Noise Solution - Working with patients with complex presentation and significant mental health problems - pilot results
“62% of the cases found it extremely helpful with self-esteem, anxiety, confidence and mood with other participants also experiencing positive benefits from the process.” Dr S. Abraham, Consultant Child and Adolescent Psychiatrist
Noise Solution Pilot - Working with patients with complex presentation and significant mental health problems
November 2014 – July 2015 info@noisesolution.org
Background to the program
Noise Solution is an organisation that works with marginalised people to increase confidence, engagement and motivation. The program uses a mix of music technology & social media as an engagement tool, teaching learners how to use computers to create something they truly value – music, whilst equally as importantly sharing their success with those important people around them via social media. The referrals for the pilot came from a partnership with Norfolk and Suffolk foundation trust interdisciplinary mental health team (I.D.T Bury South) who were independently tracking their own functioning measurement scores using the CGAS mental health system.
Funding for the Pilot came from Suffolk County Council public health department, actively looking for innovative ways to impact on the hardest to reach.
The I.D.T team often works with young people identified as “patients with complex presentation and significant mental health problems” the following issues were identified as significant for participants pre referral to Noise Solution: Mixed anxiety, depression, school refusal, Lack of engagement in psychological work, suicidal behavior, antidepressant medication, previous diagnosis of Bulimia nervosa, attachment difficulties, dissociative states, generalized anxiety, dependent personality, mixed anxiety and depressive symptoms with suicidal threats, alleged sexual assault, PTSD, emotionally unstable personality traits, possible autism, OCD and lack of engagement with services.
Consultant child and adolescent psychiatrist Dr S. Abrahams worked closely in partnership with Noise Solution referring participants who best fitted the pre agreed referral criteria below and tracked their functioning CGAS Scores pre and post Noise Solution:
- Patients who were stuck/plateaued with the medication/therapy from the team
- Patients who refused to engage in verbal therapeutic modalities
- Patients who were improving but didn’t want to discharge without extra outreach help
- Patients who’s overall social functioning was poor due to poor self esteem/motivation
We worked individually with participants over a 10 week period, sessions were based around music technology and were client led, often delivered in the home, with outcomes being set by participants. There was a clear message given at the start of the sessions that tutors were not medical professionals or mental health professionals but musicians. The intention being to work with participants encouraging through a strength of theirs (their interest in music) in a non medicalised non hierarchical manner without needing to discuss or dwell on past issues. We focused on the job in hand which was to make participants self sufficient in their music making. The sessions were blogged and participants shared their blogs with those people they identified as being important to them. The blogs job was to encourage a recognition that participants could be successful, to reflect this back to the participant and to promote a positive conversation around them that could be shared by participant, professional peers and family. They were also used where appropriate to collate electronic portfolio evidence for Arts Award qualifications.
As well as our normal self-assessment from participants, the I.D.T mental health team kept an independent track of the participants CGAS[1] scores pre and post Noise Solution. This is significant in that it provides an independently verified benchmarked score with which to qualify our results. This scale operates from 0 to 100 with 70 being the point at which patients are likely to be discharged. Referrals to Noise Solution were made with participants scores at around 45 to 50. Post Noise Solution we saw an increase from 7 of 8 participants of between 10 to 20 points on the CGAS scale. As shown in the table below.
[1] The Children's Global Assessment Scale (CGAS) is a numeric scale (1 through 100) used by mental health clinicians to rate the general functioning of children under the age of 18.
Of the one participant who's scores that didn’t increase the participant’s care coordinator noted that…
"Things have seriously deteriorated at home so her functioning is lower. However she has identified that Noise Solution was the only positive thing in her life when this was happening " Care Coordinator
Top-line Results
5 of 9 participants completed their sessions with another two partially completing. We recieved CGAS scores for one of the participants who we failed to engage, these were included in the graphic.
Of the five that completed we saw:
41% average increase in their self reported confidence scores
36% average increase in their reported self-determination scores
1 Progressed into College, 1 continued with college
2 moved from very isolated positions into a music project having developed the confidence and resilience to do so. They will continue to make music within mainstream peer groups.
1 is continuing to create music at home, having reflected that she has improved her self esteem she is using the process as a valued coping mechanism
The CGAS scores tracked by the team reflected the positive self-reflection from the participants with all but one of the participant’s scores increasing by between 10 to 20 points whilst working with Noise Solution.
The two participants that partially complete the sessions to different degrees also saw increased CGAS scores, with the mental health team attributing in part Noise Solution as a contributory factor in those increases.
Two participants declined to engage at all, without us even getting to the first session stage, often a significant hurdle. One of those participants CGAS scores also increased over the period – highlighting that other contributory factors are always in effect.
Qualitative feedback
The following are quotes from Professionals and family describing the impacts they saw throughout the interventions.
“She is nearly at the end of the programme, she has done amazingly well. It seems to be a really enjoyable and empowering experience.”
Mirela Baltaru – Care Coordinator
“I have to say that 62% of the cases found it extremely helpful with self-esteem, anxiety confidence and mood with other participants also experiencing positive benefits from the process.” Dr S. Abraham, Consultant child and adolescent Psychiatrist
“Noise Solution has provided our teenage son with invaluable support at a time when he has needed it most. Noise Solution not only provided him with the opportunity to learn new skills through amazing music technology, they have also given him the opportunity to communicate and interact with people and an organization outside of the immediate family and his counseling in a positive and exciting way. For him it is a stepping stone to being reintroduced to the outside world again after months of not being well enough to attend school due to clinical depression. He now has something to do and look forward to each week. I cannot speak highly enough of Noise Solution and the benefits it brings to children and their entire family. It is a wonderful wonderful gift.” Participant mother
Conclusions
The client group within this report is recognised, by the mental health teams, as having “complex presentation and significant mental health problems”. In addition the participants were referred because they were at a stage of stasis within those teams, either stuck/plateaued, refusing to engage with talking therapies or suffering extremely low self esteem. In that context a 55% successful completion/engagement rate was considered good by professionals in the mental health teams. It’s lower than Noise Solutions 74% average completion rate but that reflects the complexity and thresholds of this client group. This combined with a participant reported increase of confidence of 41% and positive progression facilitated into education and mainstream social groups for half the participants should, we feel, be considered as a significant impact for those young people and their families and also of huge benefit to the services they are involved with.
A strengths based approach, where success was carefully shared via social media, has provided movement for over 50% of participants from a pre referral status that saw participants and professionals feeling ‘stuck’. This progression has been mirrored by the functioning measures recorded by the mental health team. More of this independent benchmarked impact measurement can only strengthen the case for this type of work and it’s something Noise Solution will be focusing on in the future.
Finally the ability of social media to bring together the family, participant and professionals, enabling them to share and contribute to the participants success, is significant. it has proven crucial to the success and effectiveness of this time limited intervention and is something that also demands further exploration and study as a tool within our work.
These results and other work we have done have seen us invited to join the Suffolk Wellbeing Partnership - where Noise SOlution shall be part of the county's frontline primary healthcare response to those presenting with mental health concerns. We shall be working with people at the other end of the spectrum, with less complex needs, but it shall be interesting to see what impacts we have there as well.
Simon Glenister
Director
Noise Solution