Connecting People Implementation Study
Published May 2021
Published May 2021
Loneliness and social isolation are widely recognised as signiﬁcant problems for people with mental health problems. Community mental health teams (CMHTs) provide community support for people with severe and enduring mental health problems, though few evaluations of practice in CMHTs which improve service users’ social connections have been conducted.
Connecting People is strengths-based social care practice (see Box) which assists people to engage more with their communities and enhance their social connections with others (Webber et al. 2016). The programme can improve individuals’ access to social capital (the resourcefulness of someone’s social network).
The Connecting People pilot study (2011–2014), funded by NIHR SSCR, found that when Connecting People was fully integrated into health and social care teams, service users enhanced their connections to family, friends and members of the local community. However, local authority and NHS teams found it difﬁcult to implement Connecting People fully (Webber et al. 2018).
The study used implementation and comparison CMHTs teams in ﬁve mental health NHS Trusts to evaluate the implementation of Connecting People by practitioners using a pack of high-quality implementation materials – including practice guidance, training manual, service user’s guide and implementation manual –
co-produced by mental health service users and researchers.
Service users (n=159) were recruited and interviewed at the beginning of the study (n=151) and six-months later (n=127) using structured questions.
They were also asked about their experience of being supported to develop their social connections at the follow-up interview.
Practitioners were asked about their experiences in focus groups within the teams taking part in the study.
This is a programme that involves a worker:
Connecting People was not fully implemented in the community mental health teams (CMHTs) in this study. Full implementation required teams to fully engage with the local communities of service users to support the development of activities, networks and resources for people beyond mental health services. A focus on the mental health needs of those in crisis or highest need meant that community engagement received a lower priority than afforded in the Connecting People model.
As a result, there was no difference in outcomes for service users of practitioners who received the implementation materials and those that did not. The researchers measured their access to social capital (the resourcefulness of their social networks), mental well-being, experience of recovery, goal attainment and self-rated health.
Practitioners who used the Connecting People implementation materials found them helpful in framing or directing some of their work. Some found the tools for mapping people’s social connections useful, while others found the intervention provided a useful structure to help people move towards their goals.
The researchers also measured the costs of the implementation of Connecting People. They asked service users which services they used in the six months before and after implementation started. The cost of these were calculated using standard pricing tools. They also asked practitioners in the implementation teams about additional activities they undertook to carry out the programme.
They found no difference in cost between the implementation and control groups. On average, care co-ordinators met service users about once a month, with social workers having less frequent contact with them than community psychiatric nurses. There were a limited number of support workers assisting with the implementation of Connecting People in the participating teams. It is possible that more frequent than monthly contact may be required to implement Connecting People, at least in the initial phases of working with individuals.
Connecting People was partially implemented in three of the teams, though only one provided training to their staff in the model. The researchers provided a budget of
£1,000 for implementation teams to use for training or consultancy to support implementation, but there was no evidence that this was used. However, two of the teams offered additional supervision in Connecting People from a manager and a senior social worker.
Practitioners who found it difﬁcult to implement the model in their practice highlighted that their high caseloads, understafﬁng, and having to prioritise work with people in crisis often meant that they did not have capacity to support service users with their social connections.
Other barriers to implementing Connecting People included a lack of public transport in some rural and semi-urban areas which made it difﬁcult for service users to engage with community activities. Additionally, in some local communities there were limited affordable resources for people to access.
For service users, barriers included social anxieties and ﬁnancial constraints. For example, many opportunities for social contact required either payment for the activity or group, or for a coffee, which made them difﬁcult for some people on low incomes to access.
The implementation materials were designed to be used by any practitioner within multi-disciplinary CMHTs. In the study they were predominantly used by social workers, occupational therapists and support workers, who were a small proportion of CMHT members, though some community psychiatric nurses were also involved in some teams.
There appeared to be limited organisational support for the implementation of Connecting People. There was a lack of clarity about the model in most sites, due to teams not providing training on the Connecting People model.
There was also the question of whether community mental health teams are the most appropriate settings in which to introduce a model focusing on social connections when those who have most regular contact with mental health professionals are largely too unwell to focus on social connections and those who are well enough tended not to have sufﬁcient contact with practitioners for the model to be implemented. Most of the CMHTs were operating in part as de facto crisis teams and thus practitioners did not have the time, resource or capacity to focus on developing or maintaining people’s social connections.
Previous research has found that it can be implemented more fully within third sector organisations such as charities or social enterprises.
Service users in the implementation and comparison groups made similar comments about their experiences. Participants in both implementation and comparison groups said that they had received support from their practitioner to connect them with other people.
Those in the implementation group did not report receiving substantially different support from those in the comparison group. However, in the implementation team which organised and delivered training in Connecting People, most of the service users reported receiving support with their social connections in contrast to the comparison group in the same NHS Trust where most said that they had no support.
Service users in both groups offered many and varied examples of the types of activities they were supported to engage in, most commonly self-help or some form of therapy, exercise and ﬁtness, education, training, employment, hobbies and skills, and volunteering. The majority of activities took place outside the home and involved making face-to-face connections with new people, usually in an organised setting. Most of the participants felt part of a community, which was variously deﬁned but predominantly focused on the local area in which they lived.
Most of the participants in both groups stated that there had been at least some positive impact on their wellbeing from their increased social connections and/or awareness of opportunities locally. The positive impacts most commonly speciﬁed by participants (in both groups) were improvements in mental health, greater conﬁdence and self-esteem, and an improved social life.
The study was limited by having a short follow-up period (6 months) and recruitment period which placed pressure on teams who were also trying to implement the model.
Webber, M. et al (in submission) The implementation of Connecting People in community mental health teams in England: practitioner and service user perspectives, Health and Social Care in the Community.
Moran, N., Webber, M., Dosanjh Kaur, H., Morris, D., Ngamaba, K., Nunn, V., Thomas, E. & Thompson, K.
(2020) ‘Co-producing practice research – The Connecting People Implementation Study’ in Joubert, L. & Webber, M. The Routledge Handbook of Social Work Practice Research, Abingdon, Routledge, 353–367
Webber M, Ngamaba K, Moran N, Pinfold V, Boehnke JR, Knapp M, Henderson C, Rehill A, Morris D (2020) The implementation of Connecting People in community mental health teams in England: A quasi-experimental study, The British Journal of Social Work, bcaa159, published online September.
National Collaborating Centre for Mental Health (2019) The Community Mental Health Framework for Adults and Older Adults, NHS England and NHS Improvement and the National Collaborating Central for Mental Health, London.
Webber M, Morris D, Howarth S, Fendt-Newlin M, Treacy S, McCrone P (2019) Effect of the Connecting People Intervention on social capital: a pilot study, Research on Social Work Practice, 29, 5, 483-494.
Webber M, Reidy H, Ansari D, Stevens M, Morris D (2016) Developing and modelling complex social interventions: introducing the Connecting People intervention, Research on Social Work Practice, 26, 1, 14–19.
Webber M, Reidy H, Ansari D, Stevens M, Morris D (2015) Enhancing social networks: a qualitative study of health and social care practice in UK mental health services, Health and Social Care in the Community, 23, 2, 180–189.
NIHR School for Social Care Research (2014) Evaluation of the Connecting People Intervention: A Pilot Study, Research Findings 28, NIHR School for Social Care Research, London. www.sscr.nihr.ac.uk/wp-content/uploads/SSCR-research-ﬁndings_RF028.pdf