Evidence and policy suggests that people with multiple needs and exclusions often struggle to engage with services because of the way those services are set up. People may be well known to agencies and professionals but may not have been able to make and sustain changes in their lives. This webinar will provide an overview of the issues facing adults with multiple needs and exclusions. Due to agreements with the individuals involved, in the recording we are unable to show Leah’s story and Tommy’s story. These segments have been removed from the recording. If you have any queries please email: help@ripfa.org.uk

1. Supporting adults with
multiple needs and
exclusions:
An introduction to the MEAM Approach
1
Oliver Hilbery
Project Director
MEAM

2. Webinar objectives
After the webinar, delegates will be able to:
 Outline the policy context of working with people with
multiple needs
 Describe the views and experience of people with
multiple needs, including what they find helpful/
unhelpful in terms of services
 Explain how the MEAM approach works, what impact
it has had for people and for improving the
effectiveness of services
 Outline the necessary actions and steps needed to
improve services for people with multiple needs in
their area
2

3. Agenda
1 Welcome and introductions
2 Presentation
3 Questions and discussion
3

4. Why?
• Why this webinar?
• What sparks your interest in multiple needs?
• What would you like to take away from today?
4

5. The presentation
1. What is MEAM?
2. What is multiple needs?
3. What are we doing about it?
4. What’s the impact?
5. How do we make it stick?
5

6. What is MEAM?
• MEAM is four national charities –
Clinks, DrugScope Homeless Link
and Mind
• Each is a membership body:
• 1,600 frontline member agencies
• MEAM was formed because people
with multiple needs move between
our sectors and are poorly supported
• Remit to focus on policy and practice
change
6

7. What is multiple needs?
• People facing multiple
needs:
• Experience several
problems at the same
time
• Have ineffective
contact with services
• Live chaotic lives
They can end up
“recycling” around
services without ever
getting the support they
need
60,000
7

8. Multiple needs
Some stats from our work:
• 81% had been in prison
• 80% were homeless
• 133 units of alcohol a week (average consumption)
• All but one unemployed
• 48% had been a victim of crime in the last 3 months
• 44% involved with mental health services
• 36% had been in care as a child
• 35% rated health as bad or very bad
8

9. Multiple needs
Age of first involvement in services and (length of
involvement )
• Homelessness services: 23 yrs old (9 years)
• Substance misuse services: 19 years olds (7
years)
• Mental Health services:15 yrs old (8 years)
• Criminal justice services:23 yrs old (12 years)
* Length of involvement is for those still using services
9

11. Failure to tackle multiple needs
means:
• Loss of individuals’ potential
• Negative impact on local communities
• Opportunity cost effect on local services
• Significant costs to the public purse
11

12. So what are we doing about
it?
Our vision:
In every local area, people
experiencing multiple needs
are:
• Supported by effective,
coordinated services
• Empowered to tackle
their problems, reach
their full potential and
contribute to their
communities
Policy
Practice pilots
Implementation
12

13. And why do we do it
together?
• Collaboration at all levels is the best
way to tackle “intractable” problems
• It pools resources & expertise - actions
greater than sum of their parts
• No one sector can solve multiple needs
on its own - collaboration is always
preferable to ‘one size fits all’ solutions
• The world is ‘messy’ and it’s ok for
collaboration to be messy too
13

14. Policy
“We recognise that more can be done to support those
who are least well served by current approaches. Through
this strategy and the work that follows, we want to
encourage local areas to design and commission
interventions that are better coordinated and that deliver
multiple outcomes.” (227)
14

15. Practice pilots
• In 2011-2012 we ran three pilots coordinate
existing services for people facing multiple
needs more effectively
• We evaluated them very closely in partnership
with Pro Bono Economics and FTI Consulting.
• We developed “The MEAM Approach” to spread
this way of working
• Let’s watch a video about Leah and the help she
received from a coordinated intervention
15

16. http://vimeo.com/85154149
16

17. So how do areas plan a
coordinated intervention?
17

18. The MEAM Approach
Getting
started
Planning your implementation – service models and
flexible responses
Sustainability
18

19. The seven elements
• Partnership and
audit: The right
people at the table. A
service ‘for the area
as a whole’
City or area
Voluntary
Private
Public
19

20. The seven elements
• Consistency: A focus on those most in need – a
shared understanding of the problem.
15 – 20 most excluded/chaotic people
Chosen by a multi-agency panel
20

21. The seven elements
• Coordination: Effective
coordination for clients
• Outside organisational
boundaries
• Given a “remit to have no
remit”
• Asks: “What do you want
to do first?” … not “Do
you want this?”
• Able to bring services
around the individual
Source: Peter Macdiarmid/ Getty Images Europe
21

22. The seven elements
Flexibility: Ensuring flexible
responses from all local agencies
• Strategic?
• Cultural?
• Economic?
Board of senior
directors
(cross-sector)
Operational group
of managers
(also cross-
sector)
Coordinator
22

23. The seven elements
• Gap filling: Only now should you look at gaps
23

24. The seven elements
• Measuring success: a commitment to early
evaluation
24

25. What impact did it have?
Statistically significant increases in wellbeing for clients
0
1
2
3
4
5
6
Engagement with frontline
services
Intentional self-harm
Unintentional self-harm
Risk to others
Risk from others
Stress and anxiety
Social effectiveness
Alcohol and drug abuse
Impulse control
Housing
1st
2nd
3rd
Source: NDT Assessment (cumulative results – Cambridgeshire – year two) FTI/PBE
http://meam.org.uk/wp-content/uploads/2014/02/MEAM-evaluation-FTI-update-17-Feb-2014.pdf25

26. What impact did it have?
Up to 26.4% reduction in wider service use costs
Source: Monthly cost of service use (cumulative results – Cambridgeshire – year two ) FTI/PBE
http://meam.org.uk/wp-content/uploads/2014/02/MEAM-evaluation-FTI-update-17-Feb-2014.pdf
£0
£500
£1,000
£1,500
£2,000
£2,500
£3,000
£3,500
£4,000
Overall Crime Drug and
alcohol
Health Mental Health Housing
Baseline
Year 1
Year 2
Service use
costs fall
26.4%
26

27. How do we make it stick?
• Sustainability and systems change: finding ways to “lock”
the flexibility into the system
• What is “the system” for people with multiple needs?
• What are the problems in this system?
• Which bits do we have the power to change?
• How are we going to do it?
• What can we test? Where can we innovate?
• How do we “feedback” to the system?
• Who needs to be involved?
• How do we make it ‘systemic’ not ‘individual’?
27

28. What effects a person with
multiple needs? Other people, family, workers
Social services
Local commissioning
policy
Local strategies
National strategies and
commissioning, wealth, u/e,
redistribution etc
28

31. Examples of
system changes…
• Thresholds for services?
• Transitions?
• Commissioning
strategies?
• Staff cultures/joint
working?
• Funding mechanisms?
• Test, evaluate spread...
31

32. Where is this happening?
• Blackburn
• North
Tyneside
• Sunderland
• York
• Mansfield/
Ashfield
• Oxford
• Exeter
• Norwich
• Tamworth/
Litchfield
• Westminster
• Wigan
• Plus our
original
pilots
32

36. Let’s watch Tommy’s story
https://vimeo.com/85151810
36

37. Questions and discussion
37

38. Thank you
www.theMEAMapproach.org.uk
Oliver Hilbery
Project Director
oliver.hilbery@meam.org.uk
www.meam.org.uk
@meamcoalition
#multipleneeds
38

39. Contact
39
@ripfa
www.ripfa.org.uk
help@ripfa.org.uk