Evaluation of Wellness planning in self-help and mutual support groups Andy MacGregor Rebekah Pratt Susan Reid Lisa Given

WRAP evaluation: background Evaluation context : An approach developed by Mary Ellen Copeland Scottish Recovery Network (SRN) promoting the use of WRAP in Scotland SRN commissioned ScotCen to evaluate the use of WRAP in pre-existing and newly-formed self-help or mutual support groups (June 2009) Pairs of facilitators trained in WRAP, and its delivery. Delivery to groups in 2009 and Delivery over 2 days or 4 days

Aims and Objectives Aims : to assess the impact and effectiveness of WRAP as a tool for self management and wellness planning by individuals Objectives : 1.To assess the extent to which all participants who received training benefited 2.A consideration of the wider implications in relation to promoting self management, self help and wellness planning in Scotland.

What is WRAP? WRAP is a structured system to monitor uncomfortable and distressing symptoms that can help you reduce, modify or eliminate those symptoms by using planned responses. This includes plans for how you want others to respond when symptoms have made it impossible for you to continue to make decisions, take care of yourself or keep yourself safe

Methodology A mixed methods approach: Literature review: WRAP In-depth interviews with stakeholders (n=5) Group facilitators (n=8): Focus group post phase 2 level 1 training Paired interviews conducted post-WRAP delivery Structured scales: RAS and WEMWBS Online ‘blog’. Group Participants : Focus groups Follow up in-depth interviews (n=11) WEMWBS and RAS both pre- and post WRAP training (control groups)

Main results 1 WRAP approach was relevant, effective and had perceived positive impacts on participants Positive impact still reported at follow-up – intention expressed that WRAP to be used on on-going basis Structured process allowed participants to speak of experiences for the first time, group format enabled discussion and self-reflection Uptake and retention of group participants very encouraging

Main results 2 Group setting ideal for WRAP: mutual support, role of facilitators (sharing experiences, etc) WRAP viewed as appropriate for wide range of people and life experiences Facilitators developed own WRAP: increased empathy, and synergy between learning and training WRAP could facilitate discussion with family and friends

Main results 3 WRAP a living document/process – groups also helped identify triggers and monitoring Pre-existing groups vs Individual training WRAP materials and course content well-received, but too American-orientated? Crisis component of WRAP: Most challenging. Not all had experienced ‘crisis’ Difficult to recall and talk about Very valuable for those who could

Quotations: Facilitators … I had no idea what it was because the recovery agenda was a complete myth to me. Um…and then…sort of after I grasped the concept – yes, it is what I thought it would be but it’s more powerful than I thought it would be I think I got quite down recently and I was much quicker to respond, much, much quicker to start doing things that made a big difference and I have not…I went down but I didn’t crash. And then I have come up much quicker so, yeah, that’s been surprising for me.

Quotations: Facilitators (cont) The advantages are the peer support, the learning of it… if you were doing it on a one-to-one, then you only have that person and your perception, but in a group you’ve got an overall awareness.. one person's way isn't the next person's way, but just having that overall feedback allows people to absorb and learn more I think unless... you’ve been in crisis, it's gonna be very difficult to imagine what it would be like

Quotations: Participants It's like I live a secret life, nobody knows I've got this condition, but when I come here I can talk to people.. that understand what I've went through and stuff, you know?, and they might come up wi' suggestions… You just pick up different ideas WRAP gave me the confidence to talk about how I was. WRAP also gave me the confidence, to be quite honest with you… to understand other people's problems, because I didnae see that. Even although I knew I was getting step by step better on the one-to-one…

Quotations: Participants (cont) The fact that I can speak more openly about the fact that I was ill, whereas before no one knew. it's given me a better understanding of my own mental health and my mental health state. But no’ only that, it's given me confidence in myself, that I've gained throughout the group... there is light at the end o' the tunnel. But it's also given that same confidence to my family because they’ve had the benefit from the WRAP as well… because they can see the difference. It's like, you know, my eldest daughter said, “My dad's back”, and that’s how she explains it.

Scales

Main results (cont) Possible limitations in the evaluation: Blog analysis Scales: Although in almost every case improvement in scores pre- and post WRAP Control group Self-selecting group in intervention and evaluation? Relatively few groups took part in intervention Longer-term follow-up?

Recommendations 1 The WRAP approach was very relevant, effective and appeared to have a substantial and positive impact on many of the participants The WRAP materials need to either be amended (if possible) or supplemented with information relevant to the Scottish context Further development of a network of facilitators with relevant, lived experience is worthy of consideration.

Recommendations 2 Potential for a negative impact should be monitored for people with limited social networks The provision of WRAP delivered in mutual support groups should be given serious consideration WRAP could play an important role in linking in/strengthening the long-term conditions and self-management agendas in Scotland.