An Evaluation of the Multiple Complex Needs (MCN) project in Darlington
March 2014
Authors: Mark Stephenson and Natalie Wood
‘It helps me breathe a bit – knowing that all my issues are getting sorted. I couldn’t have done it on my own’
‘...it’s made the biggest difference to my life – it’s not in a mess anymore. I can focus and start a new life’
‘It has made a big difference; it’s having someone there and someone to talk to. I can trust the service’
‘They’ve helped me with confidence and self-esteem. I’ve got hope again that I can move on instead of being stuck in a rut’
‘I believe in myself more. I know I can make a better life now’
‘I’m happier, more confident. I can breathe now which means I can focus on the rest of my life’
Comments from MCN Clients
Contents
Pages
Summary of key findings4
Chapter One: Introduction
1.1Introduction9
1.2Background9
1.3Methodology10
Chapter Two: Findings
2.1Stakeholder and Provider findings 14
2.1.1Delivering the MCN project
2.1.2Key features of the work of the team
2.1.3Partnership working
2.1.4Making a difference?
2.2 MCN Client findings30
2.2.1Multiple and complex needs of MCN clients
(prior to accessing the MCN project)
2.2.2Accessing the MCN project
2.2.3Ambitions and goals
2.2.4Elements of MCN support provided
2.2.5Impact of the project on individuals
2.2.6Client achievements
2.2.7Perceived strengths of the MCN project
2.2.8Weaknesses and potential areas of development
2.3MCN data39
2.3.1Referrals and Caseload
2.3.2Disengagement
2.3.3Average length of engagement
2.3.4Outcome Star data
2.3.5The housing ‘journey’
2.4Case Study: Lucy43
Chapter Three: Discussion and Recommendations44
3.1The Impact of the MCN project
3.2Building a locally appropriate service
3.3Delivering MCN
3.4The MCN team
3.5Partnership working
3.6Conclusion
Bibliography53
Summary of key findings
The Client Group
The vast majority of clients who we interviewed and were engaging with MCN reported a long history of health and social issues including substance misuse, offending, mental/physical health problems, unemployment, domestic violence, social isolation or a lack of supportive networks. Issues were often complex and interlinked.
Clients had a history of accessing a range of services across health, social care and criminal justice and were regarded, locally, as individuals who did not engage positively with local agencies, were often excluded from key organisations, were ‘the toughest of the tough’ and were often living a chaotic life, which was entrenched.
Making a difference
Half of the client interviewees were immediately homeless prior to accessing MCN and the majority had previous experience of being ‘street homeless’ and living in a range of temporary accommodation, such as hostels, refuges, or bed and breakfast accommodation. Following engagement with MCN, all six client interviewees had secured accommodation and most were maintaining their tenancies.
Substance misuse was a current/previous issue for the vast majority of client interviewees. A third of client interviewees, who reported a substance misuse issue prior to engagement with MCN were drug free at the time of our interviews and another two clients reported that their drug or alcohol use had significantly reduced following engagement.
Two-thirds of client interviewees had a long history of offending and criminal justice involvement including prison prior to engaging with MCN. All reported that engagement with MCN had positively impacted on their offending behaviour with three clients desisting from offending and one interviewee reporting a significantly reduced pattern of offending behaviour.
Health was discussed as a key issue for the MCN client group and many client interviewees reported that their health (physical and mental) and wellbeing had improved since accessing MCN.
The project was improving the personal capital, or resources, of individuals in terms of helping them to grow in confidence and clients reported being ‘happier’.
Whilst intensively and flexibly responding to a breadth of client need, a key objective of the project is to promote engagement with appropriate specialist services and also to supplement this specialist support. Through ongoing contact and proactive and assertive engagement with other key services, there was a sense that many of the clients had progressed from a life of chaos and/or crisis towards stability; a stability that then provided ‘breathing space’ for reflection and an opportunity to begin the building process.
In order to sustain change over the longer term, it is vital that MCN helps to support the building of personal resources of clients and helps to develop a sense of personal responsibility, resilience and self reliance. MCN workers are highly skilled and have an excellent understanding of the need to adopt a balanced approach, in this respect.
Anecdotal evidence, supported in a number of our interviews, suggested that the project is impacting positively on other agencies within Darlington and MCN was regarded as a valued resource. Much of the work undertaken by the MCN team also alleviates pressure from other agencies.
Although still in the early stages of development, we did not gain an impression that cultural change had yet to permeate across to other agencies within the locality, when they are working with the client group and the ‘gap’ for an increased intensity of approach has been filled by the MCN project.
Building a locally appropriate service
First Stop was recognised by the vast majority of stakeholders as the most appropriate host of the service due to their values and their experience and knowledge of the client group.
There was agreement that there was a need for the MCN project within the locality and that a specialist service, with the appropriate expertise and capacity was needed to work with the relatively small client group. The project was regarded as ‘valuable’.
Many of the client group had limited options within the locality as they had previously ‘burnt their bridges’ with many other services. Indeed, many partner agencies within the locality regarded ‘desperation’ and lack of other options as a key referral trigger into MCN.
The MCN team have adopted a creative approach to the assessment process – an approach which meets the need of the client group whilst also meeting the need of the project and partner agencies. Assessments are largely undertaken in the community, in an environment that is conducive to relationship and trust building.
Initial contact is focused on exploring client perception of need and gaining an understanding of their goals, aspirations and ambitions.
Recommendation/sThe Strategy Group
The Strategy Group is important in ensuring that the local strategic drive and focus of the project is maintained and that the project remains relevant and appropriate to local need. We gained a sense of ‘drift’ in relation to these meetings. It is vital that this meeting is re-energised and that a renewed commitment is made by all partners and that programming these meetings is prioritised.
The Strategy Group is not only important in terms of the delivery of MCN but is also a vital forum within the locality in ensuring that the systems within Darlington respond to the needs of the client group and embed a sustainable response to the needs of the client group in the longer term.
Delivering MCN
Between April 2012 and December 2013, the MCN project received 31 referrals into MCN and theproject had engaged with 25 clients. At the time of our interviews, there were 12 clients on the MCN caseload.
Whilst the key reason for accessing the project for clients is to secure accommodation, other stated reasons included in order to address their mental health, or their drug use, or to have ‘someone to talk to’. Whilst housing provides a foundation from which clients, with the support of MCN, can then address other key issues in their life, there was a very clear sense from clients that they recognised that housing was not enough in itself and they required an holistic package of intensive care and support in order for the project to make a difference and have impact.
The MCN project works with some of the most disenfranchised, marginalised individuals within Darlington - many of whom have limited housing options and have limited access to the intensive nature of support delivered by the MCN team.
The client group requires a high level of support and their need is very great. Support was required for them to address some very basic needs.The ability of the team to provide intensive support, based on client need and for as long as the client requires that support is key to the unique service being offered by the team within the locality.
The average length of engagement with clients is six months and of the current client caseload, the project has been working with three of these individuals for 15 months, two clients for nine months and one client for ten months.
The team offer a breadth of support to clients. The support offered is not defined by the service - but is led by the needs of clients. Clients welcomed the holistic nature of the support and felt that the support was appropriate to their needs.
The intensive support on offer to individuals, coupled with access to accommodation, is pivotal when helping individuals address the problems in their life.
The core elements of MCN provision are fundamentally rooted in the increased capacity of the team due to the relatively small and ‘protected’ nature of their caseload.
A refer and accompany approach when working with clients also provides opportunities, and the time, to build and foster relationships between worker and client. The ability of the team to work on an outreach basis within the locality was regarded as a key strength of the project.
The Personalisation Fund had been accessed by many clients and has helped to provide clients with a range of items for tenancies, utilities payments, food, items and supported client engagement within the community. The Personalisation Fund has also been used to fund other experiences such as haircuts and being taken for coffee and meals. These experiences impact on client wellbeing and feelings of self worth and have helped clients to feel like a ‘normal person’.
Recommendation/sPeer approach
The MCN project, unlike other HTF projects within the region, does not incorporate an element of peer support. Whilst relationships between clients and MCN workers are very strong, our experience of reviewing other HTF projects with a peer element has reinforced our view of the vital role that peer workers can have. Peer workers provide a role model to clients and are a constant reassertion to clients of possibilities, change and opportunity. The only two clients who were contemplating future employment possibilities, discussed working in the social care field – within addictions or domestic violence. A peer worker would reinforce the potential for this option as a real possibility. Peer support – in our previous reviews – was regarded as a key aspect of service delivery. The value of the shared experience and empathy enhanced communication and was an important part of the relationship building process. We suggest First Stop considers the introduction of a peer element – possibly through the use of volunteering. This would not necessarily mean the use of ex-MCN clients as peer workers, but will include volunteers who have experience of multiple exclusion. We suggest the project contacts the Changing Lives ACE team in Sunderland to explore the potential of incorporating a peer element.
The MCN team
A key strength of the project are the MCN Assertive Outreach workers; the breadth of their work, their flexibility and tailored response to client need, their approach to client work and their commitment to clients.
MCN workers are clearly respected by partner agencies within the locality and by MCN clients.
It was evident that a trusting relationship, based on mutual respect had been established between client and worker and clients often discussed how staff delivered what they ‘promised’.
The blended nature of the team, combining workers with a breadth of key specialisms and links to key services – NECA and MIND – works well and also promotes ‘buy in’ from key agencies. The team are a strong team and have shared values and a shared approach to their work.
There was some concern locally, that the intense nature of the MCN provision may increase client expectations when they then access other services locally. However, as this approach seems to be having an impact, in order to sustain change with this client group,other services may need to reflect on how they respond and work with this client group in the future.
Recommendation/sPreparing for sustainability
Those leading the MCN project should explore further opportunities to ‘sell’ the work that it is undertaking and ensure that all partner agencies are aware of the goals, outcomes, progress and aims and objectives of the project. This process should also form part of a longer alliance building strategy within the locality; a strategy that is also focussed on sustaining the legacy of the project beyond its short-term funding timescales. It is important that the process of planning for 2015/16 starts immediately. Within this context it is also important to strengthen alliances and further develop strategic links with the local CCG, the Health and Wellbeing Board and the local Police and Crime Commissioner. As one of the key areas of the MEAM approach relates to sustainability and systems change ( it is also important that this broader group of stakeholders are engaged in order to address systems change in the longer term.
A broader support network
Whilst the MCN team have access to a regional Multiple Needs and Exclusion Forum (run by the Regional Homelessness Group) we feel that the team (including the First Stop Chief Executive) would benefit from being part of a broader regional support network with other HTF projects. We suggest that contact is made with Changing Lives in order to explore this possibility.
External support
The work undertaken by the MCN team is both stressful and intense. It is therefore vital that staffare provided with formal support structures. Whilst staff have access to internal supervision and a regular team meeting we strongly support the proposed adoption of external supervision structures.
Training needs
Whilst staff have attended a number of training sessions focussed on a number of issues, it is important that supervision consistently addresses training needs. We felt that there were opportunities for staff to attend training related to mental health and addictions recovery. A training needs assessment with staff should be undertaken.
Partnership working
We gained a strong sense that key agencies within Darlington are committed to supporting the MCN project and recognise that a different approach needed to be undertaken with the client group in order to engage and to make an impact.
The MCN team has developed strong working relationships with many key providers within locality who also work with the client group, including probation and addictions services.
The MCN team are respected and valued by partner agencies within the locality. Generally speaking, it was felt that there were good, open communications between the MCN team and other agencies and that these relationships were very much solution focussed.
The MCN project has a seconded MIND worker embedded within the team, which it was hoped would then be able to facilitate further access into MIND and mental health provision. This had not happened as anticipated, and at the time of our interviews, the role of this worker was in the process of being re-configured in order to address this perceived unmet need. This is yet another example of the service being ‘nimble’ and learning and responding flexibly, in order to meet need.
Chapter One: Introduction
1Introduction
1.1Introduction
The evaluation undertaken by Soundingboard Research and Consultancy aims to review the MultipleComplex Needs project, delivered by First Stop in Darlington, which is funded through the Homelessness Transition Fund (HTF). This includesan assessment of the processes involved, participation from key agencies, the strengths and weaknesses of the MCN team and the impact of the work of the team. To gain an understanding of the project we consulted with staff from the MCN project and those with responsibility for overseeing the project, key stakeholders within the locality and a sample of clients accessing the project. Our qualitative work has been supplemented by quantitative data collected by the MCN team.
This report has been commissioned by the North East Regional Homelessness Group.
1.2 Background
The £20m Homelessness Transition Fund was launched with the ambition to help prevent and tackle rough sleeping in England.The fund is for non-profit organisations and provided by the Department of Communities and Local Government. It is administered by Homeless Link. The objectives of the fund are to: