Think Ahead evaluation praises model’s impact but highlights mental health social work challenges

Long-term success of scheme hinges on delivering consistency and flexibility across uneven health and social care landscape, academics conclude

Think Ahead
Think Ahead participants. Photo: Think Ahead

The Think Ahead fast-track programme has “demonstrated the potential to enhance the workforce” but faces a challenge to sustain environments within which mental health social work can flourish, an independent review has found.

Today’s report, which focused on the first two cohorts of the scheme, concluded that it offers a “robust preparation” for its roughly 100 annual participants, most of whom become “highly valued recruits”.

Of Think Ahead’s initial 95 participants, who trained between 2016 and 2018, about 80% were employed as social workers 18 months after qualifying. By comparison, 74% of 2017 graduates from undergraduate or postgraduate courses were employed as social workers six months after qualifying.

But, academics from Durham and Bristol universities added, unevenness in type and quality meant practice placements for Think Ahead trainees – mostly within community mental health services delivered by local authorities or mental heath trusts – resulted in “considerable variation” in how trainees experienced the programme.

Key findings

  • Think Ahead “has demonstrated the capacity to recruit and induct a cohort of highly capable and committed practitioners”.
  • The partnership model “is able to provide an effective framework for programme delivery”, but learning experience can suffer when staff leave or preparations are insufficient.
  • The engagement of service users in programme delivery was “highly valued by participants, and enhanced commitment to social work values”.
  • There were teething problems including around readiness for practice, how well service users were involved, and practice learning consistency, though these appeared to be being addressed.

Some hosts were “unprepared for hosting a new cadre of students whose professional identity was not always well understood by non-social work colleagues”, the report said. It also found the realities of mental health social work could sometimes provide a harsh rebuttal to Think Ahead’s pitch to applicants that they could become ‘change makers’ in the profession, which risked demotivating graduates.

For Think Ahead to succeed over the longer term, it must deliver its model consistently yet with flexibility to local circumstances, including whether trainees enter a health- or local authority-led setting, the report concluded.

‘They’re brilliant’

Think Ahead’s programme structure largely mirrors that of Frontline, the fast-track children’s social work training course. Participants undertake a six-week ‘summer institute’ crash course in theory followed by a year’s qualifying placement, in a ‘unit’ of four with a supervising consultant social worker (CSW), then their master’s year as an employee at their host organisation.

This is alongside their assessed and supported year in employment (ASYE). Like Frontline, it targets graduates with at least a 2:1 in their first degree and provides a tax free bursary to cover the summer institute and year one placement, currently worth £17,200 outside London and £19,000 within the capital.

Unlike Frontline, that master’s – with other academic elements of the course – is still externally administered. The universities of York and Central Lancashire were responsible for the first three Think Ahead cohorts with Middlesex University set to take over the contract in autumn 2019.

The independent evaluation found Think Ahead’s summer institute mostly set participants up well. Some teething troubles – including around course balance and organisation, both of which trainees criticised, and the involvement of service users – were being addressed by the time the second cohort started, said researchers.

Interviewees from host authorities related mostly positive impressions of Think Ahead participants, and of their academic training. “They’re brilliant. They’re really passionate, they care,” said one.

Both employers and participants observed that while they came on placement well-grounded in the social interventions on which Think Ahead is based, having opportunities to apply them in different settings was less straightforward.

“Applying models of intervention to one’s role as a social worker in a multidisciplinary team with a particular client group (e.g. psychosis, dementia) were issues for managers and CSWs as well as participants,” the report said.

Nonetheless, most trainees found their placements to have been valuable. Meanwhile hosts felt they had offered “excellent opportunities during placements to work on the academic components of the course and to reflect on, and integrate theory with practice as a result of having a protected caseload”, the report said.

‘What’s the point in a social worker?’

Despite the broadly positive picture, the study found local differences led to major disparities in first-cohort participants’ experiences of Think Ahead. As with Frontline, the quality of support offered by host organisations’ CSWs – and the management structures above them – proved crucial.

“For some [organisations], the inclusion of a new group of graduates was relatively straightforward, whereas for others, ‘teething troubles’ (and more) were encountered, as practical and local political issues had to be addressed,” the report said.

A number of participants noted uncertainty around professional identity, going into placements in health-led settings unaccustomed to social workers.

“One of the first things that got said to us by the team when we first started is: ‘Well, what’s the point in a social worker? Why are you even here?” recalled one.

Some trainees unsurprisingly voiced frustration at the knowledge that peers were having better placements than they were. For a small number, placements were so ill-suited that they provided an “alienating experience”, the study said, influencing decisions to leave the programme.

Second-year pressures

The landscape became uneven in a different way during year two, with different hosts’ recruitment needs meaning trainees were offered contracts of varying length and stability, across a range of roles.

The second year also marks a pulling back of support as the master’s gets underway and participants enter their ASYE year. The report recommended a more managed transition phase between years one and two, to prepare participants for the increased pressure, coupled with better communication so trainees continue to feel part of the programme during its second half.

Around half of respondents to surveys early in years one and two reported being stressed. These figures were higher than the 40% of newly qualified children’s social workers who reported stress to a 2015 study, though roughly in line with a large evaluation of mental health social workers carried out in 2006.

Some participants who responded to an exit survey reported panic attacks and feeling close to burnout by the end of the programme.

Host staff members also drew attention to the pressure of the programme, with one recalling trainees crying and with “bags under their eyes”. Nonetheless, the interviewee added: “I cannot fault the quality of the participants. They have managed a really demanding workload and academic studies at the same time.”

‘Assertive enthusiasm’

Mark Trewin, a service manger for integrated mental health services in Bradford, currently seconded to the Department for Health and Social Care, said first-cohort Think Ahead trainees had brought “assertive enthusiasm for mental health” to his teams and had “changed them for the better”.

Commenting on the report’s key findings, Trewin told Community Care that Think Ahead had not been without issues but that the organisation had learned as it went along and had not expanded unsustainably.

But he added that the programme faced structural issues around employment for some participants, who could suffer “lots of stress” waiting for austerity-hit local authorities to find an appropriate role for them in year two.

“The real problem is saving vacancies for people in the right team, in the right timescale, in a local authority that’s on its knees, where apart from this small project everyone is cutting jobs,” Trewin said.

Some councils were wary of investing in training social workers who may well end up working for other authorities, or for the NHS – where there are jobs but less of a culture of social intervention – Trewin went on.

Think Ahead participants could play a key role within integrated services under the NHS long-term plan for the next decade, published in January 2019, he said. But that would depend on a cultural change to enable them to “swell the workforce while remaining as socially-minded social workers”.

‘Different, and difficult organisational climate’

Martin Webber, the professor of social work at York university who has been the academic lead for Think Ahead over its first three cohorts, acknowledged the “different, and difficult organisational climate” within which mental health social workers operate. But he said there were pros as well as cons for participants.

“I see it as an opportunity where practitioners can work in integrated trusts and contribute to people’s care and support, with nursing colleagues, psychologists and so on,” he said. “We’ve also seen examples where section 75 agreements [under which councils delegate their mental health responsibilities to NHS trusts] have broken down and local authorities have taken mental health social work back into control, and in some cases that’s worked very well for practitioners as well.

“There isn’t one model that works well,” Webber added. “It’s about having the right kind of leadership that respects social work and allows them to develop their own professional identity in the role, which sometimes gets squeezed out.”

Overall, Webber said he was pleased with what the programme had achieved to date. “We’ve been able to demonstrate that it’s possible to recruit good graduates, train them and get them through ASYE and retained in mental health teams,” he said. “We’ve been able to generate a lot more learning opportunities within mental health settings, so making a contribution to the workforce – that has been a major point of learning.”

‘Organisations value the contribution of social work’

Ella Joseph, one of Think Ahead’s co-chief executives, said she was “delighted to get an endorsement of key elements regarding who we recruit, how we train them, and their impact on the sector when they join NHS trusts and local authorities”.

Joseph said that Think Ahead was continually refining its processes around reviewing participants’ on-the-job training in order to offer as consistent as possible as experience.

“We do the best we can to provide positive, supportive and robust training environments for each and every participant, but we cannot manage away the inherent variety of placements,” she said. “We now have a very clear, structured process that we take all partners through to get organisations ready to accept a unit.”

Joseph added that despite the difficulties the mental health sector faces, more organisations were applying to Think Ahead than it could accommodate.

“Organisations partner with us because they value the contribution of social work to their mental health services, and they know being part of Think Ahead will help to maximise that contribution,” she said. “If anything, what we’re now seeing on the ground is a trend towards more social workers in mental health teams, as the value of social interventions in mental health is increasingly recognised and embraced.”

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