Westminster Homeless Health Coordination Project

Quarter 1 Report

2018-1019

Author: Nayer Ravandi

Westminster Homeless Health Coordination Project report

Quarter 1, 2018-2019

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Contents

Westminster Homeless Health Coordination Project Q1, 2018-2019 ............... 1

Introduction .................................................................................................... 3

Positive outcomes and highlights for the past 3 months: ................................. 3

Westminster Health and Wellbeing Statistics for supported housing clients .... 4

Number of ambulance call outs and hospital admissions ................................ 4

Number of ambulance call outs and subsequent numbers conveyed to hospital ............................................................................................................ 4

Number of escorted health appointments via Groundswell……………………..5

Westminster Health and Wellbeing Statistics for rough sleepers ..................... 6

Residents with substance misuse issues engaging with Turning point at Westminster homeless services…………………………………………………6-7 Westminster HHCP health events and training………………………………..7-8

Service user and staff conference……………………………………………..8-10

Number of service users attending health training……………………………..10

Number of staff attending health training………………………………………..11

Tool kits and support for services…………………………………………….11-12

Appendix…………………………………………………………………………...13

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Introduction The Westminster Homeless Health Coordination Project (HHCP) is 36 months into supporting 19 services to improve health access and decrease health inequalities of those in supported housing projects and rough sleepers. Consequently, these past months have seen an improved focus on health and wellbeing for service users and staff in Westminster. This report details the positive outcomes and achievements during the last three months.

Positive outcomes and highlights for the past 3 months: 159 staff members attended health training.

HABIP reached 100% of its target of training 250 staff members by June 2018.

The homelessness and Brain Injury Toolkit was completed in June 2018 and distributed to staff across the Homeless sector nationally.

New monthly clinics for staff have started on brain injury, occupational

therapy and mental health advice.

134 attendees at the Staff and Service User’s Conference on 17th April.

44 Service users had TB screened.

63% increase in health appointments supported by Groundswell, compared

to the last quarter.

The HHCP online resource was visited 275 times.

11 committed volunteers supporting the HHCP.

A total of 39 attendees at April and June’s Health Action Group meeting.

Abbreviations and acronyms

CHAIN Combined Homelessness and Information Network

HHCP Homeless health coordination project

CHAT Common Health assessment tool

CSTM Connections at St Martin's

DAWS Drugs and Alcohol Service

EASL Enabling Assessment Service London

FAM Frequent Attenders Meeting

HHPA Homeless Health Peer Advocacy

LAS London Ambulance Service

SPA Single Point of Access

ABI Acquired brain injury

JHT Joined homeless team

CMHT Community mental health team

IAPT Improving access to psychological therapy

WCC Westminster City Council

HABIP Homelessness and Brain Injury Project

MORS Westminster Move on and resettlement services

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Westminster Health and Wellbeing Statistics for supported housing clients Number of ambulance call outs and hospital admissions London Ambulance Service (LAS) provides the number of ambulance call outs, and supported housing projects record hospital admissions and the amount of A&E attendances, via the additional returns. Number of ambulance call outs and subsequent numbers conveyed to hospital The LAS indicated that ambulances were requested 127 at 9 services, indicating a 1% decrease in the amount of ambulance call out compared with the last quarter. Figure 1 illustrates the number of ambulance call outs at each service. The highest number of ambulance call outs were recorded at Edward Alsop Court (29) Hopkinson House (27) King Georges (18) and Harrow Road (17).

Figure 1 - Number of clients that ambulances were called out for, by project

53% of clients were conveyed to hospital following an ambulance call out, illustrating an increase of 3% compared to the last quarter. Table 1 illustrates the number and percentage of clients conveyed to hospital after an ambulance call out at each service.

11

5

29

17

27

18

6

14

0

4 3

14

8

15

11

3

9

00

5

10

15

20

25

30

35

MORS Bruce House EdwardsAlsop Court

HarrowRoad

HopkinsonHouse

KingGeorges

ShrotonStreet

CAS PassageHouse

London Ambulance Service Hostel Call Outs

Q1 # of ambulance call outs Q1 Conveyed

Project Q1 # of

Ambulance call outs

Q1 conveyed % conveyed

MORS

11 4 36%

Bruce House

5 3 60%

Edwards Alsop Court

29 14 48%

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Table 1 - The number of ambulance call outs and the number & percentage conveyed to hospital, by project.

Future focus

The HHCP will endeavour to source training to better equip staff on when an ambulance is required. The HHCP developed a treatment refusal form that can be used as a tool to encourage clients to get the medical attention they require at hospital.

The HHCP is working with services to identify methods to reduce the number of frequent attenders.

Number of escorted health appointments – via Groundswell A total of 102 appointments were made via homeless services to the Groundswell HHPA service in Q1, compared with 38 in the previous quarter, illustrating a 63% increase in referrals. See figure 2 for a breakdown of appointments at each service.

Figure 2 - Number of escorted health appointments via Groundswell, by service

0

5

10

15

20

25

30

35

40

1

14

0

57

42

9

18

36

6

0 0

Number of Groundswell Referrals

Harrow Road

17 8 47%

Hopkinson House

27 15 55%

King Georges

18 11 61%

Shroton Street

6 3 50%

CAS

14 9 64%

Passage House

0 0 N/A

Total

127 67

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Analysis

As illustrated by figure 2 there were no HHPA service bookings at Bruce House, Compass team and WMORS. Groundswell currently runs coffee mornings to increase awareness of their service at Shroton Street, CSTM, EAC, Passage Resource Centre and King George’s.

The HHCP coordinator will continue to promote the HHPA service to increase the number of HHPA bookings.

Westminster Health and Wellbeing Statistics for rough sleepers

Outreach workers record health data for rough sleepers on the Westminster Assessment on CHAIN. As it is not a requirement for all sections of the Westminster assessment to be filled in it is only possible to provide a snap shot of the health needs of rough sleepers. Please note that figures in brackets indicate the difference between this quarter and the last quarter. A total of 192 assessments were completed. Men constituted 82% and 3% of the total clients were aged 18-25, 7% aged 26-35, 13% aged 36-45, and 16% aged 46-55 with 1% aged 56-64. 50% (-1%) of rough sleepers were reported to have a physical health support need, 10% (+4%) with a high support need, 19% (-2%) with a medium health need and 21% (-2%) with a low support need. Examining the descriptive physical health data, the main physical health needs reported included; brain injury, hepatitis C, asthma, HIV, diabetes, epilepsy, liver cirrhosis and eczema. 49% (-5%) of rough sleepers were reported to be registered with a GP. 51% (no change) of the assessments did not indicate whether the client was registered with a GP.

39% (-17%) of the 192 assessments carried out were considered to have a support need around their mental health. 45% (+1%) of assessments indicated there was an alcohol support need.

46% (+6%) of assessments were considered to have a drug support need.

Residents with substance misuse issues engaging with Turning point at Westminster homeless services

Service Providers

Total number of residents

Residents identified

with substance

misuse issue

Total engaging

with turning point

Number using drugs

(not engaged)

Number using

alcohol only

Number to be targeted

Did not want to engage

Hopkinson House

29 21 8 11 ? 11 2

Edward Alsop Court

74 16 6 10 22 10 0

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Marylebone Project

45 4 3 1 3 1 0

King Georges

66 44 22 13 3 4 9

Harrow Road

43 26 16 10 8 9 1

Westminster MORS

79 38 9 24 21 19 5

Total 336 149 64 69 57 54 17

Table 2: The number of clients with substance misuse need, the number clients are engaging with Turning point for support and the number of clients are not engaging with support.

Note: The above data has been collected by Turning point about the residents substance misuse need, their drug engagements and not engagements.

Figure 3 - The number of clients with a drug support need and the number that are engaging with Turning point around their drug use and the number that are not engaging.

Westminster HHCP health events and training The following section details the numbers of service users and staff that attended training co-ordinated by the Westminster HHCP, as well as providing an update on the HHCP health events facilitated.

Health MOT event The Health MOTs were run in conjunction with the Find and Treat Mobile Health Unit visited residents in June 2018. On 26th June, two members of the TB van, staff members and the

21

16

4

44

26

38

8

6

3

22

16

9

11

10

1

13

10

24

0 5 10 15 20 25 30 35 40 45 50

Hopkinson House

Edward Alsop Court

Marylebone Project

King George

Harrow Road

Westminster MORS

NUMBER USING DRUGS (NOT ENGAGED)

TOTAL ENGAGING WITH TURNING POINT

RESIDENTS IDENTIFIED WITH SUBSTANCE MISUSE ISSUE

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HHCP coordinator encouraged the residents at Harrow Road and MORS residents to be screened.

Place Date Health Service Numbers Harrow Road 26th June TB screening 21

MORS 26th June TB screening 23

Service user and staff conference, 17th April 2018

The Homeless Heath Coordination Project facilitated the third annual Staff and Service Users Conference on 17th April 2018 at The Abbey Community Centre. The theme of the conference was “I want to improve my health in 2018” and attendees were encouraged to think about their own health and wellbeing and consider what areas of their health and wellbeing they would like to improve in 2018. Individual invitations were sent out to staff and service users and a record breaking number of 134 staff and service users attended on the day.

Networking staff and service users First aid demonstrations by Margaret Pitt

The conference included staff and service users pledging (how they could improve their health in 2018”. Here are some of the examples of the health pledges made by the conference guests.

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Pledge activity Raffle prizes to all the guests

The day concluded with a raffle where all the guests won prizes. Feedback forms from the day was very positive and data from the evaluation forms illustrated that guests from the conference found the day very useful. 85% reported the conference very useful with 72%

Take care of my mental health Get help with my Brian injury

Improve my dental health Live without violence

Drink more water and exercise more

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found the speakers very useful and 96% of attendees agreed that the conference had increased their confidence to attend health appointments in the future. Many thanks to the staff, volunteers and students from St. Mungo’s and the Groundswell peers Who helped out on the day.

Number of service users attending health training There were two HHCP health related sessions scheduled this quarter. Consequently, 10

service users took part in 2 individual health related sessions. Table 2 provides details on the

training offered and the numbers attending per service.

Training offered Presenters Service # of service

users attending

Session on different diseases, 6th April

HHCP health promotion volunteers

Shroton street 3

Session on health issues, 12th June,

HHCP health promotion volunteers

Harrow Road 1

Total 4

Table 3: Number of service users attending health training, by service

Nice range of speakers and good presentations

It’s been a very good afternoon, very informative and good to learn in an informative atmosphere.

I learnt a lot, very well organised event.

Thank you!

It’s been a very good afternoon, very informative and good to learn in an informative atmosphere.

It was a very inspiring event.

Analysis

The HHCP coordinator to recruit more health promotion volunteers to run training sessions at the hostels to increase the residents’ knowledge on their health and wellbeing. The HHCP coordinator to contact Turning point and British Red Cross to request monthly/bi monthly training to clients on spice awareness and first aid.

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Number of staff attending health training 159 staff attended training coordinated by the HHCP. Topics included brain injury, Dealing with distress, Bipolar and Schizophrenia, Novel psychoactive substance including Spice training, Universal credit, Metallization. Appendix 1 (page 13) provides a full breakdown of the trainings offered, including numbers of staff that attended and feedback provided by attendees.

Tool kits and support for services 1. The Homeless and Brain Injury Toolkit was completed in June 2018 and distributed to staff

across the homeless sector nationally.

2. HABIP

The HABIP began in July 2017 and was able to increase some awareness around homelessness and brain injury and managed to improve outcomes for clients identified to have a brain injury. The HABIP also reached 100% of its target of training 250 staff members by June 2018. Due to such a success the HABIP was secured funding for another year until March 2019. Future training sessions and also monthly brain injury clinics have been scheduled for August and September 2018.

3. Responding to deaths in Homeless services Toolkit

The HHCP coordinator has been asked to develop a toolkit about responding to deaths in homeless services. This toolkit aims to provide guidance to staff on how to respond to a client’s death in homeless services and how to support clients and staff after a client dies.

4. Responding to clients who have experienced trauma in homeless services

Toolkit

The HHCP coordinator and one of the research volunteers have been working on a trauma informed care toolkit for homeless services. This toolkit aims to help staff members to develop some understanding about trauma and how to work with clients who have experienced trauma in their lives. This toolkit will provide information on communication methods, support services, risk assessments and an action plan.

5. HHCP Research project

One of the research volunteers worked with the nurse who leads the Female Entrenched

Rough Sleeper Project. The volunteer wrote up case studies and created the full FERSP

annual report which contributed to the project securing further funding for 2018/19.

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6. Recruiting for HHCP volunteers

Due to decrease in HHCP volunteers, two new Health Promotion volunteers were recruited this quarter.

7. Monthly Health Clinics for staff

Three monthly clinics for staff have started on brain injury, occupational therapy and

mental health advice.

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Training offered Presenter Services Number attended

Feedback

Assertiveness training, 4th April

Klein Guy, IAPT WLM, UTK, St. Mungo’s, Church Army, Look ahead

7 How useful did you find the information given to you today? Very useful – 5 Useful –2 Other feedback: I learned there is difference between assertiveness and aggression, I found the space for discussion very helpful to reflect.

Dealing with distress 10th April

Angus Stevenson, ESAL

St. Mungo’s, WLM, CSTM, CGL

7 N/A

Blow to the head? Homeless? 19th April

Leigh Andrews St. Mungo’s, Riverside, WLM

6 How useful did you find the information given to you today? Very useful – 4 Useful –2 Other feedback: Very interesting and easy to understand, very useful training and helps me to put into practice.

ABI drop In clinic, 19th April

Leigh Andrews Riverside, Church Army 3 N/A

OT drop in sessions, 24th April

Nicola from ESAL Compass team, Hopkinson house

2 N/A

Stress and Worry management, 3rd May

Guy Klein- IAPT WLM, Church Army, Mayday Trust St. Mungo’s, SHP, TRG

12 How useful did you find the information given to you today? Very useful – 3 Useful –9 Other feedback: I liked the worry diary & techniques to return to present. More group exercises would be good, important to plan time for problem solving.

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Autistic spectrum drop in session, 3rd May

Dr Catherine Cheung

St. Mungo’s 4 N/A

Bipolar and Schizophrenia, 10th May

France Klemperer & Nicola G.

CSTM, Riverside, St. Mungo’s, JHT, Look ahead, Thames reach,

15 How useful did you find the information given to you today? Very useful – 9 Useful –4 Other feedback: Excellent training, I feel more confident, Peter from the peer support was very impressive, very informative.

Novel psychoactive substance including Spice training, 14th May

Peter Burleigh- Turning point

West London Mission, BWW Mind, RBKC, Marylebone project, Turning point

18 How useful did you find the information given to you today? Very useful – 16 Useful –2 Other feedback: Enjoyed the group work, it was really very helpful and informative training, very well delivered.

Harm minimizing training re change resistant drinkers, 14th May

Mark Anderson from IQVIA and Jules Moffat from Norgine

St. Mungo’s, WLM, CSTM, Look ahead

14 N/A.

Building resilience to better manage stress workshop, 17th May

Anthony Feilden Riverside, WLM, St. Mungo’s, Church Army, Mayday trust

8 How useful did you find the information given to you today? Very useful – 5 Useful –3 Other feedback: I liked techniques and knowledge, start the day with affirmations, that way I won’t need external validation.

OT drop in sessions, 22nd May

Nicola-ESAL SHB, Passage 2 N/A

ABI drop In clinic, 23rd May

Leigh Andrews St. Mungo’s, Lockheed 2 N/A

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Diabetes awareness, 6th June

Martin Jones WLM, Look ahead, CGL, SHP, St. Mung

10 How useful did you find the information given to you today? Very useful – 3 Useful –4 Other feedback: Diet and weight can be main causes for diabetes, well presented, quite informative.

Mental health advice sessions, 13th June

Jen Foster Westbourne House, Centre point

2 N/A

Universal credit training, 18th June

Clare Cross Thames Reach, St. Mungo’s, Passage, Wytham hall, Look ahead, Church Army, SHP, Mayday trust, BWWmind

16 How useful did you find the information given to you today? Very useful – 6 Useful –7 Other feedback: Good training, very informative and well presented.

First aid training, 21st June

Grant Hoyle Riverside, St. Mungo’s, WLM, SHP, Look ahead

5 How useful did you find the information given to you today? Very useful – 5 Other feedback: It was very helpful and informative. Very fun and interactive.

Occupational therapy OT Drop In, 26th June

Nicola-ESAL SHP, St. Mungo’s 2 N/A

Metallization training, 27th June

Dr Emma Williamson & Dr Jen Foster

Montfort House, St. Mungo’s, CSTM, Mayday trust, BWWmind, WLM, Look ahead, SHP, Waterloo project, Montfort house

24 How useful did you find the information given to you today? Very useful – 15 Useful –9 Other feedback: The explanations and examples were given were useful and informative, being made aware of the difference between empathy and sympathy were useful.

Total 159