/
resources.
Examples of assessments used to support & inform include: As stage
1 and 2: plus Worker Role Interview (WRI).
Forensic Stage 3 – Examples of
methods of delivery
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Directorate Patient Activity Group –Representative from patients council attend.
Experience involvement and workings of groups. CV opportunity
Library Job: Supported work experience in unit – job description, application, interview
and contract for patient.
Supported work experience / In patient Café volunteer posts- job description,
induction, training - expected to adhere to policies e.g. sickness etc. Plans to link into
SVQ in customer service when SQA accredited site.
RESTART – Skills development, vocational qualifications (potential for job access – done
through joint work with OT.)
Coachouse – Skills development & potential for job experience, -art classes, gardening
project and woodwork.
Colleges: Various college courses.
Community health project: Volunteering Activities include: cost price fruit and
vegetables sessions, an allotment project, cookery groups and outreach work.
BTCV: Wide range of practical projects offering opportunities to gain new skills &
experiences and make a positive contribution to local environment.
Volunteer Projects: Links with Volunteer Centres, wide variety of volunteering projects
available – gardening to office work.
Stage 4 – In work, early recruitment
Forensic Approach:
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Utilising support from outside agencies – following the
Supported employment,
social inclusion agenda as per patient need - including
helping employees
mental health services, mainstream services and those
adjust to specific
linked to working with ex offenders.
barriers, active support.
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Links are established with services, for when patients
are at this stage. Joint working with external services to
assist in appropriate employment, OT as point of liaison
& continued support.
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Identification and assistance with disclosure process to
protect both patients and community.
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When patients successful in achieving employment
(supported or mainstream) we continue to offer support
for both employee and employers as appropriate.
Ensuring both have key contact details for any issues
arising.
Examples of assessments used to support & inform
include: As per previous stages and Work Environment
Impact Scale (WEIS).
Generic Pathway:
Forensic Stage 4 – Examples of
methods of delivery
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APEX: Work with offenders and young people at risk of
offending to address employability needs and progress them
towards employment, education, and training.
Enable: Community business aiming to provide employment
opportunities.
Flourish House: Promotes recovery using clubhouse model,
skills development, and supported employment opportunities as
appropriate.
Volunteering Jobs: Including Salvation Army, charity shop
work, Coachouse trust & leading change group.
Sympathetic / Positive Employer: Employers who actively
challenge discrimination – e.g. SAMH
Wise Group: Assists those facing major barriers to employment
e.g. history of offending or substance misuse, progress into
employment and further education.
Stage 5 – In Work Long Term Support
Generic Pathway
Monitoring & supporting
employees &
employers to retain
jobs, support those at
risk of losing jobs
Forensic Approach
 Maintainance of contact with & support of
patient to assist in job retention.
Identification of further skills and
qualifications development to assist with
career development.
 OT maintains link with employer for
support and to identify any barriers /
issues or developments as early as
possible.
 Helping employees idenitfy and adjust to
specific barriers.
 Support in working through benefits
available to those in employment.
What next?
Employability is a central premise of our approach to the inequalities agenda, we
continue to promote the employability framework in its wider context and application
and in partnership with external agencies, whose input is crucial.
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We maintain a continued commitment to employability for all our patients by:
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Continue to identify the gap between what individuals want to do and what their
current situation allows them to achieve and where possible helping them to bridge
the gap.
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Continue to source and provide a range of opportunities for skill development,
vocational rehabilitation, qualification attainment and employment for patients at all
stages of the employability pathway.
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Continue to develop stronger working relationships with organisations, resources
and services, with joint working protocols in place to ensure consistent
communication and support for both service and patient.
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Continue support for the patient group, services and employers in relation to safe
disclosure of offending and mental health conditions.
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Continue to work towards social inclusion for our patient group - utilising main
stream services and employment strategies.
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Annual audit and review of the NHSGGC Forensic Employability pathway.
References
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Lipsey, M. (1995) What do we learn from 400 research studies on the
effectiveness of treatment with juvenile delinquents? In: McGuire, J. (ed) What
Works: Reducing Reoffending. Guidelines from research & practice. West Sussex,
England: John Wiley & Sons
National Social Inclusion Programme (2006) Vocational Services for people with
severe mental health problems: Commissioning Guidance. London: Department of
Health
Ross, J. (2007) Occupational Therapy & Vocational Rehabilitation. John Wiley &
Sons
Scottish Executive (2006) Work force Plus - an Employability Framework for
Scotland.
Social Exclusion Unit (2002) Reducing Reoffending by Ex-prisoners. London:
Social Inclusion Unit
The College of Occupational Therapy & National Social Inclusion Programme
(2007) Work Matters – Vocational Navigation for Occupational Therapy Staff.
Waddell G., & Burton, K. ( 2006) Is Work Good for your Health & Wellbeing?
London: Stationary Office
Contact Details
Catherine Totten
Specialist Practitioner Occupational Therapist
Forensic Community Mental Health Team
Clutha House
120 Cornwall St South
Glasgow
G41 1AF
Tel – 0141 427 8378
[email protected]