Achieving Continuity Across
Agency Boundaries
Revolving Doors Expert Seminar:
Improving Front Line Service Responses
14th November 2011
King’s College London, London
Michelle Cornes, Louise Joly,
Jill Manthorpe & Sue O’Halloran
with Cumbria Action for Social Support, Look Ahead and
Calderdale Smartmove
Seminar Aims
How can we achieve continuity across
homelessness, mental health and drug and
alcohol services?
What are the current objectives of interdisciplinary support? Are these right ones?
Research
Project Aims
To explore how different
agencies and professionals work
together to support people with
experience of multiple exclusion
homelessness – focussing on
workforce development and
improving practice
Methods
Fieldwork in Cumbria, Calderdale and Inner London
Interviews (n=48) and focus groups (n=17) with
stakeholders from a wide range of agencies across
health, housing, criminal justice and social care including
housing support workers/hostel staff
Interviews with people with direct experience of MEH
(‘Experts by Experience’) following their journeys through
the ‘system’ over a six month period (32 first interviews
and 22 follow-up interviews)
Partnership working with local partner agencies to
develop findings for practice
‘The basic idea is that treatment and aftercare must
be integrated to sustain the individual in the recovery
process, and for this to happen there must be a
shared recovery approach among provider agencies
in delivering coherent packages of support’
Best et al. 2010
Engage to change
St Mungo's adopted the recovery approach as our
guiding ethos five years ago…The recovery
approach is about enabling people [with mulitple
and complex problems] to live to their full potential...
It is about transformation and change. Change
can be facilitated but it comes from within.
http://www.mungos.org [Accessed 11.11.2011]
Support Planning
“Stick to my meths, get to do something and
move on to the flats… that’s it basically”
Johnny, Hostel Resident, Age 24
Assessing Motivation and
Engagement
[Discussing his drug worker] If you mess her about
she’ll come down hard on you. When I first got in, I
messed her about a lot coz I was still using. She
said “I’ve signed you off for 6 months come back in
six months” and I was like “no way” and I begged
with her and pleaded with her and I said I am telling
you now mate this is me changing now, honestly
you put me back on my script and when I’m back for
[drug] testing I’ll be clean
(Phillip, Supported Accommodation, Age 30)
Exclusion…
Being In or Out of Recovery
‘The problem of limited resources permeates the
system. All services have to determine who has
access to limited staff time’ (Anderson, 2011 p24)
“Not heard from Sam for a while and there appears
little motivation to meet with me at the moment. As
such I am going to close him”
(Sam’s Key Worker)
The Revolving Door
October 2005… Johnny Leaves Home
6 months
4 months
6 months
Eviction
7 months
Eviction
3
11 months
2
9 months
December 2009
Eviction
Hostel Support Plan:
“Stick to my meths, get to do
something and move on to the
flats… that’s it basically”
Johnny Age 24
Recovery Approach
2 years
Rough Sleeping &
Sofa Surfing.
Hostel and Other Temporary
Accommodation
Permanent
Accommodation
Second Chances
‘[Service providers] should house people who
are on drugs but some of them can’t be
[housed] at that time… they just have to
catch them the next time…’
(Phillip, Supported Housing Resident)
“The System”
Recovery Approach
“Getting Sorted”
“The tenancy is for two years …
Thankfully it’s a long way off. I
certainly don’t want to move out
now as I have just started to get
things sorted… The health things
alone might be enough for them
to say [at the end of the tenancy]
well you’re not well enough to go
back into that system, back
through the whole process…
hopefully they will recommend I
keep the flat”
(Peter, Former Hostel Resident,
Age 47)
“The System”
“I am nothing, I am a nobody”
(Johnny, Hostel Resident Age 24)
Hitting Rock Bottom
Hitting Rock Bottom
“I’ve witnessed people dying in the street with starvation,
that’s the truth … you know people in sleeping bags …
I’ve witnessed people actually wakening them up and
they’re dead because they’ve had nothing to eat or
nothing to drink… “
Jennifer, Hostel Resident, Age 32
Reframed Objectives for Cross Disciplinary
Support: Independence, Well-being and Choice
Independence Well-being and Choice
Stop
Drinkin
g
Provide a
hot meal
Maintenance &
Prevention Outcomes
Recovery and
Change Outcomes
Personalisation and Continuity of Support
People Determining Their Own Outcomes
“Housing First”
The real issue…
The recovery model (‘revolving door’)
enables us to manage capacity by keeping
only so many people in system at any one
time. Ending rough sleeping and providing
support to everyone who needs it will depend
ultimately on finding new ways to manage
increasing capacity and demand amid
shrinking resources
Any suggestions?
More Information…
For more information please contact
michellecornes@aol.com
Reports available at:
http://www.esrc.ac.uk/my-esrc/Grants/RES188-25-0010/read
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