Dr Michelle Cornes - Using the Community of Practice model for Women with Complex Needs The Road to Recovery for Women and Children Conference 2013

1. Little Miracles
Using Communities of Practice to Improve Front Line
Collaborative Responses to Women with Complex Needs
The Road to Recovery for Women and Children
Brighton 5th September 2013
Michelle Cornes & Jill Manthorpe
Social Care Workforce Research Unit, King’s College London,
Catherine Hennessy & Sarah Anderson, Revolving Doors Agency
Jo-Anne Welsh, Brighton Oasis Project

2. A Community of Practice is a
group of people who share a
concern, a set of problems, or a
passion about a topic and who
want to deepen their knowledge
and expertise by interacting on an
ongoing basis (Wenger, 1998)

3. Health and Social Care Housing Related Support
(22.12.10) Bob is admitted to an acute in-
patient mental health unit. Diagnosis:
mental and behavioural disorder due to
multiple drug use, and social anxiety
problems. Depression and attempted
suicide.
DISCHARGE PLAN
Because Bob is homeless he is referred
to a housing support project. A locum
consultant psychiatrist supports the
referral with a letter which is intended to
“expedite the tenancy”.
In the letter it is noted that any discharge
plan will include initial support from the
Crises Resolution and Home Treatment
Team. His CPN will then provide regular
monitoring and review. It is noted that the
drug and alcohol team are involved and
that he has a drugs worker allocated to
him.
8.3.10 Bob is accepted into a
Supported Housing Scheme and
discharged from hospital
Bob’s Timeline

4. Health and Social Care Housing Related Support
23.10.10 Bob has taken an overdose
of anti-depressants. Said it was an
impulse thing as he felt bad about
shoplifting… food parcel given.
Care Plans
Support Plans
?
On-going support provided
by a housing support
worker...
Bob’s Timeline

5. Cartoon from Community Care on Line June 2013

6. Community of Practice Development
Programme
To explore if ‘communities of practice’ might:
• Help us move beyond ‘sequential handovers’ toward more
meaningful collaboration
• Support workers by providing ‘shelter’ in what is an
emotionally pressured and stressful job role
Fo

7. Theory of Collective Capability
The hypothesis...
By building a network of mutual interest (a Community of
Practice) in which participants view themselves as owning the
‘same problem’ practitioners will engage in renewed
conversations about their practice, build their knowledge about
how things work, and adjust (improve) their practices
accordingly...
for achieving this.
i‘A learning process akin to what happens
in jazz ensemble’ (Soubhi et al., 2009 p53).

8. Maximising Collective Capability to
Improve Outcomes
• Agree a shared ‘work priority’
• Flatten hierarchies (shared leadership)
• Ensure frequent and timely communication
• Promote trust, mutual respect and appreciation of others’ roles and
responsibilities
• Faciliate crossing of professional boundaries and moving beyond habitual
practices toward an openess to experimentation
• Promote sharing of knowledge (explicit and tacit) and task integration

9. Psychologically Informed Environments (PIES)
‘To make the team the focus of attention is to pay due respect
to pervasive (dis)organising social defences and potentially
traumatising group dynamics that are at the heart of all work
with difficult people in difficult places’
(Scanlon, 2012 p214)

10. Community of Practice Development Programme (Mar 2012- Feb 2013)
Mental Health
Worker
Drug and Alcohol
Worker
Social Worker
Housing Support
Worker
Expert by Experience
Employment and
Training Advisor
Knowledge Broker
Facilitator
6 Communities of Practice established in
Workington, Halifax, Stoke, Brighton, Tower Hamlets, Colchester
plus a small scale (in house) evaluation -
Survey (n=33/54) and
Focus Groups with Community of Practice Members (n=34/54)
Criminal Justice
Worker

11. Evidence of Enhanced Collective Capability
Example 1: Sharing Knowledge Across Agency Boundaries
“I found it very useful. Just the fact of coming here and talking
with other professionals about best practice and reflecting on
best practice. We don’t often do that in our work... *It+ makes
you look at your own practice and how you’re working and
why you’re working like you are and it gives you ideas about
how other people are working... It’s just been really valuable.
A really good experience”
Member CP 1

12. Evidence of Enhanced Capability
Example 2: Task Integration

13. Little Miracles
Over 90% of survey respondents agreed:
• I have increased my networks and contacts
through my membership of the community of
practice
• My knowledge of the role and function of
other agencies has increased
• My skills and competencies in working with
people facing multiple needs and exclusions
has improved

14. Nice process but did it change
anyone’s life?
“From an outcomes point of view, having them stabilised for a
period of time is an outcome but it’s not one because they’ve
not progressed but they’ve not got any worse and actually
that’s a bloody big achievement for some of the customers
that we’ve been discussing” (Member CP4)

15. Integration
“The Challenge of Endings”
Emily - Outcomes (2008-2012)
Stability Fragile
Happy Tearful
Content Low
Self-esteem Distressed
Abstinent Lapsed
Made changes Suicidal
Weight loss
Fragile
Self harm
Panic attack
Child into care
Distressed
Distraught
Helpless
Stress
Debts
Overwhelmed
Vulnerable
Eviction Notice
Not engaging

16. Reality Check
‘We argue that social policy directives that optimistically
envisage a future where all [socially excluded] people will be
‘socially included’ involve an equally stubborn and dangerous
refusal to face up to the reality of these problems; a denial of
their essential complexity... Such belief systems are setting-up
socially excluded people and the workers charged with trying
to reach out to them to fail’
(Scanlon and Adlam, 2011 p131-132)

17. Not just a talking shop: sustaining the workforce in an
emotionally challenging and stressful job role
‘The value of this *Community of Practice+ is not necessarily
moving the customer on, it’s keeping the staff engaged and
motivated to continue to do what they’re doing on a daily
basis for the customer that’s presenting with the same
problem day in day out for three years. That can be quite
draining on the staff but actually to sit and talk about it and
get that collective support that we’re all going through the
same thing gives you a bit more energy and motivation to
carry on doing whatever it is, for a longer period of time’
(Member CP4)

18. Doing More for Less
Discussing the value of PIEs...
‘So our answer to the commissioners’ request, “can you do more for less”
is yes we think so. As long as commissioners are flexible and allow clinical
staffing as part of teams that are funded for housing-related support’
(Peter Cockersell, 2011)
Communities of Practice... Clinical advice for free!
“I remember thinking at the time that’s so simple why didn’t I think of that
... It was the simple thing of asking [the client] what are the positive things
in your life? ”
(CP 1: A ‘Housing Support Worker’ reflecting on the ‘solution focussed’ advice given freely by a fellow
Community of Practice member, a Community Psychiatric Nurse [CPN])

19. Can Communites of Practice provide intelligence for
local commissioners?
• Dual Diagnosis Pathway (often inaccessible to
women)
• Personality Disorder (lack of provision for
women)

20. Policy Implications
• Managers and commissioners need to nurture front line collaborative
practice. It will not just happen on its own. For a small financial
investment communities of practice can reap many benefits in terms of
delivering on the integration agenda.
• In times of austerity, accommodating the interplay between
organisational, educational and psychological factors may yield additional
benefits for both workers and service users when pursuing outcomes
linked to integration (collective capability)
• There is a need to be realistic about what outcomes can be achieved
through collaborative and integrative practice such as that found within
communities of practice. Maintenance and prevention outcomes linked to
resilient and continuous practice over the longer term should be valued
just as much as recovery (change) outcomes.

21. Reports
• Cornes, M., Manthorpe, J., Hennessy, C. and Anderson, S. (2013) Little Miracles:
Using communities of practice to improve frontline collaborative responses to
multiple needs and exclusions. London: King’s College London and Revolving Doors
Agency. Download at: http://www.revolving-doors.org.uk/documents/little-
miracles/
• Hennessy, C., Anderson, S., Cornes, M., and Manthorpe, J. (2013) Toolkit:
Developing a community of practice. London: King’s College London and Revolving
Doors Agency Download at: http://www.revolving-
doors.org.uk/documents/toolkit-for-developing-a-community-of-practice/

22. Contact Us
Michelle Cornes and Jill Manthorpe
Social Care Workforce Research Unit,
King’s College London, Strand, WC2R 2LS
michellecornes@aol.com
Catherine Hennessy and Sarah Anderson
Revolving Doors Agency, 4th Floor,
291-299 Borough High Street, SE1 1JG
Catherine.hennessy@revolving-doors.org.uk