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The Care Programme Approach and its Effectiveness

Summary Report by Sophie Jones

The Regional Health Authority of East and West Kent commissioned this report. It was decided 3 years ago to develop a user and carer empowerment programme. A one-year feasibility study was conducted, and the following two years were spent doing the research with guidance, technical support and training by consultant, Pat Donlan.

The intention of the report was to utilise and develop skills from service users in the field of research, (currently an underdeveloped area in user empowerment). It would also help to empower service users to influence the planning of future services by enabling them to be part of the management and planning board, presenting findings and an evaluation. It was hoped that this exercise would widen and develop the skill base among service users.

Share Medway Mental Health was chosen as one of five user empowerment projects to participate in the project. They decided to research the outcomes and effectiveness of The Care Programme Approach (CPA) on service user lives. It was hoped to ensure service users were getting the best possible care and if they were unhappy about CPA, that something could be done about it. It was also hoped that managers and planners could evaluate how effective CPA was, and what alterations need to be made (if any) in line with the needs of service users, and that these would be cost effective.

Service users from SHARE individually devised a list of questions about CPA. These questions were discussed by the group and reduced to a list of 14 from which a semi - structured interview was formed with the help of Pat Donlan. Requests to service users subject to CPA in the Medway area to participate as interviewees was then sent to local social services. It was decided to make one person responsible for the complete task. Other people would be involved, but a co-ordinator was appointed to complete the research project.

A summary of the findings is outlined here:
CPA is generally regarded as positive by service users, however there exists inconsistencies about how the care plan is being explained to people. There needs to be found a way of enabling service users to understand the purpose of CPA.

There are also inconsistencies about how, when and with what frequency a care plan should be carried out. It is necessary to look at the circumstances under which a review is carried out, and make recommendations about best practice.

Although people felt positive about CPA, there was also a general expression of passivity given the number of mixed responses to many of the questions.

The ability of CPA to make radical changes to the lives of service users is perhaps over-estimated. Service users feel neither more empowered nor have their needs been fully resolved. The potential of CPA to empower remains, and the question of how to enhance empowerment needs to be addressed.

Recommendations
CPA should be kept and built on. It shouldn't be forced on people; they need to feel part of the value of it. CPA should be conducted when there is a need for it, whether it is every two months, every week, or not for three years or more. The criterion for a review should be whether the individual is in crisis or distressed.

In order for service users to feel more actively involved, they should be offered an advocate, whether it is a friend, family member or volunteer. This should be standard practise, and would have the effect of giving them more of a stake in the process.

Staff training should involve the input of service users to help understand how best to empower service users in their care.

Further research needs to be carried out to understand how the staff views the CPA process, and what improvements could be made from their point of view.

Many service users interviewed enjoyed the opportunity of being asked questions about their care and reflect on their problems and treatment, maybe answering questions about the adequacy of their treatment should become part of their treatment somehow. A service user audit conducted by and for service users.

Reflections
It was a difficult subject to evaluate since there were no overall strong feeling being expressed about CPA. The evaluation was difficult, as there were no real definite patterns emerging from the research that jumped out at you.

The subject has turned out to be very topical and I have been asked to attend an audit of CPA from the service user perspective as a result of doing this research. It is thanks to Bill Gooch who was involved in the beginning and pushed for us to study the topic. He put in a lot of work into the questionnaire design and attempts to access people to interview. I took over the work without having been involved in putting the questionnaire together. This was a bit frustrating for me, but was not a problem since the questions produced a very rich, diverse and interesting response.

It was also a pleasure to work with the managers of local day centres, who were very helpful. Also the manager from the local advocacy centre was helpful in providing people to interview and was also very supportive of the whole project. I am particularly grateful to her for helping me with coming to terms with the problems presented to me by a respondent whose problems I found difficult and harrowing.

I had my fair share of personal problems while involved in this project. I am very pleased to have been able to produce the fieldwork and the report with help from Share management committee. We tape-recorded a discussion between myself and members of the Share management committee and the empowerment worker, Sue Cooksley of the findings from the fieldwork. This greatly enhanced the quality of the findings and was an enjoyable experience for all of us.

For the future, it would be good to see some or all of our recommendations put into practise and taken seriously. It would be good to be involved in on-going discussions about the best way to care for the mentally ill, and be able to influence changes in current practise.

There were many people involved in the survey and production of the report. Much was learned about research and the skills involved. It has produced an interest in participating in discussions around the best way to care for the mentally ill and effective ways to do this.

Sophie Jones with Share Medway Mental Health, April 2002