FFW presentation BPS 2016

Chronic Pain and Employment

Veronica Ball BSc OT Clinical Case ManagerThe Fit for Work Team

www.fitforworkteam.org

Veronica Ball Occupational TherapistClinical Case Managerwww.fitforworkteam.org

Areas to be explored• Individuals moving from unemployment to

employment, voluntary work or training using PMP and a job broker (Pilot 1)

• Additional interventions PMP/Mindfulness/CBT service without a job broker (Pilot 2)

• NHS Innovation challenge : Unexplained or Unresolved Pain Pilot including Case Managers and Employment support

Medically Unexplained Physical Symptoms

• It is estimated that medically unexplained physical symptoms are the main reason for between 15% and 19% of GP consultations in the UK

• And up to 70% of people suffering with MUPS will also suffer from depression and/or anxiety disorders

www.rcpsych.ac.uk

DWP From Pain to Prospects

Individuals moving from unemployment to employment, voluntary work or training using PMP and a job broker

• Job Centre Plus • 30 People changed from ESA to JSA – Taken off long term health benefits

• Chronic pain is the main barrier to work• Comprehensive face to face assessment - GP/OH

Physician• Interventions – Clinical review, GP communication– Pain Management Programme – Employment support/vocational rehabilitation

DWP From Pain to Prospects

Activity prior to Intervention •34 referred to service from DWP•24 taken into the service •17 letters to GPs to consider diagnosis and/or start/change medication•15 referred for Pain Management Programme (8 first cohort)

Pain diagnoses•4 - Fibromyalgia (one diagnosed pre pilot)•4 - Regional myofascial pain •12 - Neuropathic pain ‘element’ (one diagnosed pre pilot) •2 - CRPS type 1 •2 - Surgical interventions – ‘made things worse’.

Outcomes•5 of 8 completed first Pain Management Programme (PMP)•PHQ-9, GAD-7 and PSEQ all improved

DWP From Pain to Prospects

Vocational Outcome Final March 14th 2014

Paid employment 8Voluntary work 2Vocational Training 2Total (12 set by JCP) 12 (40%)

Work Programme return to work rate is 5-8% Work Programme - official statistical summary. DWP. 2013. https://www.gov.uk/government/organisations/department-for-work-pensions/series/work-programme-statistics--2#the-latest-release

DWP From Pain to Prospects

Outcomes for those not returning to work/training

18 people who volunteered for the service did not enter paid work/volunteering or vocational training

11 maintained contact with the team but were discharged with no clear plans for return to work

4 withdrew from or lost contact with the service

1 person died from a cause unrelated to the chronic pain condition

Case Study

• George was out of work for many years, he was diagnosed with Fibromyalgia

• He struggles with day to day activities, • He has dyslexia which affects his ability to sequence events

and difficulties with reading & writing • Issues loss of his own business, anxious about the future &

how he was going to provide for his family• He was supported by a Job Brooker to develop his CV, Job

application, and a referral for Business start-up• He was employed by b-inspired as a Premises Officer he

manages his health condition & work.

Pain to prospects• “I think with the scheme I have gained confidence everything has

fallen into place” Female, age 34, out of work for 13years now working in the education sector

• “I have more confidence very good, excellent would be the word. I would recommend the scheme to others” Male age 51, out of work for 4 months, now working in the retail sector

• “I would say go for it, I would recommend the project to others” Male age 56, out of work for 12years. Now volunteering in the charity sector

• “Magic ! More confidence in myself, health is improving slowly, you get the help you need” Male age 45, out of work for 17years. Now working in the food sector

NHS Innovation Challenge

Exploring additional interventions PMP/Mindfulness/CBT service without a job broker

IAPT/GP identifies and refers UUPP

patient

Assessment dayInitial assessment by Fit For Work Case Manager

based on biopsychosocial model

Agree intervention pathway

Action plan agreedGP review of clients

Group Pain Management Programme

7 sessions

Mindfulness (MBCT)8 sessions

Online Pain Management Programme

26 units

Medication or healthcare unmet

need

Discharge Assessment documents

repeated and compared with

initial assessment

Inform IAPT/GP of discharge

Pilot2

• Referred via GP or IAPT services• Clients with unexplained or unresolved pain

symptoms• Assessment and range of interventions PMP, self-directed computer based PMP & Mindfulness based Cognitive therapy (MBCT)

Unexplained or Unresolved Physical Pain Pilot

Fit for work Team •Case managers :Information Advice & Guidance (IAG) supported by a GP & Occupational Health Nurse•Regular supervision, cases were reviewed with clinical staff & outcomes monitoredOpen Mind IAPT•Nurses/Social Workers/CBT therapists delivered Mindfulness MBCT following training specifically in Pain Management•Regular supervision, cases reviewed and monitored

DWP From Pain to Prospects

Referral criteriaInclusion•Patients with Unexplained pain or not responding to regular therapy•Pilot targeted people of working age as UUPS prevalence is high in this groupExclusion•Patients with cancer pain•Acute referrals•Patients receiving other active intervention

Interventions

Assessed by Case Manager given choice of 3 programmes•Group pain Management•Mindfulness CBT•Self –directed computer based programme

Scoring tools

Pre assessment – self reported•Pain detect•Pain Self Efficacy Questionnaire•EQSD•PHQ-9•GAD-7•IAPT Phobia scale•Work & Social Adjustment scale

Safety /Risk identification

• FFWT GP review if • Pain detect >18• Red flags (as per NICE guidelines for painful

conditions) • Personal/Health/Work/ Other• Self harm ideation• Alcohol or substance misuse

Additional interventions107 clients referred : 56% from IAPT Therapist and 44% from GP•60% Female Vs 40% Male•34% of clients were aged 30-44 46% of clients were aged 45-59•59% were BME•68% of clients were unemployed•Average length of time in the service = 19 weeks •Main reasons for referral into the service: MSK Back/Neck & Fibromyalgia

Number who chose programme

Number who attended Finished entire programme

Pain Management Programme

23 16

13 (57% of those who chose the

programme)(81% of those who attended)

Mindfulness Therapy25 23

16 (64% of those who chose the programme)

(70% of those who attended)

Online Pain Management Programme 16 16

8 (50% of those who chose the programme and

attended)

Additional interventions Outcomes

Max. score for PHQ-9 = 27 Max. score for GAD-7 = 21Max score for EQ-5D VAS = 100 Max score for PSEQ = 60

• “It helped me to accept the pain I’m going through and show the way to manage the pain”

• “I realised I’m not suffering alone”

• “Personally made me feel better that there was someone listening”

• “Mindfulness should be in schools to help people later in life to cope. It certainly would help to reduce stress and its associated health effects”

• “I thought Mindfulness would be a waste of time. Now it’s the best thing that has happened to me in years”

• “Mindfulness helped me more than I has hoped, because in the time that I have been attending the course, I have nearly stopped my pain medication”

Clients comments who attended the PMP & Mindfulness

IAPT/GP identifies and refers UUPP

patient

Assessment dayInitial assessment by Fit For Work Case Manager

based on biopsychosocial model

Agree intervention pathway

Action plan agreedGP review of clients

Group Pain Management Programme

7 sessions

Mindfulness (MBCT)8 sessions

Discharge Assessment documents

repeated and compared with

initial assessment

Inform IAPT/GP of discharge

Unemployed ClientsJob support:•CV writing•Job search support•Interview skills•Job clubs

Employed ClientsCase Management Support:•Debt advice•Confidence building •Legal advice•Employer liaison/ mediation•Exercise referral

New Journey

Unexplained or Unresolved Pain Pilot

• 1st programme completed April 2016 awaiting results• 8 people attended with the option of either a Pain

Management Programme or Mindfulness sessions• The new journey includes interventions from Case managers

trained to support individuals through either the unemployed or employed route.

• Other issues related to Unemployed people can include housing, debts, chronic health conditions, substance misuse which often need resolving before individuals consider going back into a job role.

Any questions

Veronica BallClinical Case Manager

Fit for Work Team