King's College London

Implications for workforce development and interprofessional practice

Purpose

This study explored interprofessional working and workforce development in the context of providing support to people with experience of multiple exclusion homelessness.

Research team

Michelle Cornes, Louise Joly and Jill Manthorpe (SCWRU)
Sue O'Halloran (University of Cumbria)

Funding

Economic and Social Research Council (ESRC)

Background

In February 2009, the Economic and Social Research Council launched the ‘Multiple Exclusion Homelessness Research Programme’ with the aim of informing government policy and practice and finding solutions to bring the most vulnerable ‘homeless people’ in from the margins of society. The concept of ‘multiple exclusion homelessness’ alerts us to the potential for complex interplay between many different professional or occupational groups, reflecting how drug or alcohol dependencies; severe mental health problems; domestic violence; local authority care and prison; and participation in ‘street culture’ and ‘survival activities’ such as sex work, begging, street drinking and street-level drug dealing frequently (but not always) intersect with homelessness.

As part of the Programme, the Social Care Workforce Research Unit at King’s College London was commissioned to undertake a two year exploratory study exploring how different agencies and professionals work together to support people with experience of multiple exclusion homelessness. The objectives of the study were to enhance understanding of how interprofessional collaboration works to identify and manage the intersections between homelessness and other facets of deep social exclusion and to make recommendations as regards for whom and when, and in what respects, interprofessional collaboration might work best to prevent multiple exclusion homelessness.

Methods

The methodology was designed to explore interprofessional practice contextually across three contrasting research sites and comparatively in terms of the practices of different professional or disciplinary groups therein. Following a networking event organised by Homeless Link, three agencies were approached purposively by the researchers to cover rural, metropolitan and inner London areas. The partner agencies facilitated the fieldwork locally and formed an Advisory Group bringing together researchers, managers, practitioners, and ‘experts by experience’ (people who had been homeless) with the MEH Programme Co-ordinator.

To explore networks of support, in each fieldwork site we ‘tracked’ the first 5 referrals to come into the offices of our partner agencies (after a specified point in time) and at least 5 further cases where a person was preparing to exit from the service. Tracking involved: shadowing workers; study of case files; reflective interviews with the housing support (key) workers (n=17); and initial and follow-up interviews with ‘experts by experience’ separated by an interval of six months. We over sampled recruiting 34 ‘experts by experience’ initially thereafter completing 22 follow-up interviews (n=56) with the inner London site proving most challenging in terms of follow-up. Interviews (n=34) and focus groups (n=18) were also carried out with a range of different professionals and workers in each site (e.g. housing support workers, social workers, mental health professionals, drug and alcohol workers, offender managers).

Key findings

• Housing related support services have become the mainstay of support for people experiencing multiple exclusion homelessness. These services often work in parallel with health and social care services. As a result, we found little evidence of integrated assessment and support planning. One housing support worker summed up the situation in that ‘Everyone has got snippets of the individual but no one is collating it’.
• Because agencies are mostly working in parallel, housing support workers often find themselves working alone to manage some challenging and complex situations. We conclude that there is a need to reconceptualise the ‘job role’ of the housing support worker to ensure a better fit with the realities of working practices and to find new ways to support these largely unqualified workers in what is a very emotional and challenging role.
• In clinical practice it is recognised that the interplay between complex and multiple needs (so called ‘multiple-morbidity’) requires ‘case management’ and highly evolved forms of interprofessional practice, education and supervision. However, in incidences of multiple exclusion homelessness the combustion effect or interplay between complex and multiple needs is often ‘written off’ as ‘chaotic behaviour’ and does not generally trigger any kind of differentiated or enhanced response from service providers. We found for example that ‘homeless people’ were routinely excluded from community care assessment and longer term case management and often struggled to access specialist kinds of help such as residential and community based detoxification and psychological (talking) therapies. As result people with the most complex needs often fell through the cracks in service provision.
• The main recommendation of this study is that ensuring fairer access to case management and longer term more specialised support where appropriate is key to addressing multiple exclusion homelessness.

Timetable

2009 - 2011

Further work

We received follow-on funding of £123,000 from the ESRC to undertake a ‘Community of Practice Development Programme’ targeted at improving collaborative responses to multiple exclusion homelessness. This enabled us to continue working with two of the original fieldwork sites and to establish work in four new sites. In partnership with Revolving Doors Agency. See under Outputs, below, for publications arising from this follow-on work.