3. SOS 100 Cases: Statistical Overview
It should be noted that initial engagement levels with the service have remained at a steady 70/71% (peak was 79% in 2013). That is, approximately one third of cases referred do not engage at all. Of those that do, a further 25% approximately drop out after initial engagement with the service. In the main these were females aged 20-29yrs and 40-49yrs. The reasons related to:
- issues arising in their lives such that they decide to drop out (the door was always held open to them returning at a later date).
- dropping out with no further contact and therefore no known reason.
3.1 Patient Characteristics (Table 1-3)
- 60% of cases were female and 40% male, which was almost identical to the gender balance within the TOTAL referrals to the SOS service. Thus, the 100 cases were gender representative of the data set as a whole (Table 1).
- 71% of the cases were aged 30-59yrs (71%). This was a higher percentage than the same range in ALL referrals (57%, 116). Thus the range who engaged in this sample was narrower than those who were referred (Table 1).
- Just over two thirds (67%) of cases were unemployed (70% males; 65% females). Within this group, 61% (41) were unemployed due to being unfit to work/long-term sick. That represents 41% of the case study cases (Table 2).
- 79% (79) of case patients were on benefits (72%, 29 of males; 83%, 50 of females). The main benefits were ESA, housing support and council tax (Table 3).
3.2 SOS Operational Outcomes (Tables 4-5)
The service had set an initial target of 4 consultations within which to work in collaboration with the patient to assess their needs, identify the barriers and facilitators to addressing their needs, set achievable goals and link the patient to the identified relevant services and or activities/learning opportunities. Table 4 shows that the Link Workers were averaging 3 consultations per patient and the majority of cases were dealt with within the 4 consultation target. The target of 4 consultations does not include any additional supported visits to services/ activities that were required.
Table 5.1 shows that over half the 100 sample cases (59) had received supported visits from the Link Workers, with an average of 2.6 visits per case. Just over half of those receiving supported visits were aged 30-49yrs (Table 5.2). Proportionately more females in the age range 40-49yrs received supported visits than males.
The 59 patients who received supported visits accessed 81 services. Not all accessed services required a supported visit thus, of the 81 services accessed, 79% (64) required supported visits. It should be noted that the services generally have a similar pattern of supported visit usage with the exception of Dundee Healthy Living Initiative (DHLI) activities and Connect, where there are more cases with two visits than one visit (Table 5.3). Three 'outlier' cases are worth noting:
- one case with 7 supported visits to an activity group: in this case, the complex health status of the patient, combined with a lack of locally appropriate services and transport, meant the Link Worker had to look further afield and organise supported visits to ensure the patient got access to an appropriate activity.
- one case with 4 supported visits to a drug and alcohol support organisation: here, the supported visits acknowledged the need to create a supported routine of going to the service, without which the patient's compliance might have been in doubt.
- one case with 4 supported visits to an activity group at a support organisation for people with mental health issues: this patient suffered from chronic anxiety re leaving home and going somewhere unfamiliar. Supported visits allowed a gradual exposure that helped the patient settle in a new environment with new people.
The outliers demonstrate both the need for flexibility on a case-by-case basis in the use of supported visits and the ability and willingness of the Link Workers to 'go the extra mile' to ensure patients could access the help they needed.
There were 38 cases (64%) where at least one goal was met without the need for a supported visit and just under half (44%, 81) of all goals set (185) were met without the need for a supported visit. Of the 21 cases with 3 or more supported visits, anxiety was a feature of the patient's mental health profile in 13 (62%). However, it was only identified as a possible 'barrier' to the patient addressing their issues in a third (7, 33%) of supported visit cases. It should be noted that anxiety as a referral issue was present in 48 cases out of the SOS 100 cases, with 16 individual cases where the Mental Health goal related directly to anxiety. The latter result was in part due to the anxiety being dealt with more indirectly through addressing other goals (e.g. social isolation, where the anxiety might be an underlying issue; finance, where the anxiety might be heightened by the lack of money, concerns re benefits). In nine cases patients had issues with leaving their homes and if mobility per se was added in then just over half (52%, 11) of patients with three or more supported visits had issues with leaving their homes.
3.3 SOS: Goal Outcomes (Tables 6-8)
Goals were set in concert with the patient and focused on the patient's agenda. An average of 2.8 goals were set per case, with a range of 1-8 goals (Table 6.1, 6.2). Nearly three quarters (72%, 195) of all goals were met and 85% of goals had some positive outcome (combining the partial and met categories). In overall terms, 45% (43) of patients had all their goals met by the service and 82% (78) of patients had two thirds or more of their goals met (Table 6.4). Only 7 patients had no goals met.
The main reason patients failed to meet their goals was not turning up at the suggested service/activity (Table 6.3). Another notable reason was deterioration in the patient's mental health and beyond that - patients becoming overwhelmed by issues in their life. It should be noted that in some cases a negative cascade effect occurred (e.g. life events overwhelming a patient, leading to a deterioration of their mental state and therefore not turning up at services/activities).
The most common goal themes being addressed, in terms of individual cases, were mental health (e.g. low mood, depression, anxiety), activities, finance, physical health and social isolation (Table 7.1, Table 7.2). In terms of the number of goals set, the most common themes were the same with the addition of housing. In other words there were fewer cases where housing was a thematic per se, but where it was there tended to be more than one housing issue to address.
The SOS 100 cases produced a wide range of goal combinations, the most common of which were:
- mental health and activities; mental health and finance
- mental health, activities and health
- mental health, finance and social isolation
- housing, finance and health/mental health.
In terms of the actual issues the goals encompass then the most common issues were:
- effects of anxiety on day-to-day functioning
- effects of poor physical health (e.g. pain, mobility)
- lack of finance
- lack of structure to the day
- lack of ability/opportunities to socialise
- unsatisfactory housing re patient's needs.
Cases were not just a combination of distinct goal thematics, for example mental health and finance, but had different issues to address within a thematic, as in one case where there were three health goals and a finance goal. 22% (22) of all SOS 100 cases had such combinations: finance, housing, health and mental health were the thematics most affected. For example, in one case there were three health related goals: support re stroke; help to reduce alcohol consumption; and help with self-care/eating. In another example there were three finance related goals: reconnecting gas supply; access to bedroom tax discretionary fund; and organising a benefits payments card. This indicates not just the complexity of the needs, but how one particular thematic within a case can be key to moving the patient's whole circumstances forward.
In order to look at the Goal Thematics v Goal Achievement the data was divided into two groups following statistical convention:
- Group A: those Goal Thematics where 10 or more goals were set
- Group B: those Goal Thematics where fewer than 10 goals had been set
Within Group A 70% or more goals were achieved in five thematic groups (Fig 3b). Within Group B three goal thematics (carer, skills/learning and other, e.g. food bank, travel issues etc.) returned the highest achievement (Table 7.3). Only two thematics fell below 50% achievement: bereavement and confidence/self-esteem (both largely as a result of patients not taking up the suggested services).
In terms of Goal 1, (which might reasonably be seen as the most pressing need) the common themes were mental health, activities and social isolation. Over three quarters of first goals were met and within that 100% of the goals related to 'activities' were met. (Table 7.4).
3.4 Service Pathways (Tables 8-9)
A wide range of services were being accessed to address patient goals but in reality 55% (50) of patients had their goals addressed by accessing 2 or 3 services (Table 8, Table 8.1). A further 27% (25) of patients had their goals addressed by accessing 4 or 5 services. In part, the results reflected the fact that a number of services were providing multi-issue solutions e.g. DAMH, Penumbra, Connect, Positive Steps, Remploy, Youth Literacy Team. For example, DAMH creates an umbrella for different projects and provides everything from support groups to activities, to befriending. Thus, in one case the patient started at the 'drop-in' and graduated to the music group and befriender service. The most commonly accessed services related to counselling, finance, activities, housing and employment (Table 9.1, Table 9.2).
3.5 The Role of the Link Worker (Table 10.1 10.2)
The Link Workers undertook a variety of roles within the 100 sample cases beyond the initial collaborative identification of issues to address (Table 10.1). The principle role was that of facilitating the patient's 'goal/s', by suggesting services and groups that could potentially meet their needs; referring the patient to the relevant service/activity and making any necessary appointments. The patient chooses the services/activities they wish to engage with, not the Link Worker. The second major role was providing information to the patient on services/activities and, allied to that, researching new services. This was followed by liaising with services and supporting the patient to access the service.
Just over three quarters (76%, 212 goals) of all goals required between one and three Link Worker roles (Table 10.1), the most common being a combination of facilitation, research/information and support (Table 10.2). Section 5 of the Interim Report expands on the role of the link worker both at case level and within the wider service environment.
Email: Naureen Ahmad