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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.

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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“.

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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.

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Vic Citarella

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.

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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.

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ar-2017-imageThe 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/

Vic Citarella

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.

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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.

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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.

http://www.homeless.org.uk/events/tackling-multiple-disadvantage

Vic Citarella

It is, perhaps, self-evident that people with complex needs frequently require correspondingly multiple and complex responses…. wrote Henwood and Hudson in their 2009 CSCI study Keeping it personal. Now as Carers’ Week passes we have, in the Care Act, the strongest rights yet for carers. When put together with the duty of assessment for young carers, in the Children and Families Act, the legislative framework is suitably reflective of the very complexity identified for policy makers five years ago. It is a challenge for the Fulfilling Lives: supporting people with multiple needs evaluation to explore, understand and share how project investment resolves the problematic issues of real life complexity. Those involved in caring relationships shaped by homelessness, criminal behaviours, substance misuse and fragile mental health are potential benefiting contributors to making the most of that significant investment. The evaluation process has to identify both the benefits and contributions of carers to the success of Fulfilling Lives. Continue reading

Vic Citarella

The parliamentary ‘ping-pong’ is over, amendments agreed between the Lords and the Commons and the Care Act has Royal Assent.  Everyone – local authorities, NHS bodies, public, voluntary and private organisations – are busy assessing the potential impact of the new law on what they do. How will it help/hinder; what are the gaps; what are the costs; what will we do now and what can wait; which clauses take priority; who is going to do what and how will we cope? The questions go on and the project and risk management training is put to the test. Projects will be making similar judgements themselves and the national evaluation team too will be considering how it might impact on our work on Fulfilling Lives; Supporting people with multiple needs. Continue reading

The Big Lottery Fund is today (12th Feb) awarding £112 million across England to end ‘the revolving door of care’ faced by thousands of people with multiple problems including homelessness, mental ill health, addiction and reoffending.

The grants of up to £10 million to 12 areas across the country will help to improve and create better coordinated services to prevent people living chaotic lives being passed between charities and services, which often cannot individually deal with their wide range of needs. Continue reading