Report:
Update on Multi-Agency Review Processes to Minimise the
Risk of Multiple Exclusion
Review:
November 2013
1.
Introduction
1.1
This guideline describes the relationship between the weekly Common Case
Management Group and other risk management processes, including
Safeguarding Adults, MARAC, MAPPA and referral to Complex Case Review
meetings within NTW’s and Complex Needs Panel.
2.
Background
2.1
The CCMG meeting was established in 2010 as a response to adults who are
chronically and multiply excluded, to coordinated unified actions to meet the
needs of clients and to reduce the risk of harm as well as promoting better
access into support services and engagement. It was intended to bring about
one clear process for identifying and assessing the needs of adults who face
multiple exclusion from both housing and other support services, including
those in drug / alcohol treatment.
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3.
Group Name
3.1
Common Case Management Group (CCMG)
4.
Group Chair
4.1
The Chair is rolling between the roles of XXX. The lead for the work is xxx
5.
Multiple Exclusion
5.1
Multiple Exclusion refers to individuals who have multiple and complex needs
and who struggle to access and sustain both housing services and support
services. Rough sleeping is the most visible and obvious form of chronic
exclusion but there are a number of other key characteristics such as:
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5.2
History of exclusion/institutionalisation/abuse
Behaviour and control difficulties
Difficulty forming and sustaining relationships
Skills deficits
Poor housing/homelessness
Poor health prospects (physical, sexual and mental health)
A history of offending
Substance misuse issues, including risk of harm
Limited economic and employment prospects.
Combinations of problems vary, but usually, clients have had long term
problems often beginning in childhood and have had limited engagement with
appropriate support services (both statutory and voluntary services) or high
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dropout rates. In addition there are likely to be other harder to verify
manifestations of multiple exclusion e.g. sexual and financial exploitation.
5.3
Newcastle City Council and its partners are committed to addressing multiple
exclusion and ending rough sleeping as a habitual lifestyle to ensure that all
“Newcastle’s residents will enjoy equal chances in employment, education,
housing and health.”
6.
Group Purpose
6.1
To identify, assess and review the needs and risks associated with the clients
who are referred into the group, where usual case management or multi
agency working has not met risk resolution. The group will act as a central
point to identify or clarify a lead professional (case manager) and agree a set
of actions which will seek to reduce and manage risks within an agreed
timescale as well as promoting positive engagement. The meeting will also
agree the closure of cases when it is deemed that the person no longer
requires intensive chronic exclusion case management.
6.2
There will be 5 key principles underpinning the group:
1. Better identification and early intervention of those at risk of
exclusion
2. Systematic identification of what works
3. Improved multi-agency working
4. Personalisation, and rights and responsibilities where appropriate
5. Supporting achievement and managing under performance
6.3
A collective decision will be made by the group as to when a desired outcome
has been achieved or if the case needs to be escalated to a ‘Complex Needs
Panel’ for a dedicated multi-agency review.
6.4
A Complex Needs Panel (CNP) will be arranged for those individuals where,
despite review by the Common Case Management Group, desired outcomes
are not achieved, risk is not controlled or offending continues to escalate.
6.5
For continued reoffending or anti-social behaviour, the Common Case
Management Review Group will work alongside Integrated Offender
Management (IOM) to support the appropriate management of individual
cases.
7.
Client Group
7.1
The group will focus on clients who fit the above definition of ‘multiple
excluded’. Specifically, the group will case manage and coordinate the needs
of clients who are at risk of:
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7.2
Rough Sleeping/homelessness
Drug and/or alcohol abuse/harm
Prolific and priority offending
The clients identified for discussion in this group will have a combination of
drug & alcohol problems, mental health issues, behavioural problems,
offending and/or experiencing a chaotic social situation e.g. rough sleeping or
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begging. There may also be clients who are not accessing, or have
disengaged from treatment services and are therefore at risk of serious harm
and in need of joint case management and fast track access to services.
7.3
This will include clients who are at risk of eviction from emergency
accommodation, release from institutions (prison/hospital) and clients who are
struggling to access and sustain contact with housing and support services,
where there are limited options available to them.
7.4
Risks and needs will be verified by the lead agency referring into the CCMG.
Where there is no lead agency the CCMG will determine who is best placed
to take the role of lead professional. The underlying principle will be that one
worker coordinates care with one agency taking overall lead responsibility.
7.5
In addition, all verified rough sleepers must be referred into the CCMG via the
Lead Practitioner for Chronic Exclusion or the ACE project.
7.6
All service users who are in treatment, and known to have overdosed or who
have been present at the scene of a Drug Related Death, will be raised at the
group routinely to ensure a coordinated approach to providing support and
managing risk.
8.
Group Format
8.1
The focus of each case discussion will be;
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Resolving immediate crisis
Maintaining stability
Promoting engagement
Reducing identified risk
Supporting services/colleagues
8.2
This will involve agreeing and coordinating actions to meet the clients basic
needs, reduce risk and exclusion. To do this, a problem solving approach will
be adopted which will make best use of support and challenge resources
available.
8.3
It is also crucial that this forum is developed to ensure that commissioned
services are not managing chaotic clients in isolation or without appropriate
support from other services.
8.4
There will be a maximum of three discussions within the group to establish a
risk management plan and review processes. After three meetings, if the
situation remains unchanged, this will generate a referral into the ‘Complex
Needs Panel’ for an individual risk management meeting. Due to the nature of
the client group it might take longer than the anticipated three meetings to find
a resolution however this will be agreed within the CCMRG.
9.
Attendees
9.1
The CCMG will be attended by a range of providers, commissioners and
strategic leads, as appropriate including;
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Housing Services
Emergency accommodation providers
Daycentre providers
ACE project
Drug & alcohol services
Northumbria police
Probation
Safe Newcastle
NTW
9.2
A lead professional will be identified within each service who will then be
required to meet on a weekly basis and provide information/feedback on
individual cases
10.
Referral Process
10.1
Referral to the case management group will be via an agreed referral form or
through discussion with the chairperson.
10.2
The group will follow a joint case coordination model for individuals whose
needs are unable to be met by one individual service and where risk is
increasing despite attempts to develop a coordinated approach. A weekly list
will be sent out, usually by the Monday prior to the meeting.
11.
Terms of Reference
11.1
The group TOR is included at the back of this report, which has been agreed
by the Adult Treatment Group and Head of Commissioning via the Adult
Commissioning group.
11.2
The chair will be responsible for the development of the referral and recording
process.
12.
Complex Needs Panel – Chronic Exclusion (CNP)
12.1
This CCMG will be supported by a Complex Needs Panel (CNP) chaired by
Safeguarding Adults Unit, who will convene a multi-agency review group to
consider individual cases where despite all efforts, deterioration and risk
remain. Referral to the CNP should occur where a service or key worker has
been unable to resolve crisis and reduce risk/exclusion despite existing
CCMG arrangements and where the case does not fit the criteria of
Safeguarding Adults and is outside the remit of NTW’s Complex Case Review
process. If it does fir the criteria of SA, a referral, or informal discussion
should be undertaken according to the Supporting Safeguarding Adults
Guideline (MROC-1)
13.
Complex Case Review
13.1
NTW conduct a weekly Complex Case Review, supported by the Treatment
Effectiveness and Clinical Governance Manager] and [Andrea’s role],
keyworkers can refer in cases where there are concerns about risk.
Additionally, any clients on the CCMG list where risk is increasing, and where
they are either NTW clients due to addiction, or NTW clients due to mental
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health or dual diagnosis, then a referral can be made from the CCMG Chair to
the CCR. The CCR will add the client on to the list and inform the keyworker,
where an internal meeting will take place to action plan against risk. The
keyworker will be responsible for communicating or working with other
agencies to address risk. The NTW attendee will be responsible for
communicating the outcome to the next CCMG.
Domestic Violence and MARAC
Where clients are suspected to be victims of domestic violence, it will be
requested that the lead or closest keyworker carry out the pre-MARAC checklist with
the service user. If the service user will not comply or engage, then the referral
should be made on a non-consent basis.
Where clients are referred and discussed at MARAC, information should be shared
from the CCMG Chair to the MARAC Coordinator to ensure consistency of approach
and information sharing.
MAPPA
Where clients are being managed through the MAPPA Process, it is important that
the information shared at the group is fed back to the MAPPA Panel. This will be
done through an identified worker at the group who has a link to the Panel (such as
Probation) or through the LA MAPPA representative.
Information Sharing & Safeguarding
14.1
All meetings are held in a confidential framework with all attendees signing a
confidentiality statement. The CCMG will support the Safeguarding Adults
process, ensuring that risk management is shared, there are adequate
services around the service user and carer as well as adequate support for
individual services and providers.
14.2
All statutory and voluntary sector services should have contracts with clients
to share information with other providers to optimise care and reduce risk e.g.
individual care/support plans.
14.3
In addition Home Office Information Sharing Guidelines will be followed.
15.
Accountability & Safeguarding
For those clients not in tier 3 drug treatment, a request from the group for
assessment and treatment will be taken as priority and the client seen within 24
hours.
Accountability will remain with the referring service/key worker unless a decision
is taken in the CCMG or the CNP to transfer care, then accountability will follow
the transfer process, staying with the original service until the transfer is
complete.
Any decision to transfer care must be taken by the existing service provider. If
agreements around appropriate transfer can not be reached, this should be
referred for a CNP to support full discussion of the issues and resolution.
The CCMG and CNP will be aligned with and report directly to Adult
Commissioning and have links to a number of existing groups.
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The CCMG will be tasked with identifying feedback in terms of system
functioning, roles, responsibility, accountability and the quality of service
provision. It will seek to support system improvement/change via commissioning
and contracting processes through a performance management framework
which will support the identification of;
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High quality intervention
High quality support
Verified unmet need and gaps in service provision
Operator error and service inefficiencies
System failure
Shared data analysis
This will be via a quarterly reporting mechanism.
This process should compliment all existing care management and safeguarding
procedures, it does not replace them.
If a client is appropriate for Safeguarding Adults, MAPPA or Potentially
Dangerous Persons (PDP) or if there are safeguarding concerns in relation to
children, appropriate action should be taken.
If the CCMG is unable to reduce risk and optimise care and the group feels it has
exhausted all options and the client doesn’t fit the criteria for any of the above
processes, a referral should be made to the Complex Needs Panel (CNP) for a
multi-agency risk management review meeting.
Client Responsibility
Clients also have a responsibility to themselves and it should be recognised that
whilst services are continually supporting a risk reduction model, unless a mental
capacity issue has been identified, the client ultimately has responsibility for their
behaviour and actions and on occasion, this may need to be managed through
more appropriate mechanisms, including the legal system.
Training
All appropriate practitioners will be offered briefings to support the use of this
process????
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