Transcript Rough Sleeping Strategy 2008

Ending rough sleeping:
personalised approaches
and individual budgets
What will success look like?
We want to ensure people get the help
they need so no one has to sleep
rough and, most importantly, no one is
living on the streets in England in
2012.
For many entrenched rough sleepers the “usual”
offer and service interventions haven’t worked
Who is living on the streets?
Entrenched rough sleeping kills – it is not a positive lifestyle choice
Research on the pilots identified entrenched rough sleepers having
complex problems - autistic spectrum disorders, mental health problems
(depression and delusions) and alcohol and drug dependency
Some have been let down by the system – bad experiences of both
voluntary sector and statutory services: they fear failing again and/ or are
very angry
Some are aggressive and a risk to others in the “usual” accommodation
pathways
Some use the streets as a coping mechanism – avoiding the psychosocial pain of past traumas and damaged relationships. Living day to day
and hand to mouth on the streets means you never have the time to
reflect on painful areas of your life, or be in a position to seek help to
start healing.
What is Personalisation?
Personalisation developed and championed by In Control
Came from the adult social care sector – particularly adults
with physical disabilities and learning disabilities. Still early
days for some groups – e.g. people with mental health needs
Aims to be person centred and put the individual in control of
their care; delivers tailored services through greater choice.
Initial testing in adult social care settings found the approach
saved money…although this varied between client groups
Major investment in adult social care to gear up for
personalisation and restructure services and commissioning
arrangements
Rough Sleeping Pilots
Pilots to test out the belief that
“personalised budgets and individualised offers are key tools to
tackle entrenched rough sleeping”
4 pilot areas
Range of partners
• City of London
• Rough sleeper specialist
advisors
• Voluntary sector providers:
Outreach, hostels,
floating support, day
centres…
• Police
• Mental health specialists
• Housing Options
• Supporting People
• RSLs and private landlords
• Nottingham
• Northampton
• Exeter and
North Devon
Pilot approaches
• 5 – 15 entrenched rough sleepers identified in each area
• Dedicated personal budget outreach worker in two pilots;
multi-disciplinary team in one pilot area; existing provider
working with housing options gateway in one pilot
• Maximum/ indicative individual budgets set in two pilots;
needs led budgets in the other areas
• Spending decisions (up to an agreed cap) made at the
front line
• Multi agency panels and steering groups overseeing the
pilots in three areas – both new and existing forums – to
bring in expertise, new ideas and share the risks
Learning: Outcomes – what has been
achieved?
Large number are now in accommodation (93% in
Exeter and North Devon; 100% in Nottingham; 75% in
City)
Of the rest
• Most are engaged with services
• Most have an action plan
• Some are claiming benefits for first time (93% in
City)
• Re-building relationships
Learning: the budgets
Three main areas of spend:
Promoting engagement
• phone credit,
• clothing
• travel
• meaningful activities – including volunteering
• personal allowances
Removing barriers
• paying for utility connections/arrears, birth certificates for ID, rent in
advance and deposits, repayment of fines
• accommodation placements (usually B&B “tasters” with “no strings
attached” ahead of benefit claims)
• TV/ micro-wave for own room to reduce need to share communal areas
Enhanced personalised support
• additional floating support
• domiciliary care packages
• specialist care – detox packages etc.
All the pilots have struggled to spend the total funding allocated – money
helps, and is a key tool, but it isn’t everything…
Learning: What’s made the difference?
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A client centred approach
Quality time with and for clients/small case loads
Being clear about long term objectives: choices are conditional
upon them exploring ways to come indoors
Working at times and locations to suit the individual, not the service
provider
Not assuming a rough sleepers first priority is accommodation
Asking people what they want rather than offering specific services
(open enquiries are harder to refuse and make it easier for people
to engage)
Having a “whatever it takes” (as long as it’s safe and legal)
approach
Taking a “whole family” approach – working with couples and
parents
Being persistent, inventive, intensive and flexible
Planning ahead – predicting problems at transition points and
ensuring resources are there to respond when needed
Being clear it’s a two way process, and being “in control” means
choice and accountability
Learning: Ongoing Challenges
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Sustaining chaotic clients who have a long history of sleeping rough
– some are seen as “un-manageable” and impossible to help by
other services – need lots of persuasion skills
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Criminal Justice System catching up - police not always on board, or
able to recognise changes achieved
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Engaging mental health/LD services – need for new models and
pathways that emphasise intensive social, emotional and practical
support rather than “treatment”
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Funding long term intensive support
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Historic behaviours re-emerging
 Changing minds/ priorities
 Testing the boundaries – asking for the impossible as a way of
avoiding change
Case Story: Jim
August 2009: Living in a skip; wouldn’t speak to outreach worker
December 2009: Persistence paying off – told outreach worker he was
waiting for his mother to die before killing himself… agreed to talk
more, but only after church service on Sundays
March 2010: Living in B&B with an allowance (IB funded) – refusing to
claim benefits; meeting mother for tea and cakes after church with
outreach worker; mother encouraging him to think about the future
May 2010: Has made a claim for benefits; planning move to temporary
flat; intensive floating support from another provider – who is willing to
“go the extra mile” as Jim has been involved in drawing up his own
action plan and setting his own goals
The future: Still early days…but engaged, more positive, maintaining
relationships
Case Story: Tracy
August 2009: Living on the streets (c. 5 years), history of abandoning
and being evicted from hostels. Doesn’t really want to come in. “Quite
happy – being looked out for by male friends on the streets”.
December 2009: Would quite like a flat, but would need a lot of
support (she has learning difficulties). Wants to work with animals –
outreach worker arranges placement in local dog shelter.
March 2010: Tracy came in during the cold weather. Was planning to
leave, but has struggled to get to the animal shelter in time for
breakfast. Outreach worker suggested this would be easier if she was
living indoors. Tracy accepted a temporary flat – although has left a
few times, to stay with male partners. Assertive outreach has
supported her to return and to report DV to the police.
May 2010: Still in temporary accommodation and planning to move
into women only supported housing with additional floating support
Over to you…
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Henry – 54 years old
Sleeps around subway under a busy road, leading between car
park and train station; usually builds a shelter with cardboard
Drinks heavily – aggressive when very intoxicated
Rough sleeping for 15 years (occasional periods in custody or
hostels)
Has “burnt his bridges” with local hostels – doesn’t want to go in
anyway because it’s full of “junkies”
Physical health is very poor – has had spells in hospital for
infections in his leg. He knows he’s unwell but says it’s too late for
him… (he often looks angry and sad about this)
Usually tells outreach workers to “go away” – they can and have
done nothing for him - and how would they like people to come
into their house uninvited?!
Your outreach team has now signed up for the individual budget
personalised approach. Henry has said he might listen…
… so how might you approach Henry?
Questions and Discussion
For more information contact:
[email protected]