Using MYCAW (My Concerns and Well-Being) Teresa Meekings
In 2018 she founded Community Massage London CIC in order to be better able to work in the voluntary sector (i.e. to be more readily accountable, have an asset lock and comply with NHS data and security protection requirements) and be directly involved in delivering services on the WLCCG (West London Clinical Commissioning Group) social prescribing – My Care My Way- “Self Care” project. They also partnered with SMART London, a mental health charity to deliver monthly unwind sessions at two locations.
Demonstrating impact reliably is not easy. Testimonials from clients on websites or on fliers can be helpful, but to work in a more integrative way in health and wellbeing, whether with NHS, community organisations or social services there is a need to provide something more compelling. There are various measures that could be used, but often these have drawbacks which can range from being too one dimensional to being too complex for clients to want to complete. The solution I found was MYCAW. I first came across MYCAW while I was working as a volunteer with cancer patients at University College Hospital London Cancer Centre. (MYCAW was originally developed to improve on a pre-existing measure that looked at the effect of holistic therapies in cancer patients) I liked the fact that it was easy for patients to complete whilst focussing on their concerns and what they wanted to achieve. It was also validated, (so its use had been compared with existing accepted measures) and would therefore be seen as reliable. MYCAW, also had the flexibility to look at a range of different
areas, such as physical, mental and overall wellbeing so it was helpful in maintaining a holistic person-centred focus. Around the same time, I had a contract to deliver reflexology to carers in my local borough and that flexibility alongside the fact that MYCAW was easy to use, persuaded me to trial it with my clients to get clearer evidence of the impact of my service.
Clients were happy to complete the forms and although I needed to create a customised
spreadsheet to evaluate results the trial was successful. Clients showed significant improvements. Being able to demonstrate overall impact was not the only benefit. The types of issues unpaid carers face are wide-ranging with impact on their physical and mental health as well as their wellbeing, so it was helpful to be able to evidence the impact of reflexology on each of those dimensions. I continue to use MYCAW questionnaires where possible in the social enterprise which I set up. In addition, I also use other measures so I can compare what I see using MYCAW with what other measures tell me. As an example, in one project which involves supporting people with mental health needs in primary care I use MYCAW together with Warwick Edinburgh Mental Wellbeing Scale questionnaires WEMWS. They measure different outcomes but they both show similar improvements. To explain this, WEMWS provides a more detailed understanding of mental health changes, but less sense of what matters to the client. MYCAW on the other hand provides a better sense of client wellbeing and physical health. I also use Patient Activation Measures Questionnaires within a borough wide social prescribing scheme in which my social enterprise is involved delivering holistic therapies to over 65’s.
PAMS looks at the client’s ability to care for themselves and be proactive with their health and have the benefit that there has been a lot of work done to understand what changes in overall PAM scores across populations imply for the demand on the NHS and other resources. PAM’s however have the drawback that they are not as person centred and easy to complete as MYCAW. Looking at it from a different perspective though, MYCAW has not had as much work done on evidencing the impact that changes in MYCAW scores might mean for demand on NHS services. Some of that evidence is starting to emerge however from the Tower Hamlets social prescribing scheme where MYCAW has been adopted across the scheme. Lastly
MYCAW does not have any licensing costs, whereas PAM’s do. This has positives and negatives. PAM’s benefit from continuing investment and development in the same way as any other commercial product, whilst development and investment in MYCAW is driven by the scale of its adoption. Overall though MYCAW has the benefits of being free, versatile and easy to use.
MYCAW, enabled me to show the difference/impact in a visual form and also allows for client comments and any self-care they undertake or factors that may positively or negatively affect their scoring to be included. The questionnaire takes a snapshot of the client’s concerns before the first session and at the end of a series of sessions- it is vital to have this baseline assessment before treatment begins, if we are to show the difference we make. It is also important to remember, that not everyone necessarily shows improvement – for a variety of reasons, it may not be the right therapy, factors in their condition or stressors may play a part, but it is important to show this too. Some people have asked me if is essential to set up a social enterprise in order to get contracts. My answer would be it depends – One or two therapists have been able to work with a local GP and gain
some clients direct – though many GP’s say they cannot refer patients. If your aim is to get contracts with CCG’s or Local Authorities it is a different matter. With a CCG they will want to see the accountability and transparency of an incorporated organisation which has a social purpose. As a small private company you might not be able to bid for a contract on your own – There may be minimum asset or turnover requirements. To deal with this you could partner with other organisations to provide a social prescribing offer.
In addition, CCG’s are being encouraged to work with the voluntary sector and this often happens through an umbrella body in the form of a Council for Voluntary services – but are likely to be Charities or Community Interest Companies (CIC). They will also normally prefer to work with other charities or social enterprises. Lastly, it is possible for some types of social enterprises to get grant funding . One possible structure is a CIC limited by guarantee. This kind of structure can help to provide a level playing field with other organisations, This is important whether you are interested in getting involved in partnership that aims to bid for social prescribing contracts; or whether your aim is to compete against other organisations for contracts. In addition, some funders will provide grants to CIC’s so that you can set up your own social projects. This form of incorporation allows the company to pay you as a director/employee for your work, but does not distribute profits though share dividends. Like a Charity, It has an “asset lock” – This means that the CIC reinvests any surplus/profit into the organisation or build up its assets. If the CIC does eventually wind up any remaining funds are passed to another not for profit organisation. Whilst this form of incorporation does have some additional costs, there are factors which balance those and which can make it better than having sole trader status.
Resources
MYCAW form
how to analyse MYCAW
http://www.pennybrohn.org.uk/wp-content/uploads/2014/08/Polley_et_al_200770a9.pdf
©Teresa Meekings 2019