The project’s research questions
Does seeing an Employment Adviser within NHS Talking Therapies improve work-related outcomes and are there inequalities in these outcomes across different socio-demographic groups?
Research method: Population-based administrative databases and robust econometric methods (ie a difference-in-difference approach and matching) will be used to study exposed groups (ie clients of the NHS Talking Therapies service) who saw an Employment Adviser matched with NHS Talking Therapy clients who did not see an Employment Adviser. Covariates used will include socio-demographic and socio-economic characteristics such as age, sex, employment status, ethnicity, and industry.
Claire de Oliveira and Emma Sharland will co-lead on this research question.
What are the mechanisms through which Employment Advisers influence service users’ trajectories of absenteeism, presenteeism, and entry/maintaining/return to work, from the perspective of service users, Employment Advisers, and therapists? Or more simply, ‘Do Employment Advisers make a difference in supporting service users to work? If so, what difference do they make for whom and how do they do it?’
Research method: In-depth qualitative interviews with Employment Advisers, Employment Adviser Service users and therapists from within the NHS Talking Therapies service. Service users, who saw an Employment Adviser in the previous 12 months, will be categorised into one of three cohorts based on their circumstances at the point at which they first met an Employment Adviser:
- Employed and at work but struggling
- Employed but off sick
- Not employed (unemployed or economically inactive)
Interviews will be recorded (with permission), transcribed verbatim and will then be subjected to thematic analysis using framework/matrix and case summary approaches.
Annie Irvine and Jane Suter will co-lead on this research question.
Does seeing an Employment Adviser help reduce secondary healthcare costs via improvements in mental health and/or work functioning?
Research method: Using the same cohort and methods as in research question 1, the impact of seeing an Employment Adviser on secondary healthcare costs will be estimated. In order to understand the role of mental health and/or work functioning as a mediator in this causal pathway, we will also use a covariate decomposition approach and causal mediation analysis.
Claire de Oliveira and Maria Ana Matias will co-lead on this research question.
Does the Employment Adviser programme provide value for money?
To answer this we focus on two broad objectives - improving health or improving societal welfare, leading to two questions:
- Does the introduction of employment advisers lead to improvements in population health?
- Does the introduction of employment advisers lead to improvements in societal welfare?
Research method: We will develop a decision analytic model to capture the impact of Employment Advisers on individuals’ mental health, which will then be linked to health care costs and health related quality of life. This will allow us to assess the cost effectiveness of Employment Advisers from an NHS perspective, to see if they improve population health.
The model will then be expanded to capture broader impacts including employment/unemployment, earnings, benefit receipt, absenteeism and presenteeism. By combining the health and non-health impacts we can consider whether Employment Advisers improve societal welfare.
David Glynn and Simon Walker will co-lead on this research question.
Synthesis and Dissemination: Bringing the findings together and communicating them to different audiences
A final work package will integrate findings from across all four research questions and use ‘scenario vignettes’ of characters and situations that exemplify service users who may benefit, or not, from seeing EAs.
These vignettes will be used to translate findings into concrete recommendations for employees, NHS services, and policymakers.
Lina Gega will lead this work package.