This document summarizes a study on addressing homelessness for those experiencing multiple social exclusions. It finds that a lack of coordinated care between agencies leads to people falling through the cracks or being bounced between services. It calls for stronger local leadership to fully implement coordinated care frameworks, ensuring funding protects vulnerable groups. It also recommends reevaluating the role of housing support workers and moving from multi-professional to truly integrated interprofessional support systems.

1. Working together to address
Multiple 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

2. 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.

3. 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

4. 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.

5. 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

6. 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)

7. 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)

8. 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.

9. 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

10. 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…

11. 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)

12. 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

13. 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

14. 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).

15. 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

16. 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

17. The final challenge
to 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