Today we publish the first in a short series of briefings on multiple needs, drawing on data and insight from the Fulfilling Lives: Supporting people with multiple needs programme.
Everyone deserves the opportunity to reach their full potential. But the current system is not working for people with multiple needs. Many of their interactions with public services are negative and/or avoidable. Few receive the care and treatment they need.
This results in substantial costs to the public purse. When people first join the Fulfilling Lives programme they are each using, on average, at least £25,000 in public services per year. Across all 3,000 plus Fulfilling Lives beneficiaries this equals over £88.5million. There are also serious social and economic impacts as well as the tragic waste of human life and potential – 1 in 20 beneficiaries have died since the start of the programme.
Fulfilling Lives offers a different approach – involving persistent and ongoing support, free from restrictive timescales and focusing on beneficiaries’ priorities. Change will take time, but after just one year, the evidence suggests that Fulfilling Lives reduces negative behaviours and misdirected demand for services – including a reduction in homelessness, evictions, visits to A&E and interactions with the criminal justice system. This creates the opportunity to use resources differently. This initial annual reduction in use of services is worth at least £2,100 per beneficiary per year – £7.3million across all Fulfilling Lives beneficiaries.
Read the briefing here. Further information about data sources can be found in the accompanying method notes here.
Beth Collinson will be joining the Fulfilling Lives national evaluation team from April 2019 leading on our learning programme. In this, her first blog, she talks about the inspiration gained from attending a recent event held by one of the Fulfilling Lives partnerships.
Throughout my PhD, the social contagion of recovery (from substance misuse), became a predominant element of my work. In one of my first presentations, I explained that just as human emotions like happiness can be contagious, recovery is too. A colleague of mine (Professor David Best) explains in his work that the social contagion of recovery has the potential for “transmitting hope and the belief that recovery is possible even to those who are not yet ready to commit to abstinence“.
The national evaluation team have published key findings from local evaluations in their latest report, Promising Practice. The report:
- Highlights approaches and interventions that appear promising based on local evaluation evidence;
- Shares learning on successful implementation of these approaches;
- Considers how different interventions are contributing the the programme’s systems change ambitions; and
- Informs further evaluation activities.
Having purpose, an eye for detail and a sense of curiosity are the Fulfilling Lives workforce attributes I have flagged as desirable in previous blogs. Time is often at a premium for staff. Smaller caseloads and flexibility are ways of extending the time available to beneficiaries. Which brings me round to another attribute for the practitioner which, is pragmatism.
As I said in the item on curiosity, practitioners engaged with the evaluation of theory not only contribute to better practice but ensure theory is grounded in pragmatism. Thereby theory becomes better as well. People become less inclined to say: ‘that is alright in theory, but it doesn’t work in practice’. A pragmatic practitioner doesn’t just know the theory, but they act on it because it works.
It’s now six months since I joined the Fulfilling Lives national evaluation team. My background is in community and criminal justice research, so I have a degree of familiarity with the target group. I have evaluated initiatives to help re-engagement on release from prison, to provide pathways to education and ultimately employment, and to help with accommodation and independent living. Offenders often have chaotic lifestyles and multiple needs including experience of homelessness, alcohol and/or drug dependency, and/or mental health issues. You can often find childhood trauma, special educational needs or attachment issues as well. What struck me time and time again when listening to offenders and their workers tell me their stories was the lack of coherent support available to people who are in desperate need of help.
The latest national evaluation report on the Fulfilling Lives (Supporting People with Multiple Needs) programme, published today by CFE, shows continuing high demand for help. The 12 funded projects have successfully engaged with nearly 3,000 people affected by homelessness, substance misuse, offending and mental ill health.
Beneficiaries who remain with the programme show clear signs of progress, but this takes time and substantial resource. Project staff often need to spend extended periods of time with beneficiaries and have to be flexible to cope with chaotic lives. However some beneficiaries have needs for which they will always require support. What constitutes success varies from person to person and in many cases, success is about developing strategies, resilience and understanding to effectively manage their needs.
The report includes clear messages and promising practice, providing recommendations not just for those who work to support people with multiple needs, but also for service commissioners and funders.
Read the full report here: http://mcnevaluation.co.uk/wpfb-file/annual-report-2017-v1-final-pdf/
A key feature of Fulfilling Lives is that it is a learning programme; it aims to gather and share learning about what works, what doesn’t and what needs to change. A frequently used method to collect views and experiences from which to develop learning is the survey. In this blog, Kerry Dowding (Research and Evaluation Officer, Fulfilling Lives South East) shares her tricks and tips on how to get the most out of your survey design. Kerry has been creating surveys for the voluntary sector for the last eight years, and received a Masters of Research in 2016.
It’s 4.50pm, and you remember that you promised to send out a few survey questions by the end of the day. You scribble out some questions that roughly fit the bill, and send them off. The responses you get back are less than inspiring. So you end up going with the ideas you originally had for the project. We’ve all been there!
At the centre of the Fulfilling Lives (Multiple Needs) programme is evaluation and here the workforce is on the frontline. For it is they who source, collate and complete the two key measures – the Homelessness Outcomes Star and the NDT Assessment – with the service beneficiaries. Frontline workers say something they enjoy about the programme is the move away from a purely target driven approach. To make the most of this we need to make sure that the essential evaluation is not a chore. Not tasks that are completed as an add-on to a day’s work but ones that are integral to the way of working alongside beneficiaries and peer workers.
I have blogged previously about purpose and it’s time to move on to the detail – where the devil lies (alongside salvation) . The question is how do we recruit, train, support and retain an effective workforce? A workforce with the knowledge, skills and experience to change lives and systems alongside people with complex needs including homelessness, offending, substance misuse and mental ill-health. One that supports people to overcome barriers to services and engagement. A workforce that is genuine and honest about the collaborative involvement of individuals with lived experience.
It is a big ask to come up with an exhaustive list of what the workforce does and how it goes about its tasks. Anyone that has spent time drawing up job descriptions knows the lengths you can go to trying to capture everything. Equally, they know the struggles of seeking to be both precise and concise. Perhaps that’s why so many job descriptions are rarely used in guiding day-to-day work and are only got out either when there is a vacancy or a workforce problem. In projects like Fulfilling Lives (Multiple Needs) the issues are compounded because many of the roles are evolving and breaking new territory.
Helen Gavaghan, Senior Engagement Worker at Inspiring Change Manchester (ICM), gives an inkling of some of the things workers do to support people to think about change. She says some ‘traditional’ approaches need challenging and staff freed up to be open about working with both their own and their client’s lived experience. She concludes by suggesting learning about what it is that staff are doing is collected and brought together as a tool-kit for other practitioners.
In the Fulfilling Lives (Multiple Needs) projects, when considering the learning that is being fed back overall, I feel there could be more detailed examination of what the frontline project workers do that makes a difference to people’s lives. I believe that there is some valuable learning that could be collected and shared and, if it isn’t, may be lost. General explanations of the approach, such as “building trusting relationships” and “avoidance of judgement” are fine – but I believe are in no way getting down to the specifics and nuances of the great work that is going on.
Vic Citarella delves further into the significance of ‘purpose’ for service users and the workforce in the Big Lottery Fulfilling Lives (Multiple Needs) projects.
Indications are emerging from evaluations that the ‘purpose’ of each Fulfilling Lives project is very important in generating value and ownership. For beneficiaries, engaging in meaningful activities appears to create a vital sense of purpose. Equally for the workforces involved feedback suggests that the ‘purposeful’ nature of job roles generates added value and personal motivation. In my last workforce blog, I suggested that the value stemmed from four sources:
- Meaningful service user engagement
- Concepts of open-endedness and persistence (turned into practice)
- The ideas around psychologically informed environments (PIE) and the like
- Systems Change
In focussing on workforce matters in this series of blogs I have therefore dug a bit deeper to address questions such as: what is the purpose of purpose? How is purpose agreed, described and refreshed? What is it about the four sources which users and workers value that drives them on to achieve their goals?
The National Expert Citizen’s Group is a group of individuals with lived experience of homelessness, substance misuse, mental ill health and offending behaviour. The group is comprised of individuals from the 12 funded project areas for the Big Lottery Fund’s ‘Fulfilling Lives: Supporting people with multiple needs’. CFE Research facilitates the group. Members from the group have been accepted to run a workshop at the 2017 Multiple Needs summit in Milton Keynes. Sarah Robinson, the group’s facilitator (and research manager on the programme’s National Evaluation), will be supporting two group members to lead and present at their first national conference.
Sarah Robinson (CFE) and Wayne Richmond and Nicola Plumb (Blackpool Fulfilling Lives) share their reflections on a National Expert Citizens’ Group Workshop
On Monday 28th and Tuesday 29th November 2016 CFE facilitated a two day workshop for the National Expert Citizens’ Group (NECG). The NECG is a group of individuals with lived experience of multiple needs; the group is formed by representatives from each of the 12 funded Fulfilling Lives project areas. The Monday was a training and planning day for the experts by experience. The day focused on training delegates to chair meetings/events and facilitate workshops at events. It was an opportunity to build the confidence and skills of the experts. The activities used to test their skills focused on deciding the direction of the NECG over the next 12 months.
In the first of a series of blogs, Vic Citarella considers the crucial role of the workforce in Fulfilling Lives for people with multiple and complex needs. Vic is keen to start a dialogue with projects on this topic. You can get in touch with him using the details below.
“The CFE and University of Sheffield 2nd annual report into the national evaluation of Fulfilling Lives: Supporting people with multiple needs programme has chapters on ‘interventions and approaches’ and on ‘working the frontline’. The report says it raises as many questions as it answers but without doubt it pinpoints the workforce and what they do as the mission critical factor in the projects. More is promised by way of research and future evaluation. That means, among other things, dialogue with the practitioners, the managers, the stakeholders and the customers of the services.
In the hunt for a bike for my daughter the typing of “kids bikes” in Google returned just shy of 78 million results in less than one second! After years in research I still find it extraordinary the number of sources of information that are returned when performing any internet search (“kids bike bells” a meagre 1.5 million returns in 0.76).
Chatting with friends over the weekend the topic turned to the works of Keanu Reeves (don’t ask) and his big break: the film Bill and Ted’s Excellent Adventure (1989!). We all agreed that the central philosophy of ‘Be excellent to each other’ was a pretty sound one.
CFE Research, working in partnership with the University of Sheffield, have published their latest report on the evaluation of the Big Lottery Fund’s ‘Fulfilling Lives: Supporting people with multiple needs’ programme.
Supporting those who are chronically excluded and disadvantaged – experiencing homelessness, mental ill health, substance misuse and reoffending – is a challenge that needs a different approach. The £112 million initiative is funding 12 projects across England to provide more person-centred and co-ordinated support.
Latest findings from the evaluation show that projects have made a good start in reaching those with greatest need. But continued effort is needed to reach ‘hidden’ and harder to reach groups such as women with multiple needs and people from Black and minority ethnic communities.
The initiative still has six years to run, and as such few beneficiaries have successfully moved on to date. But there are signs that those who remain on the programme are making progress, accepting help, engaging better with services and building trusting relationship. Frontline staff report that flexible, open-ended support that focuses on beneficiaries’ own priorities is key to making a difference.
Read the full annual report here
The All Party Parliamentary Group on Complex Needs and Dual Diagnosis, is looking for examples of good practice in working with people with co-existing substance misuse and mental health issues, to inform an online ‘library’ for policy makers, commissioners, providers, academics, experts by experience and others to reference.
For anyone who is interested in either providing a case study of good practice or contributing to this work in general, please do get in touch with us at email@example.com with the attached form.
They are also planning on conducting a short survey to ascertain the current strengths, risks and opportunities facing services supporting people with multiple complex needs so please do look out for this in the next few weeks.
Sent on behalf of David Burrowes MP & Lord Victor Adebowale CBE
Co-Chairs of the APPG on Complex Needs and Dual Diagnosis
Turning Point provides the secretariat to the APPG on Complex Needs and Dual Diagnosis.
I am part of the National Expert Citizens Group (NECG). This is a group which draws people from all twelve Fulfilling Lives areas together to learn and try to influence on issues which are important to us. We all bring our own skills and expertise but the one thing that we have in common is that we all have lived experience of multiple needs.
On Friday 29th January we came together in Stoke-on-Trent to meet with Home Office representatives and Public Health England. On the agenda: The National Drug Strategy Review due to be published in March 2016.
On the 29th January, in Stoke on Trent, the National Expert Citizen’s Group of Fulfilling Lives were invited to review the National Drugs Strategy. The strategy focuses on three key themes: Reducing Demand, Restricting Supply and Building Recovery. The day focused on the third strand – Building Recovery. A member from the Home Office’s Drug Strategy Team provided an initial presentation to set the scene. The rest of the day focused on obtaining expert’s views and opinions, from their lived experience, on key aspects that are needed to inform the new strategy. The review was particularly interested in:
— Barriers to recovery
— How to reduce the stigma of substance misuse
— What works well in recovery – particularly around housing and employment
The day was recorded graphically and in notes.
Home Office Fulfilling Lives – Juli Dosad Banter Graphic Recording small
The Home Office will be providing an annotated strategy after its publication later this year which marks which areas were changed/influenced by the views of the experts. A follow up session with the Home Office will occur at the May NECG meeting in Bristol.