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Working together to addressMultiple Exclusion Homelessness Michelle Cornes, Louise Joly, Jill Manthorpe, Sue O’Halloran, Rob Smyth King’s College London, University of Cumbria, Look Ahead Housing & Care Presentation by Sue O’Halloran to the International Symposium on Contemporary Issues in Public Health and Social Welfare Yerevan, Armenia, February 2011
Objectives of the study describe the varied nature of the workforce dealing with multiple exclusion homelessness Show how interprofessional collaboration helps us to manage the interfaces between homelessness and other aspects of deep social exclusion Find out how interprofessional collaboration can best work to prevent multiple exclusion homelessness.
The Common Assessment Framework The Common Assessment Framework (CAF) is the method that the relevant agencies must work within to deliver health and social care to the individual. It states that, in any geographical locality, there must be shared understanding and agreement, among different agencies and professionals, around procedures for information sharing and coordination. It requires that the care management be led by a ’lead worker’, who can be a single person or possibly a multidisciplinary team of professionals who meet to coordinate the individual’s care and support needs
Focus Groups - Case Vignettes Looking at:- the causal routes into homelessness the relationship between homelessness and deep social exclusion the degree of overlap between various deeply socially excluded groups the outcomes of interprofessional interventions and finding best practice.
An example from the study A man with a long-standing alcohol problem… has suffered ahead injury and fits…also has a chronic infection in one leg He is street homeless… pushed out of one local authority… recently on remand for assaulting a policewoman … when he came out of prison, he came into one of the hostels. Hostels couldn’t manage him…he threatened the hostel staff and he was evicted… he is back on the street…doesn’t want help with his substance misuse …so he doesn’t meet threshold for help from the drug services
Fieldwork Three different settings a housing support & homeless prevention service for offenders, in a remote and sparsely populated rural area. a rent deposit (bond guarantee) scheme based in a metropolitan town an inner-London hostel Three organisations hosted the fieldwork Fieldwork involving 13 vignette focus groups and 23 individual interviews (to date, work is continuing)
Example (continued) He has a degree of physical disability…but he won’t meet the threshold for ordinary residential care…he has a degree of cognitive impairment but we are not sure how much…probably not too much so he doesn’t fit the mental health criteria… and he is a very difficult person in his behaviour So if you add it up he has got multiple needs but there isn’t actually a service that meets his needs… so he remains on the street.’ (Testimony from a Housing Support Worker)
Exclusions However, remember that exclusions (‘gate keeping’) are rooted in:- ever tightening eligibility criteria and high case loads extend across adult social care and are not restricted to people with experience of multiple exclusion homelessness.
Compartmentalisation The process of compartmentalising needs in terms of separate specialist referrals for drugs, alcohol and mental health problems is a central feature of much ‘joint working’ in multiple exclusion homelessness and can compound exclusion
Tell me about Sam’s support plan.. With Sam you have got the behaviour, the paranoia… the family dynamics or history… and the addiction which always seems to be the stumbling block, alcohol use and the rent arrears as usual… all the indicators of someone having a chaotic lifestyle Last time he was here in the hostel… he totally lost the plot.. and went about dressed as a vampire most of the time…
Tell me about Sam’s support plan.. So there was so much wrong with him really… and the relationship with his girlfriend… there were issues of domestic violence on top of that All of which it made it even more confusing… and made Sam even more difficult to work with (Testimony from a Hostel Worker)
Emerging results Our key finding is that duplication across the system and a lack of ‘joined-up’ working means that people are being bounced between different parts of the system or left largely out in the cold …devoid of proper care
Emerging results in most cases housing support workers are providing much more than low intensity ‘housing related support’ as care management increases, housing support workers are filling the vacuum… …left by the retreat of social workers from ‘direct work’ with adults
Conclusion – 3 ways forward Our findings indicate three ways forward Firstly:- we need, in each locality, clear leadership and commitment at the highest levels to secure - across health, housing and adult social care - integrated commissioning that will ensure the effective implementation of the ‘Common Assessment Framework’ (CAF).
Conclusion – 2nd key finding Secondly, local homeless forums must lobby hard to ensure that local services are available to all adults i.e. including those with experience of multiple exclusion homelessness. Previously dedicated funds are becoming absorbed within mainstream local authority budgets - the forums need to check that people with experience of multiple exclusion homelessness are not ‘assessed out’ of services
Conclusion – 3rd key finding Thirdly, we need to re-evaluate the job role of the housing support worker, recognising that the role has extended well beyond the provision of low intensity support, and provide the training and management support that these workers need
The final challengeto secure a conceptual shift:- away from ‘multi-professional working’ towards ‘integrated interprofessional working’ so that we can reintegrate ‘homeless people’ back into the adult population in need of health and social care and provide them with the integrated care they need