Ending rough sleeping: personalised approaches and individual budgets

Ending rough sleeping:

personalised approachesand 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 psycho-social 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

4 pilot areas

• City of London

• Nottingham

• Northampton

• Exeter and North Devon

Range of partners

• 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

Pilots to test out the belief that “personalised budgets and individualised offers are key tools to

tackle entrenched rough sleeping”

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 budgetsThree 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?

• 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

• 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

• Criminal Justice System catching up - police not always on board, or able to recognise changes achieved

• Engaging mental health/LD services – need for new models and pathways that emphasise intensive social, emotional and practical support rather than “treatment”

• Funding long term intensive support

• 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…

• 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:

Rebecca.pritchard@communities.gsi.gov.uk